Prospective study of major dietary patterns and risk of coronary heart disease in men

Energy density of meals and snacks in the British diet in relation to overall diet quality, BMI and waist circumference: findings from the National Diet and Nutrition Survey

This cross-sectional study examined how energy density (ED) in meals and snacks is associated with overall diet quality, BMI and waist circumference (WC). On the basis of the data from 7-d weighed dietary record, all eating occasions were divided into meals or snacks based on time (meals: 06.00-10.00, 12.00-15.00 and 18.00-21.00 hours; snacks: others) or contribution to energy intake (EI) (meals: ≥15; snacks: <15%) in 1451 British adults aged 19-64 years. Irrespective of the definition of meals and snacks, both meal ED and snack ED (kJ/g; calculated on the basis of solid food only) were inversely associated with overall diet quality assessed by the healthy diet indicator (regression coefficient (β)=-0·29 to -0·21 and -0·07 to -0·04, respectively) and Mediterranean diet score (β=-0·43 to -0·30 and -0·13 to -0·06, respectively) in both sexes (P≤0·002), although the associations were stronger for meal ED. After adjustment for potential confounders, in both men and women, meal ED based on EI contribution showed positive associations with BMI (β=0·34; 95% CI 0·06, 0·62 and β=0·31; 95% CI 0·01, 0·61, respectively) and WC (β=0·96; 95% CI 0·27, 1·66 and β=0·67; 95% CI 0·04, 1·30, respectively). In addition, meal ED based on time was positively associated with WC in men (β=0·59; 95% CI 0·07, 1·10) and snack ED based on time was positively associated with BMI in women (β=0·15; 95% CI 0·04, 0·27). In analyses in which only acceptable EI reporters were included, similar results were obtained. In conclusion, the findings suggest stronger associations of meal ED with overall diet quality, BMI and WC compared with snack ED.

Taking it Personally: Personalized Utilization of the Human Microbiome in Health and Disease

The genomic revolution enabled the clinical inclusion of an immense body of person-specific information to an extent that is revolutionizing medicine and science. The gut microbiome, our "second genome," dynamically integrates signals from the host and its environment, impacting health and risk of disease. Herein, we summarize how individualized characterization of the microbiome composition and function may assist in personalized diagnostic assessment, risk stratification, disease prevention, treatment decision-making, and patients' follow up. We further discuss the limitations, pitfalls, and challenges that the microbiome field faces in integrating patient-specific microbial data into the clinical realm. Finally, we highlight how recent insights into personalized modulation of the microbiome, by nutritional and pre-, pro-, and post-biotic intervention, may lead to development of individualized approaches that may enable us to harness the microbiome as a central precision medicine target.

Maternal Dietary Patterns and Gestational Diabetes Mellitus in a Multi-Ethnic Asian Cohort: The GUSTO Study

Gestational Diabetes Mellitus (GDM) is associated with an increased risk of perinatal morbidity and long term health issues for both the mother and offspring. Previous research has demonstrated associations between maternal diet and GDM development, but evidence in Asian populations is limited. The objective of our study was to examine the cross-sectional relationship between maternal dietary patterns during pregnancy and the risk of GDM in a multi-ethnic Asian cohort. Maternal diet was ascertained using 24-h dietary recalls from participants in the Growing up in Singapore towards healthy outcomes (GUSTO) study—a prospective mother-offspring cohort, and GDM was diagnosed according to 1999 World Health Organisation guidelines. Dietary patterns were identified using factor analysis, and multivariate regression analyses performed to assess the association with GDM. Of 909 participants, 17.6% were diagnosed with GDM. Three dietary patterns were identified: a vegetable-fruit-rice-based-diet, a seafood-noodle-based-diet and a pasta-cheese-processed-meat-diet. After adjusting for confounding variables, the seafood-noodle-based-diet was associated with a lower likelihood of GDM (Odds Ratio (95% Confidence Interval)) = 0.74 (0.59, 0.93). The dietary pattern found to be associated with GDM in our study was substantially different to those reported previously in Western populations.

Ethnic Differences in the Food Intake Patterns and Its Associated Factors of Adolescents in Kelantan, Malaysia

Objective: The aim of the study was to identify the ethnic differences in dietary patterns and its association with socio-economic, dietary and lifestyle practices among adolescents in Kelantan, Malaysia. Methods: A population-based study of 454 adolescents aged 12 to 19 years was included. A validated food frequency questionnaire was used to assess dietary patterns and three dietary patterns were identified based on the principal component analysis method. Results: Malay adolescents had significantly higher scores for the Western-based food pattern and local-based food pattern, whereas Chinese adolescents showed higher scores for the healthy-based food pattern. Multivariate analyses show that age and physical activity (PA) levels were positively associated with healthy-based food pattern in Malay (All, p < 0.001), whereas higher consumption of eating-out from home (EatOut) (p = 0.014) and fast food (p = 0.041) were negatively associated. High weekly breakfast skipping (p < 0.001) and EatOut (p = 0.003) were positively associated with a Western-based pattern, whereas age (p < 0.001) and household income (p = 0.005) were negatively associated. Higher frequency of daily snacking (p = 0.013) was positively associated with local-based food pattern. For Chinese adolescents, age (p < 0.001), PA levels (p < 0.001) and maternal education level (p = 0.035) showed positive associations with the healthy-based pattern, whereas high EatOut (p = 0.001) and fast food intakes (p = 0.001) were negatively associated. Higher weekly consumption of EatOut (p = 0.007), fast food (p = 0.023) and carbonated beverages (p = 0.023), and daily snacking practice (p = 0.004) were positively associated with higher Western-based food pattern, whereas age (p = 0.004) was inversely associated. Conclusion: This study showed that there were significant differences in dietary patterns and its association factors between Malay and Chinese adolescents. More importantly, these findings suggest that unhealthy dietary and lifestyle practices could increase the risk of adherence to unhealthy Western-based food pattern that is high in fat, sugar and salt contents, and, consequently, increase the risk of developing obesity and metabolic-related disorders during these critical years of growth.

A posteriori data-derived dietary patterns and incident coronary heart disease: Making sense of inconsistent findings

Inconsistent findings have been reported from numerous prospective studies for the relations of the 'Western' (unhealthy) and 'Prudent' (healthy) diet patterns, derived using factor, principle components, or cluster analysis methods, with incident coronary heart disease (CHD). Among contemporary prospective studies, the 'Prudent' diet pattern was inversely related to CHD risk in 7 of 12 studies, while the 'Western' diet pattern positively related to risk in only 3 of 11 studies. To explain these inconsistent findings, we compared the methods and results from these prospective studies conducted in the U.S., Europe, and Asia. A 'Prudent' diet pattern was consistently related to 18-65% lower risk of incident CHD in 7 studies conducted in the U.S., Europe and Asia. In 3 of 4 U.S. studies, but not cohorts in Europe or Asia, the 'Western' diet pattern was related to 37-64% greater CHD risk. In Asian cohorts, the 'Western' diet pattern was not related to increased CHD risk, which may be partially explained by the overall higher fish intake among Asians. The 'a posteriori', or data driven, approach to diet patterns is based on reported dietary intake and we found the components of each dietary pattern differed by geographic location and diet assessment instrument. We discuss how the non-standardized methods used to discern diet patterns from the dietary data may contribute to discrepant results. Further, the disparate findings may also be explained by differing sample characteristics, follow-up period, and CHD ascertainment. In summary, 'a posteriori' derived 'Prudent' diet pattern was related to cardiovascular health.

Dietary Predictors of Overweight and Obesity in Iranian Adolescents

BACKGROUND

Considering both diet and energy expenditures possess some influence on weight status, research into dietary determinants of obesity is challenging but essential to rational planning of well-organized interventions to avoid obesity.

OBJECTIVES

This study aimed to determine whether dietary factors were predictive of overweight and obesity in adolescents in the Iranian population.

PATIENTS AND METHODS

A total of 840 students, ages 15 - 17, from six schools were enrolled in this cross-sectional study. A diet-patterns approach often has been used to describe the eating patterns in adolescents. Height, weight, and waist circumference anthropometric indices, physical activity, waist hip ratio, and BMI measurements were determined. Daily dietary data and weighed food records were collected in 2010 and 2011. Abdominal obesity was defined according to world health organization guidelines, and the relationship between dietary predictor variables and the measures of adiposity were determined by using linear regression. Usual dietary intakes were assessed in an experimental study of Esfahani students.

RESULTS

In total, 38.5% of girls and 32.2% of boys had a Western dietary pattern as the more prevalent pattern. The diet quality of adolescents with the lowest score on each dietary pattern was compared with those recording the highest scores. Those with the Western dietary pattern score were less likely to exercise and had a higher prevalence of general obesity. Adolescents in the greater quartile of the Mediterranean dietary patterns had the lowest odds of being overweight (OR 0.50, 95%; CI 0.27 - 0.73) and obese (OR 0.48, 95%; CI 0.15 - 0.80) than those in the lower quartile, whereas those in the greater quartile of the Western dietary pattern had the highest odds of being overweight (OR 1.69, 95%; CI 1.10 - 2.04) and obese (OR 1.44, 95% CI 1.05 - 1.84). Higher consumption of a Western dietary pattern and a salty dietary pattern were associated significantly with obesity (P < 0.05). Intake of a Western dietary pattern and a salty-sweet dietary pattern were associated positively with measures of adiposity, namely body mass index and waist circumference.

CONCLUSIONS

This study showed significant associations between the seven dietary patterns and overweight and obesity among adolescents. Using dietary patterns within adolescents can provide important information on dietary consumption, and this approach is clearer and much easier to follow.

Dietary patterns associated with body mass index (BMI) and lifestyle in Mexican adolescents

Background

The objetive in this study is to determine the relationship between dietary patterns, BMI, type 2 diabetes mellitus family history (T2DMFH) and some lifestyle variables such as smoking and skipping breakfast in a Mexican adolescent population.

Methods

Cross-sectional, observational, analytical study.Subjetcts: 14-16 years old male and female adolescents (n 373). A previously validated food frequency questionnaire (FFQ) was used and dietary patterns were derived using principal component analysis (PCA). Scores for dietary patterns were categorized by tertiles.

Results

Three major dietary patterns that explained 47 % of variance were found: westernized, high in protein/fat and prudent pattern. Subjects at the highest tertile of prudent pattern had lower BMI. And was also associated with less T2DMFH and less smoking habit when compared with the lowest tertile. We found a positive correlation between BMI and high scores for westernized and high in protein/fat pattern

Conclusions

Dietary patterns of adolescents are a public health concern because there is a direct association between inadequate diet at this early age and obesity

Association of Empirically Derived Dietary Patterns with Cardiovascular Risk Factors: A Comparison of PCA and RRR Methods

Introduction

Principal component analysis is used to determine dietary behaviors of a population whereas reduced rank regression is used to construct disease-related dietary patterns. This study aimed to compare both types of DP and theirs associations with cardiovascular risk factors (CVRF).

Materiel and Methods

Data were derived from the cross sectional NESCAV (Nutrition, Environment and Cardiovascular Health) study, aiming to describe the cardiovascular health of the Greater region’s population (Grand duchy of Luxembourg, Wallonia (Belgium), Lorraine (France)). 2298 individuals were included for this study and dietary intake was assessed using a 134-item food frequency questionnaire.

Results

We found that CVRF-related patterns also reflect eating behaviours of the population. Comparing concordant food groups between both dietary pattern methods, a diet high in fruits, oleaginous and dried fruits, vegetables, olive oil, fats rich in omega 6 and tea and low in fried foods, lean and fatty meat, processed meat, ready meal, soft drink and beer was associated with lower prevalence of CVRF. In the opposite, a pattern characterized by high intakes of fried foods, meat, offal, beer, wine and aperitifs and spirits, and low intakes of cereals, sugar and sweets and soft drinks was associated with higher prevalence of CVRF.

Conclusion

In sum, we found that a “Prudent” and “Animal protein and alcohol” patterns were both associated with CVRF and behaviourally meaningful. Moreover, the relationships of those dietary patterns with lifestyle characteristics support the theory that food choices are part of a larger pattern of healthy lifestyle.

Development of a diet-induced murine model of diabetes featuring cardinal metabolic and pathophysiological abnormalities of type 2 diabetes

The persistent rise in global incidence of type 2 diabetes (T2D) continues to have significant public health and economic implications. The availability of relevant animal models of T2D is critical to elucidating the complexity of the pathogenic mechanisms underlying this disease and the implications this has on susceptibility to T2D complications. Whilst many high-fat diet-induced rodent models of obesity and diabetes exist, growing appreciation of the contribution of high glycaemic index diets on the development of hyperglycaemia and insulin resistance highlight the requirement for animal models that more closely represent global dietary patterns reflective of modern society. To that end, we sought to develop and validate a murine model of T2D based on consumption of an energy-dense diet containing moderate levels of fat and a high glycaemic index to better reflect the aetiopathogenesis of T2D. Male C57BL/6 mice were fed an energy-dense (ED) diet and the development of pathological features used in the clinical diagnosis of T2D was assessed over a 30-week period. Compared with control mice, 87% of mice fed an ED diet developed pathognomonic signs of T2D including glucose intolerance, hyperglycaemia, glycosylated haemoglobin (HbA1c) and glycosuria within 30 weeks. Furthermore, dyslipidaemia, chronic inflammation, alterations in circulating leucocytes and renal impairment were also evident in ED diet-fed mice compared with mice receiving standard rodent chow. Longitudinal profiling of metabolic and biochemical parameters provide support of an aetiologically and clinically relevant model of T2D that will serve as a valuable tool for mechanistic and therapeutic studies investigating the pathogenic complications of T2D.

The Effect of the Sodium to Potassium Ratio on Hypertension Prevalence: A Propensity Score Matching Approach

This study investigated the effect of the sodium to potassium ratio on hypertension prevalence and blood pressure. The study population was constructed by pooling the Korean National Health and Nutrition Examination Surveys between 2010 and 2014. The study population was divided into quartiles based on the sodium to potassium ratio, and the effect was inferred by the difference in hypertension prevalence across quartiles by six pairwise comparisons using a propensity score matching technique. The quartiles with the higher sodium to potassium ratio had higher hypertension prevalence rates based on the following pairwise comparisons: the first vs. third quartile, the first vs. fourth quartile, the second vs. third quartile, and the second vs. fourth quartile. The prevalence differences were 2.74% point (p < 0.05), 3.44% point (p < 0.01), 2.47% point (p < 0.05), and 2.95% point (p < 0.01), respectively. In addition, statistically significant higher systolic (p < 0.05) and diastolic blood pressure (p < 0.01) was observed in the second quartiles compared to the first quartiles. Because a strong association was also detected between the sodium to potassium ratio and blood pressure even at a low level of sodium to potassium ratio, a lower sodium to potassium ratio diet than a usual diet is recommended to control high blood pressure in Korea.

Blood fatty acid patterns are associated with prostate cancer risk in a prospective nested case-control study

BACKGROUND

Circulating fatty acids are highly correlated with each other, and analyzing fatty acid patterns could better capture their interactions and their relation to prostate cancer. We aimed to assess the associations between data-derived blood fatty acid patterns and prostate cancer risk.

METHODS

We conducted a nested case-control study in the Physicians' Health Study. Fatty acids levels were measured in whole blood samples of 476 cases and their matched controls by age and smoking status. Fatty acid patterns were identified using principal component analysis. Conditional logistic regression was used to estimate odds ratio (OR) and 95 % confidence interval (CI).

RESULTS

Two patterns explaining 40.9 % of total variation in blood fatty acid levels were identified. Pattern 1, which mainly reflects polyunsaturated fatty acid metabolism, was suggestively positively related to prostate cancer risk (ORquintile 5 vs. quintile 1 = 1.37, 95 % CI = 0.91-2.05, P trend = 0.07). Pattern 2, which largely reflects de novo lipogenesis, was significantly associated with higher prostate cancer risk (ORquintile5 vs. quintile1 = 1.63, 95 % CI = 1.04-2.55, P trend = 0.02). This association was similar across tumor stage, grade, clinical aggressiveness categories and follow-up time.

CONCLUSION

The two patterns of fatty acids we identified were consistent with known interactions between fatty acid intake and metabolism. A pattern suggestive of higher activity in the de novo lipogenesis pathway was related to higher risk of prostate cancer.

The Western dietary pattern is associated with increased serum concentrations of free estradiol in postmenopausal women: implications for breast cancer prevention

Little is known about the possible influence of food consumption on the serum concentrations of endogenous sex hormones in postmenopausal women. We evaluated the relationships of the Western dietary pattern with serum concentrations of free estradiol and testosterone of postmenopausal women to test the hypothesis that a highly Western dietary pattern is associated with high serum concentrations of these hormones. We used data from a representative subsample of 305 women from the control group of a population-based case-control study conducted in Mexico from 2004 to 2007. A Western dietary pattern index value was compared with log natural serum concentrations of testosterone and estradiol using multiple linear regression models. The median values of serum concentrations of free estradiol and testosterone were 0.26 pg/mL (interquartile range, 0.14-0.43) and 0.40 pg/mL (interquartile range, 0.30-0.70), respectively. A multiple linear regression model showed that for each unit increase in the Western dietary pattern index, there was a 16.2% increase in the serum concentrations of free estradiol (β=0.15; 95% confidence interval [CI], 0.01-0.29); for each additional serving per week of chicken eggs, the increase was 31.0% (β=0.27; 95% CI, 0.106-0.441); for each additional serving per week of red meat, the increase was 64.9% (β=0.50; 95% CI, 0.01-1.01). There was no relationship found between dietary patterns and serum concentrations of free testosterone. The present findings suggest that intake of a Western diet, particularly of chicken eggs and meat, increases serum concentrations of free estradiol; these results have implications for breast cancer prevention.

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 pattern as identified by factorial analysis and its association with lipid profile and fasting plasma glucose among Iranian individuals with spinal cord injury

OBJECTIVES

Plasma lipids (triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C)) may be associated with dietary intakes. The purpose of this study was to identify the most common food patterns among Iranian persons with spinal cord injury (SCI) and investigate their associations with lipid profile.

DESIGN

Cross-sectional.

SETTING

Tertiary rehabilitation center.

PARTICIPANTS

Referred individuals to Brain and Spinal Injury Research Center (BASIR) from 2011 to 2014.

OUTCOME MEASURES

Dietary intakes were assessed by 24-hour dietary recall interviews in three non-consecutive days. Principal component analysis (PCA) was used to identify dietary patterns.

RESULTS

Total of 100 persons (83 male and 17 female) entered the study. Four food patterns were detected. The most common dietary pattern (Pattern 1) included processed meat, sweets desserts and soft drink and was similar to 'Western' food pattern described previously. Pattern 1 was related to higher levels of TC and LDL-C (r = 0.09; P = 0.04 and r = 0.11; P = 0.03 for TC and LDL-C, respectively) only in male participants. Pattern 2 which included tea, nuts, vegetable oil and sugars had a positive association with TC level (r = 0.11; P = 0.02) again in male participants. Pattern 3 which represented a healthy food pattern showed no significant influence on lipid profiles.

CONCLUSION

In this study, the four most common dietary patterns among Iranian individuals with SCI have been identified. Western food pattern was the most common diet and was associated with increased TC and LDL-C. The healthy food pattern, in which the major source of calories was protein, was not associated with variance in lipid profile.

Association between Dietary Patterns and Cardiovascular Risk Factors among Middle-Aged and Elderly Adults in Taiwan: A Population-Based Study from 2003 to 2012

BACKGROUND

Cardiovascular disease (CVD) is one of the leading causes of mortality and loss of disability-adjusted life years in developed countries. This study derived a dietary pattern using an a priori method and additionally derived dietary patterns using a posteriori methods, and assessed the relationship with CVD risk factors in Taiwanese middle-aged and elderly adults.

METHODS

Cross-sectional analyses of 62,965 subjects aged 40 years and above from the Mei Jau (MJ) database collected between 2003 and 2012 in Taiwan. Diet was assessed using a 22 item semi-quantitative food frequency questionnaire. Using this information, three dietary patterns were generated. The a priori diet was labeled the Taiwanese dietary pattern and was derived using hypothesized effect of 22 food groups, while two a posteriori dietary patterns, "vegi-fruits" and "meat-processed", were derived using principal component analysis. The association between dietary patterns and a range of CVD risk factors (i.e. blood lipids, blood glucose and C-reactive protein) was evaluated using linear regression.

RESULTS

The results showed that high intake (Q5, quintile 5) of Taiwanese diet was negatively associated with CVD risk factors at (p < 0.001, model 3), but not with triacylglycerol. In addition, high intake of vegi-fruit dietary pattern (Q5) was negatively associated with CVD risk factors (p < 0.001), but not with high-density lipoprotein, while high consumption of meat-processed dietary pattern (Q5) was positively associated with CVD risk factors (p < 0.001), but negatively related with triacylglycerol in Q3 level and no association with C-reactive protein.

CONCLUSION

A negative association was observed between Taiwanese or vegi-fruit dietary patterns and CVD risk factors, while a positive association was found between meat-processed dietary pattern and CVD risk factors. The findings suggested that a diet rich in vegetables and fruits has a beneficial effect in the management of CVD risk factors.

Major dietary patterns in relation to demographic and socio-economic status and food insecurity in two Iranian ethnic groups living in Urmia, Iran

Objective

To identify major dietary patterns and their association with socio-economic status (SES) and food insecurity in two major ethnic groups living in Urmia, north-west Iran.

Design

A cross-sectional study.

Setting

All four geographical zones of Urmia city.

Subjects

Participants (n 723; 427 women and 296 men), aged 20–64 years, from two ethnic groups (445 Azeri Turks and 278 Kurds).

Results

Three major dietary patterns were extracted: ‘Traditional High SES’ (THS), ‘Traditional Low SES’ (TLS) and ‘Transitional’. After adjusting for confounders, the THS pattern was positively associated with education level and negatively associated with moderate or severe food insecurity in Azeri Turks; whereas, among Kurds, it was more common in women and positively associated with age. The TLS pattern was more common among men and negatively associated with educational level and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men, positively associated with being married and negatively associated with household income/capita. The ‘Transitional’ pattern was positively associated with being employed and negatively associated with age and all levels of food insecurity in Azeris; while, among Kurds, it was more common among men and negatively associated with age, being married and physical activity level.

Conclusions

Findings suggest that household SES and food insecurity are associated with detrimental dietary patterns and that this effect may be stronger than cultural and ethnic background. These patterns differ by age and gender. Therefore, such characteristics should be considered in planning and formulating diet-related policies and programmes.

Metabolomics as a tool in the identification of dietary biomarkers

Current dietary assessment methods including FFQ, 24-h recalls and weighed food diaries are associated with many measurement errors. In an attempt to overcome some of these errors, dietary biomarkers have emerged as a complementary approach to these traditional methods. Metabolomics has developed as a key technology for the identification of new dietary biomarkers and to date, metabolomic-based approaches have led to the identification of a number of putative biomarkers. The three approaches generally employed when using metabolomics in dietary biomarker discovery are: (i) acute interventions where participants consume specific amounts of a test food, (ii) cohort studies where metabolic profiles are compared between consumers and non-consumers of a specific food and (iii) the analysis of dietary patterns and metabolic profiles to identify nutritypes and biomarkers. The present review critiques the current literature in terms of the approaches used for dietary biomarker discovery and gives a detailed overview of the currently proposed biomarkers, highlighting steps needed for their full validation. Furthermore, the present review also evaluates areas such as current databases and software tools, which are needed to advance the interpretation of results and therefore enhance the utility of dietary biomarkers in nutrition research.

Foods, Nutrients, and Dietary Patterns: Interconnections and Implications for Dietary Guidelines

Dietary guidelines provide evidence-based statements on food choices to meet nutritional requirements and reduce the risk of prevailing chronic disease. They involve a substantial amount of research translation, and their implementation has important health consequences. Foods, however, are complex combinations of nutrients and other compounds that act synergistically within the food and across food combinations. In addition, the evidence base underpinning dietary guidelines accesses research that reflects different study designs, with inherent strengths and limitations. We propose a systematic approach for the review of evidence that begins with research on dietary patterns. This research will identify the combinations of foods that best protect, or appear deleterious to, health. Next, we suggest that evidence be sought from research that focuses on the effects of individual foods. Finally, nutrient-based research should be considered to explain the mechanisms by which these foods and dietary patterns exert their effects, take into account the effects of ingredients added to the food supply, and enable assessments of dietary sufficiency. The consideration of individual nutrients and food components (e.g., upper limits for saturated fat, added sugar, and sodium) provides important benchmarks for evaluating overall diet quality. The concepts of core and discretionary foods (nutrient-rich and nutrient-poor foods, respectively) enable distinctions between foods, and this has implications for the relation between food policy and food manufacturing. In summary, evidence supporting healthy dietary patterns provides the foundation for the development of dietary guidelines. Further reference to individual foods and nutrients follows from the foundation of healthy dietary patterns.

Nutrient Patterns and Their Food Sources in Older Persons from France and Quebec: Dietary and Lifestyle Characteristics

Background: Dietary and nutrient patterns have been linked to health outcomes related to aging. Food intake is influenced by environmental and genetic factors. The aim of the present study was to compare nutrient patterns across two elderly populations sharing a common ancestral cultural background, but living in different environments. Methods: The diet quality, lifestyle and socioeconomic characteristics of participants from the Three-City Study (3C, France, n = 1712) and the Québec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n = 1596) were analyzed. Nutrient patterns and their food sources were identified in the two samples using principal component analysis. Diet quality was compared across sample-specific patterns by describing weekly food intake and associations with the Canadian Healthy Eating Index (C-HEI). Results: Three nutrient patterns were retained in each study: a healthy, a Western and a more traditional pattern. These patterns accounted for 50.1% and 53.5% of the total variance in 3C and NuAge, respectively. Higher education and non-physical occupations over lifetime were associated with healthy patterns in both studies. Other characteristics such as living alone, having a body mass index lower than 25 and being an ex-smoker were associated with the healthy pattern in NuAge. No association between these characteristics and the nutrient patterns was noted in 3C. The healthy and Western patterns from each sample also showed an inverse association with C-HEI. Conclusion: The two healthy patterns showed important similarities: adequate food variety, consumption of healthy foods and associations with common sociodemographic factors. This work highlights that nutrient patterns derived using a posteriori methods may be useful to compare the nutritional quality of the diet of distinct populations.

Food patterns measured by principal component analysis and obesity in the Nepalese adult

OBJECTIVE

About one-fourth of Nepalese adults are overweight or obese but no studies have examined their risk factors, especially pertaining to diet. The present study aimed to identify dietary patterns in a suburban Nepalese community and assess their associations with overweight and obesity prevalence.

METHODS

This cross-sectional study used data from 1073 adults (18 years or older) participating in the baseline survey of the Dhulikhel Heart Study. We derived major dietary patterns from a principal component analysis of reported intake from a Food Frequency Questionnaire. Overweight was defined as Body Mass Index (BMI) of 25 kg/m(2) or higher and obesity was defined as BMI of 30 kg/m(2) or higher. Statistical analysis was conducted using generalised estimating equations with multivariate logistic regression (with household as cluster) adjusting for age, sex, ethnicity, religion, marital status, income, education, alcohol consumption, smoking, physical activity and systolic blood pressure.

RESULTS

Four dietary patterns were derived: mixed, fast food, refined grain-meat-alcohol and solid fats-dairy. The refined grain-rice-alcohol pattern was significantly associated with overweight (adjusted OR 1.19, 95% CI 1.03 to 1.39; p=0.02) after adjusting for demographic and traditional cardiovascular risk factors. In adults of 40 years or older, the fast food pattern was associated with obesity controlling for demographic and traditional risk factors (adjusted OR 1.69, 95% CI 1.19 to 2.39; p value=0.003).

CONCLUSIONS

Our results suggest that refined grains-meat-alcohol intake is associated with higher prevalence of overweight, and fast food intake is associated with higher prevalence of obesity in older adults (40 years or above) in suburban Nepalese adults.

Fruit Intake and Abdominal Aortic Calcification in Elderly Women: A Prospective Cohort Study

Cardiovascular disease (CVD) is the leading cause of death worldwide. There is a consistent inverse relationship between fruit intake with CVD events and mortality in cross-sectional and prospective observational studies, but the relationship of fruit intake with measurements of atherosclerosis in humans is less clear. Nutritional effects on abdominal aortic calcification (AAC), a marker for subclinical intimal and medial atherosclerotic vascular disease, have not been studied previously. The aim of this study was to examine the cross-sectional relationship of total and individual fruit (apple, pear, orange and other citrus, and banana) intake with AAC, scored between 0 and 24. The current study assessed baseline data for a cohort of 1052 women over 70 years of age who completed both a food frequency questionnaire assessing fruit intake, and underwent AAC measurement using dual energy X-ray absorptiometry. AAC scores were significantly negatively correlated with total fruit and apple intakes (p < 0.05), but not with pear, orange or banana intakes (p > 0.25). In multivariable-adjusted logistic regression, each standard deviation (SD; 50 g/day) increase in apple intake was associated with a 24% lower odds of having severe AAC (AAC score >5) (odd ratio OR): 0.76 (0.62, 0.93), p = 0.009). Total and other individual fruit intake were not associated with increased odds of having severe AAC. Apple but not total or other fruit intake is independently negatively associated with AAC in older women.

Examining associations between dietary patterns and metabolic CVD risk factors: a novel use of structural equation modelling

The association between dietary patterns and metabolic cardiovascular risk factors has long been addressed but there is a lack of evidence towards the effects of the overall diet on the complex net of biological inter-relationships between risk factors. This study aimed to derive dietary patterns and examine their associations with metabolic cardiovascular risk factors following a theoretic model for the relationship between them. Participants included 417 adults of both sexes, enrolled to the cross-sectional population-based study performed in Brazil. Body weight, waist circumference, high-sensitivity C-reactive protein, blood pressure, total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio, fasting plasma glucose and serum leptin were evaluated. Food consumption was assessed by two non-consecutive 24-h dietary recalls adjusted for the within-person variation of intake. A total of three dietary patterns were derived by exploratory structural equation modelling: 'Traditional', 'Prudent' and 'Modern'. The 'Traditional' pattern had a negative and direct effect on obesity indicators (serum LEP, body weight and waist circumference) and negative indirect effects on total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio and fasting plasma glucose. The 'Prudent' pattern had a negative and direct effect on systolic blood pressure. No association was observed for the 'Modern' pattern and metabolic risk factors. In conclusion, the 'Traditional' and 'Prudent' dietary patterns were negatively associated with metabolic cardiovascular risk factors among Brazilian adults. Their apparent protective effects against obesity and high blood pressure may be important non-pharmacological strategies for the prevention and control of obesity-related metabolic disorders and CVD.

Food patterns and the prevention of depression

An emerging field of research in nutritional epidemiology is the assessment of several links between nutritional quality and mental health. Specifically, some studies have pointed out that several food patterns could be associated with a reduced risk of depression among adults. This association seems to be consistent across countries, cultures and populations according to several systematic reviews and meta-analyses of observational studies. Some previously described food patterns, specifically the Mediterranean Food Pattern, the Alternative Healthy Eating Index, the Prudent diet or the Provegetarian Food Pattern may be effective to reduce the future risk of depression. Among them, only the Mediterranean Food Pattern has been tested for primary prevention in a large randomised trial, but the inverse association found was not statistically significant. The scientific report of the 2015 Dietary Guidelines for Americans Advisory Committee concluded that current evidence is still limited. Notwithstanding, this field is promising and, according to large and well-conducted observational studies, food patterns potentially associated with reduced risk of depression are those emphasising seafood, vegetables, fruits and nuts. There is a need to assess whether differences in the intake of some micro or macronutrients between these dietary patterns can make a difference in their association with a lower risk of depression. Moreover, the shape of the dose-response curve and the potential existence of a nonlinear threshold effect have not yet been established.

Dietary Patterns and Their Relationship With Semen Quality

Diet is a complex exposure variable, which calls for multiple approaches to examine the relationship between diet and disease risk. To address these issues, several authors have recently proposed studying overall dietary patterns by considering how foods and nutrients are consumed in combinations. The aim of the study was to investigate the associations between dietary patterns, semen quality parameters, and the level of reproductive hormones. The study population consisted of 336 men who attended the infertility clinic for diagnostic purposes and who had normal semen concentration of 20 to 300 mln/ml or slight oligozoospermia (semen concentration of 15-20 mln/ml). Participants were interviewed, and a semen sample was provided by them. Diet was assessed via food frequency questionnaire, and dietary patterns were identified by factor analysis. Men were classified into three groups according to scores of each dietary pattern: Western, Mixed, or Prudent. A positive association was observed between sperm concentration and Prudent dietary pattern, and level of testosterone and Prudent dietary pattern ( p = .05, p = .03, respectively). Additionally, Prudent dietary pattern was identified to decrease the DNA fragmentation index ( p = .05). The results were adjusted for sexual abstinence, age, smoking, past diseases, and alcohol consumption. Higher consumption of a Prudent dietary pattern was associated with higher sperm concentration and higher level of testosterone. Sperm chromatin structure was inversely related to higher consumption of a Prudent dietary pattern. Further research is needed to confirm these findings and extend these results to other populations.

Dietary Patterns Are Associated with Predicted Cardiovascular Disease Risk in an Urban Mexican Adult Population

BACKGROUND

Dietary patterns may predict cardiovascular disease (CVD) risk more accurately than does consumption of specific nutrients or foods.

OBJECTIVE

We evaluated the association between Mexican adults' dietary patterns and development of a >10% risk of 10-y CVD (using the Framingham risk score) over 7 y of follow-up.

METHODS

This prospective cohort study included 1196 men and women aged 20-80 y with a 10-y predicted risk <10% and without a CVD diagnosis at baseline in 2004-2007. Data on sociodemographic, lifestyle, and medical history factors were collected with a self-administered questionnaire. Dietary intake was evaluated by using a semiquantitative food-frequency questionnaire. The relations between dietary patterns and predicted CVD were analyzed by using pooled logistic regression models.

RESULTS

With the use of factor analysis, we identified 3 major dietary patterns in participants' dietary data. The "prudent" pattern was characterized by high positive loadings for the consumption of fresh fruit, vegetables, and whole grains. The "meat/fish" pattern showed positive loadings for the consumption of red meat, processed meat, eggs, fats, fish, and poultry. Finally, the "refined foods" pattern featured positive loadings for corn tortillas, refined grains, soft drinks, and alcohol. After adjustment for potential confounders, compared with participants in the lowest quintile of the prudent pattern, those in the highest quintile had a lower RR of 10-y CVD (RR: 0.40; 95% CI: 0.20, 0.79; P-trend = 0.006). In contrast, participants in the highest quintile of the refined-foods pattern had a greater risk of elevated 10-y CVD (RR: 2.98; 95% CI: 1.46, 6.10; P-trend = 0.020) than did those in the lowest quintile. Finally, the meat/fish dietary pattern was not significantly associated with 10-y CVD.

CONCLUSION

Our data suggest that the prudent pattern is associated with a reduced risk of 10-y CVD, whereas the refined-foods pattern may increase 10-y CVD in Mexican adults.

Cross-Sectional Associations between Empirically-Derived Dietary Patterns and Indicators of Disease Risk among University Students

The transition from adolescence to adulthood is a unique period during which lifelong dietary habits are shaped. Dietary patterns (DPs) among young adults attending college have not been adequately described, and associations between DPs and indicators of disease risk are not well understood in this age group. Dietary data were collected from undergraduates participating in the Tufts Longitudinal Health Study (TLHS; 1998-2007) by Food Frequency Questionnaire (FFQ; n = 1323). DPs were derived using principal components analysis with varimax rotation. Scree plots; eigenvalues; factor loadings; and previous studies were used to determine and label the DPs retained. Cross-sectional relationships between DP scores and anthropometric measures (percent body fat (PBF) and (BMI) and lipid biomarkers (total; HDL and LDL cholesterol; and triglycerides) were assessed with multivariable regression models; adjusted for demographics; physical activity; smoking; intention to gain/lose weight; and total energy intake. Effect modification by sex was tested. Three DPs were identified: Prudent; Western; and Alcohol. Greater adherence to the Prudent DP was associated with favorable anthropometric outcomes. The Alcohol DP was associated with a favorable lipid profile. Associations between the Western DP and blood lipids differed by sex; with unfavorable impact observed only among males. Our findings add to the literature linking DPs in young adults with measurable adiposity and cardiometabolic outcomes; suggesting that improving nutrition among college students could reduce chronic disease risk.

Major dietary patterns and risk of acute myocardial infarction in young, urban Pakistani population

Objective:

To investigate the role of dietary intake in the development of premature acute myocardial infarction (AMI) in a hospital-based Pakistani population in Karachi.

Methods:

In a case control study, 203 consecutive patients (146 males and 57 females) with their first AMI and age below 45 years were enrolled with informed consent. Similarly, 205 gender and age matched (within 3 years) healthy adults were also included as controls. Dietary intake of both cases and controls was assessed by using a simple 14-item food frequency questionnaire. Using factor analysis, 3 major dietary patterns- prudent dietary pattern, combination dietary pattern and western dietary pattern were identified. Fasting plasma/serum of both cases and controls were analyzed for homocysteine, folate, vitamin B₁₂, blood Pb, ferritin, cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides. ANOVA and conditional logistic regression were used to predict the association of dietary patterns with AMI.

Results:

Consumption of prudent diet, characterized by high consumption of legumes, vegetables, wheat, chicken and fruits, is protective against the risk of premature AMI. Moderate to high consumption of combination diet, characterized by high intake of eggs, fish, fruits, juices and coffee was associated with decreased risk of AMI. No association was observed between western diet, characterized by high intake of meat, fish and tea with milk and risk of AMI.

Conclusions:

Consumption of a prudent dietary pattern and a combination dietary pattern is protective against the risk of AMI in a Pakistani population.

Dietary patterns and their association with acute coronary heart disease: Lessons from the REGARDS Study

Shikany et al used data from 17,418 participants in the REGARDS study, a national, population-based, longitudinal study of white and black adults aged ≥ 45 years, enrolled between 2003–2007. They examined 536 acute coronary heart disease events at follow-up (median 5.8 years) in relation to five dietary patterns (Convenience, Plant-based, Sweets, Southern, and Alcohol and Salad). After adjustment for baseline variables, the highest consumers of the Southern pattern experienced a 56% higher hazard for acute CHD.

Analysis of Dietary Pattern Impact on Weight Status for Personalised Nutrition through On-Line Advice: The Food4Me Spanish Cohort

Obesity prevalence is increasing. The management of this condition requires a detailed analysis of the global risk factors in order to develop personalised advice. This study is aimed to identify current dietary patterns and habits in Spanish population interested in personalised nutrition and investigate associations with weight status. Self-reported dietary and anthropometrical data from the Spanish participants in the Food4Me study, were used in a multidimensional exploratory analysis to define specific dietary profiles. Two opposing factors were obtained according to food groups’ intake: Factor 1 characterised by a more frequent consumption of traditionally considered unhealthy foods; and Factor 2, where the consumption of “Mediterranean diet” foods was prevalent. Factor 1 showed a direct relationship with BMI (β = 0.226; r² = 0.259; p < 0.001), while the association with Factor 2 was inverse (β = −0.037; r² = 0.230; p = 0.348). A total of four categories were defined (Prudent, Healthy, Western, and Compensatory) through classification of the sample in higher or lower adherence to each factor and combining the possibilities. Western and Compensatory dietary patterns, which were characterized by high-density foods consumption, showed positive associations with overweight prevalence. Further analysis showed that prevention of overweight must focus on limiting the intake of known deleterious foods rather than exclusively enhance healthy products.

No association between blood telomere length and longitudinally assessed diet or adiposity in a young adult Filipino population

PURPOSE

Telomeres, DNA-protein structures that cap and protect chromosomes, are thought to shorten more rapidly when exposed to chronic inflammation and oxidative stress. Diet and nutritional status may be a source of inflammation and oxidative stress. However, relationships between telomere length (TL) and diet or adiposity have primarily been studied cross-sectionally among older, overweight/obese populations and yielded inconsistent results. Little is known about the relationship between diet or body composition and TL among younger, low- to normal-weight populations. It also remains unclear how cumulative exposure to a specific diet or body composition during the years of growth and development, when telomere attrition is most rapid, may be related to TL in adulthood.

METHODS

In a sample of 1459 young adult Filipinos, we assessed the relationship between blood TL at ages 20.8-22.5 and measures of BMI z-score, waist circumference, and diet collected between the ages of 8.5 and 22.5. TL was measured using monochrome multiplex quantitative PCR, and diet was measured using multiple 24-h recalls.

RESULTS

We found no associations between blood TL and any of the measures of adiposity or between blood TL and the seven dietary factors examined: processed meats, fried/grilled meats and fish, non-fried fish, coconut oil, fruits and vegetables, bread and bread products, and sugar-sweetened beverages.

CONCLUSIONS

Considering the inconsistencies in the literature and our null results, small differences in body composition and consumption of any single pro- or anti-inflammatory dietary component may not by themselves have a meaningful impact on telomere integrity, or the impact may differ across distinct ecological circumstances.

The Association of a Mediterranean-Style Diet Pattern with Polycystic Ovary Syndrome Status in a Community Cohort Study

Polycystic ovary syndrome (PCOS) is a common condition in reproductive-aged women. While lifestyle management is first-line treatment in PCOS, the dietary intake of women with PCOS is unclear and there is no research assessing dietary patterns of women with and without PCOS. The aim of this study was to examine dietary patterns in a large cohort of women with and without PCOS. Data were from 7569 participants in the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health population assessed at 2009 (Survey 5) (n = 414 PCOS, n = 7155 non-PCOS). Dietary patterns were evaluated using factor analysis and multiple logistic regressions assessed their associations with PCOS status. Three dietary patterns were identified that explained 27% of the variance in food intake between women with and without PCOS: Non-core foods; Meats and take-away and Mediterranean-style. The Mediterranean-style dietary pattern was independently associated with PCOS status. On adjusted analysis for each 1 SD increase in the Mediterranean-style dietary pattern, there was a 26% greater likelihood that women had PCOS. This may indicate an improvement in the quality of dietary intake following a diagnosis of PCOS. Future research should examine the contribution of dietary patterns to the incidence and severity of PCOS and the potential for modification of dietary patterns in the lifestyle management of PCOS.

Changes of dietary patterns during participation in a web-based weight-reduction programme

Objective

To examine the weight-loss success associated with distinct dietary patterns and to determine changes of these dietary patterns during participation in a web-based weight-reduction programme.

Design

Factor analysis was used to identify the dietary patterns of twenty-two food groups that were administered in 14 d dietary protocols at baseline and after 3 months. Successful weight loss (≥5 % of initial weight) and BMI were calculated. Logistic regression analyses were used to assess the rates of weight-loss success from each dietary pattern and changing or remaining in the initial dietary pattern. A generalised linear mixed model was used to estimate the effects of changing or staying in a dietary pattern on change in BMI.

Subjects

Adults (n 1635) aged 18–81 years.

Setting

Users of a web-based weight-reduction programme (2006–2012).

Results

Participants who aligned to a healthful dietary pattern at baseline (OR=1·8; 95 % CI 1·5, 2·3) and after 3 months (OR=1·5; 95 % CI 1·2, 1·9) had a greater chance of successfully losing weight. After adjusting for age, sex, initial dietary pattern and BMI, participants who started with or changed to the healthful dietary pattern had a greater chance of being successful (OR=1·4; 95 % CI 1·1, 1·7) and a higher BMI reduction of 0·30 (95 % CI 0·2, 0·5) kg/m2 compared with those who started with or changed to the energy-dense or high-carbohydrate dietary pattern.

Conclusions

A favourable healthful dietary pattern at the beginning and after 3 months was positively associated with anthropometry. However, successful weight loss was feasible in each dietary pattern.

Mediterranean and western dietary patterns are related to markers of testicular function among healthy men

STUDY QUESTION

Are there any associations of dietary patterns with semen quality, reproductive hormone levels, and testicular volume, as markers of testicular function?

SUMMARY ANSWER

These results suggest that traditional Mediterranean diets may have a positive impact on male reproductive potential.

WHAT IS KNOWN ALREADY

The Mediterranean diet has been related to lower risk of multiple chronic diseases, but its effects on reproduction potential are unclear.

STUDY DESIGN, SIZE, DURATION

Cross-sectional sample of 215 male university students recruited from October 2010 to November 2011 in Murcia Region (Spain).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Two hundred and nine healthy men aged 18-23 years were finally included in this analysis. Diet was assessed using a validated food frequency questionnaire, and dietary patterns were identified by factor analysis. Linear regression was used to analyze the relation between diet patterns with semen quality parameters, reproductive hormone levels and testicular volume adjusting for potential confounders.

MAIN RESULTS AND THE ROLE OF CHANCE

We identified two dietary patterns: a Mediterranean (characterized by high intakes of vegetables, fruits and seafood) and a Western pattern (characterized by high intakes of processed meats, French fries and snacks). The Mediterranean pattern was positively associated with total sperm count (P, trend = 0.04). The Western pattern was positively related to the percentage of morphologically normal sperm (P, trend = 0.008). We found an inverse association between adherence to the Western pattern and sperm concentration among overweight or obese men (P, trend = 0.04).

LIMITATIONS, REASONS FOR CAUTION

As with all cross-sectional studies, causal inference is limited. However, participants were blinded to the study outcomes thus reducing the potential influenced their report of diet. Although we adjusted for a large number of known and suspected confounders, we cannot exclude the possibility of residual confounding or chance findings.

WIDER IMPLICATIONS OF THE FINDINGS

This study was carried out on healthy and young men, so it is difficult to predict whether and how the observed differences in semen quality translate into reproductive success for men in couples trying to conceive. These results suggest that traditional Mediterranean diets may have a positive impact on male reproductive potential.

Dietary patterns and CVD: a systematic review and meta-analysis of observational studies

Epidemiological studies show that diet is linked to the risk of developing CVD. The objective of this meta-analysis was to estimate the association between empirically derived dietary patterns and CVD. PubMed was searched for observational studies of data-driven dietary patterns that reported outcomes of cardiovascular events. The association between dietary patterns and CVD was estimated using a random-effects meta-analysis with 95 % CI. Totally, twenty-two observational studies met the inclusion criteria. The pooled relative risk (RR) for CVD, CHD and stroke in a comparison of the highest to the lowest category of prudent/healthy dietary patterns in cohort studies was 0·69 (95% CI 0·60, 0·78; I 2=0%), 0·83 (95% CI 0·75, 0·92; I 2=44·6%) and 0·86 (95% CI 0·74, 1·01; I 2=59·5%), respectively. The pooled RR of CHD in a case-control comparison of the highest to the lowest category of prudent/healthy dietary patterns was 0·71 (95% CI 0·63, 0·80; I 2=0%). The pooled RR for CVD, CHD and stroke in a comparison of the highest to the lowest category of western dietary patterns in cohort studies was 1·14 (95% CI 0·92, 1·42; I 2=56·9%), 1·03 (95% CI 0·90, 1·17; I 2=59·4%) and 1·05 (95% CI 0·91, 1·22; I 2=27·6%), respectively; in case-control studies, there was evidence of increased CHD risk. Our results support the evidence of the prudent/healthy pattern as a protective factor for CVD.

Dietary pattern and risk of hodgkin lymphoma in a population-based case-control study

Classic Hodgkin lymphoma (cHL) has few known modifiable risk factors, and the relationship between diet and cHL risk is unclear. We performed the first investigation of an association between dietary pattern and cHL risk in 435 cHL cases and 563 population-based controls from Massachusetts and Connecticut (1997-2000) who completed baseline diet questionnaires. We identified 4 major dietary patterns ("vegetable," "high meat," "fruit/low-fat dairy," "desserts/sweets") using principal components analysis. We computed multivariable odds ratios and 95% confidence intervals for associations of dietary pattern score (quartiles) with younger-adult (age <50 years), older-adult (age ≥50 years), and overall cHL risk. Secondary analyses examined associations by histological subtype and tumor Epstein-Barr virus (EBV) status. A diet high in desserts/sweets was associated with younger-adult (odds ratio(quartile 4 vs. quartile 1) = 1.60, 95% confidence interval: 1.05, 2.45; Ptrend = 0.008) and EBV-negative, younger-adult (odds ratio = 2.11, 95% confidence interval: 1.31, 3.41; Ptrend = 0.007) cHL risk. A high meat diet was associated with older-adult (odds ratio = 3.34, 95% confidence interval: 1.02, 10.91; Ptrend = 0.04) and EBV-negative, older-adult (odds ratio = 4.64, 95% confidence interval: 1.03, 20.86; Ptrend = 0.04) cHL risk. Other dietary patterns were not clearly associated with cHL. We report the first evidence for a role of dietary pattern in cHL etiology. Diets featuring high intake of meat or desserts and sweets may increase cHL risk.

Southern Dietary Pattern is Associated With Hazard of Acute Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

BACKGROUND

The association of overall diet, as characterized by dietary patterns, with risk of incident acute coronary heart disease (CHD) has not been studied extensively in samples including sociodemographic and regional diversity.

METHODS AND RESULTS

We used data from 17 418 participants in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national, population-based, longitudinal study of white and black adults aged ≥45 years, enrolled from 2003 to 2007. We derived dietary patterns with factor analysis and used Cox proportional hazards regression to examine hazard of incident acute CHD events - nonfatal myocardial infarction and acute CHD death - associated with quartiles of consumption of each pattern, adjusted for various levels of covariates. Five primary dietary patterns emerged: Convenience, Plant-based, Sweets, Southern, and Alcohol and Salad. A total of 536 acute CHD events occurred over a median (interquartile range) 5.8 (2.1) years of follow-up. After adjustment for sociodemographics, lifestyle factors, and energy intake, highest consumers of the Southern pattern (characterized by added fats, fried food, eggs, organ and processed meats, and sugar-sweetened beverages) experienced a 56% higher hazard of acute CHD (comparing quartile 4 with quartile 1: hazard ratio, 1.56; 95% confidence interval, 1.17-2.08; P for trend across quartiles=0.003). Adding anthropometric and medical history variables to the model attenuated the association somewhat (hazard ratio, 1.37; 95% confidence interval, 1.01-1.85; P=0.036).

CONCLUSIONS

A dietary pattern characteristic of the southern United States was associated with greater hazard of CHD in this sample of white and black adults in diverse regions of the United States.

Associations of diet quality with cognition in children – the Physical Activity and Nutrition in Children Study

Evidence on the associations of dietary patterns with cognition in children is limited. Therefore, we investigated the associations of the Baltic Sea Diet Score (BSDS) and the Dietary Approaches to Stop Hypertension (DASH) score with cognition in children. The present cross-sectional study sample included 428 children aged 6–8 years (216 boys and 212 girls). The BSDS and the DASH score were calculated using data from 4 d food records, higher scores indicating better diet quality. Cognition was assessed by the Raven's Coloured Progressive Matrices (CPM) score, a higher score indicating better cognition. Among all children, the BSDS (standardised regression coefficient β = 0·122,P =0·012) and the DASH score (β = 0·121,P =0·015) were directly associated with the Raven's CPM score. Among boys, a lower BSDS (β = 0·244,P< 0·001) and a lower DASH score (β = 0·202,P= 0·003) were related to a lower Raven's CPM score. Boys in the lowest quartile of the BSDS (22·5v. 25·3,P= 0·029) and the DASH score (22·4v. 25·7,P= 0·008) had a lower Raven's CPM score than those in the highest quartile of the corresponding score. Among girls, the BSDS or the DASH score were not associated with cognition. In conclusion, a poorer diet quality was associated with worse cognition in children, and the relationship was stronger in boys than in girls.

Dietary Patterns, Alcohol Consumption and Risk of Coronary Heart Disease in Adults: A Meta-Analysis

Previous studies reported the potential associations between dietary patterns and the risk of coronary heart disease (CHD) in adulthood, however a consistent perspective has not been established to date. Herein, we carried out this meta-analysis to evaluate the associations between dietary patterns and the risk of CHD. MEDLINE and EBSCO were searched for relevant articles published up to April 2015. A total of 35 articles (reporting 37 original studies) met the inclusion criteria and were included in the present meta-analysis. The decreased risk of CHD was shown for the highest compared with the lowest categories of healthy/prudent dietary patterns (odds ratio (OR) = 0.67; 95% confidence interval (CI): 0.60, 0.75; p < 0.00001) and alcohol consumption (OR = 0.68; 95% CI: 0.59, 0.78; p < 0.00001). There was evidence of an increased risk of CHD in the highest compared with the lowest categories of the unhealthy/Western-type dietary patterns (OR = 1.45; 95% CI: 1.05, 2.01; p = 0.02). The results of this meta-analysis indicate that different dietary patterns may be associated with the risk of CHD.

What an anticardiovascular diet should be in 2015

PURPOSE OF REVIEW

Given scientific and public debate about optimal diet to prevent cardiovascular disease, and interest in diet and other chronic diseases, we propose that following a few simple dietary principles would reduce chronic disease incidence.

RECENT FINDINGS

Nutrition research has been criticized for focusing on individual nutrients and foods, treated like drug therapy. With a few important exceptions, clinical trials of supplemental nutrients have not shown benefit. Although highly specific nutrition information is elusive, diet patterns have provided consistent answers, important for public health. Observational cohort studies have found that some dietary patterns are reported with high reliability over long periods and predict future cardiovascular and other inflammatory-related diseases. Two randomized clinical trials confirmed this finding. There are many common features of Mediterranean and prudent diets, particularly the plant-centered aspect, coupled with variety of foods eaten. A dietary pattern characterized by high fruit, vegetable, legume, whole grain, nut, berry, seed, and fish intakes, and possibly by intakes of dairy, coffee, tea, chocolate, and alcohol (not in excess), but low meat and detrimentally processed foods is associated with reduced incidence of cardiovascular disease and rates of noncardiovascular, noncancer chronic inflammatory-related mortality.

SUMMARY

A plant-centered diet may be broadly recommended.

Dietary patterns for meals of Brazilian adults

The use of dietary patterns (DP) in nutritional research is well established; however, only a few studies of DP according to specific meals have been conducted. The purpose of this study was to identify the DP regarding breakfast, lunch and dinner meals of the population (aged 20 years and older of both sexes) that participated in the Health Care Survey of Sao Paulo. Food intake was estimated by using the Multiple Source Method – considering two 24- h dietary recalls. On the basis of the food groups for each meal, a factor analysis, with a principal component estimation, was applied (varimax rotation) in order to derive the DP. Prevalences of meal skipping were 5·6 % for breakfast, 3·6 % for lunch and 12·8 % for dinner. The findings revealed three breakfast DP: healthy, traditional and snack; five lunch DP: traditional, salad, sweetened juice, Western and meats; and four dinner DP: coffee with milk and bread, transitional, traditional, and soup and fruits. The results of this study indicate that the DP identified in accordance with the meal nicely discriminates food intake, emphasising peculiarities that are not found in global analyses and might support dietary advice.