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Studying the Framingham Heart Study

Researchers will look at insights from 50 years, 14,000 people, 1,300 papers

SAR Professor Paula Quatromoni points out that people who eat more fruits and vegetables have fewer strokes. Photo by Kalman Zabarsky

In 1948, doctors began physical examinations and lifestyle interviews of more than 5,200 residents in Framingham, Mass. The Framingham Heart Study was born, and more than half a century later it remains one of the largest and longest-running epidemiological research projects in the world. On Saturday, October 14, BU’s Sargent College will present a symposium on the study, which has been a collaborative effort between the National Heart, Lung, and Blood Institute and Boston University since 1971.

Optimizing Health: Fifty Years of Insights from the Framingham Study begins at 9 a.m. in Room 101 at Sargent College. The event, which celebrates SAR’s 125th anniversary, will feature presentations by investigators of the study. BU Today talked with one of the speakers, Paula Quatromoni, a SAR assistant professor of nutrition who began working with the study in 1992, analyzing data and publishing extensively about it.

Little was known about the general causes of heart attack and stroke in 1948. Today, 1,300 scientific papers later, the risk factors behind cardiovascular disease — especially dietary intake — are common knowledge, thanks largely to the Framingham study, which has screened a total of 14,000 participants and is now screening the third generation of participants: 4,100 of the original enrollees’ grandchildren.

BU Today: What are the Framingham Heart Study’s major accomplishments in the area of diet and nutrition?

Quatromoni: We’ve been learning about the eating patterns of a representative slice of the American population, how those habits have evolved, and how they’ve affected the cardiovascular health of three generations of people in Framingham. We’ve done a lot of work looking at how diet has changed in the population — that’s the strength of such a long-standing study — and so we’ve seen many people really embrace some of the dietary guidelines that have come out. We’ve seen from Framingham data that people really got the message about eating food with less cholesterol — dietary cholesterol intakes have fallen over time and blood cholesterol levels have improved as a result. The study has also proven to be a great opportunity to provide more evidence about the recommendations that ultimately emerge as the U.S. dietary guidelines from the USDA and the Department of Health and Human Services. In my talk on Saturday I’m going to focus on the importance of eating more fruits and vegetables, because there’s evidence from Framingham that people who do that have fewer strokes. And while we’re trying to link the guidelines with individual foods, one of the things I’ve done in is pushed the limits of our analyses to start to look at the total diet — people’s overall daily food choices — and how some people have a “heart-healthy” diet and other people have a diet made up very much of what we call empty calorie foods, or junk foods, and how this affects their risk for heart disease, stroke, and diabetes.

Will other lecturers at tomorrow’s event focus on healthy eating?

There will be some interesting material presented on nutrition and bone health, and nutrigenetics. Marion Hannon, an assistant professor of medicine at Harvard Medical School, is going to be talking about osteoporosis and nutrition, and Jose Ordovas, director of the Nutrition and Genomics Laboratory at Tufts, will discuss diet-gene interactions and how, depending on a person’s genetic makeup, we can personalize nutrition recommendations.

What is the most surprising thing you’ve learned from the study?

I was surprised at the data showing that women and men have very different eating patterns. Women seem to do a better job at staying on a diet that’s closer to the U.S. dietary guidelines, and our research has given us important insights into behavioral interventions. It’s obvious that people who look for dietary advice are at many different starting points, so we know that one type of nutrition message isn’t going to work for everybody. Our research on eating patterns has helped us to identify that you can’t just put a uniform nutrition message out there. And now, with the third generation of participants, we’re even trying to tailor it to a person’s genetic makeup.

Despite all that has been learned from the study, we hear talk of an obesity epidemic, especially among children. What are the repercussions of this?

The repercussions of obesity in children are that as those children age, when they become teenagers and young adults, they are going to be much more likely to develop such conditions as metabolic syndrome, heart disease, and diabetes earlier. They’re going to be living a longer portion of their lives with the potential for chronic diseases and disability. So it’s going to have huge implications in terms of our expenditures for health care, because kids as they become adults can potentially get much sicker sooner.

Despite the recent rise in obesity, there has been a decline in cardiovascular-related deaths since 1950. On the whole, have Americans been eating better over the past few decades?

We’re definitely moving in the right direction. A small percentage of the population is really putting it all together in the sense of adopting an eating plan that is close to the dietary guidelines. We’ve certainly found that some guidelines are easier for people to adopt than others. Our messages about cholesterol in the 1980s had a lot of force behind them with a national cholesterol education program. I believe the message about saturated fat raising the body’s LDL, or “bad cholesterol” that builds up plaque in artery walls, has been much more challenging. It’s also a challenge to get out the message about the danger of trans fat, which is formed when liquid oils are made into solid fats — people don’t necessarily think about the snack foods that end up in the school cafeteria, or in the snack machines and stores in schools, or even in their kids’ lunch boxes. However, I think the messages about the benefits of whole grains are starting to get out there.

Do you use any of your Framingham Heart Study research in the classroom?

Yes. I teach nutritional epidemiology and medical nutrition therapy to graduate students, and we often review the literature from the Framingham Heart Study. I bring a lot of those resources into the classroom because they’re so relevant, whether we’re talking about obesity or heart disease or diabetes. The study is a great teaching tool, and I also have students working with me on the research.