Fundamental dietary patterns and their correlates among US whites

Consumption Expenditure on Processed Meat and Its Correlates: An Ethnic Comparison

Background: The objective of the present study is to investigate the influences of sociodemographic and household factors on consumption expenditure on processed meat among households in Malaysia.Methods: Data were extracted from the Malaysian Household Expenditure Survey (HES) 2016. Lognormal hurdle models were utilized to assess the likelihood of consuming processed meat and the amount consumed. The independent variables consisted of household heads' age, educational level, gender, marital status, employment status, ethnicity, as well as household income, household region and household locality.Results: Bumiputera households with younger heads were more likely to consume processed meat and spent more than households with older heads. Chinese and Indian households in a higher income group had a higher likelihood of consuming and spending on processed meat than those in a lower income group. The probability of consuming processed meat and the amount consumed were positively associated with being from East Malaysia and urban areas.Conclusions: There are distinguished roles of sociodemographic and household factors across ethnic groups in consumption expenditure on processed meat. Policy makers should take account of age, income, education, household region and household locality factors when formulating intervention measures.

Food Consumption and Dietary Patterns of Local Adults Living on the Tibetan Plateau: Results from 14 Countries along the Yarlung Tsangpo River

The distinct Tibetan regional diet is strongly influenced by the regional biogeography, indigenous traditions, popular religious beliefs and food taboos. In the context of the nutritional transition in Tibet, studies seldom report on the food consumption and dietary patterns of Tibetan residents. This is a cross-section study of 552 local adults (≥18 years old, 277 men and 275 women) living in 14 agricultural countries along the Yarlung Tsangpo River. Dietary intakes were assessed by a culturally specific FFQ and compared with the Chinese Dietary Pagoda (2016). Dietary Patterns were extracted by using PCA method. The binary logistic regression model was applied to assess the association between independent variables (genders, regions and age groups) and adherence to dietary patterns. With the exception of meat (100 ± 260 g/day) and soybean nuts (42 ± 12 g/day), which exceeded the recommended dietary intakes of CDP, the dietary intake of other foods were not up to the recommended value. In particular, the intake of aquatic products (2 ± 0.1 g/day), vegetables (90 ± 19 g/day), dairy products (114 ± 29 g/day), cereals (117 ± 27 g/day) and fruits (97 ± 25 g/day) were seriously inadequate, which were 95%, 70%, 62%, 53.2% and 51.5% lower than the recommended intakes, respectively. Four dietary patterns were identified. “Local traditional diet” was characterized by a high intake of tsampa (roasted highland barley flour), culturally specific beverages (sweet tea and yak buttered tea), potato and yak beef and was associated with female, rural and older adults (≥51 years old). The male, urban and 18~30 years old group had a higher adherence score with the “Han diet”, which was comprised of rice, pork, dumplings, eggs, milk and cabbage. The “Beverage diet”, which mainly include tsampa, chang (homemade barley wine) and sweet tea, was associated with the following group: female, urban and aged 18~30 years. The “Out-sourced diet” pattern, consisting of mainly rice, steam bread and some processed meat, was associated with being male, urban and 18–30 years of age. These findings indicate that the dietary practice of the Tibetan people still has strong local characteristics, but it is also undergoing a dietary transition with the penetration of the Chinese Han diet and the increased consumption of outsourced (processed) foods. The unbalanced dietary intake of Tibetan residents should be taken seriously by all parties.

Dietary patterns and their effects on postpartum weight retention of lactating women in south central China

OBJECTIVES

Postpartum weight retention is a short- and long-term risk factor for overweight and obesity in women. The aim of this study was to evaluate dietary patterns and their effects on postpartum weight retention among lactating women in south central China.

METHODS

The study included 305 lactating women. A 24-h recall method on 3 consecutive d was used to collect dietary information. Furthermore, principal component analysis was performed to explore the main dietary patterns. The association between the postpartum weight retention and dietary patterns was assessed using a general linear regression model.

RESULTS

Two food patterns were obtained. Lactating women with dietary pattern 1 mainly ate red meat, coarse cereals, and fresh vegetables (leafy). Those with dietary pattern 2 mainly ate fresh vegetables (non-leafy), soy milk, and bacteria and algae. The mean energy, protein, fat, and carbohydrate intakes of the highest quartile (Q4) of both patterns exceeded the Chinese Recommended Nutrient Intake, whereas the calcium, selenium, vitamin A, B₁, and C nutrient intakes in the highest quartile (Q4) of both patterns were lower than recommended. Dietary pattern 2 (B = -0.523, 95% confidence interval, -0.948 to -0.099) was negatively associated with postpartum weight retention.

CONCLUSIONS

This study identified two dietary patterns among lactating women in south central China. A diet characterized by high intake of fresh vegetables (non-leafy), soy milk, and bacteria and algae was negatively associated with postpartum weight retention.

Food purchase patterns: empirical identification and analysis of their association with diet quality, socio-economic factors, and attitudes

Background

Empirically derived food purchase patterns provide information about which combinations of foods were purchased from households. The objective of this study was to identify what kinds of patterns exist, which level of diet quality they represent and which factors are associated with the patterns.

Methods

The study made use of representative German consumption data in which approximately 12 million food purchases from 13,125 households are recorded. In accordance with healthy diet criteria the food purchases were assigned to 18 food groups of the German Food Pyramid. Based on these groups a factor analysis with a principal component technique was applied to identify food patterns. For these patterns nutrient and energy densities were examined. Using regression analysis, associations between pattern scores and socio-economic as well as attitude variables, reflecting personal statements about healthy eating, were analyzed.

Results

In total, three food purchase patterns could be identified: a natural, a processed and a traditional one. The first one was characterized by a higher purchasing of natural foods, the second by an increased purchasing of processed foods and the third by a meat-oriented diet. In each pattern there were specific diet quality criteria that could be improved whereas others were in line with actual dietary guidelines. In addition to socio-demographic factors, attitudes were significantly associated with the purchase patterns.

Conclusions

The findings of this study are interesting from a public health perspective, as it can be assumed that measures focusing on specific aspects of diet quality are more promising than general ones. However, it is a major challenge to identify the population groups with their specific needs of improvement. As the patterns were associated with both socio-economic and attitude variables these grouping criteria could be used to define target groups.

Western Dietary Pattern Is Associated with Irritable Bowel Syndrome in the French NutriNet Cohort

Background: Diet appears to play a key role in the pathogenesis of the irritable bowel syndrome (IBS). Some dietary patterns (DP) could increase the risk of triggering or worsening IBS symptoms. This cross-sectional study aimed to assess the association between a posteriori derived DP and IBS in a large French population, the web-based NutriNet-Santé cohort. Methods: Study population included participants of the NutriNet-Santé study who completed a questionnaire based on Rome III criteria assessing IBS. A principal component analysis (PCA) was performed to identify major DPs based on 29 food groups' consumption. Associations between DP quintiles and IBS were investigated with multivariable logistic regressions. Results: 44,350 participants were included, with 2423 (5.5%) presenting IBS. Three major DP were extracted using PCA, "healthy," "western," and "traditional." After adjustments on confounders, the "western" DP was positively associated with IBS (OR _{Q5 vs. Q1} = 1.38, 95% CI 1.19-1.61, p trend < 0.0001) and the "traditional" DP was positively associated with IBS in women (OR _{Q5 vs. Q1} = 1.29 95% CI 1.08-1.54, p trend = 0.001). Conclusions: In this study, a "western" DP-highly correlated with the consumption of fatty and sugary products and snacks-was associated with a moderate increased risk of IBS.

Validity of the Rapid Eating Assessment for Patients for assessing dietary patterns in NCAA athletes

Background

Athletes may be at risk for developing adverse health outcomes due to poor eating behaviors during college. Due to the complex nature of the diet, it is difficult to include or exclude individual food items and specific food groups from the diet. Eating behaviors may better characterize the complex interactions between individual food items and specific food groups. The purpose was to examine the Rapid Eating Assessment for Patients survey (REAP) as a valid tool for analyzing eating behaviors of NCAA Division-I male and female athletes using pattern identification. Also, to investigate the relationships between derived eating behavior patterns and body mass index (BMI) and waist circumference (WC) while stratifying by sex and aesthetic nature of the sport.

Methods

Two independent samples of male (n = 86; n = 139) and female (n = 64; n = 102) collegiate athletes completed the REAP in June-August 2011 (n = 150) and June-August 2012 (n = 241). Principal component analysis (PCA) determined possible factors using wave-1 athletes. Exploratory (EFA) and confirmatory factor analyses (CFA) determined factors accounting for error and confirmed model fit in wave-2 athletes. Wave-2 athletes’ BMI and WC were recorded during a physical exam and sport participation determined classification in aesthetic and non-aesthetic sport. Mean differences in eating behavior pattern score were explored. Regression models examined interactions between pattern scores, participation in aesthetic or non-aesthetic sport, and BMI and waist circumference controlling for age and race.

Results

A 5-factor PCA solution accounting for 60.3% of sample variance determined fourteen questions for EFA and CFA. A confirmed solution revealed patterns of Desserts, Healthy food, Meats, High-fat food, and Dairy. Pattern score (mean ± SE) differences were found, as non-aesthetic sport males had a higher (better) Dessert score than aesthetic sport males (2.16 ± 0.07 vs. 1.93 ± 0.11). Female aesthetic athletes had a higher score compared to non-aesthetic female athletes for the Dessert (2.11 ± 0.11 vs. 1.88 ± 0.08), Meat (1.95 ± 0.10 vs. 1.72 ± 0.07), High-fat food (1.70 ± 0.08 vs. 1.46 ± 0.06), and Dairy (1.70 ± 0.11 vs. 1.43 ± 0.07) patterns.

Conclusions

REAP is a construct valid tool to assess dietary patterns in college athletes. In light of varying dietary patterns, college athletes should be evaluated for healthful and unhealthful eating behaviors.

[Factors associated with the addition of salt to prepared food]

The scope of this research was to investigate the potential differences between men and women in the addition of salt to prepared food. The study included 47,557 individuals aged 18 to 64 participating in the Risk and Protection Factors for Chronic Disease Surveillance System by Telephone Interview carried out in 26 Brazilian state capitals and the Federal District in 2006. Differences between men and women were tested by the chi-square test and the association magnitudes between the dependent and independent variables were estimated by the Odds Ratio obtained by Multiple Logistic Regression analysis. The prevalence of the addition of salt to prepared food was 8.3%, being higher among men (9,8% vs 6,9%, p < 0.01). After adjustment, the addition of salt to prepared food was higher in individuals with self-rated fair to poor health, reporting cardiovascular disease and living in the North of Brazil. Hypertensive individuals reported addition of less salt to prepared food. Educational level was not associated with salt usage. Men add more salt than women. Public health policies aimed at reducing salt intake by the population should take into account the gender differences in salt intake and the factors that contribute to such differences.

Associations between dietary patterns and self-reported hypertension among Brazilian adults: a cross-sectional population-based study

Hypertension is a prevalent cardiovascular disease, the important modifiable risk factor of which is diet. The aim of this study was to derive dietary patterns and to test associations with self-reported hypertension and other characteristics, namely demographic, socioeconomic, and lifestyle factors. Data were obtained from the population-based cross-sectional study titled Health Survey of the City of São Paulo, with a random sample of residents of the city of São Paulo, Brazil, aged older than 20 years of both sexes (n=1,102). In 2008, a structured questionnaire with information about socioeconomic, anthropometric, lifestyle, and dietary factors was applied. Dietary intake was estimated by two 24-hour dietary recalls, adjusted by Multiple Source Method. Dietary patterns were obtained through exploratory principal component factor analysis. Poisson regression was used to assess relationships. Three dietary patterns were identified: prudent (fruits, vegetables, whole-grain bread, white cheeses, juices, reduced-fat milk/nonfat milk), traditional (rice, beans, bread/toast/crackers, butter/margarine, whole milk, coffee/teas, sugar), and modern (sodas, pastries/sandwiches/pizzas, yellow cheeses, pastas, sauces, alcoholic beverages, sweets, processed meats). Hypertension and demographic, socioeconomic, and lifestyle factors, as well as the presence of health insurance, were associated with adherence to one or more identified dietary patterns. These results suggest the existence of a target audience for planning and executing public policies of food and nutrition to prevent and control hypertension.

Dietary patterns of Pakistani adults and their associations with sociodemographic, anthropometric and life-style factors

Dietary pattern analysis is an epidemiological method designed to consider the complexity of food preferences and diet patterns of populations. Few studies from South Asia have used this methodology to describe population food intake. Our objective was to identify dietary patterns and understand their associations with sociodemographic, anthropometric and life-style factors among low-income Pakistani urban adults. Dietary information was collected by a thirty-three-item FFQ and dietary patterns were derived by principal component analyses in 5491 subjects enrolled in the Control of Blood Pressure and Risk Attenuation (COBRA) study. Three dietary patterns were identified: a fat and sweet pattern characterised by fried snacks/foods, desserts, organ meats, bakery products, Pakistani bread and food purchased from outside the home; a fruit and vegetable pattern including fruits, juices, raw and cooked vegetables, lean meat and low-fat milk; and a seafood and yogurt pattern identified by prawns, fish, potatoes and yogurt. The fat and sweet pattern scores were low among older subjects, those with high BMI and waist circumference but high among females and physically active participants. The fruit and vegetable pattern was associated with younger age, high BMI, education and non-tobacco use. The seafood and yogurt pattern was associated with high BMI, increased physical activity and non-tobacco use. In conclusion, distinct dietary patterns exist for the Pakistani population that may be related to some of the population characteristics and thus may have importance in suggesting dietary and life-style interventions in the prevention of chronic diseases.

Dietary patterns affect lung cancer risk in never smokers

A number of studies suggest a role of dietary factors as risk predictors of lung cancer in never smokers. However, it is difficult to interpret the observed associations of lung cancer risk with any particular dietary item due to high correlation among different dietary items. In this study, we derived uncorrelated patterns of dietary items in the never smokers and evaluated the association of these patterns with lung cancer risk, using food frequency data from 299 never-smoker lung cancer patients and 317 controls enrolled in an ongoing case-control lung cancer study. We identified 2 major dietary patterns in never smokers: a "healthy eating" pattern including vegetables, fruits, and low-fat food items, and a "mixed dishes" pattern including most foods with positive loadings. Using multivariable regression analysis, we show that the healthy eating pattern is associated with a significant reduction of lung cancer risk among never smokers. The effect of the healthy eating pattern remained significant after adjustment for age, gender, education, caloric intake, secondhand smoke exposure, and family history of cancer. This finding, if confirmed in a prospective study, has a clear preventive significance, by promoting interventions encouraging healthier diets.

Patterns of food acquisition in Brazilian households and associated factors: a population-based survey

OBJECTIVE

To identify food acquisition patterns in Brazil and relate them to the sociodemographic characteristics of the household.

DESIGN

A cross-sectional national Household Budget Survey (HBS). Principal component factor analysis was used to derive food patterns (factors) on the basis of the acquisition of food classified into thirty-two food groups.

SETTING

The source of data originates from the 2002-2003 HBS carried out by the Brazilian Institute of Geography and Statistics between June 2002 and July 2003 using a representative sample of all Brazilian households.

SUBJECT

A total of 48 470 households allocated into 443 strata of households that were geographically and socio-economically homogeneous as a study unit.

RESULTS

We identified two patterns of food acquisition. The first, named 'dual', was characterized by dairy, fruit, fruit juice, vegetables, processed meat, soft drinks, sweets, bread and margarine, and by inverse correlations with Brazilian staple foods. In contrast, the second pattern, named 'traditional', was characterized by rice, beans, manioc, flour, milk and sugar. The 'dual' pattern was associated with higher household educational level, income and the average age of adults on the strata, whereas the 'traditional' presented higher loadings in less-educated households and in the rural setting.

CONCLUSIONS

Dietary patterns described here suggest that policies and programmes to promote healthy eating need to consider that healthy and non-healthy foods may be integrated within [corrected] the same pattern.

Race and region are associated with nutrient intakes among black and white men in the United States

Stroke mortality rates and prevalence of several chronic diseases are higher in Southern populations and blacks in the US. This study examined the relationships of race (black, white) and region (Stroke Belt, Stroke Buckle, other) with selected nutrient intakes among black and white American men (n = 9229). The Block 98 FFQ assessed dietary intakes and multivariable linear regression analysis was used to examine whether race and region were associated with intakes of fiber, saturated fat, trans fat, sodium, potassium, magnesium, calcium, and cholesterol. Race and region were significant predictors of most nutrient intakes. Black men consumed 1.00% lower energy from saturated fat compared with white men [multivariable-adjusted β: 1.00% (95% CI = -0.88, -1.13)]. A significant interaction between race and region was detected for trans fat (P < 0.0001), where intake was significantly lower among black men compared with white men only in the Stroke Belt [multivariable-adjusted β: -0.21 (95% CI = -0.11, -0.31)]. Among black men, intakes of sodium, potassium, magnesium, and calcium were lower, whereas cholesterol was higher, compared with white men (P < 0.05 for all). Comparing regions, men in the Stroke Buckle had the lowest intakes of fiber, potassium, magnesium, and calcium compared with those in the Stroke Belt and other regions; men in both the Stroke Buckle and Stroke Belt had higher intakes of cholesterol compared with those in other regions (P < 0.005 for all). Given these observed differences in dietary intakes, more research is needed to understand if and how they play a role in the health disparities and chronic disease risks observed among racial groups and regions in the US.

The relative importance of socioeconomic indicators in explaining differences in BMI and waist:hip ratio, and the mediating effect of work control, dietary patterns and physical activity

Socioeconomic differences in overweight are well documented, but most studies have only used one or two indicators of socioeconomic position (SEP). The aim of the present study was to explore the relative importance of indicators of SEP (occupation, education and income) in explaining variation in BMI and waist:hip ratio (WHR), and the mediating effect of work control and lifestyle factors (dietary patterns, smoking and physical activity). The Oslo Health Study, a cross-sectional study, was carried out in 2000-1, Oslo, Norway. Our sample included 9235 adult working Oslo citizens, who attended a health examination and filled in two complementary FFQ with < 20% missing responses to food items. Four dietary patterns were identified through factor analysis, and were named 'modern', 'Western', 'traditional' and 'sweet'. In multivariate models, BMI and WHR were inversely associated with education (P < 0.001/P < 0.001) and occupation (P = 0.002/P < 0.001), whereas there were no significant associations with income or the work control. The 'modern' (P < 0.001) and the 'sweet' (P < 0.001) dietary patterns and physical activity level (P < 0.001) were inversely associated, while the 'Western' dietary pattern (P < 0.001) was positively associated with both BMI and WHR. These lifestyle factors could not fully explain the socioeconomic differences in BMI or WHR. However, together with socioeconomic factors, they explained more of the variation in WHR among men (21%) than among women (7%).

A vegetable-fruit-soy dietary pattern protects against breast cancer among postmenopausal Singapore Chinese women

BACKGROUND

Prospective epidemiologic studies in Asian populations consistently show that soy is protective against breast cancer.

OBJECTIVE

The objective was to prospectively evaluate whether the protective effect of soy is due to soy isoflavones alone or to their combination with other beneficial dietary factors in an Asian population.

DESIGN

Using principal components analysis, we previously identified a "meat-dim sum" pattern characterized by meat, starch, and dim sum items and a "vegetable-fruit-soy" pattern characterized by cruciferous vegetables, fruit, and tofu items in a population-based cohort of Singapore Chinese initiated between 1993 and 1998. Component scores representing intakes of each pattern were used in multivariable Cox regression models to analyze the relation between diet at baseline and breast cancer incidence.

RESULTS

As of 31 December 2005, 629 incident breast cancer cases had been diagnosed among the 34,028 women. With greater intake of the vegetable-fruit-soy dietary pattern, we observed a dose-dependent trend (P < 0.01) for decreasing breast cancer risk among postmenopausal women [hazard ratio (HR): 0.70; 95% CI: 0.51, 0.95 for the fourth compared with first quartile]. A stronger association for the vegetable-fruit-soy pattern was observed among postmenopausal women with > or =5 y of follow-up (HR: 0.57; 95% CI: 0.36, 0.88; P for trend <0.01). No trend was observed for a greater intake of the meat-dim sum dietary pattern and increased breast cancer risk.

CONCLUSION

Our findings support the hypothesis that a diet characterized by vegetables, fruit, and soy has an early-acting protective effect on breast carcinogenesis.

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.

Urinary potassium is a clinically useful test to detect a poor quality diet

Poor eating habits, a strong predictor of health outcomes, are not objectively assessed in routine clinical practice. In this study, we evaluated the use of urinary potassium (K(+)) as a means to identify people consuming a poor quality diet. Consecutive patients with kidney stones (n = 220), aged 18-50 y, from a population-based lithotripsy unit, collected a single 24-h urine sample to assess urinary K(+). They also completed a FFQ to derive the recommended foods score (RFS), an index of overall diet quality, and had their blood pressure, heart rate, weight, and height measured. Urinary K(+) was related positively with the intake of recommended food items, including vegetables, fruit, whole grains, low-fat dairy products, fish and poultry, and wine and negatively to those not recommended by current dietary guidelines, including red meat, fast food, and high-energy drinks. Urinary K(+) was also correlated with the RFS (r = 0.226; P < 0.001). Using a receiver operating characteristic curve, K(+) excretion values below the gender-specific median (men, 60 mmol/d; women, 41 mmol/d) were identified as the optimal cutoff values for a poor quality diet, indicated by the RFS. Higher urinary K(+) was inversely related to adjusted BMI (P-trend = 0.03), diastolic blood pressure (P-trend = 0.04) and heart rate (P-trend = 0.006), after controlling for potential confounders. Urinary K(+) provides a summary measure of diet quality, is significantly related to BMI, blood pressure, and heart rate, and may be useful clinically to detect poor dietary habits and monitor response to dietary interventions.

Dietary patterns and health and nutrition outcomes in men living with HIV infection

BACKGROUND

Nutritional status is an important determinant of HIV outcomes.

OBJECTIVE

We assessed the association between dietary patterns identified by cluster analysis and change in body mass index (BMI; in kg/m(2)), CD4 count, and viral load (VL).

DESIGN

HIV-positive adult male subjects (n = 348) with a BMI >or= 20.5 were evaluated by biochemical, body composition, and dietary data. Cluster analysis was performed on 41 designated food groups derived from 3-d food records. Dietary clusters were compared for sociodemographic, nutrient intake, and clinical outcomes. Multivariate linear regression assessed associations between dietary clusters and change in BMI, CD4 count, and VL.

RESULTS

We observed 3 dietary patterns: juice and soda; fast food and fruit drinks; and fruit, vegetable, and low-fat dairy. Subjects in the fast food and fruit drinks pattern had the lowest fiber intake, highest VL, and lowest CD4 count and had a lower income than did subjects in the other 2 clusters. Subjects in the fruit, vegetable, and low-fat dairy diet pattern had higher intakes of protein, fiber, and micronutrients and the highest BMI and CD4 count. Subjects in the juice and soda pattern had higher energy intakes and lowest BMI. On average, the fast food and fruit drinks cluster and fruit, vegetable, and low-fat dairy cluster gained 0.33 (P = 0.06) and 0.42 (P = 0.02), respectively, more in BMI than the juice and soda cluster across the study interval in a multivariate model.

CONCLUSIONS

In a cohort of HIV-positive men, we identified 3 distinct dietary patterns; each pattern was associated with specific nutrition, demographic, and HIV-related variables.

Associação dos padrões alimentares com obesidade geral e abdominal em mulheres residentes no Sul do Brasil

Com objetivo de estudar a associação de padrões alimentares com obesidade, realizou-se estudo transversal de base populacional com amostra representativa de 1.026 mulheres (20 a 60 anos) em São Leopoldo, Rio Grande do Sul, Brasil. A obesidade geral foi avaliada pela utilização de índice de massa corporal (IMC > 30kg/m²) e a adiposidade abdominal, circunferência da cintura (CC> 88cm). Os padrões alimentares foram identificados por análise fatorial. Para análise multivariada, foi utilizada regressão de Poisson. Entre o total de mulheres, 18% (IC95%: 15,66-20,53) tinham obesidade geral e 23,3% (IC95%: 20,72-26,06) abdominal. Após controle para fatores de confusão, o baixo consumo do PA-frutas associou-se positivamente com o IMC (RP = 2,18; IC95%: 1,35-3,53; p = 0,001). Já o baixo consumo do PA-vegetais apresentou efeito protetor para o aumento nos níveis de IMC (RP = 0,64; IC95%: 0,47-0,86; p = 0,004) e o do PA-nozes/oleaginosas para o aumento na medida da CC (RP = 0,93; IC95%: 0,89-0,98; p = 0,008). O estudo aponta para a complexidade envolvida na relação entre padrões alimentares e obesidade e a necessidade de novos estudos, objetivando o melhor entendimento do tema.

Dietary Patterns and Breast Cancer Risk in the Shanghai Breast Cancer Study

The association of breast cancer with dietary patterns such as a western diet has not been studied in Asian women. We examined this among Shanghai Breast Cancer Study participants. Cases were of ages 25 to 64 years, diagnosed 08/1996-03/1998, and identified through a rapid case ascertainment system supplemented by the Shanghai Cancer Registry. Controls, selected from the general population of urban Shanghai, were frequency matched to cases by 5-year age group. Participants provided information on diet, lifestyle, and reproductive factors. In principal component analysis among 1,556 controls, two patterns emerged: a "vegetable-soy" pattern (tofu, cauliflower, beans, bean sprouts, green leafy vegetables) and a "meat-sweet" pattern (shrimp, chicken, beef, pork, candy, desserts). In adjusted unconditional logistic regression analyses including 1,446 cases and 1,549 controls with complete covariate data, risk was not associated with the vegetable-soy pattern. It was associated with the meat-sweet pattern (4th versus 1st quartile: odds ratio, 1.3; 95% confidence interval, 1.0-1.7; P(trend) = 0.03), but only in postmenopausal women, specifically among those with estrogen receptor-positive tumors (4th versus 1st quartile: odds ratio, 1.9; 95% confidence interval, 1.1-3.3; P(trend) = 0.03). Our findings indicate that a western diet increases breast cancer risk in postmenopausal Chinese women. They also suggest the value of quantifying aggregate risk for common combinations of foods.

Dietary patterns and their correlates among middle-aged and elderly Chinese men: a report from the Shanghai Men's Health Study

Dietary patterns, which reflect the complexity of food preference, lifestyle and socio-economic status, may play a major role in health and longevity. Understanding dietary patterns and their correlates is important to the research of diet and health relationships. In the Shanghai Men's Health Study (SMHS) a total of 61,582 men aged 40-74 were recruited between 2002 and 2006. Their food intake over the previous year was collected using a validated FFQ. Study participants (75.6%) reported little or no change in meat and vegetable intake in the 5 years prior to recruitment. Using the baseline data of the SMHS, we assessed dietary patterns, as well as their relationship with socio-demographic and lifestyle factors and with prevalence of some chronic diseases. Three major dietary patterns, fruit-, vegetable- and meat-based diets, were identified in our population. Consumption of the fruit diet appeared to be more common among men who were older and more physically active, had higher income, and lower waist-to-hip ratio (WHR), while this diet was less common among manual labourers. The meat- or vegetable-based diets were less common among elderly men and more common among men with higher WHR. Dietary patterns appeared to be associated with the presence of health conditions. In general, subjects with a chronic disease were more likely to have the vegetable-based diet and less likely to have the fruit- or meat-based diets. Future studies of diet and health in this population will need to carefully take into account these potential confounders.

Dietary patterns, insulin sensitivity and adiposity in the multi-ethnic Insulin Resistance Atherosclerosis Study population

Epidemiological investigations increasingly employ dietary-pattern techniques to fully integrate dietary data. The present study evaluated the relationship of dietary patterns identified by cluster analysis with measures of insulin sensitivity (SI) and adiposity in the multi-ethnic, multi-centre Insulin Resistance Atherosclerosis Study (IRAS, 1992–94). Cross-sectional data from 980 middle-aged adults, of whom 67% had normal and 33% had impaired glucose tolerance, were analysed. Usual dietary intake was obtained by an interviewer-administered, validated food-frequency questionnaire. Outcomes included SI, fasting insulin (FI), BMI and waist circumference. The relationship of dietary patterns to log(SI+1), log(FI), BMI and waist circumference was modelled with multivariable linear regressions. Cluster analysis identified six distinct diet patterns – ‘dark bread’, ‘wine’, ‘fruits’, ‘low-frequency eaters’, ‘fries’ and ‘white bread’. The ‘white bread’ and the ‘fries’ patterns over-represented the Hispanic IRAS population predominantly from two centres, while the ‘wine’ and ‘dark bread’ groups were dominated by non-Hispanic whites. The dietary patterns were associated significantly with each of the outcomes first at the crude, clinical level (P<0·001). Furthermore, they were significantly associated with FI, BMI and waist circumference independent of age, sex, race or ethnicity, clinic, family history of diabetes, smoking and activity (P<0.004), whereas significance was lost for SI. Studying the total dietary behaviour via a pattern approach allowed us to focus both on the qualitative and quantitative dimensions of diet. The present study identified highly consistent associations of distinct dietary patterns with measures of insulin resistance and adiposity, which are risk factors for diabetes and heart disease.

Dietary patterns in adolescence are related to adiposity in young adulthood in black and white females

Few studies have systematically used a total diet approach to classify adolescent dietary patterns. We examined dietary patterns in relation to nutrient intakes and adiposity in the National Heart, Lung, and Blood Institute Growth and Health Study cohort of 2371 black and white girls recruited at 9-10 y of age and followed for 10 y. Serial measurements were obtained for indices of anthropometry, dietary intake, physical activity, and sociodemographic variables. Dietary patterns for the 2 racial subgroups were separately identified by cluster analysis of 40 food groupings derived from 3-d food records. Nutrient intakes and measures of adiposity (BMI, percent body fat, and waist circumference) were compared by dietary pattern. We identified 4 discrete dietary patterns for black and for white adolescents. A Healthy pattern, followed by 12% of white girls and characterized by a high intake of fruits, vegetables, dairy, grains without added fats, mixed dishes and soups, and a low intake of sweetened drinks, other sweets, fried foods, burgers, and pizza, was related to more favorable nutrient intakes and a smaller increase in waist circumference. Among black girls, none of the dietary patterns appeared distinctly advantageous in terms of mitigating increases in adiposity. In conclusion, a cumulative pattern of food intake consistent with recommendations for general health appears to help prevent overweight, but this pattern was followed by only a minority of adolescent girls.

Long-term stability of food patterns identified by use of factor analysis among Swedish women

Limited data exist on the reproducibility of food patterns measured by factor analysis as well as on the use of stability of patterns over time. Our primary objective was to explore the long-term stability of food patterns derived by confirmatory factor analysis among 33,840 women participating in the Swedish Mammography Cohort. Our secondary objective was to compare factor solutions from confirmatory factor analysis with those derived by use of exploratory factor analysis. Diet was assessed by a food frequency questionnaire in 1987 and 1997, and food patterns were derived by the use of exploratory and confirmatory factor analysis. We observed four major food patterns (Healthy, Western/Swedish, Alcohol, and Sweets) at both time points. Correlations between confirmed food patterns in 1987 and 1997 were 0.37 for the Healthy pattern, 0.27 for the Western/Swedish pattern, 0.54 for the Alcohol pattern, and 0.44 for the Sweets pattern (P < 0.0001 for all associations). Patterns derived by the use of exploratory factor analysis were strongly associated with those derived by the use of confirmatory factor analysis (r >/= 0.90, P < 0.0001, for all associations). The patterns derived in this study were similar to those derived in other studies, indicating reproducibility of food patterns across populations. Our study suggests that food patterns measured by the use of confirmatory factor analysis are reproducible over time, and weaker correlations observed may reflect natural changes in eating behavior, the food supply, and/or perceptions of what is considered healthy. Testing whether patterns measured over a long time period can be used in analytic studies is the next step in assessing the validity of this method.

Empirically derived dietary patterns and risk of postmenopausal breast cancer in a large prospective cohort study

BACKGROUND

Inconsistent associations have been reported between diet and breast cancer.

OBJECTIVE

We prospectively examined the association between dietary patterns and postmenopausal breast cancer risk in a US-wide cohort study.

DESIGN

Data were analyzed from 40 559 women who completed a self-administered 61-item Block food-frequency questionnaire in the Breast Cancer Detection Demonstration Project, 1987-1998; 1868 of those women developed breast cancer. Dietary patterns were defined by using principal components factor analysis. Cox proportional hazard regression was used to assess breast cancer risk.

RESULTS

Three major dietary patterns emerged: vegetable-fish/poultry-fruit, beef/pork-starch, and traditional southern. The vegetable-fish/poultry-fruit pattern was associated with higher education than were the other patterns, but was similar in nutrient intake to the traditional southern pattern. After adjustment for confounders, there was no significant association between the vegetable-fish/poultry-fruit and beef/pork-starch patterns and breast cancer. The traditional southern pattern, however, was associated with a nonsignificantly reduced breast cancer risk among all cases (in situ and invasive) that was significant for invasive breast cancer (relative hazard = 0.78; 95% CI = 0.65, 0.95; P for trend = 0.003). This diet was also associated with a reduced risk in women without a family history of breast cancer (P = 0.05), who were underweight or normal weight [body mass index (in kg/m(2)) < 25; P = 0.02], or who had tumors positive for estrogen receptor (P = 0.01) or progesterone receptor (P = 0.003). Foods in the traditional southern pattern associated with reduced breast cancer risk were legumes, low mayonnaise-salad dressing intake, and possibly cabbage.

CONCLUSIONS

The traditional southern diet or its components are associated with a reduced risk of invasive breast cancer in postmenopausal women.

Prospective study of dietary patterns and persistent cough with phlegm among Chinese Singaporeans

RATIONALE

Using principal components analysis to examine dietary patterns complements the evaluation of individual food and nutrient intake in relation to health outcomes, but has not yet been applied to nonmalignant respiratory disease or symptoms.

OBJECTIVE

To examine the relation between patterns of dietary intake at baseline and new onset of persistent cough with phlegm in a population-based cohort of Singapore Chinese.

METHODS

A 165-item validated food frequency questionnaire was administered in-person at baseline in 1993. We identified 623 cases of incident cough with phlegm among 52,325 subjects by telephone interview from 1999 through 2004. We identified two distinct food patterns: a "meat-dim sum" pattern characterized by pork and chicken dim sum foods and noodle dishes, and a "vegetable-fruit-soy" pattern characterized by vegetables, fruit, and soyfood items.

MAIN RESULTS

The meat-dim sum pattern was positively associated with new-onset cough with phlegm (odds ratio, 1.43; 95% confidence interval, 1.08, 1.89; comparing fourth to first quartile, p for trend = 0.02), after adjustment for age, sex, total energy intake, smoking, education, and nonstarch polysaccharide intake, a protective factor for cough with phlegm in this cohort. Weaker associations were seen for more chronic symptoms and for incident asthma. A weak inverse association for the vegetable-fruit-soy pattern disappeared after adjustment for nonstarch polysaccharide intake.

CONCLUSION

A diet rich in meats, sodium, and refined carbohydrates may increase risk of developing cough with phlegm, independently of the apparent beneficial effects of a diet high in fiber in this Singapore Chinese cohort.

Dietary patterns using the Food Guide Pyramid groups are associated with sociodemographic and lifestyle factors: the multiethnic cohort study

Dietary patterns have been used to identify typical combinations of foods that may be associated with disease risks. We defined dietary patterns among 195,298 participants of the Multiethnic Cohort Study in Hawaii and Los Angeles in 1993-1996. Intakes of Food Guide Pyramid groups were calculated from a quantitative FFQ for subjects of 5 ethnic groups (African Americans, Hawaiians, Japanese Americans, Latinos, and whites). Three distinct dietary patterns, "Fat and Meat," "Vegetables," and "Fruit and Milk," were identified by exploratory factor analysis with a varimax rotation and validated by confirmatory factor analysis. Similar factor loadings were found for each of 10 ethnic-gender groups in stratified analyses. The odds ratios (OR) for being above the median scores for each factor were calculated. Age, gender, and ethnicity had relatively strong associations with dietary patterns whereas education showed only weak associations. BMI > or = 30 was strongly positively associated with the Fat and Meat pattern (OR = 2.14, 95% CI: 2.08-2.20, vs. BMI < 25). Current smokers showed a positive association with the Fat and Meat pattern (OR = 1.67, CI: 1.62-1.72, vs. nonsmokers) and inverse associations with the Vegetables (OR = 0.66, CI: 0.64-0.68) and Fruit and Milk patterns (OR = 0.53, CI: 0.52-0.55). Physical activity was positively associated with the Vegetables and Fruit and Milk patterns but not with the Fat and Meat pattern. These findings support the hypothesis that dietary patterns are influenced by interrelated sociocultural, demographic, and other lifestyle factors and may be useful in investigations of diet-disease relations.

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.

Dietary Patterns and Prostate Cancer Risk in the National Health and Nutrition Examination Survey Epidemiological Follow-up Study Cohort

Ecological studies implicate a "Western" diet in prostate cancer development, but whether dietary patterns measured in individuals are associated with risk has not been studied previously. We examined this issue using prospective data from the nationally representative United States Health Examination Epidemiological Follow-up Study. Among 3,779 men followed from 1982-84 to 1992, 136 incident cases were identified. Using principal component analysis on responses to a 105-item dietary questionnaire, the following three distinct patterns were identified: a vegetable-fruit pattern; a red meat-starch pattern characterized by red meats, potatoes, cheese, salty snacks, and desserts; and a Southern pattern characterized by such foods as cornbread, grits, sweet potatoes, okra, beans, and rice. In adjusted proportional hazards models, prostate cancer risk was not associated with the vegetable-fruit or red meat-starch pattern, but higher intake of the Southern pattern showed a reduction in risk (3rd versus 1st tertile relative risk, 0.6; 95% confidence interval, 0.4-1.1; trend P = 0.08) that approached statistical significance. The inverse association was observed in black and non-black men and was not attributable to intake of any individual foods or nutrients. A Southern dietary pattern may reflect a history of living in the South and serve as an integrative marker of sunlight exposure and protection through 1,25-dihydroxyvitamin D production. Further evaluation and better characterization of the pattern would offer more information on potentially beneficial features of the diet or its associated lifestyle.

Dietary patterns associated with risk factors for cardiovascular disease in healthy US adults

BACKGROUND

Certain nutrients are well established as dietary risk factors for cardiovascular disease (CVD), but dietary patterns may be a better predictor of CVD risk.

OBJECTIVE

This study tested the hypothesis that the complex dietary behaviors of US adults can be grouped into major dietary patterns that are related to risk factors for CVD.

DESIGN

With the use of food-frequency questionnaire data from the third National Health and Nutrition Examination Survey, dietary patterns of healthy US adults (>/or =20 y old; n = 13 130) were identified by factor analysis. Log-transformed biomarker data were associated with major dietary patterns after control for confounding variables in regression analyses. All statistical analyses accounted for the survey design and sample weights.

RESULTS

Of 6 dietary patterns identified, 2 patterns emerged as the most predominant: the Western pattern was characterized by high intakes of processed meats, eggs, red meats, and high-fat dairy products, and the American-healthy pattern was characterized by high intakes of green, leafy vegetables; salad dressings; tomatoes; other vegetables (eg, peppers, green beans, corn, and peas); cruciferous vegetables; and tea. The Western pattern was associated (P < 0.05) positively with serum C-peptide, serum insulin, and glycated hemoglobin and inversely with red blood cell folate concentrations after adjustment for confounding variables. The American-healthy pattern had no linear relation with any of the biomarkers examined.

CONCLUSIONS

The identification of common dietary patterns among free-living persons is promising for characterizing high-risk groups at the US population level. The dietary patterns identified here are similar to those reported in other nonrepresentative samples and are associated with biomarkers of CVD risk, which confirms that dietary pattern analysis can be a valuable method for assessing dietary intakes when predicting CVD risk.

Measuring socio-economic position in dietary research: is choice of socio-economic indicator important?

OBJECTIVES

To examine the association between socio-economic position (SEP) and diet, by assessing the unadjusted and simultaneously adjusted (independent) contributions of education, occupation and household income to food purchasing behaviour.

DESIGN

The sample was randomly selected using a stratified two-stage cluster design, and the response rate was 66.4%. Data were collected by face-to-face interview. Food purchasing was examined on the basis of three composite indices that reflected a household's choice of grocery items (including meat and chicken), fruit and vegetables.

SETTING

Brisbane City, Australia, 2000.

PARTICIPANTS

: Non-institutionalised residents of private dwellings located in 50 small areas (Census Collectors Districts).

RESULTS

When shopping, respondents in lower socio-economic groups were less likely to purchase grocery foods that were high in fibre and low in fat, salt and sugar. Disadvantaged groups purchased fewer types of fresh fruits and vegetables, and less often, than their counterparts from more advantaged backgrounds. When the relationship between SEP and food purchasing was examined using each indicator separately, education and household income made an unadjusted contribution to purchasing behaviour for all three food indices; however, occupation was significantly related only with the purchase of grocery foods. When education and occupation were simultaneously adjusted for each other, the socio-economic patterning with food purchase remained largely unchanged, although the strength of the associations was attenuated. When household income was introduced into the analysis, the association between education, occupation and food purchasing behaviour was diminished or became non-significant; income, however, showed a strong, graded association with food choice.

CONCLUSIONS

The food purchasing behaviours of socio-economically disadvantaged groups were least in accord with dietary guideline recommendations, and hence are more consistent with greater risk for the development of diet-related disease. The use of separate indicators for education, occupation and household income each adds something unique to our understanding of how socio-economic position is related to diet: each indicator reflects a different underlying social process and hence they are not interchangeable, and do not serve as adequate proxies for one another.

Validation of a soy food-frequency questionnaire and evaluation of correlates of plasma isoflavone concentrations in postmenopausal women

BACKGROUND

Soy foods may have various health benefits, but little is known about the patterns and correlates of soy consumption among postmenopausal women in the United States.

OBJECTIVE

We assessed the reliability and validity of a soy food-frequency questionnaire (FFQ) and examined demographic, lifestyle, and dietary correlates of plasma isoflavone concentrations in postmenopausal women.

DESIGN

In this cross-sectional study, soy isoflavone intake and plasma isoflavone concentration were analyzed in 96 postmenopausal women aged 50-79 y; the data were obtained at 2 visits that were 1 wk apart. Intake was determined with a 20-item soy FFQ and a comprehensive FFQ that included questions about tofu and soymilk. Fasting plasma daidzein and genistein concentrations were determined with liquid chromatography-mass spectrometry.

RESULTS

Intraclass correlations between week 1 and week 2 values were >0.98 for both the soy and comprehensive FFQs. Median reported isoflavone intake was <2 mg/d. Pearson's product-moment correlation coefficients relating isoflavone intakes with plasma isoflavone concentrations ranged from 0.35 to 0.43. Plasma isoflavone concentrations were positively associated with age, fiber consumption, servings of fruit and vegetables, and dietary supplement use and were inversely associated with caffeine consumption; no associations with body mass index, education, dietary beliefs, activity level, alcohol intake, or fat intake were observed.

CONCLUSIONS

Within a population with low soy consumption, the soy FFQ and comprehensive FFQ showed good reliability and moderate validity. Associations of plasma isoflavone concentrations with other dietary behaviors suggest that these compounds may serve as biomarkers of health behaviors in populations with low soy consumption.