Relationship between Dietary Patterns and Cardiovascular Disease Risk in Korean Older Adults

Network Approach to Evaluate the Effect of Diet on Stroke or Myocardial Infarction Using Gaussian Graphical Model

Background/Objectives/Methods: Current research on the link between diet and stroke or myocardial infarction primarily focuses on individual food items. However, people's eating habits involve complex combinations of various foods. By employing an innovative approach known as the Gaussian graphical model to identify dietary patterns along with the Cox proportional model, the study aimed to identify dietary networks and explore their relationship with the incidence of stroke and/or myocardial infarction in the Korean population. The research utilized data from 84,729 participants in the Korean Genome and Epidemiological Study (KoGES), including the HEXA cohort (61,140 participants), CAVAS cohort (15,419 participants), and Ansan-Ansung cohort (8170 participants). Results: The network identified five dietary patterns or communities consisting of different food groups, while nine food groups did not belong to any community. The High-Protein and Green Tea Community consistently reduced the risk of stroke and myocardial infarction (MI), particularly among females. In most communities, no significant associations with stroke risk were noted in males, and the Rice and High-Calorie Beverages Community was linked to an increased risk of MI in both the total population and females. Conclusions: Dietary patterns derived from network analysis revealed distinct dietary habits in the Korean population, offering new insights into the relationship between diet and the risk of stroke and MI.

Visit-to-visit lipid variability on long-term major adverse cardiovascular events: a prospective multicentre cohort from the CORE-Thailand registry

Lipid variability (LV) has been studied and proposed as a potential predictor for cardiovascular disease (CVD), and increased LV may contribute to adverse clinical outcomes. This study aimed to investigate the association of various LV parameters with the risk of long-term major adverse cardiovascular events (MACE) among the Thai population. The study used data from the CORE-Thailand Registry, a prospective multicentre study of adults with high cardiovascular risk or established CVD. The primary outcome was 4-point MACE, including non-fatal myocardial infarction, non-fatal stroke, heart failure hospitalisation, and all-cause mortality. LV was defined as visit-to-visit variability in individual and combined lipid parameters using the coefficient of variation (CV), and patients were stratified into four groups according to CV quartiles. The hazard ratio (HR) and 95% confidence interval (CI), adjusted for potential confounders, were calculated using the Cox proportional hazards model. In a total of 9,390 patients, 6,041 patients with data of intra-individual LV were included. After adjusting covariates in the Cox proportional hazards model, higher LV was independently associated with an increased risk of 4-point MACE (HR for quartiles 2, 3, and 4 of the CV of total cholesterol, compared to first quartile, were 3.63 (95% CI 3.20-4.06, P < 0.001), 6.85 (95% CI 6.23-7.47, P < 0.001), and 8.91 (95% CI 8.18-9.64, P < 0.001), respectively). The present study demonstrated that higher visit-to-visit LV, particularly in the higher quartiles, was independently associated with MACE, MI, and all-cause mortality in the Thai population at high cardiovascular risk or established atherosclerotic CVD, indicating that LV might be useful as a potential risk indicator.

Carbohydrate-based diet may increase the risk of cardiovascular disease: A pooled analysis of two prospective cohort studies

BACKGROUND & AIMS

According to cumulative epidemiologic studies, balancing macronutrients for energy is important to prevent metabolic diseases; however, this has not been studied extensively in Asian populations whose carbohydrate intake levels are relatively high. Therefore, we aimed to investigate the longitudinal association between carbohydrate intake and cardiovascular disease (CVD) among Korean adults in two community-based cohort studies.

METHODS

We included 9608 and 164,088 participants from the Korean Association Resource and Health Examinee studies, respectively, in the analysis. Carbohydrate intake was estimated using a validated semi-quantitative food frequency questionnaire. The proportion of total energy from carbohydrate (P_CARB) was calculated, and participants were divided into sex-specific quartiles based on their P_CARB values. Incident cases of CVD, including myocardial infarction, coronary artery disease, and stroke, were identified through self-reported questionnaires. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between P_CARB and CVD risk. The fixed effects model was used to pool the results.

RESULTS

In the fully adjusted model, significant positive associations between P_CARB and CVD risk were observed in the pooled analysis, showing that the HRs (95% CIs) for CVD across increasing quartiles of P_CARB were 1.00 (reference), 1.16 (0.94-1.44), 1.25 (0.96-1.63), and 1.48 (1.08-2.03). The restricted cubic spline regression analysis confirmed a linear dose-response relationship between P_CARB and CVD risk in both cohort studies, with all p-values for nonlinearity >0.05.

CONCLUSION

Our findings suggest that a carbohydrate-based diet high in proportion to total energy intake may increase the risk of CVD among middle-aged Korean adults, underscoring the importance of balanced macronutrient distribution. However, more research is needed to evaluate the sources and quality of carbohydrates in relation to CVD risk in this population.

Dietary patterns and predicted 10-year cardiovascular disease risk in a multiethnic Asian population

BACKGROUND AND AIMS

Studies examining associations between dietary patterns and Framingham risk score (FRS) and predicted 10-year cardiovascular diseases (CVD) risk in an Asian population are lacking. This study aimed to identify a posteriori dietary patterns across three major ethnic groups in Singapore and ascertain their associations with locally modified FRS and predicted 10-year CVD risk.

METHODS AND RESULTS

This cross-sectional study included 8594 Singapore residents (aged 21-75 years) from the Singapore Multi-Ethnic Cohort. Data on sociodemographic and lifestyle factors were collected via questionnaires. Food consumption was assessed using a validated Food Frequency Questionnaire. Dietary patterns were identified using principal component analysis and associations with CVD risk factors, FRS and predicted CVD risk (%) were analysed using multiple linear and logistic regression. Four dietary patterns emerged that explained 25.6% of variance. The 'processed food and sugar-sweetened beverages' pattern was significantly associated with higher FRS (β: 0.13; 95% CI: 0.04, 0.23), while the 'ethnic breads, legumes and nuts' (β: 0.13; 95% CI: 0.22, -0.04) and 'whole grains, fruit and dairy' (β: 0.17; 95% CI: 0.24, -0.10) patterns were significantly associated with lower FRS. The 'meat and vegetables' pattern was not significantly associated with FRS. Increased adherence to the 'whole grains, fruit and dairy' pattern was associated with lower odds of having predicted CVD risk of ≥10% (p-trend: 0.03).

CONCLUSION

Adherence to the 'ethnic breads, legumes and nuts' and 'whole grains, fruit and dairy' patterns was associated with a lower predicted CVD risk, and an inverse association for the 'processed food and sugar-sweetened beverages' pattern in an Asian population. These findings can inform the development of culturally sensitive dietary interventions to prevent CVD.

Diet Quality and Biological Risk in a National Sample of Older Americans

Objectives: Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. Methods: We analyzed nationally representative data from 3734 older adults who participated in the Health and Retirement Study Venous Blood Study in 2016 and Health Care and Nutrition Survey in 2013. Results: Eleven out of 13 individual dietary components were associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. Discussion: Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, and fatty acids, while limiting consumption of sodium, added sugar, and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity.

Association of Dietary Factors With Grip Strength, Body Fat, and Prevalence of Sarcopenic Obesity in Rural Korean Elderly With Cardiometabolic Multimorbidity

Background and Aims

Aging accompanied by cardiometabolic multimorbidity (CM) promotes chronic low-grade inflammation, increased oxidative stress, and insulin resistance (IR), which result in loss of muscle mass and functional impairment. Better quality diets have been directly associated with muscle health and decreased risk of all-cause mortality. However, no study has investigated the relationship of dietary factors with grip strength, body composition, and prevalence of sarcopenic obesity (SO) in Korean rural residents according to their CM pattern. Therefore, we aimed to examine this association among this population.

Materials and Methods

This cross-sectional study utilized data from 932 rural residents aged ≥ 65 years. An exploratory tetrachoric factor analysis revealed four multimorbidity patterns: CM, inflammatory disease, respiratory disease, and cancer and other diseases. All participants were categorized into the CM and non-CM groups. Skeletal muscle mass and the prevalence of sarcopenia were estimated using bioelectrical impedance analysis (BIA). Dietary assessment was analyzed using a validated 106-item food frequency questionnaire. Adjusted multiple linear regression and multivariate logistic regression were employed to examine the association of dietary factors with muscle strength, quality, and SO prevalence ratio in elderly participants.

Results

The mean age of the participants was 71.8 ± 0.1 years (65.8% women). Dietary fat and protein intake were positively correlated with handgrip strength in women with CM, after adjusting for covariates (p = 0.001). Similarly, protein intake (g/kg) was positively associated with appendicular skeletal muscle mass (ASM; kg/m²) and ASM (%) in both sexes in the CM and non-CM groups. Regarding the tertiles of wheat intake (g/d), 2.1-fold increase in SO prevalence ratios [prevalence ratio (PR): 2.149, confidence intervals (CIs): 1.134–4.071] was observed in the highest tertile (T3: 269.1 g/d), compared to the lowest tertile (Q1: 8.6 g/d) in the CM group. Higher tertile of meat intake (T2: 34.8 g/d, T3: 99.5 g/d) had a 2-fold increase in SO (PR: 1.932, CIs: 1.066–3.500) compared to the lowest tertile (T1: 9.2 g/d) in the CM group.

Conclusion

Overconsumption of wheat and meat negatively impacted the development of SO, while protein intake was positively associated with grip strength and skeletal muscle mass in elderly Koreans with CM.

Differences in Dietary Patterns among the Polish Elderly: A Challenge for Public Health

The aim of the study was to assess the diversity of dietary patterns within the elderly, in relation to the region of residence, household structure, and socioeconomic status. The questionnaire was conducted in a group of 427 Polish adults aged 60 and older from June to September 2019. The sample was selected by means of the snowball method in two regions. Principal component analysis (PCA) was used to extract and identify three dietary patterns (factors) from the frequency of eating 32 groups of foods. Logistic regression analysis was used to determine the relationship between the identified dietary patterns (DPs), region, household status, and socioeconomic index (SES). Adherence to the identified DPs, i.e., traditional, prudent, and adverse, was associated with socioeconomic status (SES) and living environment, i.e., living alone, with partner, or with family, while the region did not differentiate them. Less people living with their family were characterized by the frequent consumption of traditional food (the upper tertile of this DP), while more of them often consumed food that was typical for both prudent and adverse DPs (the upper tertiles of these DPs). The presence of a partner when living with family did not differentiate the adherence to DPs. A high SES decreased the chances of adhering to the upper tertiles of the “prudent” and “traditional” DPs, while living with family increased the chances of adhering to both the upper and middle tertiles of the “prudent” DP. Identifying the dietary patterns of the elderly contributes to a better understanding of the food intake of the senior citizens living in different social situations, in order to support public policies and nutritional counseling among this age group.