Diet Quality and Cardiovascular Disease Risk in Postmenopausal

Women With Type 2 Diabetes Mellitus: The Women’s Health Initiative

Student’s Name

Institutional Affiliation


The title of the report was long, and each word contributed to the readers’ understanding. However, the words “The women’s health initiative” could be removed, and the title would remain meaningful. But the author included it to specify the study population comprised of women only. The title communicated the important aspects of the research (diet and cardiovascular disease risk in postmenopausal women with type 2 diabetes mellitus). It further explains the source of the support for the research (women’s health initiative). If the article had been published in a different journal, it would have been crucial to indicate that the study was quantitative. Since it was not a keyword, it could not be used to retrieve the survey since it was likely to miss the study if one used the word. The keywords included “cardiovascular disease prevention,” “diabetes mellitus,”” diet,” “nutrition,” and “women.”


The abstract was written in the modern abstract style that includes subheadings like background, methods and results, conclusions, and the keywords. The subtitles were written were clear and provided a deeper understanding of the article to help readers determine whether the article is of interest. The background section described the topic briefly and stating the main objective of the study. The methods and results part highlighted how the research was conducted and significant findings. It, however, did not specify whether the research method was qualitative or quantitative. The methods and results indicate the population of the participants and provide a brief and description of results. The authors, however, disregarded the QHR’s specifications of abstracts with 150 words or less as it contained about 250 words. The abstract ends with a brief recommendation of what a quality diet looks like and the importance of balanced diets in reducing the risk of CVD in postmenopausal women suffering from type 2 diabetes mellitus.


The introduction It is well written and organized. It began with a brief explanation of events that led to the study. The first paragraph mentions two previous studies which indicated some connection between diet and type 2 diabetes mellitus and a statement justifying the reasons that pushed for the study. The problem is stated with no ambiguity, and any reader would understand it in the first reading. The authors set the ground adequately before introducing the issue, which makes it easy to identify the problem. Moreover, the problem brings the reader to understand the need for the study. The article states that there is adequate information about the relationship between diet and cardiovascular health in the general population, but very little is known regarding the same relationship but among the population of people with type 2 diabetes mellitus. The expected increase in the number of individuals with type 2 diabetes mellitus also makes the study more significant in preparation for the nursing practitioners to understand how to better care for the patients. The statement interrelates research question for the new study. The problem is very significant to nursing practice since it will help clinicians to determine the appropriate diet that they serve patients of cardiovascular issues and who also have type 2 diabetes mellitus. The expected increase in the number of individuals with type 2 diabetes mellitus also makes the study more significant in preparation for the nursing practitioners to understand how to better care for the patients. It will also help nurses to determine suitable ways of caring for different patients based on their conditions. The availability of limited research and the circumstances surrounding the research question, a quantitative approach was the most suitable technique to provide accurate and reliable results.   

Hypotheses or Research questions

The article fails to give an explicit statement of the research question or hypotheses. After an elaborate explanation of the situation, the author leaves it to the reader to figure out the two. I believe the research question was,” How does dietary intake influence CVD among individuals with type 2 diabetes?” However, it is easy for a reader to deduce the research question from the introduction, and there exists a clear relationship between the literature review and the research question. 

Literature Review

 The literature review using primary sources was not up to date since very little has been done regarding the topic. However, the authors attempted to provide some state-of-the-art synthesis of the evidence concerning the problem which seemed sufficient to justify the study. The information gathered provided a sound basis for the new study. The authors did not provide a conceptual framework for the study. The absence of the framework is not justified since the occurrence of cardiovascular conditions is influenced by many factors and thus it would have been important that the authors provide an approach in which they handled the research.     


Hirahatake et al. were very thorough with the procedures, probably because they were dealing with conditions that impacted the lives of many individuals. They obtained approval by the review boards of the participating institutions. Each client also gave written consent before being included in the study. The study was designed to reduce risks and increase benefits to participants since numerous precautions have been taken to avoid affecting the lives of participants while trying to find a way of finding them suitable care.    

Research Design

The study employed a mixed design methodology and was very thorough in the procedures. The comparisons and number of data collections were appropriate based on the sensitive nature of the study. The study, however, made less effort to minimize biases.

Population and sample

Hirahatake et al. gave a clear description of the population of interest and the inclusion criteria. The population of interest was postmenopausal women aged between 50 to 79 years. The researchers used convenient sampling. The sample was adequate since the researchers initially had 9618 women but were eliminated to remain with a final sample study of 5809 women. Other than having attained menopause, the participants were supposed to have type 2 diabetes which could be validated using medical reports. The research also excluded women who reported a history of CVD at baseline and those who reported extreme energy intake did not fall within the range of 465 and 3931 kcal/d. They set strict sampling criteria to limit sampling biases.

Data collection and measurement

The data collection occurred at the baseline by conducting interviews and administering questionnaires. The two methods were suitable because they enabled interviews allowed for clarification while open questionnaires gave the participants room to explain their situation. In clinics, much data was collected through observation and measuring, which were suitable methods, to collect data regarding height and weight. The study population was well-defined, and the team chose an adequate number of participants. The high sensitive nature of the topic aligned perfectly with the vigorous criteria of strict data collection measures. The researchers also specified the equipment used to collect data, for example, the calibrated beam balance for measuring weight. Well-trained professionals compiled the results. There was no intervention in the study. Only baseline dietary data were used for the analysis as a caution to avoid possible biases and sample size limitations of the follow-up data.  


The researchers used Cox proportional hazard models to evaluate the relationship between diet quality and CVD. To compare Baseline features, Chi-square tests were used for categorical variables in calculating the analysis of variance of continuous variables. The use of chi-square and ANOVA were suitable methods since much of the comparisons were for the mean. The authors did exemplary work in analyzing the data. They provided a sufficient explanation of the data and gave elaborate tables to illustrate the findings. The findings offered adequate information for use in EBP. Type one and type errors were well avoided, and problems of missing values were addressed well. For instance, individuals who died during the study were not eliminated from the study but instead were treated as continuous data.

Hirahatake and colleagues provided a thoughtful discussion of the results. After 21 years of follow up, the study realized that 11.2% of the women developed CHD, while 6.7% experienced a stroke. There existed a strong monotonic inverse association higher aMed, DASH, and ADA diet scores and increased the possibility of CHD and stroke. The finding s further showed a lack of association between Paleolithic dietary pattern score and stroke. The outcomes were aligned with existing information in literature reviews. All the major results were discussed in connection with the literature reviews to evidence the consistency. All the references used were justified. They also noted a few limitations during the study, for example, they noted measurement error and potential biases in self –reported data which led to misclassification between diet and disease endpoints and hence systematic errors and underestimation of effect size. The results were obtained from a wide sample and thus allowed for generalizability. The authors had a lengthy discussion but did not include the implications and recommendations section.


The authors deserve to be congratulated for the well-written report and detailed procedures and discussions. The tables also conveyed a good picture and readers can understand the topic well. 

Research credibility

Kristin Hirahatake is a project scientist at UC Irvine with a good experience in research. Her education and vast experience make the results very credible. I believe the findings are valid, and I appreciate the team for the excellent work done. The study will contribute significantly to nurses taking care of patients with CVDs. 

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