An anatomy of the way composite scores work

Mediterranean diet and a health behavior index in relation to cardiovascular biomarkers: Data from the Health and Retirement Study

BACKGROUND AND AIM

Although lifestyle factors have been repeatedly examined for their role on cardiovascular diseases, their composite effect has not been frequently explored. We aimed to investigate the relation of dietary patterns (DPs) and a health behavior index (HBI) with cardiovascular biomarkers.

METHODS AND RESULTS

A cross-sectional analysis with data from 3461 US residents, participants in the Health and Retirement Study (HRS), was performed. Nutritional data were obtained with a food frequency questionnaire, while adherence to Mediterranean Diet (MD) was determined by the Mediterranean Diet Score. A posteriori DPs were estimated using principal component analysis and the HBI was constructed combining adherence to MD, smoking status, physical activity levels, alcohol consumption and body mass index. Multiple linear regression models were performed to examine the relation between DPs or HBI and levels of C-reactive protein (CRP), glycosylated hemoglobin (HbA1C), cystatin C (Cys C), total cholesterol (TC), high density lipoprotein (HDL) and TC:HDL in blood. Multiple linear regression showed that the "healthy" DP and the MD had a significant negative association with CRP and Cys C (p < 0.05), while the "Western-type" DP had a significant positive association with TC:HDL ratio, CRP and Cys C. Moreover, the HBI was positively associated with HDL (p < 0.05) and negatively associated with TC:HDL ratio, CRP and Cys C (p < 0.05).

CONCLUSIONS

Adherence to MD and to a healthy dietary pattern was negatively associated with biomarkers of inflammation, while the HBI was associated with a better cardiometabolic profile, assessed with blood biomarkers.

Dietary patterns in association to cancer incidence and survival: concept, current evidence, and suggestions for future research

Assessing diet through dietary patterns has become popular in diet-disease investigations due to the appealing simplicity of expressing several dietary exposures through one variable. Current evidence suggests that there may exist a priori and a posteriori dietary patterns that are consistently associated with reduced all-cause, as well as site-specific cancer risk across different populations. Typical examples include the Mediterranean dietary pattern, the Healthy Eating Index, a number of "healthy" a posteriori dietary patterns, and others. Despite their apparent differences, by inspecting their components it seems that multiple dietary patterns reflect core constituents of a healthy diet. Ongoing research is targeted to: (a) identify the common features underlying the beneficial-for-cancer-prevention dietary patterns, (b) decompose the estimated associations of dietary patterns with cancer risk to the individual associations of their components, and (c) construct dietary patterns for site-specific cancer risk prediction. Results of these and other initiatives could be helpful for public health policy makers and responsible bodies to (a) better formulate relevant messages for informing people about the components of cancer-preventing diets, and (b) promote small changes in eating patterns that can lower cancer risk and improve cancer outcomes.