Dietary patterns of adults in Québec and their nutritional adequacy

Canadian Adults with Moderate Intakes of Total Sugars have Greater Intakes of Fibre and Key Micronutrients: Results from the Canadian Community Health Survey 2015 Public Use Microdata File

Background: Global dietary guidelines recommend reducing free sugars intake, which may affect choices of sugars-containing foods, including important sources of key micronutrients. The purpose of the study was to compare the intakes of nutrients stratified by intakes of sugars in Canadian adults. Methods: The first-day 24-h dietary recalls from adults (n = 11,817) in the 2015 Canadian Community Health Survey-Nutrition were used to compare macronutrients, micronutrients and food categories across quintiles of total sugars [by %energy (%E)], adjusted for misreporting status and covariates. Results: Canadian adults consumed on average 86.9 g/day (18.8 %E) from total sugars and 47.5 g/day (9.9 %E) from free sugars. Mean intakes for the 1st (Q1), 3rd (Q3) and 5th (Q5) quintiles of total sugars were 7.9%E, 18.3%E and 33.3%E, respectively. Q3 had higher fibre, calcium, vitamin D, vitamin A, vitamin C and potassium intakes than Q1 (p < 0.001), reflecting higher fruit, milk and yogurt (p < 0.001) consumption. Compared to Q5, Q3 had higher intakes of folate, vitamin B₁₂, iron and zinc. Conclusion: This study provides the first detailed analyses of Canadian adults’ macro- and micro-nutrient intakes stratified by different intakes of total sugars. Moderate intakes of total sugars may result in greater intakes of fibre and micronutrients. Overall nutrient intake should be considered when making food choices.

Associations between dietary patterns and blood pressure in a sample of Australian adults

BACKGROUND

Investigating effects of whole diets on blood pressure (BP) can contribute to development of diet-based recommendations for health. Our aim was to assess the relationship between dietary patterns and BP in a sample of free-living Australian adults.

METHODS

Usual dietary patterns of participants recruited to dietary intervention studies were assessed using factor analysis (two 24-h recalls). The mean of seven days of daily, seated BP measurements were used.

RESULTS

Complete data from 251 participants (112 males; mean age 55.1(9.1) (SD) years; body mass index (BMI) 29.5(3.9) kg/m²) was included. Three dietary patterns were identified. Only Dietary Pattern 2 was positively associated with home systolic BP (β = 1.88, 95% CI 0.16, 3.60) after adjusting for age, sex, BMI, anti-hypertensive medication, smoking, education, physical activity and energy intake. This dietary pattern was characterised by high consumption of low-fibre bread, pasta, noodles and rice, meat dishes, poultry dishes and egg dishes, mixed cereal dishes, salted nuts and low consumption of milk and yoghurt (low-fat), vegetable juice, vegetables and high-fibre bread. Dietary Pattern 2 was also positively associated with intakes of energy (P = 0.002) and sodium (P = 0.005) and inversely associated with potassium intake (P = 0.002). After adjustment for energy, only the inverse association with potassium remained (P <  0.001).

CONCLUSIONS

In this sample of Australian adults, Dietary Pattern 2 was associated with higher BP and thus chronic disease risk, supporting the evidence that diets high in energy and sodium, and low in potassium from vegetables and dairy, are detrimental to cardiovascular health.

Dietary patterns among French-speaking men residing in Montreal, Canada

The purpose of this study was to describe dietary patterns among 1636 French-speaking men residing in Montreal, Canada and to assess sociodemographic and lifestyle characteristics of men adhering to the dietary patterns identified. Participants were population controls from the Prostate Cancer and Environment Study, a case-control study conducted between 2006 and 2011 in Montreal. Information on diet was collected using a food frequency questionnaire, and principal component analysis, a data-driven method and a posteriori method, was used to identify dietary patterns. Three dietary patterns were identified; Healthy, Modified Western – Salty and Modified Western - Sweet patterns accounted for 7.0%, 5.4%, and 3.2% of the variance, respectively. The Healthy pattern was characterized by consumption of fruits, vegetables, vegetable soup, chicken, fish and seafood, cheese, rice, yogurt, and wine. The Modified Western – Salty pattern included high loadings for beef, pork, chicken, hot-dogs or sausages, cold cuts, bacon, barbecue cooking, meat slightly blackened, potatoes, pasta with tomato sauce, pizza, pastries, dark carbonated soft drinks, ice cream, and white bread. The third pattern, labelled as Modified Western - Sweet, had high loadings of cookies, muffins, cakes, pastries, pies, ice cream, fruits and vegetables. In multivariate analyses, the Healthy pattern was positively associated with higher income and education, moderate recreational physical activity and less heavy smoking, and inversely associated with French ancestry. The Modified Western – Salty pattern was positively associated with French, other European, and Latino ancestries, and with married and common-law relationships. Finally, the Modified Western – Sweet pattern was more common among men of French ancestry and users of vitamin/mineral supplements. The Healthy pattern has been frequently observed in other Western populations, but the other two are described for the first time in a study population of men.

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First study of data-driven dietary patterns focussing on men only in Montreal.

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3 dietary patterns: Healthy, Modified Western –Salty, and Modified Western –Sweet.

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The Modified Western – Salty and Modified Western – Sweet patterns are novel.

Exploring the Dietary Patterns of Young New Zealand Women and Associations with BMI and Body Fat

Examining dietary patterns provides an alternative approach to investigating dietary behaviors related to excess adiposity. The study aim was to investigate dietary patterns and body composition profiles of New Zealand European (NZE) women, participating in the women’s EXPLORE (Examining the Predictors Linking Obesity Related Elements) study. Post-menarche, pre-menopausal NZE women (16–45 years) (n = 231) completed a validated 220-item, self-administrated, semi-quantitative food frequency questionnaire. Body mass index (BMI) was calculated using measured height (cm) and weight (kg); body fat percentage (BF%) was measured using air displacement plethysmography (BodPod). Dietary patterns were identified using principal component factor analysis. Associations between dietary patterns, age, BMI and BF% were investigated. Four dietary patterns were identified: snacking; energy-dense meat; fruit and vegetable; healthy, which explained 6.9%, 6.8%, 5.6% and 4.8% of food intake variation, respectively. Age (p = 0.012) and BMI (p = 0.016) were positively associated with the “energy-dense meat” pattern. BF% (p = 0.016) was positively associated with the “energy-dense meat” pattern after adjusting for energy intake. The women following the identified dietary patterns had carbohydrate intakes below and saturated fat intakes above recommended guidelines. Dietary patterns in NZE women explain only some variations in body composition. Further research should examine other potential factors including physical activity and socioeconomic status.

Dietary patterns in Swedish adults; results from a national dietary survey

Dietary patterns derived by statistical procedures is a way to identify overall dietary habits in specific populations. The aim of this study was to identify and characterise dietary patterns in Swedish adults using data from the national dietary survey Riksmaten adults 2010-11 (952 women, 788 men). Principal component analyses were used and two patterns were identified in both sexes: a healthy pattern loading positively on vegetables, fruits, fish and seafood, and vegetable oils, and negatively on refined bread and fast food, and a Swedish traditional pattern loading positively on potatoes, meat and processed meat, full-fat milk products, sweet bakery products, sweet condiments and margarine. In addition, a light-meal pattern was identified in women with positive loadings on fibre-rich bread, cheese, rice, pasta and food grain dishes, substitute products for meat and dairy products, candies and tea. The healthy pattern was positively correlated to dietary fibre (r 0·51-0·58) and n-3 (r 0·25-0·31) (all P<0·0001), and had a higher nutrient density of folate, vitamin D and Se. The Swedish traditional and the light-meal pattern were positively correlated to added sugar (r 0·20-0·25) and the Swedish traditional also to SFA (r 0·13-0·21) (all P<0·0001); both patterns were in general negatively correlated to micronutrients. Dietary pattern scores were associated with, for example, age, physical activity, education and income. In conclusion, we identified three major dietary patterns among Swedish adults. The patterns can be further used for examining the association between whole diet and health outcomes.

The Mediterranean diet and nutritional adequacy: a review

The Mediterranean dietary pattern, through a healthy profile of fat intake, low proportion of carbohydrate, low glycemic index, high content of dietary fiber, antioxidant compounds, and anti-inflammatory effects, reduces the risk of certain pathologies, such as cancer or Cardiovascular Disease (CVD). Nutritional adequacy is the comparison between the nutrient requirement and the intake of a certain individual or population. In population groups, the prevalence of nutrient inadequacy can be assessed by the probability approach or using the Estimated Average Requirement (EAR) cut-point method. However, dietary patterns can also be used as they have moderate to good validity to assess adequate intakes of some nutrients. The objective of this study was to review the available evidence on the Nutritional Adequacy of the Mediterranean Diet. The inclusion of foods typical of the Mediterranean diet and greater adherence to this healthy pattern was related to a better nutrient profile, both in children and adults, with a lower prevalence of individuals showing inadequate intakes of micronutrients. Therefore, the Mediterranean diet could be used in public health nutrition policies in order to prevent micronutrient deficiencies in the most vulnerable population groups.

Dietary patterns are associated with weight gain in newlyweds: findings from a cross-sectional study in Shanghai, China

OBJECTIVE

The present study aimed to characterize the dietary patterns of newlyweds married within one year and to examine the factors associated with weight changes.

DESIGN

A cross-sectional study was carried out in 2009.

SETTING

Baoshan District, Shanghai, China.

SUBJECTS

A total of 342 pairs of newlyweds were recruited at their first visit. Weight and height were measured and food intake was measured based on an FFQ with forty-nine items. Dietary patterns were identified through factor analysis, and the factors associated with weight changes were determined by multiple regression models.

RESULTS

Average weight gain of the participants during marital transition was 1.9 kg (2.2 kg for men and 1.6 kg for women). Four major dietary patterns were identified: vegetable pattern, sweets and fats pattern, legume pattern and poultry, beef and mutton pattern. In multivariate analyses, the highest quintile of factor 2 (sweets and fats pattern) was significantly associated with weight gain after marriage in a comparison with the lowest quintile (β = 2.94; 95 % CI 0.75, 5.15; P = 0.01) in men. The highest quintile of factor 4 (poultry, beef and mutton pattern) was inversely associated with weight gain after marriage in a comparison with the lowest quintile (β = -1.21; 95 % CI -2.32, -0.11; P = 0.03).

CONCLUSIONS

Our results suggest that a pattern rich in sugar, oil and condiments may lead to greater marital weight gain in men; another pattern rich in poultry, beef and mutton may lead to less marital weight gain in both men and women.

Nutritional adequacy of three dietary patterns defined by cluster analysis in 997 pregnant Japanese women: the Osaka Maternal and Child Health Study

OBJECTIVE

To examine the adequacy and inadequacy of dietary patterns in pregnant women for which information is absolutely lacking.

DESIGN

Diet was assessed by a validated, self-administered diet history questionnaire (DHQ). Dietary patterns were extracted from the intake of thirty-three food groups (g/4184 kJ (1000 kcal)), which were summarized from 147 foods assessed with the DHQ, by cluster analysis. Nutritional inadequacy for selected twenty nutrients in each dietary pattern was examined using the reference values given in the Dietary Reference Intakes (DRI) for Japanese as the temporal gold standard.

SETTING

Japan.

SUBJECTS

Nine hundred and ninety-seven pregnant Japanese women aged 18-43 years.

RESULTS

The three dietary patterns identified were labelled as 'meat and eggs' (n 423), 'wheat products' (n 371) and 'rice, fish and vegetables' (n 203). The 'rice, fish and vegetables' pattern characterized by high intake of rice, vegetables, potatoes, pulses, fruits, seaweed, fish and miso soup showed significantly the lowest prevalence of inadequate intake for fifteen nutrients and significantly the highest prevalence of inadequate sodium intake. In contrast, the 'wheat products' pattern characterized by high intake of bread, noodles, confectioneries and soft drinks showed the highest prevalence of inadequate intake for fourteen nutrients. The median number of nutrients not meeting the DRI as a marker of overall nutritional inadequacy was eight in the 'rice, fish and vegetables' pattern. It was significantly lower at ten in the 'meat and eggs' and eleven in the 'wheat products' patterns (P<0.001).

CONCLUSIONS

In pregnant Japanese women, the dietary pattern high in rice, fish, vegetables, fruit and some others showed a better profile of nutritional adequacy except for sodium.

Dietary patterns of men in ALSPAC: associations with socio-demographic and lifestyle characteristics, nutrient intake and comparison with women's dietary patterns

OBJECTIVE

The aim of this study is to obtain distinct dietary patterns using principal components analysis (PCA) in men taking part in the Avon Longitudinal Study of Parents and Children and to determine the associations with (a) the patterns derived in the study women (the men's partners), (b) socio-demographic and lifestyle factors and (c) estimated nutrient intakes.

DESIGN AND METHODS

A total of 4681 men taking part in a population-based cohort study recorded their current frequency of food consumption through questionnaire. Dietary patterns were identified using PCA, and scores were calculated for each pattern. A wide variety of social and demographic characteristics and lifestyle factors were also collected through self-completion questionnaire.

RESULTS

Four dietary patterns were established: 'health conscious', 'traditional', 'processed/confectionery' and 'semi-vegetarian'. There were relatively strong correlations and levels of agreement between the 'health conscious' and 'vegetarian' style patterns in men and women (P<0.001). Strong associations were evident between several socio-demographic variables and the dietary patterns, similar to those earlier reported in women. Finally, nutrient intakes were plausibly associated with dietary pattern scores.

CONCLUSIONS

Distinct dietary patterns in men have been identified using PCA that are similar, but not identical to those obtained in their partners at the same time point. Researchers should always consider stratifying by gender when examining dietary patterns. This study will form the basis for further work investigating the associations between parental and child dietary patterns.

Women's dietary patterns change little from before to during pregnancy

Principal component analysis (PCA) is a popular method of dietary patterns analysis, but our understanding of its use to describe changes in dietary patterns over time is limited. Using a FFQ, we assessed the diets of 12,572 nonpregnant women aged 20-34 y from Southampton, UK, of whom 2270 and 2649 became pregnant and provided complete dietary data in early and late pregnancy, respectively. Intakes of white bread, breakfast cereals, cakes and biscuits, processed meat, crisps, fruit and fruit juices, sweet spreads, confectionery, hot chocolate drinks, puddings, cream, milk, cheese, full-fat spread, cooking fats and salad oils, red meat, and soft drinks increased in pregnancy. Intakes of rice and pasta, liver and kidney, vegetables, nuts, diet cola, tea and coffee, boiled potatoes, and crackers decreased in pregnancy. PCA at each time point produced 2 consistent dietary patterns, labeled prudent and high-energy. At each time point in pregnancy, and for both the prudent and high-energy patterns, we derived 2 dietary pattern scores for each woman: a natural score, based on the pattern defined at that time point, and an applied score, based on the pattern defined before pregnancy. Applied scores are preferred to natural scores to characterize changes in dietary patterns over time because the scale of measurement remains constant. Using applied scores, there was a very small mean decrease in prudent diet score in pregnancy and a very small mean increase in high-energy diet score in late pregnancy, indicating little overall change in dietary patterns in pregnancy.

Validity of dietary patterns to assess nutrient intake adequacy

The purpose of the present study was to conduct a systematic review of the literature on the value of the methods used to assess dietary patterns for measuring nutrient intake adequacy in the population. Systematic review on Pubmed database up to April 2008. The search included specific key words and MeSH terms. No language limit was set. Only studies that compared food patterns with nutrient intake adequacy or nutrient biomarkers were included in the analysis. The search resulted in 1504 articles. The inclusion and exclusion criteria limited the selection to thirty articles. Nineteen studies evaluated the usefulness of the dietary patterns, eithera prioridefined (thirteen studies), or defined by factor analysis (four studies) or by cluster analysis (two studies), but only nine of them tested their validity (foura prioridefined and foura posterioridefined). Diet indices showed moderate to good validity results for measuring the adequacy of intakes for α-carotene, β-carotene, vitamin C, vitamin B6, Ca, folic acid, Fe and Mg. The factor analysis approach showed moderate to good validity correlations with the adequacy of intake of α-carotene, β-carotene, lutein, lycopene, vitamin C, vitamin B6and folic acid. Vitamin B12and vitamin E are the micronutrients with less probability of being adequately assessed with dietary patternsa prioriora posterioridefined. Diet indices are tools with fair to moderate validity to assess micronutrient intake adequacy.

Dietary patterns and nutritional adequacy in a Mediterranean country

Dietary patterns have been related to health outcomes and morbi-mortality. Mediterranean diet indexes are correlated with adequate nutrient intake. The objective of the present study was to analyse the adequacy of nutrient intake ofa posterioridefined Mediterranean (MDP) and Western (WDP) diet patterns in the Seguimiento Universidad de Navarra (SUN) cohort. A sample of 17 197 subjects participated in the study. Participants completed a 136-item validated semi-quantitative FFQ. Principal component analysis was used to define dietary patterns. Individuals were classified according to quintiles of adherence based on dietary pattern scores. Non-dietary variables, such as smoking and physical activity habits, were also taken into account. The probability approach was used to assess nutrient intake adequacy of certain vitamins (vitamins B12, B6, B3, B2, B1, A, C, D and E) and minerals (Na, Zn, iodine, Se, folic acid, P, Mg, K, Fe and Ca). Logistic regression analysis was used to assess the adequacy of nutrient intake according to adherence to dietary patterns. WDP and MDP were defined. A higher quintile of adherence to an MDP was associated to a lower prevalence of inadequacy for the intake of Zn, iodine, vitamin E, Mg, Fe, vitamin B1, vitamin A, Se, vitamin C and folic acid. The adjusted OR for not reaching at least six (or at least ten) nutrient recommendations were 0·09 (95 % CI: 0·07, 0·11) (and 0·02 (95 % CI: 0·00, 0·16)) for the upper quintile of MDP and 4·4 (95 % CI: 3·6, 5·5) and 2·5 (95 % CI: 1·1, 5·4) for the WDP. The MDP was associated to a better profile of nutrient intake.

Food consumption patterns in the Waterloo Region, Ontario, Canada: a cross-sectional telephone survey

BACKGROUND

The demographics and lifestyles of Canadians are changing, thereby influencing food choices and food preparation in the home. Although different dietary practices are associated with increased risk of foodborne illness, our ability to evaluate food consumption trends and assess risks associated with foodborne illness is limited by lack of data on current eating habits and consumer food safety practices. The objective of this study was to describe, for the first time, the food consumption patterns in a Canadian-based population from a food safety perspective, in order to establish baseline data on actual food intake of individuals.

METHOD

A cross-sectional telephone survey of 2,332 randomly selected residents of Waterloo Region, Ontario, Canada (C-EnterNet pilot site) was conducted between November 2005 and March 2006. Food intake was assessed using a 7-day dietary recall method.

RESULTS

Certain food items were consumed more than others among the same food groups, and consumption of many food items varied by gender and age. Specific foods considered high-risk for the transmission of certain enteric pathogens were significantly more likely to be consumed by males (i.e. unpasteurized juice, bean sprouts, and undercooked meat) and elderly individuals (i.e. undercooked eggs). The majority of households prepared and consumed most meals at home, allocating an average of 44 minutes to prepare a meal.

CONCLUSION

Baseline data on actual food intake is useful to public health professionals and food safety risk assessors for developing communication messages to consumers and in foodborne outbreak investigations.

Dietary patterns of children and adolescents analyzed from 2001 Korea National Health and Nutrition Survey

The purpose of this study was to identify dietary patterns among children and adolescents in Korea and to examine their associations with obesity and some blood profiles. One day food consumption data measured by 24-hour recalls on 2704 subjects aged 1 to 19 were used from 2001 Korea National Health and Nutrition Survey. The data of blood profiles available in the ages of 10 or older was also used. After categorizing each food consumed into 29 food or food groups, five dietary patterns were derived through a factor analysis and subjects were classified into three major dietary patterns via a cluster analysis using the factor scores. Three dietary patterns were identified as 'traditional diet' (25.6%), 'westernized-fast food' (6.2%), and 'mixed diet' (68.2%). The 'traditional diet' pattern had a higher percentage in boys. Both the 'traditional diet' and the 'westernized-fast food' had higher proportions of adolescents (12-19 y) than younger children, while the 'mixed diet' had a higher percentage of preschool children (1-5 y). Obesity rate analyzed within each age group showed no differences among 3 dietary pattern clusters. Blood pressure and all plasma profiles were not different among dietary patterns when adjusted with age and gender. Conclusively, children and adolescents in Korea had three distinct dietary patterns, which were associated with gender and age. These patterns could be useful to plan nutrition interventions for teenager health promotion.

Dietary transition stages based on eating patterns and diet quality among Haitians of Montreal, Canada

OBJECTIVES

To identify dietary transition stages based on dietary patterns of adult Haitians having lived in Montreal for various lengths of time, and to assess associated dietary quality.

SUBJECTS

One hundred and eighty-one Haitians aged 25-60 years were recruited by the modified random digit dialling method.

DESIGN

Socio-economic, diet and lifestyle variables were documented by questionnaire. Three non-consecutive 24-hour dietary recalls were conducted over a 3-month period. Dietary patterns were studied using cluster analysis, and their association with proportion of lifetime in Canada and with socio-economic status (SES) was examined. Diet quality criteria were micronutrient adequacy and healthfulness based on dietary recommendations of the World Health Organization.

RESULTS

Four dietary phenotypes were identified which could roughly represent stages of dietary transition or acculturation (Traditional, Pre-Western, Western and Modern). Subjects in the 'Traditional' cluster were older and had lived for a significantly lower proportion of their lifetime in Canada; they also tended to be of lower SES. Diet quality was significantly higher in the 'Traditional' than the 'Western' type, particularly with respect to healthfulness. A significantly lower proportion of subjects complying with limited intake of total fat ( < 30%) and cholesterol ( < 45%) was observed in the 'Western' compared with other diet phenotypes. Less than 15% of all subjects consumed enough dietary fibre, irrespective of diet type.

CONCLUSION

Dietary transition stages could be identified on the basis of food patterns of Haitians according to the proportion of their lifetime in Canada. Encouraging the youth to retain the traditional food culture in its positive aspects would appear relevant

Dietary patterns are associated with sexual maturation in Korean children

The purpose of this study was to investigate the association between dietary patterns and sexual maturation among Korean children. A cross-sectional study was conducted in 422 boys and 365 girls aged 9–12 years living in Seoul, Korea. Three-day food records were obtained, and pubertal stages were determined with a questionnaire using Tanner stages. Body fat was measured by bioelectrical impedance analysis, and bone mass content at the right calcaneus was measured by portable dual-emission X-ray absorptiometry. Exploratory factor analysis with a Varimax rotation was applied to identify dietary patterns using twenty-four food groups. Four distinct dietary patterns – ‘rice and Kimchi’, ‘shellfish and processed meat’, ‘pizza and drinks’ and ‘milk and cereal’ – were obtained. Twenty-six per cent (24% stage 2, 2% stage 3) of boys had genital development, and 79% (63% stage 2, 16% stage 3) of girls showed breast development. In boys, genital development was weakly positively associated with ‘shellfish and processed meat’ dietary factor scores (odds ratio 1·65, CI 0·95, 2·89,pfor trend 0·07) after adjusting for confounders. In girls, breast development was significantly positively associated with the factor score of ‘shellfish and processed meat’ (odds ratio 1·88, CI 1·08, 3·26,pfor trend 0·05). These results suggest that dietary patterns were related to body composition and sexual maturation among the Korean children. Further investigations are needed to identify components of the foods consumed in high amounts in these patterns and how they are related to sexual maturation.

Dietary patterns and associated lifestyles in preconception, pregnancy and postpartum

OBJECTIVE

To identify dietary patterns in women who are planning immediate pregnancy in preconception, weeks 6, 10, 26 and 38 of pregnancy, and 6 months postpartum, and to describe how particular lifestyles, the body mass index (BMI) and sociodemographic factors are associated to these patterns.

DESIGN

Longitudinal study throughout the reproductive cycle of food consumption carried out in a Spanish Mediterranean city.

SETTING

Faculty of Medicine and Health Sciences, Rovira i Virgili University.

SUBJECTS

In total, 80 healthy female volunteers who were planning immediate pregnancy.

INTERVENTIONS

A seven-consecutive-day dietary record was used to evaluate the dietary intake. Exploratory factor analysis was used to identify the main dietary patterns in each of the periods. Fitted multiple linear regression models were used to study the associations between the lifestyle and sociodemographic variables, and each dietary pattern.

RESULTS

The 'sweetened beverages and sugars' pattern was identified from preconception to 6 months postpartum and the 'vegetables and meat' pattern to the end of pregnancy. The 'sweetened beverages and sugars' pattern is positively associated with smoking and negatively associated with physical activity before conception and in the first trimester of pregnancy. The 'vegetables and meat' pattern is negatively associated with the BMI during the preconception period and positively associated with age in weeks 10 and 38 of pregnancy. It is shown that the patterns do not change significantly throughout the period studied.

CONCLUSIONS

We have identified two stable dietary patterns from preconception to postpartum. The 'sweetened beverages and sugars' pattern is associated with habits of risk for the health of the pregnant woman and her offspring.

SPONSORSHIP

'Comisión Interministerial de Ciencia y Tecnología' (CICYT: ALI89-0388) and 'Instituto de Salud Carlos III', RCMN (C03/08), Madrid, Spain'.

Dietary patterns in the Southampton Women's Survey

OBJECTIVE

Dietary pattern analysis is receiving increasing attention as a means of summarizing the multidimensional nature of dietary data. This research aims to compare principal component analysis (PCA) and cluster analysis using dietary data collected from young women in the UK.

DESIGN

Diet was assessed using a 100-item interviewer-administered food frequency questionnaire. PCA and cluster analysis were used to examine dietary patterns.

SETTING

Southampton, UK.

SUBJECTS

A total of 6125 non-pregnant women aged 20-34 years.

RESULTS

PCA identified two important patterns: a 'prudent' diet and a 'high-energy' diet. Cluster analysis defined two clusters, a 'more healthy' and a 'less healthy' cluster. There was a strong association between the prudent diet score and the two clusters, such that the mean prudent diet score in the less healthy cluster was -0.73 standard deviations and in the more healthy cluster was +0.83 standard deviations; the difference in the high-energy diet score between the two clusters was considerably smaller.

CONCLUSIONS

Both approaches revealed a similar dietary pattern. The continuous nature of the outcome of PCA was considered to be advantageous compared with the dichotomy identified using cluster analysis.

SPONSORSHIP

The study was funded by the Dunhill Medical Trust, the University of Southampton and the Medical Research Council.

Food patterns measured by factor analysis and anthropometric changes in adults

BACKGROUND

Sixty-five percent of US adults are overweight, and 31% of these adults are obese. Obesity results from weight gains over time; however, dietary determinants of weight gain remain controversial.

OBJECTIVE

Our objective was to examine whether food patterns derived from exploratory factor analysis are related to anthropometric changes. We hypothesized that we would derive a healthy food pattern and that it would predict smaller changes in body mass index (BMI; in kg/m(2)) and waist circumference (in cm) than would other food patterns in models adjusted for baseline anthropometric measures.

DESIGN

The subjects were 459 healthy men and women participating in the Baltimore Longitudinal Study of Aging. Diet was assessed by using 7-d dietary records, from which 40 food groups were formed and entered into a factor analysis.

RESULTS

Six food patterns were derived. Factor 1 (reduced-fat dairy products, fruit, and fiber) was most strongly associated with fiber (r = 0.39) and loaded heavily on reduced-fat dairy products, cereal, and fruit and loaded moderately on fruit juice, nonwhite bread, nuts and seeds, whole grains, and beans and legumes. In a multivariate-adjusted model in which the highest and lowest quintiles were compared, factor 1 was inversely associated with annual change in BMI (beta = -0.51; 95% CI: -0.82, -0.20; P < 0.05; P for trend < 0.01) in women and inversely associated with annual change in waist circumference (beta = -1.06 cm; 95% CI: -1.88, -0.24 cm; P < 0.05; P for trend = 0.04) in both sexes.

CONCLUSION

Our results suggest that a pattern rich in reduced-fat dairy products and high-fiber foods may lead to smaller gains in BMI in women and smaller gains in waist circumference in both women and men.

A longitudinal study of food intake patterns and obesity in adult Danish men and women

OBJECTIVE

The aim of this study was to test the hypothesis that specific food intake patterns or changes in food intake patterns were related to future changes in body mass index (BMI).

DESIGN

Longitudinal observational study, with clinical and questionnaire examinations at baseline and two follow-up surveys, after 5 and 11 years.

SUBJECTS

In all, 3785 men and women attended at baseline, of which 2436 aged 30-60 y attended all three examinations.

MEASUREMENTS

A 26-item food frequency questionnaire, standardised measurements of height and weight and a lifestyle questionnaire. Food intake patterns were identified by factor analysis. Regression models including: scores on each factor, BMI, smoking, leisure time physical activity, education, parity, age; and as outcomes: baseline BMI, BMI change between baseline, 5- and 11-y follow-up and obesity at 11-y follow-up, respectively.

RESULTS

For men, three factors labelled 'Green', 'Sweet' and 'Traditional', and for women, two factors labelled 'Green' and 'Sweet-Traditional' were identified. Scores on the 'Sweet' and 'Sweet-Traditional' factors were inversely associated with baseline BMI. For men, baseline 'Traditional' factor score and, for women, baseline 'Sweet-Traditional' factor score was inversely associated with subsequent 11- and 5-y BMI change, respectively. Using the three examinations, a more advanced longitudinal model, which included preceding changes in BMI and factor scores, was tested but no significant associations between factor scores, changes in factor scores and subsequent BMI changes or obesity were found.

CONCLUSION

In this longitudinal study of a Danish population, food intake factors could not consistently predict changes in BMI or obesity development.

Dietary patterns and health outcomes

A systematic review of the literature on dietary patterns (multiple dietary components operationalized as a single exposure) in relation to nutrient adequacy, lifestyle and demographic variables, and health outcome was conducted. Most of the published reports on the subject have used one of two methods to determine dietary patterns: (a) diet indexes or scores that assess compliance with prevailing dietary guidance as dietary patterns, and (b) data-driven methods that use factor or cluster analysis to derive dietary patterns. Irrespective of the approach used, patterns characterized by fruit/vegetable/whole grain/fish/poultry consumption generally have been reported to relate to micronutrient intake, and to selected biomarkers of dietary exposure and disease risk in the expected direction. Age, income, and education have been reported to be among positive predictors of the so-called more healthful dietary patterns. An inverse association of healthful dietary patterns with all-cause mortality and cardiovascular disease risk was reported in most studies. However, the magnitude of risk reduction was modest and was attenuated after control for confounders. Few published studies showed an association between risk of most incident cancers and dietary patterns. Both of the currently used approaches for extracting dietary patterns have limitations, are subject to dietary measurement errors, and have not generated new diet and disease hypotheses.

Diet Quality Among Older Quebecers As Assessed By Simple Indicators

To determine whether older Quebecers are eating adequately and whether summary scores represent diet quality, a representative subset of participants aged 55 to 74 (weighted n=460, 47% male) was studied from the 1990 Enquête québécoise sur la nutrition dataset. Participants’ diet quality was scored from adjusted 24-hour recalls. Foods were coded into Canada's Food Guide to Healthy Eating food groups. Usual Dietary Adequacy Score (maximum=18) and Dietary Diversity Score (maximum=4) were calculated from adjusted food guide portions and validated internally in relation to achievement of nutrient recommendations using correlation analysis. Average usual Dietary Adequacy Score (mean ± standard error) was 14.96 ± 0.15 (men) and 13.72 ± 0.15 (women). Only 7% of men and 1% of women achieved the maximum usual score. Fortyfour percent of men and 45% of women scored a usual Dietary Diversity Score of 3, and 55% of men and 50% of women achieved 4. Thus, approximately half of older Quebecers showed inadequate dietary variety, and consumed fewer than the minimum recommended number of servings from certain food groups. Summary diet quality indicators are useful for tracking diet quality, and provide critical data for planning nutrition education programs targeting older persons.

Consistency of food intake factors by different dietary assessment methods and population groups

Several studies have used factor analysis to identify food intake patterns in epidemiological studies as an alternative to nutrient-based analyses, but few have validated the factors in a larger population. Our present objectives were: to compare the factor scores based on a food-frequency questionnaire (FFQ) with scores based on a 7 d diet record; to examine the consistency of the factor score correlations across strata of age, BMI, energy intake, education, physical activity and smoking and to compare factors identified in two sub-populations. In 879 men and 927 women, of the total population sample of 3785, scores on food intake factors, three for men ('green', sweet' and 'traditional') and two for women ('green' and 'sweet-traditional'), identified in data from the FFQ and the diet record, were compared. The loadings of foods on the factors were very similar and the correlations between the corresponding factor scores, based on the two dietary assessment methods, were: for men 'green' 0.61, 'sweet' 0.55, 'traditional' 0.34; for women, 'green' 0.61, 'sweet-traditional' 0.57. Stratification did not significantly modify the correlations, with a few inconsistent exceptions. Factors obtained in a different subsample of the population, for which there was only data from the FFQ, were almost identical to the factors found in the subsample, who provided both FFQ and diet record information with regard to food loadings and model fit. In conclusion, the food intake factors identified were reproducible using two different dietary assessment methods and, furthermore, independent of stratification.

Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population

BACKGROUND

Few studies have examined food consumption patterns in relation to biological risk factors for cardiovascular disease.

OBJECTIVE

The objective of the study was to describe food consumption patterns in the general Dutch population and their association with cardiovascular risk factors.

DESIGN

We performed a cross-sectional study of 19 750 randomly selected men and women aged 20-65 y from 3 Dutch municipalities. Food consumption patterns were identified with the use of factor analysis of data from a validated food-frequency questionnaire.

RESULTS

Three food consumption patterns were identified: the "cosmopolitan" pattern (greater intakes of fried vegetables, salad, rice, chicken, fish, and wine), the "traditional" pattern (greater intakes of red meat and potatoes and lesser intakes of low-fat dairy and fruit), and the "refined-foods" pattern (greater intakes of French fries, high-sugar beverages, and white bread and lesser intakes of whole-grain bread and boiled vegetables). Higher scores for the traditional pattern were associated with older age, and higher scores for the refined-foods pattern were associated with younger age, but both were associated with lower educational level, cigarette smoking, less physical activity, and higher body mass index. Independent of other lifestyle factors and body mass index, the cosmopolitan-pattern score was significantly associated with lower blood pressure and higher HDL-cholesterol concentrations, and the traditional-pattern score was associated with higher blood pressure and higher concentrations of HDL cholesterol, total cholesterol, and glucose. The refined-foods-pattern score was associated with higher total cholesterol concentrations and lower intakes of micronutrients.

CONCLUSION

In this Dutch population, food consumption patterns were independently associated with blood pressure and plasma glucose and cholesterol concentrations.

Dietary intake of older adults in the Kingston area

The objectives of this research were to describe the dietary intake and identify risk factors for poor dietary intake in community-dwelling older adults living in the Kingston, Frontenac, and Lennox & Addington Health Unit area. Dietary intake information was collected from a convenience sample of 105 relatively healthy, active older adults (84 women, 21 men) using 24-hour recalls from three non-consecutive days. Risk factors for poor dietary intake were identified through a structured interview. Multiple linear regression was used to generate a model to predict dietary intake, which was measured using a diet score based on Canada's Food Guide to Healthy Eating. Group averages reflected reasonable diet quality, but some subjects had very low nutrient intakes, particularly of zinc and vitamins B6, B12, and C. On average, women had a lower-than-recommended intake from all food groups, while men consumed adequate amounts of all food groups except milk products. Higher scores indicated better overall diet quality, and the following were significant predictors of a high diet score: "almost always" preparing one's own meals, food "almost always" or "sometimes/never" tasting good, eating lunch every day, and taking fewer prescription medications. This model requires validation with a larger and more diverse population of community-dwelling older adults.

Food intake patterns and risk of coronary heart disease: a prospective cohort study examining the use of traditional scoring techniques

OBJECTIVE

This study analyses the risk of coronary heart disease (CHD) associated with food intake patterns.

DESIGN

A cohort study with follow-up in 1996 for first admission to hospital for a CHD diagnosis or death caused by CHD (280 cases). Three food patterns were identified from a food frequency questionnaire: (1) a predefined healthy food index; (2) a prudent diet (reflecting frequent intakes of wholemeal cereals, fruit and vegetables); and (3) a Western food pattern (reflecting frequent intakes of meat products, butter and white bread) derived by factor analysis. Both factor scores had a mean of zero and a standard deviation of 1.

SETTING

Copenhagen County, Denmark.

SUBJECTS

A random sample of 7316 adults participated in health examinations conducted either in 1982-1984, 1987, or 1991-1992.

RESULTS

The healthy food index and the Western pattern were not associated with CHD. The prudent pattern was associated with a decreased risk of CHD (Hazard ratio (HR per score unit increase)=0.85; 95% confidence intervals (CI), 0.75, 0.96), but the association vanished (HR=1.06; 95% CI, 0.93, 1.21) after controlling for confounding. Body mass index (BMI) modified the effect of the prudent and the Western patterns on CHD risk, suggesting an inverse association between both patterns and CHD in persons with low BMI, while the risk of CHD seemed to be positively related to the prudent and the Western pattern in those with high BMIs.

CONCLUSIONS

This study showed no association between dietary patterns and CHD risk, but suggests that BMI modifies the relation between diet and CHD risk.

Food intake patterns and body mass index in observational studies

OBJECTIVE

To review studies of patterns of food intake, as assessed by diet index, factor analysis or cluster analysis, and their associations with body mass index or obesity (BMI/Ob).

DESIGN

Systematic literature review MEDLINE search with crosscheck of references.

STUDIES

Thirty observational studies relating food intake patterns to anthropometric information were identified and reviewed. Food intake patterns were defined using a diet index, factor or cluster analysis in 12, nine and nine studies, respectively. Measures of body mass were made concurrently with the diet assessment in all studies, and only in a few cases were the primary outcomes related to BMI/Ob.

RESULTS

The food intake patterns identified could, in most factor or cluster analysis studies, be categorised as: (a) meat, fatty, sweet or energy dense foods; (b) vegetables, fruit, whole grain and low-fat foods; or (c) by high alcohol consumption. The diet indexes were designed to capture a high diversity and/or food combinations matching the recommendations. The relationships with BMI/Ob were inconsistent-ten studies found that intake patterns, which we categorised as fatty, sweet or energy dense were positively associated with BMI/Ob, while similar patterns in four other studies were negatively associated with BMI. The significant associations between diet index score and BMI/Ob were consistently negative, while the associations between factor scores or cluster membership and BMI/Ob were less clear in terms of food intake pattern. Men and women had similar food intake patterns, but food intake patterns were less often positively associated with BMI/Ob in women. In 11 studies, there were no significant associations between food intake pattern and BMI/Ob.

CONCLUSION

This review showed that no consistent associations could be identified between BMI or Ob and food intake patterns, derived from diet index, factor analysis or cluster analysis. However, the heterogeneity of food intake patterns identified by such analyses and the lack of gold standards for the application of these techniques hampers consistent analysis of a relation between food intake patterns and health.

Dietary patterns and mortality in Danish men and women: a prospective observational study

The analysis of dietary patterns emerged recently as a possible approach to examining diet-disease relation. We analysed the risk of all-cause and cardiovascular mortality associated with dietary patterns in men and women, while taking a number of potential confounding variables into account. Data were from a prospective cohort study with follow-up of total and cause-specific mortality. A random sample of 3698 men and 3618 women aged 30-70 years and living in Copenhagen County, Denmark, were followed from 1982 to 1998 (median 15 years). Three dietary patterns were identified from a twenty-eight item food frequency questionnaire, collected at baseline: (1) a predefined healthy food index, which reflected daily intakes of fruits, vegetables and wholemeal bread, (2) a prudent and (3) a Western dietary pattern derived by principal component analysis. The prudent pattern was positively associated with frequent intake of wholemeal bread, fruits and vegetables, whereas the Western was characterized by frequent intakes of meat products, potatoes, white bread, butter and lard. Among participants with complete information on all variables, 398 men and 231 women died during follow-up. The healthy food index was associated with reduced all-cause mortality in both men and women, but the relations were attenuated after adjustment for smoking, physical activity, educational level, BMI, and alcohol intake. The prudent pattern was inversely associated with all-cause and cardiovascular mortality after controlling for confounding variables. The Western pattern was not significantly associated with mortality. This study partly supports the assumption that overall dietary patterns can predict mortality, and that the dietary pattern associated with the lowest risk is the one which is in accordance with the current recommendations for a prudent diet.