In this study we describe the development of the Cardiovascular Disease Population Risk Tool for Nutrition (CVDPoRT-Nutrition), a tool for estimating 5-year risk of incident cardiovascular disease (CVD) informed by detailed dietary assessment. This tool builds on an existing CVDPoRT algorithm[1] by replacing its original nutritional factors with one of five distinct dietary pattern scores, resulting in five separate sex-specific algorithms, referred to as CVDPoRT-Nutrition. The dietary indices include the Dietary Approaches to Stop Hypertension (DASH),[2] the Healthy Eating Index (HEI),[3] the Alternative HEI (AHEI),[4] the Mediterranean Style Dietary Pattern Score (MSDPS),[5] and the Dietary Guidelines for Americans Adherence Index (DGAI) 2015.[6]
This directory contains files for implementation of the CVDPoRT-Nutrition algorithms described in the following research paper:
- Extension of a cardiovascular disease risk prediction algorithm using dietary indices: Development and validation of the Cardiovascular Disease Population Risk Tool - Dietary Approaches to Stop Hypertension (CVDPoRT-DASH)
- CVDPoRTNutritionScore_f1.csv: Contains the sex and dietary-index specific beta estimates and standard errors for formula 1.
- CVDPoRT_baselinehazards_f2.csv: Contains the male and female baseline hazard values for formula 2.
- recalibration_f3.csv: Contains the age/sex-specific recalibration coefficients for formula 3.
See the statistical analysis section of the paper for formulas needed to estimate 5 year cardiovascular risk using the CVDPoRT-Nutrition models.
- Refer to Manuel DG et al [1] to estimate sex-specific CVDPoRT score using the original reduced CVDPoRT algorithm. Beta coefficients can be found in Appendix 4 of this paper; diet variables (fruit and vegetable, potato, and juice daily consumption) can be zeroed out. Note that CVDPoRT score, not CVDPoRT risk is modeled in Formula 1.
- Dietary index-specific and sex-specific CVDPoRT-Nutrition Score is estimated using Formula 1. CVDPoRTScore comes from (1), described above. Model coefficients are found in the CVDPoRTNutritionScore_f1.csv file.
- To convert the 5 year CVDPoRT-Nutrition Score from (2) to a risk, use Formula 2 and the sex-specific CVDPoRT baseline hazards from the CVDPoRT_baselinehazards_f2.csv file.
- To recalibrate the 5 year dietary index-specific and sex-specific CVDPoRT-Nutrition risk from (3), use Formula 3 and recalibration slope and intercept values from the recalibration_f3.csv file.
[1] Manuel DG, Tuna M, Bennett C, et al. Development and validation of a cardiovascular disease risk-prediction model using population health surveys: the Cardiovascular Disease Population Risk Tool (CVDPoRT). CMAJ. 2018;190(29):E871-E882.
[2] Matsunaga M, Hurwitz EL, Li D. Development and Evaluation of a Dietary Approaches to Stop Hypertension Dietary Index with Calorie-Based Standards in Equivalent Units: A Cross-Sectional Study with 24-Hour Dietary Recalls from Adult Participants in the National Health and Nutrition Examination Survey 2007-2010. Journal of the Academy of Nutrition and Dietetics. Jan 2018;118(1):62-73.e4. doi:10.1016/j.jand.2017.03.010
[3] Guenther PM, Casavale KO, Reedy J, et al. Update of the Healthy Eating Index: HEI-2010. Journal of the Academy of Nutrition and Dietetics. Apr 2013;113(4):569-80. doi:10.1016/j.jand.2012.12.016.
[4] Chiuve SE, Fung TT, Rimm EB, et al. Alternative dietary indices both strongly predict risk of chronic disease. The Journal of nutrition. Jun 2012;142(6):1009-1018. doi:10.3945/jn.111.157222.
[5] Rumawas ME, Dwyer JT, McKeown NM, Meigs JB, Rogers G, Jacques PF. The development of the Mediterranean-style dietary pattern score and its application to the American diet in the Framingham Offspring Cohort. The Journal of nutrition. Jun 2009;139(6):1150-6. doi:10.3945/jn.108.103424.
[6] Jessri M, Lou WY, L'Abbe MR. The 2015 Dietary Guidelines for Americans is associated with a more nutrient-dense diet and a lower risk of obesity. The American journal of clinical nutrition. Nov 2016;104(5):1378-1392. doi:10.3945/ajcn.116.132647.