NUTR 230C: Interpreting Nutrition Evidence

Definition:

"A cohort study tracks two or more groups forward from exposure to outcome. This type of study can be done by going ahead in time from the present (prospective cohort study) or, alternatively, by going back in time to comprise the cohorts and following them up to the present (retrospective cohort study)" ¹

Why this type of study is used:

• To identify incidence and natural history of a disease¹ 
• To examine multiple outcomes after a single exposure¹ 
• As a substitution for  an experiment when experimentation is not available²

Format and features

•   Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement checklist for cohort studies ³

Calcium intake is not associated with increased coronary artery calcification: the Framingham Study.

Samelson EJ, Booth SL, Fox CS, Tucker KL, Wang TJ, Hoffmann U, Cupples LA, O'Donnell CJ, Kiel DP.

Am J Clin Nutr. 2012 Dec;96(6):1274-80.

Abstract

BACKGROUND: Adequate calcium intake is known to protect the skeleton. However, studies that have reported adverse effects of calcium supplementation on vascular events have raised widespread concern.

OBJECTIVE: We assessed the association between calcium intake (from diet and supplements) and coronary artery calcification, which is a measure of atherosclerosis that predicts risk of ischemic heart disease independent of other risk factors.

DESIGN: This was an observational, prospective cohort study. Participants included 690 women and 588 men in the Framingham Offspring Study (mean age: 60 y; range: 36-83 y) who attended clinic visits and completed food-frequency questionnaires in 1998-2001 and underwent computed tomography scans 4 y later in 2002-2005.

RESULTS: The mean age-adjusted coronary artery-calcification Agatston score decreased with increasing total calcium intake, and the trend was not significant after adjustment for age, BMI, smoking, alcohol consumption, vitamin D-supplement use, energy intake, and, for women, menopause status and estrogen use. Multivariable-adjusted mean Agatston scores were 2.36, 2.52, 2.16, and 2.39 (P-trend = 0.74) with an increasing quartile of total calcium intake in women and 4.32, 4.39, 4.19, and 4.37 (P-trend = 0.94) in men, respectively. Results were similar for dietary calcium and calcium supplement use

CONCLUSIONS: Our study does not support the hypothesis that high calcium intake increases coronary artery calcification, which is an important measure of atherosclerosis burden. The evidence is not sufficient to modify current recommendations for calcium intake to protect skeletal health with respect to vascular calcification risk.

1. Grimes DA, Schulz KF. Cohort studies: marching towards outcomes. The Lancet. 2002;359(9303):341-345.
2. Chapter 5: Risk: Looking forward. In: Fletcher RH, Fletcher SW, eds. Clinical epidemiology : the essentials. 4th ed. Baltimore: Lippincott Williams & Wilkins; 2005: p. 85.
3. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). STROBE checklist for cohort studies. [2007]; http://www.strobe-statement.org/fileadmin/Strobe/uploads/checklists/STROBE_checklist_v4_cohort.pdf. Accessed March 1, 2013.