NUTR 305: NUTRITIONAL EPIDEMIOLOGY Fall 2016 Course Syllabus Time and location of the course: Tuesdays 1:30-3:00PM Fridays 8:45-10:15AM Location: Jaharis 155 (Except practicum #1: September 30th in Sacker 514 and practicum #2: October 14th in Jaharis 156)

Instructor : Fang Fang Zhang, MD, PhD Assistant Professor, Friedman School of Nutrition Science and Policy 150 Harrison Ave, Boston, MA 02111 Email : [email protected] | Phone : 617-636-3704

Teaching Assistants: Danielle Haslam, MA MS Ph.D. Candidate, Nutritional Epidemiology Friedman School of Nutrition Science and Policy Email : [email protected]

Mengxi Du MS/MPH Candidate Tufts University School of Medicine Friedman School of Nutrition Science and Policy Email : [email protected]

Office Hours: Email anytime to set up an appointment

Tufts Graduate Credit: 1.0

Prerequisites for taking this course: Required prerequisites for this course are the following: 1) Introductory Human Nutrition (e.g., NUTR 201 or 202) 2) Introductory Epidemiology (e.g., NUTR 204 or MPH 201) 3) Biostatistics (e.g., NUTR 209/309 A&B or MPH 205)

Course Description: This course is designed for graduate students who are interested in conducting or better interpreting epidemiological studies relating diet and nutritional status to disease and health. There is an increasing awareness that various aspects of diet and nutrition may be important contributing factors in chronic disease. There are many important problems, however, in the implementation and interpretation of these studies. The purpose of this course is to examine methodologies used in nutritional epidemiological studies, and to review the current state of knowledge regarding diet and other nutritional indicators as etiologic factors in disease.

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Course Objectives: At the conclusion of the course, students should be able to: 1. Describe the utility and limitations of different epidemiological study designs for research in nutritional epidemiology. 2. Describe the strengths and limitations of different methods of measuring diet and identify when specific dietary methods may be most appropriate. 3. Explain the statistical methods commonly used in nutritional epidemiology to analyze diet-disease associations. 4. Describe strategies that can be used to evaluate or adjust for other dietary and lifestyle factors that may explain or influence relationships of diet and disease. 5. Describe the current state of epidemiological evidence for relationships of diet to the development of selected diseases. 6. Describe the issues in studying gene-nutrient interactions and discuss the influence of genetics on data collected in nutritional epidemiological studies. 7. Critically evaluate nutritional epidemiology research publications.

Course texts and Materials (for the course as a whole): Required: Willett W. Nutritional Epidemiology (3rd edition). New York: Oxford University Press, 2012. Recommended: Hu F. Obesity Epidemiology. New York: Oxford University Press, 2008 Margetts BM, Nelson M. Design Concepts in Nutritional Epidemiology. New York: Oxford University Press, 1997.

Readings and Online Discussions To further understand the material, a selection of classic and contemporary research articles are assigned. The majorities are assigned as required reading and others are recommended readings to enhance learning. All additional readings are posted online on TRUNK. Please note that all students are responsible for doing the readings. All students are expected to complete the required readings prior to the class, and raise at least 2 questions for 1 or 2 selected readings. Selected readings are highlighted in blue in the syllabus. Students are also required to join discussions in an online forum supported through Trunk. For classes on Tuesday, students are required to submit their questions online by noon of Monday and join the discussions by noon of Tuesday. For classes on Friday, students are required to submit their questions online by 5pm of Wednesday and join the discussions by 5pm of Thursday. Students can join the discussions by responding to others’ questions or initiating a discussion topic relevant to the required readings. Submitting questions and joining the discussions online count toward 10% of your final course grade and, as mentioned, participating in class discussions is an additional 5% of your final course grade.

Assignments: There will be two assignments for students to work on independently. Your grades on Assignments 1 and 2 account for 10% of your final course grade, respectively.

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Practica: There will be two practica during the semester. These classes are intended to reinforce important concepts covered in the lectures and are designed to help students critically evaluate and interpret the findings from nutritional epidemiological studies. The two practica will be instructor-led and will require students to interpret SAS statistical output and published data.

Final project: There will be one final project on a Brief Critical Review, is outlined later in the semester, and contributes to 30% of your final course grade. Summary of Grade Contribution: 1) Assignment 1: Dietary Assessment Methods 10% 2) Assignment 2: Energy Adjustment & Measurement Error 10% 3) Midterm Exam (in-class, closed book exam) 35% 4) Online Discussion 10% 5) Class Participation 5% 6) Final Project: Brief Critical Review 30%

Class Policies and Expectations: Students will be expected to complete all required readings (textbook and assigned research articles) prior to each lecture. All students will be required to read the articles before class and join the online discussions in order to be able to participate in the class discussion.

Students will have only one opportunity to complete each assignment, and all assignments are due on the date/time specified. There will be no exceptions unless permission has been granted by the instructor. Students will have only one opportunity to complete the midterm exam and final project. The exam and final project must be completed and successfully submitted within the specified time period. There will be no exceptions unless permission is granted by the instructor.

If students anticipate arriving late to lecture, or need to leave early, they must notify the instructor beforehand. It is preferable for students who arrive more than 10 minutes late to not disrupt the class or disrespect the lecturer and fellow students by entering the classroom.

Academic Conduct Academic integrity, including avoiding plagiarism, is critically important. Each student is responsible for being familiar with the standards and policies outlined in the Friedman School’s Policies and Procedures manual (http://nutrition.tufts.edu/student/documents). It is the responsibility of the student to be aware of, and comply with, these policies and standards. In accordance with Tufts University’s policy on academic misconduct, violations of standards of academic conduct will be sanctioned by penalties ranging from grade reduction or failure on an assignment; grade reduction or failure of a course; up to dismissal from the school, depending on the nature and context of any infraction (http://uss.tufts.edu/studentaffairs/judicialaffairs/Academic%20Integrity.pdf).

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Accommodations of Disabilities Tufts University is committed to providing equal access and support to all students through the provision of reasonable accommodations so that each student may access their curricula and achieve their personal and academic potential. If you have a disability that requires reasonable accommodations, please contact the Friedman School Assistant Dean of Student Affairs at 617-636-6719 to make arrangements for determination of appropriate accommodations. Please be aware that accommodations cannot be enacted retroactively, making timeliness a critical aspect for their provision.

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Course Schedule

Class 1: Dietary Assessment Methods: Records and Recalls

Learning Objectives for class 1: Upon completion of this class, students will be able to understand: 1. What are the common variations in dietary assessment? How do these variations affect the validity and reliability in dietary assessment? 2. How would you conduct a 24-hour diet recall and food record?What are the advantages of disadvantages of diet recalls and records in assessing diet? 3. What are the new developments in diet recalls and records?

Required Readings for class 1: Chapter 3: Nature of Variation in Diet Chapter 4: 24 hour recall and Food Record Methods

Stote KS, Radecki SV, Moshfegh AJ, Ingwersen LA, Baer DJ. The number of 24 h dietary recalls using the US Department of Agriculture’s automated multiple-pass method required to estimate nutrient intake in overweight and obese adults. Public Health Nutr, 2011;14:1736-1742.

Diep CS, Hingle M, Chen TZ, Dadabhoy HR, Beltran A, Baranowski J, Subar AF, Baranowski, T. A validation study of the Automated Self-Administered 24- Hour Dietary Recall for Children (ASA24-Kids) among 9 to 11-year-old youth. J Acad Nutr Diet. 2015 Oct; 115(10): 1591-8.

Recommended: Schoeller DA, et al. Letter to the Editor: Self-report-based estimates of energy intake offer an inadequate basis for scientific conclusions. AJCN, 2013;87:1413- 1415.

*** Class 2: Overview of Nutritional Epidemiology

Learning Objectives for class 2: Upon completion of this class, students will be able to understand: 1. What is the definition/objective of nutritional epidemiology research? 2. What types of study designs are used in nutritional epidemiological research? 3. What are the types of measures of nutritional exposure and outcome? 4. What are some of the key issues in nutritional epidemiology?

Required Readings for class 2:

Willett, Chapter 1: Overview of Nutritional Epidemiology 6

Willett, Chapter 2: Foods and Nutrients

Freudenheim JL. Study design and hypothesis testing: Issues in the evaluation of evidence from research in nutritional epidemiology. Am J ClinNutr. 1999;69:1315S–1321S.

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Class 3: Dietary Assessment Methods: FFQ

Learning Objectives for class 3: Upon completion of this class, students will be able to: 1. How would you develop a FFQ for collecting dietary intake data? 2. What is the basic assumption behind FFQ and how do you decide which foods to include? 3. How would you design a calibration study and a validation study? What factors may influence the findings of a validation study? 4. What are the strengths and limitations of different methods used to measure diet in epidemiological studies?

Required Readings for class 3: Chapter 5: Food Frequency Methods Chapter 6: Reproducibility & Validity of Food Frequency Questionnaires

Willett WC, Hu FB. Not the time to abandon the food frequency questionnaire: point. CancerEpidemiol Biomarkers Prev. 2006 Oct;15(10):1757-8.

Kristal AR, Potter JD. Not the time to abandon the food frequency questionnaire: counterpoint. Cancer Epidemiol Biomarkers Prev. 2006 Oct;15(10):1759-60.

Kristal AR, Peters U, Potter JD. Is it time to abandon the food frequency questionnaire? Cancer Epidemiol Biomarkers Prev. 2005 Dec;14(12):2826-8. Tucker KL, Bianchi LA, Maras J, Bermudez OI. Adaptation of a food frequency questionnaire to assess diets of Puerto Rican and non-Hispanic adults. Am J Epi. 1998;148:507–518.

Subar AF, Thompson FE, Kipnis V, Midthune D, Hurwitz P, McNutt S, McIntosh A, Rosenfeld S. Comparative validation of the Block, Willett, and National Cancer Institute food frequency questionnaires: the Eating at America's Table Study. Am J Epi. 2001;154:1089–1099.

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Class 4: Energy Intake Validation and Dietary Under- and Over-reporting

Learning Objectives for class 4: Upon completion of this class, students will be able to: 1. Why is validity an issue when measuring energy intake? 2. What factors affect validity of reported energy intake? 3. How is validity of energy intake assessed? 4. What is the effect of poor validity of energy intake in epidemiological studies?

Required Readings for class 4:

Subar AF, Kipnis V, Troiano RP, Midthune D, Schoeller DA, Bingham S, Sharbaugh CO, Trabulsi J, Runswick S, Ballard-Barbash R, Sunshine J, Schatzkin A. Using intake biomarkers to evaluate the extent of dietary misreporting in a large sample of adults: the OPEN study. Am J Epidemiol. 2003;158(1):1–13.

Livingstone MBE and Black AE. Markers of the Validity of Reported Energy Intake. J Nutr. 2003, 133: 895S-920S.

Optional: Black AE. Critical evaluation of energy intake using the Goldberg cut-off for energy intake:basal metabolic rate. A practical guide to its calculation, use and limitations. Int J ObesRelatMetabDisord. 2000 Sep;24(9):1119–1130.

Huang TT, Roberts SB, Howarth NC, McCrory MA. Effect of screening out implausible energy intake reports on relationships between diet and BMI. Obes Res. 2005;13:1205–1217.

Mendez, M.A., Popkin, B.M., Buckland, G., Schroder, H., Amiano, P. et al. Alternative methods for accounting for underreporting and overreporting when measuring dietary intake-obesity relations. Am J Epid. 2010.

Class 5: Measurement Error: Effects and Remedies

Learning Objectives for class 5: Upon completion of this class, students will be able to: 1. What types of statistical corrections can be used to measures of association? 2. What types of statistical corrections can be used for measurement error in confounding variables? 3. How to interpret studies applying measurement error correction techniques? 7

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Required Readings for class 5: Chapter 12: Correction for the effects of measurement error

Freedman LS, Schatzkin A, Midthune D, Kipnis V. Dealing With Dietary Measurement Error in Nutritional Cohort Studies. J Natl Cancer Inst 2011;103:1–7.

Kipnis V, Subar AF, Midthune D, Freedman LS, Ballard-Barbash R, Troiano RP, Bingham S, Schoeller DA, Schatzkin A, Carroll RJ. Structure of dietary measurement error: results of the OPEN biomarker study. Am J Epidemiol. 2003;158(1):14–21; and discussion 22–26.

Thiébaut AC, Freedman LS, Carroll RJ, Kipnis V. [Editorial] Is it necessary to correct for measurement error in nutritional epidemiology? Ann Intern Med. 2007 Jan 2;146(1):65–67.

*** Class 6: Energy Adjustment

Learning Objectives for class 6: Upon completion of this class, students will be able to: 1. Why is energy intake measured and why do we need to energy adjust? 2. What are the components of energy expenditure? 3. What are the energy adjustment methods? 4. What considerations do you need to take into account when energy adjusting nutrient data? 5. Interpret the meaning of regression coefficients in statistical models

Required Readings for class 6:

Chapter 11: Implications of Total Energy For Epidemiologic Analyses

Hu FB, Stampfer MJ, Rimm E, Ascherio A, Rosner BA, Spiegelman D, Willett WC. Dietary fat and coronary heart disease: a comparison of approaches for adjusting for total energy intake and modeling repeated dietary measurements. Am J Epidemiol. 1999;149:531–540.

Willett WC, Howe GR, Kushi LH. Adjustment for total energy intake in epidemiologic studies. Am J ClinNutr 1997, 65(4 Suppl): 1220S-1228S

Mackerras D. Energy adjustment: the concepts underlying the debate. J ClinEpidemiol. 1996;49:957–962.

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*** Class 7: Practicum 1: Energy Adjustment

Recommended Reading for class 8: None

*** Class 8: Nutrition Biomarkers

Learning Objectives for class 8: Upon completion of this class, students will be able to: 1. What are the advantages of using biomarkers in nutritional epidemiology? 2. What is the difference between a direct and surrogate biomarker of exposure? 3. How would you define validity, relative validity, calibration & reproducibility? 4. What is the principal behind the trial comparison methods of evaluating a FFQ? 6. What are the important considerations relating to the use of nutritional biomarkers? 7. What are the common surrogate biomarkers used in epidemiological studies? 8. What are the underlying assumptions on the use of biomarkers in epidemiological studies?

Required Readings for class 8: Chapter 8: Biochemical Indicators of dietary intake

Marklund, M., Leander, K., Vikstrom, M., Laguzzi, F., Gigagnte, B. et al. Polyunsaturated fat intake estimated by circulating biomarkers and risk of cardiovascular disease and all-cause mortality in a population-based cohort of 60-year-old men and women. Circulation. 2015;132:586-594.

O’Sullivan, Aifric., Gibney, MJ., Brennan, L. Dietary intake patterns are reflected in metabolomic profiles: potential role in dietary assessment studies. Am J Clin Nutr. 2011;93:314-21.

Potischman N. Biologic and methodologic issues for nutritional biomarkers. J Nutr. 2003 Mar;133Suppl 3:875S-880S.

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*** Class 9: Physical Activity and Health

Learning Objectives for class 9: Upon completion of this class, students will be able to: 1. Become familiar with the various methods used for assessment of physical activity in youth and adults 2. Recognize the importance of physical activity and fitness in chronic disease and health outcomes

Required Readings for class 9:

Steeves, JA., et al. Women workers and women at home are equally inactive: NHANES 2003-2006. Med Sci Sports Exerc. 47(8):1635-1642, 2015.

Peter T. Katzmarzyk , Timothy S. Church , Cora L. Craig , And Claude Bouchard. Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer. Med Sci Sports Exerc. 2009 May;41(5):998-1005.

Optional: Church et al. Trends over 5 decades in U.S. Occupation-related physical activity and their associations with obesity. Plos One 6(5): 2011

Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Bhaumik S. Cochrane Database Syst Rev. 2016 Mar 17;3:CD010912. doi: 10.1002/14651858.CD010912.pub3. Review.

Valerie Carson, Suzy L.Wong , Elizabeth Winkler, Genevieve N. Healy, Rachel C. Colley, Mark S. Tremblay. Patterns of sedentary time and cardiometabolic risk among Canadian adults. Preventive Medicine 65 (2014) 23–27

Class 10: Dietary Patterns: Theoretical

Learning Objectives for class 10: Upon completion of this class, students will be able to: 1. Why use dietary pattern techniques to capture diet? 2. What are the types of food pattern methods used in nutritional epidemiology? 3. What are the advantages and disadvantages of theoretical derived patterns? 4. What are considerations in creating a diet index score? 5. How to interpret the results of studies using theoretically derived dietary patterns?

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Required Readings for class 10: Chiuve SE, Fung TT, Rimm EB, Hu FB, McCullough ML, Wang M, Stampfer MJ, Willett WC. Alternative dietary indices both strongly predict risk of chronic disease. J Nutr 2012. 142(6): 1009-18. Bhupathiraju SN, Lichtenstein AH, Dawson-Hughes B, Tucker KL.Adherence index based on the AHA 2006 diet and lifestyle recommendations is associated with select cardiovascular disease risk factors in older Puerto Ricans. J Nutr. 2011 Mar;141(3):460-9.

Imamura F1, Jacques PF, Herrington DM, Dallal GE, Lichtenstein AH. Adherence to 2005 Dietary Guidelines for Americans is associated with a reduced progression of coronary artery atherosclerosis in women with established coronary artery disease. Am J Clin Nutr. 2009 Jul;90(1):193-201

Waijers PMCM, Feskens EJM, Ocke MC. A critical review of predefined diet quality scores. Br J Nutr. 2007;97:219–231.

*** Class 11: Dietary Patterns: Empirical

Learning Objectives for class 11: Upon completion of this class, students will be able to: 1. Why use empirically derived dietary patterns? 2. What is the difference between factor analysis and cluster analysis? 3. How valid are these techniques? 4. What are the advantages and disadvantages of empirically derived patterns? 5. What are the limitations of dietary pattern approaches?

Required Readings for class 11:

Smith AD, Emmett PM, Newby PK, Northstone K. A comparison of dietary patterns derived by cluster and principal components analysis in a UK cohort of children. Eur J ClinNutr 2011 May 25.

Moeller SM, Reedy J, Millen AE, Dixon LB, Newby PK, Tucker KL, Krebs-Smith SM, Guenther PM. Dietary patterns: challenges and opportunities in dietary patterns research an Experimental Biology workshop, April 1, 2006. J Am Diet Assoc. 2007 Jul;107(7):1233–1239.

Brunner EJ, Mosdol AM, Witte DR, et al. Dietary patterns and 15-y risk of major coronary events, diabetes, and mortality. Am J ClinNutr. 2008;87:1414–1421.

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*** Class 12: Practicum 2: Cluster/Factor Analysis

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Class 13: Methodological considerations in study design

Learning Objectives for class 13: Upon completion of this class, students will be able to: 1. Understand the difference between categorized versus continuous presentation of independent variables 2. Understand the issues with missing data and outliers 3. Understand the approaches for using repeated dietary assessments and related hypotheses 4. Understand the need for subgroup analyses and interactions 5. Understand the importance of selection of confounders

Required Readings for class 13:

Chapter 13: Issues in Analysis and Presentation of Dietary Data

Bernstein AM, Rosner BA, Willett WC. Cereal fiber and coronary heart disease: a comparison of modeling approaches for repeated dietary measurements, intermediate outcomes, and long follow-up. Eur J Epidemiol. 2011, 26(11): 877-86

Mozaffarian et al. Changes in diet and lifestyle and long-term weight gain in women and men. NEJM, 2011. 364(25): 2392-404.

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Class 14: The role of meta-analysis in Nutritional Epidemiology

Learning Objectives for class 14: Upon completion of this class, students will be able to: 1. Understand the utility of meta-analysis in nutrition epidemiology, including strengths and limitations. 2. Evaluate, summarize and interpret findings from meta-analyses while considering prior and new evidence. 3. Discuss how findings from meta-analysis can be used to shape dietary recommendations and policy and be communicated to the public.

Required Readings for class 14:

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Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013 Jan 2;309(1):71-82.

Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ. 1998 Jan 10;316(7125):140-4.

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000 Apr 19;283(15):2008-12

Recommended: Wang TJ, Larson MG, Vasan RS, Cheng S, Rhee EP, McCabe E, Lewis GD, Fox CS, Jacques PF, Fernandez C, O'Donnell CJ, Carr SA, Mootha VK, Florez JC, Souza A, Melander O, Clish CB, Gerszten RE. Metabolite profiles and the risk of developing diabetes. Nat Med. 2011 Apr;17(4):448-53.

Roberts LD, Koulman A, Griffin JL. Towards metabolic biomarkers of insulin resistance and type 2 diabetes: progress from the metabolome. Lancet Diabetes Endocrinol. 2014 Jan;2(1):65-75. doi: 10.1016/S2213-8587(13)70143-8.

Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta- analysis.Diabetes Care. 2010 Nov;33(11):2477-83 *** Class 15: Controversies in Epidemiology: Observational studies vs. RCT

Learning Objectives for class 15:

Upon completion of this class, students will be able to understand:

1. What are the inherent differences between intervention and observational studies? 2. How do treatment (secondary) and primary prevention study paradigms differ? 3. What is the optimal way to model nutritional exposures in a prevention study? 4. What are the main reasons why nutritional intervention studies do not replicate findings from epidemiologic studies?

Required Readings for class 15:

Morris MC, Tangney CC. A potential design flaw of randomized trials of vitamin supplements. JAMA. 2011;305(13):1348-9.

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Moats C, Rimm EB. Vitamin intake and risk of coronary disease: observation versus intervention. CurrAtheroscler Rep 2007;9:508–514. Heaney RP. Nutrients, endpoints, and the problem of proof. J Nutr 2008;138:1591– 1595.

Recommended:

Saposnik G, Ray JG, Sheridan P, McQueen M, Lonn E. Homocysteine-lowering therapy and stroke risk, severity, and disability: additional findings from the HOPE 2 trial. Stroke 2009;40:1365–1372.

Lonn E, Yusuf S, Arnold MJ, Sheridan P, Pogue J, Micks M, et al. Homocysteine lowering with folic acid and B vitamins in vascular disease. N Engl J Med 2006;354:1567–1577.

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Class 16: Comparative Effectiveness Analysis on Diet and CVD

Required Readings for class 16:

Afshin A, Penalvo J, Del Gobbo L, Kashaf M, Micha R, Morrish K, Pearson- Stuttard J, Rehm C, Shangguan S, Smith JD, Mozaffarian D. CVD Prevention Through Policy: A review of Mass Media, Food/Menu Labeling, Taxation/Subsidies, Built Environment, School Procurement, Worksite Wellness, and Marketing Standards to Improve Diet. Curr Cardiol Rep. 2015 17:98.

Technical reference that will be discussed in class:

Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, Lim S, Danaei G, Ezzati M, Powles J. Global Sodium Consumption and Death from Cardiovascular Causes. N Engl J Med. 2014;371:624-34.

*** Class 17: Mid-term Exam *** Class 18: Nutrition and Musculoskeletal Health

Learning Objectives for class 18:

Upon completion of this class, students will be able to understand: 14

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1. The epidemiology and public health burden of osteoporosis and fracture 2. The role of calcium and vitamin D in age-related bone loss and fracture 3. The controversy surrounding evidence that calcium and vitamin D have a detrimental effect on cardiovascular health

Required Readings for class 18:

Cauley JA. Public Health Impact of Osteoporosis. Journal of Gerontology: Medical Sciences. 2013 October; 68(10):1243-51

Bischoff-Ferrari HA et al. A Pooled Analysis of Vitamin D Dose Requirements for Fracture Prevention. New England Journal of Medicine. 2012 July 5; 367(1): 40-49.

Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. The British Medical Journal. 2015 Sept.; 351:h4580.

Weaver CM, Alexander DD, Boushey CJ, Dawson-Hughes B, Lappe JM, LeBoff MS, Liu S, Looker AC, Wallace TC, Wang DD. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporosis International. 2016; 27: 367-376.

Recommended:

Bolland MJ et al. Effect of Calcium Supplements on Risk of Myocardial Infarction and Cardiovascular Events: Meta-analysis. The British Medical Journal. 2010 July; 341:c3691.

Ensrud KE. Epidemiology of Fracture Risk with Advancing Age. Journal of Gerontology: Medical Sciences. 2013 October; 68(10):1236-42.

Hill Gallant KM, Weaver CM, Towler DA, Thuppal SV, Bailey RL. Nutrition in Cardioskeletal Health. Advances in Nutrition. 2016 May; 7: 544-555.

Lewis JR et al. The Effects of Calcium Supplementation on Verified Coronary Heart Disease Hospitalization and Death in Postmenopausal Women: A Collaborative Meta‐Analysis of Randomized Controlled Trials. Journal of Bone and Mineral Research. 2015 January; 30(1): 165-75.

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Class 19: TBA

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Learning Objectives for class 19: 1. What is gene-nutrient interaction? 2. Role of gene-nutrient interaction in susceptibility of chronic diseases 3. How to evaluate gene-nutrient interaction 4. Implications of gene-nutrient interaction

Required Readings for class 19:

Ulrich CM, Kampman E, Bigler J, et al. Colorectal adenomas and the C677T MTHFR polymorphism: evidence for gene-environment interaction? Cancer Epidemiol Biomarkers Prev. Aug 1999;8(8):659-668.

Matsuo K, Hamajima N, Shinoda M, et al. Gene-environment interaction between an aldehyde dehydrogenase-2 (ALDH2) polymorphism and alcohol consumption for the risk of esophageal cancer. Carcinogenesis. Jun 2001;22(6):913-916.

Recommended:

Hunter DJ. Gene-environment interactions in human diseases. Nature reviews. Genetics. Apr 2005;6(4):287-298.

Lichtenstein P, Holm NV, Verkasalo PK, et al. Environmental and heritable factors in the causation of cancer--analyses of cohorts of twins from Sweden, Denmark, and Finland. The New England journal of medicine. Jul 13 2000;343(2):78-85.

Smith GD, Ebrahim S. 'Mendelian randomization': can genetic epidemiology contribute to understanding environmental determinants of disease? Int J Epidemiol. Feb 2003;32(1):1-22.

Khoury MJ, Flanders WD. Nontraditional epidemiologic approaches in the analysis of gene-environment interaction: case-control studies with no controls! Am J Epidemiol. Aug 1 1996;144(3):207-213.

*** Class 20: Nutrition and Vision

Learning Objectives for class 20: TBA

Required Readings for class 20: TBA *** Class 21: Nutrition and Infectious Disease

Learning Objectives for class 21: Upon completion of this class, students will be 16

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able to:

1. Recognize the importance of nutritional status in relation to immune function in people living with HIV (PLHIV) 2. Identify methods of nutritional assessment to address issues related to nutritional status, dietary quality, and food security in PLHIV. 3. Develop awareness of the complex relationships between nutrition and metabolic status, food insecurity, and adherence to medications among PLHIV.

Required Readings for class 21:

Sarah J. Fielden, Aranka Anema, Pamela Fergusson, Katherine Muldoon, Nils Grede, Saskia de Pee. Measuring Food and Nutrition Security: Tools and Considerations for Use Among People Living with HIV. AIDS Behav. Published Online: 03 Dec 2013

Saskia de Pee and Richard D. Semba. Role of nutrition in HIV infection: Review of evidence for more effective programming in resource-limited settings. Food and Nutrition bulletin. 2010 Vol 31, No. 4

Nutrition Requirements for People Living with HIV/AIDSReport of a technical consultation, 13-15 May 2003, Geneva, Switzerland

Class 22: Nutrition and Global Burden of Disease Learning Objectives for class 22: 1. Understand the background and rationale for the Global Burden of Disease study 2. Understand the data sources and methodology used in modeling dietary burdens of disease 3. Understand the main findings on the impacts of diet on disease burdens.

Required Readings for class 22: Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian D, Global Burden of Diseases Nutrition and Chronic Diseases Expert Group. Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010. (2015) Circulation, 132(8): 639-66.

Afshin A, Micha R, Khatibzadeh S, Fahimi S, Shi P, Powles J, et al.; 2010 Global Burden of Diseases, Injuries, and Risk Factors Study: NUTRItrition and ChrOnic Diseases Expert Group (NUTRICODE), and Metabolic Risk Factors of ChrOnic Diseases Collaborating Group. The impact of dietary habits and 17

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metabolic risk factors on cardiovascular and diabetes mortality in countries of the Middle East and North Africa in 2010: a comparative risk assessment analysis. BMJ Open. 2015 May 20;5(5):e006385.

*** Class 23: Nutrition and Diabetes

Learning Objectives for class 23: Upon completion of this class, students will be able to understand: 1. What are the population diabetes trends in US adults? 2. What are the metabolic consequences of diabetes? 3. What is the relationship between diet and diabetes? 4. What are the methodological issues in analyzing the relationship between diet and diabetes?

Required Readings for class 23: Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001 Sep 13;345(11):790–797. Hu FB.Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011 Jun;34(6):1249-57. doi: 10.2337/dc11-0442. Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB.Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA. 2009 May 27;301(20):2129-40. doi: 10.1001/jama.2009.726. Review. Recommended:

Curbing the Diabetes Pandemic: The Need for Global Policy Solutions. Hu FB, Satija A, Manson JE. JAMA. 2015 Jun 16;313(23):2319-20. doi: 10.1001/jama.2015.5287

Understanding nutritional epidemiology and its role in policy. Satija A, Yu E, Willett WC, Hu FB. Adv Nutr. 2015 Jan 15;6(1):5-18. doi: 10.3945/an.114.007492. Print 2015 Jan.

Hu FB, Willett WC, Li T, Stampfer MJ, Colditz GA, Manson JE. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med 2004;351(26):2694–2703. deKoning L, Malik VS, Rimm EB, Willett WC, Hu FB. Sugar-sweetened and artificially sweetened beverage consumption and risk of type 2 diabetes in men. Am J ClinNutr. 2011 Jun;93(6):1321–1327. Epub 2011 Mar 23.

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*** Class 24: International Nutrition

Learning Objectives for class 24: 1. Recognize key topics in international nutrition. 2. Differentiate between forms of malnutrition. 3. Understand the framework for causes of and action to combat child undernutrition 4. Understand indicators of nutritional assessment of populations and individuals in developing countries

Required Readings for class 24: Black, R. E., C. G. Victora, S. P. Walker, Z. A. Bhutta, P. Christian, M. de Onis, M. Ezzati, S. Grantham-McGregor, J. Katz, R. Martorell, R. Uauy, Maternal, and Group Child Nutrition Study. 2013. 'Maternal and child undernutrition and overweight in low-income and middle-income countries', Lancet, 382: 427-51.

Bhutta, Z. A., J. K. Das, A. Rizvi, M. F. Gaffey, N. Walker, S. Horton, P. Webb, A. Lartey, R. E. Black, Group Lancet Nutrition Interventions Review, Maternal, and Group Child Nutrition Study. 2013. 'Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?', Lancet, 382: 452-77.

International Food Policy Research Institute. 2016. "Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030." In. Washington, DC. (Executive Summary)

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Class 25: Nutrition and Cancer

Learning Objectives for class 25: 1. To be able to summarize the current state of the science for diet and human cancer. 2. To be able to discuss major methodological challenges (specific to the study of cancer) that have slowed down our understanding of the relation of diet to cancer. 3. Understand important questions that remain unanswered in the relation of diet to cancer.

Required Readings for class 25: 19

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Willett, W. Nutrition and Cancer: the search continues. Nutr Cancer. 2008;60(5):557-9.

Chan DS, Lau R, Aune D, Vieira R, Greenwood DC, Kampman E, Norat T. Red and processed meat and colorectal cancer incidence: meta-analysis of prospective studies. PLoS One. 2011;6(6):e20456.

Prentice RL, Caan B, Chlebowski RT, Patterson R, Kuller LH, Ockene JK, et al. Low- fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial. Prentice RL1

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Class 26: Translation of nutritional epi findings into dietary guidelines and health policy

Learning Objectives for class 26: Upon completion of this class, students will be able to understand: 1. To be able to identify key nutritional problems for which a case can be made for population-wide interventions or dietary recommendations. 2. To be able to critically evaluate the strength of nutritional epidemiology evidence in terms of study design and analytic methods 3. To understand the processes by which findings from nutritional epidemiology are translated into action and to consider potential barriers and benefits. To consider the various levels of nutrition policy and sectors involved.

Required Readings for class 26:

Satija A, Yu E, Willett WC, Hu FB. Understanding nutritional epidemiology and its role in policy. Adv Nutr. 2015;6:5-18. (Required in Class 23)

Trikalinos TA, Moorthy D, Chung M, Yu W, Lee J, Lichtenstein AH, Lau J. Concordance of randomized and nonrandomized studies was unrelated to translational patterns of two nutrient-disease associations. J Clin Epi. 2012; 65:16- 29.

Yu WW, Schmid CH, Lichtenstein AH, Lau J, Trikalinos TA. Empirical evaluation of meta-analytic approaches for nutrient and health outcome dose-response data. Res Synth Methods. 2013; 4:256-68.

Watts ML, Hager MH, Toner CD, Weber JA. The art of translating nutritional 20

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science into dietary guidance: history and evolution of the Dietary Guidelines for Americans. Nutr Rev. 2011;69:404-12

Recommended: Chung M, Balk EM, Ip S, Lee J, Terasawa T, Raman G, Trikalinos T, Lichtenstein AH, Lau J. Systematic review to support the development of nutrient reference intake values: challenges and solutions. Am J ClinNutr. 2010;92:273-6

Lichtenstein AH, Yetley EA, Lau J. Application of systematic review methodology to the field of nutrition. J Nutr. 2008; 138:2297-2306.

This schedule is subject to modifications at the discretion of the instructor

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# Day and Date Location Time Lecture Topic Lecturer Assignments 1 Tuesday, Sept 6 Jaharis 155 1:30-3:00PM Dietary Assessment Methods: Records and Recalls Cheryl Gilhooly Assignment 1 assigned 2 Friday, Sept 9 Jaharis 155 8:45-10:15 AM Overview of Nutritional Epidemiology Fang Fang Zhang 3 Tuesday, Sept 13 Jaharis 155 1:30-3:00PM Dietary Assessment Methods: FFQ Sherman Bigornia Complete FFQ/24HR 4 Friday, Sept 16 Jaharis 155 8:45-10:15 AM Energy Intake Validation and Dietary Under- and Sai Das Over-reporting 5 Tuesday, Sept 20 Jaharis 155 1:30-3:00PM Measurement error: Effects and Remedies Fang Fang Zhang Return FFQ/24HR data 6 Friday, Sept 23 Jaharis 155 8:45-10:15 AM Energy adjustment Fang Fang Zhang 7 Tuesday, Sept 27 Sackler 514 1:30-3:00PM Practicum 1: Energy adjustment Shilpa Bhupathiraju Assignment 1 due 8 Friday, Sept 30 Jaharis 155 8:45-10:15 AM Nutrition Biomarkers Shilpa Bhupathiraju Assignment 2 assigned 9 Tuesday, Oct 4 Jaharis 155 1:30-3:00PM Physical activity and health Jennifer Sacheck 10 Friday, Oct 7 Jaharis 155 8:45-10:15 AM Dietary Patterns: Theoretical Fang Fang Zhang 11 Tuesday, Oct 11 Jaharis 155 1:30-3:00PM Dietary Patterns: Empirical Danielle Haslam 12 Friday, Oct 14 Jaharis 156 8:45-10:15 AM Practicum 2: Cluster/Factor Analysis Samantha Berger 13 Tuesday, Oct 18 Jaharis 155 1:30-3:00PM Methodological considerations in study design Fang Fang Zhang 14 Friday, Oct 21 Jaharis 155 8:45-10:15 AM The role of meta-analysis in Nutritional Epidemiology Marta Guasch-Ferre Assignment 2 due 15 Tuesday, Oct 25 Jaharis 155 1:30-3:00PM Controversies in Epidemiology: Observational studies Dariush Mozaffarian vs. RCT 16 Friday, Oct 28 Jaharis 155 8:45-10:15 AM Comparative effectiveness analysis on diet and CVD Jose Penalvo 17 Tuesday, Nov 1 1:30-3:00PM Midterm Examination 18 Friday, Nov 4 Jaharis 155 8:45-10:15 AM Nutrition and Musculoskeletal Health Kyla Shea Final critique assigned 19 Tuesday, Nov 8 Jaharis 155 8:45-10:15 AM Gene-Nutrient Interactions Fang Fang Zhang NOTE: Friday Schedule Friday, Nov 11 No Classes Veteran’s Day 20 Tuesday, Nov 15 Jaharis 155 1:30-3:00PM Nutrition and Vision Chung-Jung Chiu 21 Friday, Nov 18 Jaharis 155 8:45-10:15 AM Nutrition and Infectious Disease Alice Tang 22 Tuesday, Nov 22 Jaharis 155 1:30-3:00PM Nutrition and Global Burden of Disease Gita Singh Friday, Nov 25 No Class Thanksgiving 23 Tuesday, Nov 29 Jaharis 155 1:30-3:00PM Nutrition and Diabetes Frank Hu 24 Friday, Dec 2 Jaharis 155 8:45-10:15AM International Nutrition Kassandra Harding 25 Tuesday, Dec 6 Jaharis 155 1:30-3:00 PM Nutrition and Cancer Dominique Michaud 26 Friday, Dec 9 Jaharis 155 8:45-10:15AM Translation of nutritional epi findings into dietary Alice Lichtenstein guidelines and health policy 27 Tuesday, Dec 13 No class Final Critique Due. Final Critique Due