Dietary patterns and risk of nonfatal acute myocardial infarction in Costa Rican adults

Traditional rural dietary pattern and all-cause mortality in a prospective cohort study of elderly Costa Ricans: the Costa Rican Longevity and Healthy Aging Study (CRELES)

BACKGROUND

Costa Rica is experiencing a fast demographic aging. Healthy diets may help to ameliorate the burden of aging-related conditions.

OBJECTIVE

This study aimed to investigate the association of a traditional dietary pattern and 2 of its major components (beans and rice) with all-cause mortality among elderly Costa Ricans.

METHODS

The Costa Rican Longevity and Healthy Aging Study (CRELES), a prospective cohort study of 2827 elderly Costa Ricans (60+ y at baseline), started in 2004. We used a food frequency questionnaire (FFQ) to assess usual diet. We calculated dietary patterns using principal component analysis. Multivariate energy-adjusted proportional-hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

Over a 15-y follow-up, encompassing 24,304 person-years, 1667 deaths occurred. The traditional Costa Rican dietary pattern was more frequent in rural parts of the country, and it was inversely associated with all-cause mortality. Subjects in the fifth quintile of intake had 18% lower all-cause mortality than those in the first quintile (HR: 0.82; 95% CI: 0.69, 0.98; P-trend = 0.01), particularly among males (HR: 0.73; 95% CI: 0.56, 0.95). Bean intake was associated with lower all-cause mortality among all subjects (HR: 0.79; 95% CI: 0.68, 0.91, highest compared with lowest tertile) and in sex-stratified analysis. Rice consumption was inversely associated with all-cause mortality solely among males (HR: 0.75; 95% CI: 0.60, 0.94, highest compared with lowest tertile).

CONCLUSIONS

Our results suggest that a traditional Costa Rican rural dietary pattern is associated with lower all-cause mortality in elderly Costa Ricans. Beans, a major component of this traditional dietary pattern, was also associated with lower all-cause mortality. These findings could have important implications for public health, given the nutritional transition and the reduction of intake of traditional diets in Latin American countries.

The Prospective Associations of Lipid Metabolism-Related Dietary Patterns with the Risk of Diabetes in Chinese Adults

Background: This study aimed to identify lipid metabolism-related dietary patterns with reduced rank regression (RRR) among Chinese adults and examine their associations with incident diabetes. Methods: We derived lipid metabolism-related dietary patterns using an RRR with 21 food groups as predictors as well as total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, body mass index (BMI), and waist circumference from the responses of 17,318 participants from the second resurvey of the China Kadoorie Biobank (CKB). The dietary scores were calculated for the entire cohort. We followed up 479,207 participants for diabetes incidence from the baseline and used multivariable Cox regression models to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Two lipid metabolism-related dietary patterns were extracted. The dietary pattern—characterized by high intakes of fish, poultry, and other staples as well as fresh fruit and vegetables—was correlated with a higher BMI, waist circumference, and LDL cholesterol. Participants in the highest quintile (Q5) had a 44% increased risk of diabetes incidence when compared with those in the lowest quintile (Q1) (HR = 1.44; 95% CI: 1.31–1.59). Conclusions: A dietary pattern characterized by high intakes of both animal and plant foods was related to obesity and dyslipidemia and could increase the risk of diabetes incidence.

A Traditional Costa Rican Adolescents' Diet Score Is a Valid Tool to Capture Diet Quality and Identify Sociodemographic Groups With Suboptimal Diet

Traditional diet indices may capture diet quality according to local food culture. Higher adherence to traditional diet scores may help prevent disease, yet evidence in adolescents is limited. This cross-sectional study aimed to develop and validate a Traditional Costa Rica Adolescents Diet Score (TCRAD) and determine its association with sociodemographic characteristics, under the hypothesis that girls, adolescents from rural areas, and with low socioeconomic status, have a more traditional healthy diet. A total of 804 urban and rural adolescents (13-18 years old) participated in the study. The TCRAD showed adequate internal validity as shown by significant associations with intake of 14 traditional foods and nutrients (legumes, vegetables, fruits, oils, dairy, and corn tortilla scored as healthy; and white rice, red/processed meat, solid fats, desserts/pastries, sugar-sweetened beverages, snacks, fast food, and bread and cookies scored as unhealthy). A high TCRAD score, indicative of a healthier and more traditional diet, was observed among adolescents in the low socioeconomic group vs. medium or high socioeconomic categories (42.9, 41.2, and 38.2%, respectively, p < 0.05), adolescents living in rural areas vs. urban (47.6 vs. 34.2%, p < 0.05), and among boys vs. girls (46.9 vs. 37.5%, p < 0.05). The TCRAD score is a valid tool to capture diet quality of adolescents in Costa Rica and could be used to measure association of diet with disease outcomes in this and similar populations. Public health nutrition programs in Costa Rica should focus on improving intake of foods and nutrients, and prioritize girls, adolescents in urban areas, and adolescents with high socioeconomic status.

Diet and Leukocyte Telomere Length in a Population with Extended Longevity: The Costa Rican Longevity and Healthy Aging Study (CRELES)

Elderly Costa Ricans have lower mortality rates compared to their counterparts from developed countries. Reasons for this survival advantage are not completely known. In the present study, we aimed to identify dietary factors associated with leukocyte telomere length (LTL), a marker of biologic aging, in the elderly population of Costa Rica. We conducted prospective analysis in 909 participants aged 60+ years from the Costa Rican Longevity and Healthy Aging Study (CRELES). We used a food frequency questionnaire to assess usual diet. We calculated dietary patterns using Principal Component Analysis (PCA). We used generalized linear models to examine the association of dietary patterns and food groups with leukocyte telomere length. We found two major dietary patterns explaining 9.15% and 7.18% of the total variation of food intake, respectively. The first dietary pattern, which represents a traditional Costa Rican rice and beans pattern, was more frequent in rural parts of the country and was positively associated with baseline LTL: β (95% CI) = 42.0 base-pairs (bp) (9.9 bp, 74.1 bp) per one-unit increase of the traditional dietary pattern. In analysis of individual food groups, intake of grains was positively associated with baseline LTL: β (95% CI) = 43.6 bp (13.9 bp, 73.3 bp) per one-serving/day increase of consumption of grains. Our results suggest that dietary factors, in particular a traditional food pattern, are associated with telomere length and may contribute to the extended longevity of elderly Costa Ricans.

Exploration of the Principal Component Analysis (PCA) Approach in Synthesizing the Diet Quality of the Malaysian Population

(1) Background: One of the most main dietary assessments is through a posteriori application. Although extensive research has incorporated dietary assessment of a population through a posteriori application, this study is the first to examine the Malaysian population and use an a posteriori method and principal component analysis (PCA) to assess the dietary patterns of the Malaysian population. The correlation between all dietary patterns derived via PCA and selected nutrient intake were determined in this sample of study; (2) Methods: A total of 3063 respondents (18 to 59 years old) covering Peninsular Malaysia, Sabah, and Sarawak, participated in this study. PCA was applied on the food frequency questionnaire collected from the respondents, and descriptive statistics and PCA were performed using SPSS version 21; (3) Results: Six patterns were identified: "traditional", " prudent", " modern", "western", "Chinese", and "combination" diets. All together, these six patterns were able to explain 45.9% of the total variability. Few components derived from the factor loadings showed positive association with several nutrient markers. The traditional dietary pattern showed a moderate, positive correlation with total protein and total sugar intake, there was a significant moderate correlation between the prudent dietary pattern and dietary fibre, and there was a moderate positive association between the Chinese dietary pattern and total energy; and (4) Conclusions: The exploration of the PCA approach above may provide justification for assessment of dietary patterns rather than reliance on single nutrients or foods to identify potential connections to overall nutritional wellbeing as well as to explore the diet-disease relationship. However, study of pattern analysis must be conducted among the Malaysian population to produce validity and reproducibility for this dietary approach in light of the numerous methodological issues that arise when performing PCA.

Dietary Patterns and Mediterranean Diet Score and Hazard of Recurrent Coronary Heart Disease Events and All-Cause Mortality in the REGARDS Study

BACKGROUND

Previously, we reported on associations between dietary patterns and incident acute coronary heart disease (CHD) in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study. Here, we investigated the associations of dietary patterns and a dietary index with recurrent CHD events and all-cause mortality in REGARDS participants with existing CHD.

METHODS AND RESULTS

We included data from 3562 participants with existing CHD in REGARDS. We used Cox proportional hazards regression to examine the hazard of first recurrence of CHD events-definite or probable MI or acute CHD death-and all-cause mortality associated with quartiles of empirically derived dietary patterns (convenience, plant-based, sweets, Southern, and alcohol and salads) and the Mediterranean diet score. Over a median 7.1 years (interquartile range, 4.4, 8.9 years) follow-up, there were 581 recurrent CHD events and 1098 deaths. In multivariable-adjusted models, the Mediterranean diet score was inversely associated with the hazard of recurrent CHD events (hazard ratio for highest score versus lowest score, 0.78; 95% confidence interval, 0.62-0.98; PTrend=0.036). The Southern dietary pattern was adversely associated with the hazard of all-cause mortality (hazard ratio for Q4 versus Q1, 1.57; 95% confidence interval, 1.28-1.91; PTrend<0.001). The Mediterranean diet score was inversely associated with the hazard of all-cause mortality (hazard ratio for highest score versus lowest score, 0.80; 95% confidence interval, 0.67-0.95; PTrend=0.014).

CONCLUSIONS

The Southern dietary pattern was associated with a greater hazard of all-cause mortality in REGARDS participants. Greater adherence to the Mediterranean diet was associated with both a lower hazard of recurrent CHD events and all-cause mortality.

Systematic review of palm oil consumption and the risk of cardiovascular disease

BACKGROUND

The high amount of saturated fatty acids (SFA) coupled with the rising availability and consumption of palm oil have lead to the assumption that palm oil contributes to the increased prevalence of cardiovascular diseases worldwide. We aimed at systematically synthesising the association of palm oil consumption with cardiovascular disease risk and cardiovascular disease-specific mortality.

METHODS

We systematically searched Central, Medline and Embase databases up to June 2017 without restriction on setting or language. We performed separate searches based on the outcomes: coronary heart disease and stroke, using keywords related to these outcomes and palm oil. We searched for published interventional and observational studies in adults (Age: >18 years old). Two investigators extracted data and a consensus was reached with involvement of a third. Only narrative synthesis was performed for all of the studies, as the data could not be pooled.

RESULTS

Our search retrieved 2,738 citations for stroke with one included study and 1,777 citations for coronary heart disease (CHD) with four included studies. Palmitic acid was reported to be associated with risk of myocardial infarction (MI) (OR 2.76; 95%CI = 1.39-5.47). Total SFA intake was reported to be not significant for risk of MI. Varying intake of fried foods, highest contributor to total SFA with 36% of households using palm oil for frying, showed no significant associations to risk of MI. Odds of developing first non-fatal acute MI was higher in palm oil compared to soybean oil with 5% trans-fat (OR = 1.33; 95%CI = 1.09-1.62) than palm oil compared to soybean oil with 22% trans-fat (OR = 1.16; 95%CI = 0.86-1.56). Nevertheless, these risk estimates were non-significant and imprecise. The trend amongst those taking staple pattern diet (characterised by higher palm oil, red meat and added sugar consumption) was inconsistent across the factor score quintiles. During the years of 1980 and 1997, for every additional kilogram of palm oil consumed per-capita annually, CHD mortality risk was 68 deaths per 100,000 (95% CI = 21-115) in developing countries and 17 deaths per 100,000 (95%CI = 5.3-29) in high-income countries, whereas stroke was associated with 19 deaths per 100,000 (95%CI = -12-49) and 5.1 deaths per 100,000 (95% CI: -1.2-11) respectively. The evidence for the outcomes of this review were all graded as very low. The findings of this review should be interpreted with some caution, owing to the lack of a pooled effect estimate of the association, significant bias in selection criteria and confounding factors, inclusion of other food items together with palm oil, and the possible out-dated trend in the ecological study.

CONCLUSION

In view of the abundance of palm oil in the market, quantifying its true association with CVD outcomes is challenging. The present review could not establish strong evidence for or against palm oil consumption relating to cardiovascular disease risk and cardiovascular disease-specific mortality. Further studies are needed to establish the association of palm oil with CVD. A healthy overall diet should still be prioritised for good cardiometabolic health.

Fried food intake and risk of nonfatal acute myocardial infarction in the Costa Rica Heart Study

Economic development in middle-income countries has led to a noticeable rise in the availability of commercial deep fried foods and lifestyles that require eating meals “on the go” and outside of the home. Yet, data from these countries where fried foods were traditionally prepared at home are scarce, despite several studies showing the potential adverse effects of fried food consumption on risk for heart disease. We aimed to examine whether consumption of fried foods inside or outside of the home is associated with an increased risk of myocardial infarction (MI) among Hispanic/Latinos living in Costa Rica. Participants were incident cases of a first acute MI (n = 2,154) and randomly selected controls matched for age, sex, and residence (n = 2,154). After adjustment for traditional cardiovascular risk factors, including history of diabetes, history of hypertension, smoking, abdominal obesity, income, educational years, occupation, alcohol intake, dietary intakes of saturated fatty acid, fiber intake, and total energy intake, the multivariable-adjusted odds ratio (OR, 95% CI) for risk of MI were 1.00 (reference), 1.02 (0.86–1.21), 1.26 (0.81–1.95), and 1.58 (1.08–2.30) for intake of fried foods outside of the home <1/week, 1-3/week, 4-6/week, and 1/day, respectively (P trend = 0.02); and 1.00, 0.81 (0.65–1.00), 0.81 (0.61–1.09), and 0.93 (0.72–1.19), respectively (P for trend = 0.65) for intake of fried foods inside the home. The data suggest that consumption of fried foods outside of the home, a practice that has been associated with economic development, could have adverse effects on cardiovascular disease.

Comparison of Metabolic Syndrome Indicators in Two Samples of Central and South Americans Living in the Washington, D.C. Area in 1993-1994 and 2008-2009: Secular Changes in Metabolic Syndrome in Hispanics

The Central and South American populations are growing rapidly in the US; however, there is a paucity of information about their health status. Objectives: we estimated the prevalence of metabolic syndrome (MetS) and its individual components from two cohorts of Central and South Americans. Methods: This cross-sectional, medical record extraction survey sampled 1641 adults from a Washington, D.C clinic. A questionnaire was used to collect socio-demographic, medical history, anthropometric, biochemical, and clinical data. Results: among the 1993–1994 cohort, the MetS prevalence was 19.7%. The most prevalent MetS components were low high-density lipoprotein (HDL) cholesterol (40.4% men and 51.3% women), elevated triglycerides (40.9% men and 33.1% women), and high body mass index (BMI) ≥ 25 kg/m² (27.6% men and 36.6% women). The overall prevalence of MetS in the 2008–2009 cohort was 28%. The most common abnormal metabolic indicator was an elevated BMI ≥ 25 kg/m² (75.6%). 43.2% of men and 50.7% of women had HDL levels below normal, while the prevalence of hypertriglyceridemia was 46.5% and 32.5% for men and women, respectively. Conclusion: the prevalence of MetS was significantly greater in 2008–2009 compared with 1993–1994 (p ≤ 0.05). Dyslipidemia and high BMI have increased. Although similar components were identified in both the 1993–1994 and 2008–2009 study populations, the risks of MetS have increased over time.

Prevalence of the Metabolic Syndrome in Central and South American Immigrant Residents of the Washington, DC, Area

The objective of this study was to estimate the prevalence of Metabolic Syndrome (MetS) and its risk components and then compare differences in the risk components among low-income, uninsured Central and South American recent immigrants to the USA. This cross-sectional survey sampled 1,042 adult patients from a medical clinic in metropolitan Washington, DC. The overall prevalence of the MetS was 26.9% estimated using the modified harmonized definition. The most common abnormal metabolic indicator for women was an elevated BMI ≥ 30 kg/m² (36.1%), while, for men, it was an elevated triglyceride level (46.5%). The risk of abnormal MetS indicators increased steadily with increasing BMI. The abnormal indicator combination identifying the most subjects with the MetS included the following: high triglycerides, low HDL cholesterol, and obesity. MetS rates were highest among subjects from El Salvador and Honduras, 31.3% and 28.0%, respectively, and lowest among subjects from Bolivia (21.7%). Dyslipidemia and high BMI increased the likelihood of having the MetS, which is consistent with studies on Mexican Americans in the San Antonio Heart Study and studies within Central and South American countries. This study adds new baseline epidemiological data for largely understudied, low-income, and mostly recent immigrant groups.

Genetic enhancement of palmitic acid accumulation in cotton seed oil through RNAi down-regulation of ghKAS2 encoding β-ketoacyl-ACP synthase II (KASII)

Palmitic acid (C16:0) already makes up approximately 25% of the total fatty acids in the conventional cotton seed oil. However, further enhancements in palmitic acid content at the expense of the predominant unsaturated fatty acids would provide increased oxidative stability of cotton seed oil and also impart the high melting point required for making margarine, shortening and confectionary products free of trans fatty acids. Seed-specific RNAi-mediated down-regulation of β-ketoacyl-ACP synthase II (KASII) catalysing the elongation of palmitoyl-ACP to stearoyl-ACP has succeeded in dramatically increasing the C16 fatty acid content of cotton seed oil to well beyond its natural limits, reaching up to 65% of total fatty acids. The elevated C16 levels were comprised of predominantly palmitic acid (C16:0, 51%) and to a lesser extent palmitoleic acid (C16:1, 11%) and hexadecadienoic acid (C16:2, 3%), and were stably inherited. Despite of the dramatic alteration of fatty acid composition and a slight yet significant reduction in oil content in these high-palmitic (HP) lines, seed germination remained unaffected. Regiochemical analysis of triacylglycerols (TAG) showed that the increased levels of palmitic acid mainly occurred at the outer positions, while C16:1 and C16:2 were predominantly found in the sn-2 position in both TAG and phosphatidylcholine. Crossing the HP line with previously created high-oleic (HO) and high-stearic (HS) genotypes demonstrated that HP and HO traits could be achieved simultaneously; however, elevation of stearic acid was hindered in the presence of high level of palmitic acid.

Seasoning ingredient variety, but not quality, is associated with greater intake of beans and rice among urban Costa Rican adults

Exposure to a variety of flavors may promote food enjoyment, but few studies have examined the relationship between food seasoning and food intake. We hypothesized that using a higher variety (number) of 11 seasonings to prepare 2 staple foods (beans, white rice) would be associated with intake of those foods in a population-based case-control study of Costa Rican adults in urban vs rural areas (n=1025), where cooking and dietary practices differ. Participants were surveyed about the variety of seasoning ingredients added when preparing beans or rice. Ingredients were also categorized by their dietary quality (healthfulness), and scores for seasoning variety and quality were created. Multivariable linear regression was used to determine the association between variety and quality scores (continuously and in tertiles (T)) and intake of each staple food. Seasoning variety was positively associated with daily servings of beans (β=.02, P=.01; 1.31 and 1.23 servings/day in T2 and T3 versus 1.02 servings/day in T1, P<.05) and rice (β=.04, P=.005) in the urban areas only. No differences in ingredient quality across increasing intakes of beans or rice were noted, and the joint associations between variety and quality were not significant. In conclusion, a greater variety, but not quality, of seasoning ingredients was positively associated with intakes of beans and rice in urban Costa Rican adults. Our results suggest that increasing the variety of seasonings added to beans may be a culturally-appropriate strategy to improve intake of this healthy staple food among urban Costa Rican adults.

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.

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.

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.

Association between dietary patterns during pregnancy and birth size measures in a diverse population in Southern US

Despite increased interest in promoting nutrition during pregnancy, the association between maternal dietary patterns and birth outcomes has been equivocal. We examined maternal dietary patterns during pregnancy as a determinant of offspring’s birth weight-for-length (WLZ), weight-for-age (WAZ), length-for-age (LAZ), and head circumference (HCZ) Z-scores in Southern United States (n = 1151). Maternal diet during pregnancy was assessed by seven dietary patterns. Multivariable linear regression models described the association of WLZ, WAZ, LAZ, and HCZ with diet patterns controlling for other maternal and child characteristics. In bivariate analyses, WAZ and HCZ were significantly lower for processed and processed-Southern compared to healthy dietary patterns, whereas LAZ was significantly higher for these patterns. In the multivariate models, mothers who consumed a healthy-processed dietary pattern had children with significantly higher HCZ compared to the ones who consumed a healthy dietary pattern (HCZ β: 0.36; p = 0.019). No other dietary pattern was significantly associated with any of the birth outcomes. Instead, the major outcome determinants were: African American race, pre-pregnancy BMI, and gestational weight gain. These findings justify further investigation about socio-environmental and genetic factors related to race and birth outcomes in this population.

Palm oil and blood lipid-related markers of cardiovascular disease: a systematic review and meta-analysis of dietary intervention trials

BACKGROUND

Palm oil (PO) may be an unhealthy fat because of its high saturated fatty acid content.

OBJECTIVE

The objective was to assess the effect of substituting PO for other primary dietary fats on blood lipid-related markers of coronary heart disease (CHD) and cardiovascular disease (CVD).

DESIGN

We performed a systematic review and meta-analysis of dietary intervention trials. Studies were eligible if they included original data comparing PO-rich diets with other fat-rich diets and analyzed at least one of the following CHD/CVD biomarkers: total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, TC/HDL cholesterol, LDL cholesterol/HDL cholesterol, triacylglycerols, apolipoprotein A-I and B, very-low-density lipoprotein cholesterol, and lipoprotein(a).

RESULTS

Fifty-one studies were included. Intervention times ranged from 2 to 16 wk, and different fat substitutions ranged from 4% to 43%. Comparison of PO diets with diets rich in stearic acid, monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs) showed significantly higher TC, LDL cholesterol, apolipoprotein B, HDL cholesterol, and apolipoprotein A-I, whereas most of the same biomarkers were significantly lower when compared with diets rich in myristic/lauric acid. Comparison of PO-rich diets with diets rich in trans fatty acids showed significantly higher concentrations of HDL cholesterol and apolipoprotein A-I and significantly lower apolipoprotein B, triacylglycerols, and TC/HDL cholesterol. Stratified and meta-regression analyses showed that the higher concentrations of TC and LDL cholesterol, when PO was substituted for MUFAs and PUFAs, were not significant in young people and in subjects with diets with a lower percentage of energy from fat.

CONCLUSIONS

Both favorable and unfavorable changes in CHD/CVD risk markers occurred when PO was substituted for the primary dietary fats, whereas only favorable changes occurred when PO was substituted for trans fatty acids. Additional studies are needed to provide guidance for policymaking.

Baseline dietary patterns are a significant consideration in correcting dietary exposure for weight loss

BACKGROUND/OBJECTIVES

Dietary pattern studies are traditionally the domain of epidemiological research. From a clinical perspective, there is a need to explore the effects of changing food and dietary patterns of individuals. The aim was to identify patterns of food choice in the context of a clinical weight loss trial. Cluster analysis based on reported serves of food groups revealed dietary patterns informative for the clinical setting.

SUBJECTS/METHODS

Cluster analysis was conducted using diet history data from two clinical trials at baseline, and outcomes at 3 months were reviewed based on these clusters (n=231). The cluster solution was analysed using defined food groups in serves and with respect to clinical parameters and requirements for selected nutrients.

RESULTS

Two distinct dietary patterns were identified from the reported baseline dietary intakes. Subjects in Cluster 1 reported food patterns characterised by higher intakes of low-fat dairy and unsaturated oils and margarine and were generally more closely aligned to food choices encouraged in national dietary guidelines. Subjects in Cluster 2 reported a dietary pattern characterised by non-core foods and drinks, higher- and medium-fat dairy foods, fatty meats and alcohol. At 3 months, Cluster 2 subjects reported greater reductions in energy intake (-5317 kJ; P<0.001) and greater weight loss (-5.6 kg; P<0.05) compared with Cluster 1.

CONCLUSIONS

Overweight subjects with reported dietary patterns similar to dietary guidelines at baseline may have more difficulty in reducing energy intake than those with poor dietary patterns. Correcting exposure to non-core foods and drinks was key to successful weight loss.

Carbohydrate nutrition differs by diabetes status and is associated with dyslipidemia in Boston Puerto Rican adults without diabetes

Puerto Rican adults have a greater prevalence of type 2 diabetes (T2D) and lower HDL-cholesterol (HDL-C) than the general U.S. population. Carbohydrate nutrition may play a role in this disparity. Cross-sectional analyses included data from 1219 Puerto Ricans aged 45-75 y enrolled in the Boston Puerto Rican Health Study. Using the Pearson chi-square test and ANCOVA, lifestyle characteristics and dietary intake, as assessed by semiquantitative FFQ, were compared by T2D status based on fasting plasma glucose concentration and medication use. Food source rankings for carbohydrate, dietary glycemic load (GL), and fiber were obtained using the SAS procedure PROC RANK. Geometric mean plasma HDL-C and TG concentrations were compared across quintiles of dietary carbohydrate, glycemic index (GI), GL, and fiber by using ANCOVA and tests for linear trend. In multivariable analyses, individuals with T2D (39.5%) had lower dietary carbohydrate, GL, and total sugar intake from lower intake of sugar, fruit drinks, and soda compared with those without T2D. In individuals without T2D, dietary carbohydrate and GL were inversely associated with HDL-C (P < 0.0001). Associations between dietary fiber and HDL-C were confounded by carbohydrate intake, apparently from concurrent consumption of legumes with white rice, a refined carbohydrate food. No associations were observed between carbohydrate, dietary GI, GL, or fiber and TG. In conclusion, individuals with T2D showed evidence of dietary modification. Among those without diabetes, a high intake of refined carbohydrates was associated with decreased HDL-C. Longitudinal research on carbohydrate nutrition in relation to diabetes risk factors and blood lipids in Puerto Ricans is warranted.

Dietary patterns obtained through principal components analysis: the effect of input variable quantification

Principal components analysis (PCA) is a popular method for deriving dietary patterns. A number of decisions must be made throughout the analytic process, including how to quantify the input variables of the PCA. The present study aims to compare the effect of using different input variables on the patterns extracted using PCA on 3-d diet diary data collected from 7473 children, aged 10 years, in the Avon Longitudinal Study of Parents and Children. Four options were examined: weight consumed of each food group (g/d), energy-adjusted weight, percentage contribution to energy of each food group and binary intake (consumed/not consumed). Four separate PCA were performed, one for each intake measurement. Three or four dietary patterns were obtained from each analysis, with at least one component that described 'more healthy' and 'less healthy' diets and one component that described a diet with high consumption of meat, potatoes and vegetables. There were no obvious differences between the patterns derived using percentage energy as a measurement and adjusting weight for total energy intake, compared to those derived using gram weights. Using binary input variables yielded a component that loaded positively on reduced fat and reduced sugar foods. The present results suggest that food intakes quantified by gram weights or as binary variables both resulted in meaningful dietary patterns and each method has distinct advantages: weight takes into account the amount of each food consumed and binary intake appears to describe general food preferences, which are potentially easier to modify and useful in public health settings.

Genetic predictors for cardiovascular disease in hispanics

A less favorable cardiovascular risk factor profile but paradoxically lower cardiovascular morbidity and mortality have been observed in Hispanics--a pattern often referred to as the Hispanic paradox. It has been proposed that the specific genetic susceptibility of this admixed population and gene-environment interactions may partly explain the paradox. During the past few years, there have been major advances in the identification of genetic risk factors using genome-wide association studies (GWAS) for cardiovascular disease, especially in Caucasians. However, no GWAS of cardiovascular disease have been reported in Hispanics. In the Costa Rican Heart Study, we reported both the consistency and disparity of genetic effects on risk of coronary heart disease (CHD) between Hispanics and other ethnic groups. We demonstrated that the improvement in the identified genetic markers on discrimination of CHD in Hispanics was modest. Future genetic research on Hispanics should consider the diversity in genetic structure, lifestyle, and socioeconomics among various subpopulations and comprehensively evaluate potential gene-environment interactions in relation to cardiovascular risk.

Dietary patterns in an ethnoculturally diverse population of young Canadian adults

PURPOSE

Dietary patterns of food consumption were investigated among young urban Toronto adults, including men and women from different ethnocultural groups.

METHODS

We performed a cross-sectional analysis among 1153 adults aged 20 to 29 years, from the Toronto Nutrigenomics and Health Study. Principal components analysis of food intake scores was used to identify food consumption patterns. Logistic regression, analysis of variance, and t-tests were used to test for differences in dietary patterns between ethnocultural groups and between men and women. Partial correlations were used to investigate the relationship between patterns and nutrient intake.

RESULTS

Three predominant patterns were identified and termed "prudent," "Western," and "Eastern" patterns. Caucasians had significantly higher prudent pattern scores than did Asians and South Asians, while Asians had significantly higher Eastern pattern scores than did other ethnocultural groups (p<0.01). Women had higher prudent pattern scores (odds ratio [OR]=4.31, 95% confidence interval [CI]=3.11-5.96) and lower Western pattern scores (OR=0.62, 95% CI=0.45-0.84) than did men. Dietary pattern scores were correlated with nutrient and energy intakes.

CONCLUSIONS

We observed distinct dietary patterns in this population of young adults. These dietary patterns varied significantly between ethnocultural groups and between men and women. The patterns were associated with nutrient intake levels; this association may have important public health implications.

A higher ratio of beans to white rice is associated with lower cardiometabolic risk factors in Costa Rican adults

BACKGROUND

A high intake of white rice is associated with the metabolic syndrome and type 2 diabetes. Costa Ricans follow a staple dietary pattern that includes white rice and beans, yet the combined role of these foods on cardiometabolic risk factors has not been studied.

OBJECTIVE

We aimed to determine the association between intake of white rice and beans and the metabolic syndrome and its components in Costa Rican adults (n = 1879) without diabetes.

DESIGN

Multivariate-adjusted means were calculated for components of the metabolic syndrome by daily servings of white rice and beans (<1, 1, or >1) and by the ratio of beans to white rice. The OR for the metabolic syndrome was calculated by substituting one serving of beans for one serving of white rice.

RESULTS

An increase in daily servings of white rice was positively associated with systolic blood pressure (BP), triglycerides, and fasting glucose and inversely associated with HDL cholesterol (P-trend <0.01 for all). An increase in servings of beans was inversely associated with diastolic BP (P = 0.049). Significant trends for higher HDL cholesterol and lower BP and triglycerides were observed for 1:3, 1:2, 1:1, and 2:1 ratios of beans to white rice. Substituting one serving of beans for one serving of white rice was associated with a 35% (95% CI: 15%, 50%) lower risk of the metabolic syndrome.

CONCLUSION

Increasing the ratio of beans to white rice, or limiting the intake of white rice by substituting beans, may lower cardiometabolic risk factors.

Coronary heart disease prevention: nutrients, foods, and dietary patterns

Diet is a key modifiable risk factor in the prevention and risk reduction of coronary heart disease (CHD). Results from the Seven Countries Study in the early 1970s spurred an interest in the role of single nutrients such as total fat in CHD risk. With accumulating evidence, we have moved away from a focus on total fat to the importance of considering the quality of fat. Recent meta-analyses of intervention studies confirm the beneficial effects of replacing saturated fat with polyunsaturated fatty acids on CHD risk. Scientific evidence for a detrimental role of trans fat intake from industrial sources on CHD risk has led to important policy changes including listing trans fatty acid content on the "Nutrition Facts" panel and banning the use of trans fatty acids in food service establishments in some cities. The effects of such policy changes on changes in CHD incidence are yet to be evaluated. There has been a surging interest in the protective effects of vitamin D in primary prevention. Yet, its associations with secondary events have been mixed and intervention studies are needed to clarify its role in CHD prevention. Epidemiological and clinical trial evidence surrounding the benefit of B vitamins and antioxidants such as carotenoids, vitamin E, and vitamin C, have been contradictory. While pharmacological supplementation of these vitamins in populations with existing CHD has been ineffective and, in some cases, even detrimental, data repeatedly show that consumption of a healthy dietary pattern has considerable cardioprotective effects for primary prevention. Results from these studies and the general ineffectiveness of nutrient-based interventions have shifted interest to the role of foods in CHD risk reduction. The strongest and most consistent protective associations are seen with fruit and vegetables, fish, and whole grains. Epidemiological and clinical trial data also show risk reduction with moderate alcohol consumption. In the past decade, there has been a paradigm shift in nutritional epidemiology to examine associations between dietary patterns and health. Several epidemiological studies show that people following the Mediterranean style diet or the Dietary Approaches to Stop Hypertension (DASH) diet have lower risk of CHD and lower likelihood of developing hypertension. Studies using empirical or data driven dietary patterns have frequently identified two patterns - "Healthy or Prudent" and "Western". In general, the "Healthy", compared to the "Western" pattern has been associated with more favorable biological profiles, slower progression of atherosclerosis, and reduced incidence. Evidence on changes in dietary patterns and changes in CHD risk is still emerging. With the emergence of the concept of personalized nutrition, studies are increasingly considering the role of genetic factors in the modulation of the association between nutrients and CHD. More studies of genetic variation and dietary patterns in relation to CHD are needed.

Exploring dietary patterns by using the treelet transform

Principal component analysis (PCA) has been used extensively in the field of nutritional epidemiology to derive patterns that summarize food and nutrient intake, but interpreting it can be difficult. The authors propose the use of a new statistical technique, the treelet transform (TT), as an alternative to PCA. TT combines the quantitative pattern extraction capabilities of PCA with the interpretational advantages of cluster analysis and produces patterns involving only naturally grouped subsets of the original variables. The authors compared patterns derived using TT with those derived using PCA in a study of dietary patterns and risk of myocardial infarction among 26,155 male participants in a prospective Danish cohort. Over a median of 11.9 years of follow-up, 1,523 incident cases of myocardial infarction were ascertained. The 7 patterns derived with TT described almost as much variation as the first 7 patterns derived with PCA, for which interpretation was less clear. When the authors used multivariate Cox regression models to estimate relative risk of myocardial infarction, the significant risk factors were comparable whether the model was based on PCA or TT factors. The present study shows that TT may be a useful alternative to PCA in epidemiologic studies, leading to patterns that possess comparable explanatory power and are simple to interpret.

Dietary patterns are associated with metabolic syndrome in adult Samoans

The prevalence of metabolic syndrome has reached epidemic levels in the Samoan Islands. In this cross-sectional study conducted in 2002-2003, dietary patterns were described among American Samoan (n = 723) and Samoan (n = 785) adults (> or =18 y) to identify neo-traditional and modern eating patterns and to relate these patterns to the presence of metabolic syndrome using Adult Treatment Panel III criteria. The neo-traditional dietary pattern, similar across both polities, was characterized by high intake of local foods, including crab/lobster, coconut products, and taro, and low intake of processed foods, including potato chips and soda. The modern pattern, also similar across both polities, was characterized by high intake of processed foods such as rice, potato chips, cake, and pancakes and low intake of local foods. The neo-traditional dietary pattern was associated with significantly higher serum HDL-cholesterol in American Samoa (P-trend = 0.05) and a decrease in abdominal circumference in American Samoa and Samoa (P-trend = 0.004 and 0.01, respectively). An inverse association was found with metabolic syndrome, although it did not reach significance (P = 0.23 in American Samoa; P = 0.13 in Samoa). The modern pattern was significantly positively associated with metabolic syndrome in Samoa (prevalence ratio = 1.21 for the fifth compared with first quintile; 95% CI: 0.93.1.57; P-trend = 0.05) and with increased serum triglyceride levels in both polities (P < 0.05). Reduced intake of processed foods high in refined grains and adherence to a neo-traditional eating pattern characterized by plant-based fiber, seafood, and coconut products may help to prevent growth in the prevalence of metabolic syndrome in the Samoan islands.

Comparison of 3 methods for identifying dietary patterns associated with risk of disease

Reduced rank regression and partial least-squares regression (PLS) are proposed alternatives to principal component analysis (PCA). Using all 3 methods, the authors derived dietary patterns in Costa Rican data collected on 3,574 cases and controls in 1994-2004 and related the resulting patterns to risk of first incident myocardial infarction. Four dietary patterns associated with myocardial infarction were identified. Factor 1, characterized by high intakes of lean chicken, vegetables, fruit, and polyunsaturated oil, was generated by all 3 dietary pattern methods and was associated with a significantly decreased adjusted risk of myocardial infarction (28%-46%, depending on the method used). PCA and PLS also each yielded a pattern associated with a significantly decreased risk of myocardial infarction (31% and 23%, respectively); this pattern was characterized by moderate intake of alcohol and polyunsaturated oil and low intake of high-fat dairy products. The fourth factor derived from PCA was significantly associated with a 38% increased risk of myocardial infarction and was characterized by high intakes of coffee and palm oil. Contrary to previous studies, the authors found PCA and PLS to produce more patterns associated with cardiovascular disease than reduced rank regression. The most effective method for deriving dietary patterns related to disease may vary depending on the study goals.

Fruit and vegetable intake and the risk for developing coronary heart disease

The aim of the paper was to study the relationship between dietary intake of fruit and vegetable intake and the risk of coronary heart disease. We used data from a case-control study, conducted from 2001 to 2003, among 290 randomly selected cases (mean age 59.98 +/- 10.03 years) with first event of an acute coronary syndrome and 290 selected paired controls by sex, age and region (mean age 59.43 +/- 10.10 years), admitted to the same hospitals as cases without any suspicion of coronary disease. Using questionnaires, we assessed fruit and vegetable intake and estimated odds ratio of developing coronary heart disease by the intake. The benefit of fruit or vegetable consumption increased proportionally by the number of servings consumed (p for trend < 0.0001). Those in the upper tertile of fruit consumption (> 5 items/day) had 60% lower risk for coronary heart disease (odds ratio= 0.56, 95% CI = 0.35-0.89, p < 0.05), when compared to those in the lowest tertile (<1 item/day). Consumption of vegetable >3 items/day was associated with 70% lower risk of coronary heart disease (OR = 0.25, 95% CI = 0.09 - 0.66, p < 0.05), compared to subjects who did not consume vegetables. In agreement with previous studies, we found an inverse relation between vegetable and fruit intake and coronary heart risk. Consumption of fruits and vegetables seemed to provide significant protection against coronary heart disease.

Adjusting for energy intake in dietary pattern investigations using principal components analysis

OBJECTIVE

The effect of energy adjustment on variables entered into principal component analysis (PCA) to derive dietary patterns has received little attention.

DESIGN AND METHODS

As part of regular self-completion questionnaires, used in the Avon Longitudinal Study of Parents and Children, pregnant women were asked to record the frequency of consumption of a variety of food items. A total of 12 053 women completed the questionnaire. Individual dietary types were identified using PCA, before and after adjusting the food variables for energy intake. Associations with estimated nutrient intakes and with birthweight were examined for the two solutions and when energy adjustment was performed at a later stage of the analysis.

RESULTS

Slight differences were seen in terms of the components extracted and the factor loadings obtained. The associations with nutrient intakes showed that there was a general reduction in the size of the correlation coefficients for the energy-adjusted components compared to the unadjusted components. There did not appear to be any difference in the size of the effects of the dietary pattern scores on birthweight, whether energy was adjusted for before entry into the PCA or after.

CONCLUSIONS

In this sample, it is not necessary to adjust for energy intake before entry into a PCA analysis to determine dietary patterns when using food frequency questionnaire data. Effects of energy intake can be determined at a later stage in the analytical process.This study determines the effect of adjusting for energy on dietary patterns resulting from PCA and the subsequent effect on future outcomes.

Replacements for trans fats-will there be an oil shortage?

Manufacturers use the process of hydrogenation to create trans fats in order to increase the shelf life of baked and fried foods. Ingestion of trans fats is associated with an increased risk of cardiovascular disease. A groundswell of public sentiment is causing regulatory bodies to ban the use of trans fats in foods. Alternatives to trans fats are needed now in order to preserve the freshness and provide an appealing texture of many packaged foods. As trans fats become phased out, there are eight types of approaches currently being developed to substitute for these fats as ingredients for baked and fried foods: (1) modified hydrogenation, (2) genetically modified seeds, (3) interesterification, (4) fractionation and blending, (5) butter and animal fat, (6) natural saturated oils, (7) natural unsaturated oils, and (8) fat substitutes. These alternatives to trans fats will require close scrutiny to ascertain whether they will also turn out to be linked with cardiovascular disease.