Multivariate analysis of dietary patterns in 939 Swiss adults: sociodemographic parameters and alcohol consumption profiles

Vegan-vegetarian diets in pregnancy: danger or panacea? A systematic narrative review

BACKGROUND

Although vegan-vegetarian diets are increasingly popular, no recent systematic reviews on vegan-vegetarian diets in pregnancy exist.

OBJECTIVES

To review the literature on vegan-vegetarian diets and pregnancy outcomes.

SEARCH STRATEGY

PubMed, Embase, and the Cochrane library were searched from inception to September 2013 for pregnancy and vegan or vegetarian Medical Subject Headings (MeSH) and free-text terms.

SELECTION CRITERIA

Vegan or vegetarian diets in healthy pregnant women. We excluded case reports and papers analysing vegan-vegetarian diets in poverty and malnutrition. Searching, paper selection, and data extraction were performed in duplicate.

DATA COLLECTION AND ANALYSIS

The high heterogeneity of the studies led to a narrative review.

MAIN RESULTS

We obtained 262 full texts from 2329 references; 22 selected papers reporting maternal-fetal outcomes (13) and dietary deficiencies (nine) met the inclusion criteria. None of the studies reported an increase in severe adverse outcomes or in major malformations, except one report of increased hypospadias in infants of vegetarian mothers. Five studies reported vegetarian mothers had lower birthweight babies, yet two studies reported higher birthweights. The duration of pregnancy was available in six studies and was similar between vegan-vegetarians and omnivores. The nine heterogeneous studies on microelements and vitamins suggest vegan-vegetarian women may be at risk of vitamin B12 and iron deficiencies.

AUTHOR'S CONCLUSIONS

The evidence on vegan-vegetarian diets in pregnancy is heterogeneous and scant. The lack of randomised studies prevents us from distinguishing the effects of diet from confounding factors. Within these limits, vegan-vegetarian diets may be considered safe in pregnancy, provided that attention is paid to vitamin and trace element requirements.

Investigation of population heterogeneity of diet use among middle-aged Australians

The purpose of the study was to determine patterns of diet use among middle-aged Australian men and women and the relationships between these different usage patterns and demographic characteristics, health status and health habits. A cross-sectional mail survey was conducted among a random sample of 2975 people aged 40-71 years in Victoria, Australia. A total of 1031 usable questionnaires were obtained which included information about the use of diets (e.g. low-fat and low-salt) during the past 3 months along with demographic information, health status and health habits. Based on the responses about the use of thirteen diets for both sexes, latent class analysis was employed to identify the optimal number of use of diets and the assignment of participants to particular groups. Three types of diet uses were identified and provisionally named: diet use, selected diet use and non-diet use. This classification was associated with demographics, health status and health habits, and these associations differed between men and women. The findings suggest that nutrition education programmes should be tailored to the different needs of the diet use groups.

Effects of N-acetylcysteine on alcohol abstinence and alcohol-induced adverse effects in rats

Alcoholism is rampant in modern society and some antioxidant compound could perhaps be useful to reduce the damage done by alcohol consumption and abstinence. The present study was undertaken to investigate the association of N-acetylcysteine (NAC) intake, alcoholism, and alcohol abstinence on lipid profile, in vivo low-density lipoprotein (LDL) oxidation, oxidative stress, and antioxidant status in serum and liver of rats. Initially, male Wistar 30 rats were divided into two groups: (C, N=6) given standard chow and water; (E, N=24) receiving standard chow and aqueous ethanol solution in semi-voluntary research. After 30 days of ethanol exposure, (E) group was divided into four subgroups (N=6/group): (E-E) continued drinking 30% ethanol solution; (E-NAC) drinking ethanol solution containing 2 g/L NAC; (AB) changed ethanol solution to water; (AB-NAC) changed ethanol to aqueous solution 2 g/L NAC. After 15 days of the E-group division, E-E rats had higher serum alanine transaminase, lower body weight, and surface area, despite higher energy intake than C. E-E rats had also lower feed efficiency, dyslipidemia with enhanced triacylglycerol, very low-density lipoprotein (VLDL), lipid hydroperoxide (LH) and in vivo oxidized-LDL (ox-LDL). AB, E-NAC, and AB-NAC rats ameliorated serum oxidative stress markers and normalized serum lipids. E-E rats had higher hepatic LH and lower reduced glutathione (GSH)/oxidized glutathione (GSSG) ratio than C, indicating hepatic oxidative stress. AB and E-NAC rats normalized hepatic LH, GSSG, and the GSH/GSSG ratio, compared to E-E. AB-NAC rats had the lowest serum ox-LDL, hepatic LH levels, and the highest GSH reductase activity in hepatic tissue. In conclusion, the present study brought new insights into alcohol consumption, because ethanol exposure enhanced serum in vivo ox-LDL, as well as serum and hepatic oxidative stress. N-acetylcysteine offers promising therapeutic value to inhibit ethanol-induced adverse effects. Ethanol withdrawal had beneficial effects on serum lipids, but was more effective when coupled with NAC supplementation. Ethanol abstinence and NAC intake interact synergistically, improving serum lipids and hepatic antioxidant defenses.

Dietary patterns among a national sample of British children aged 1 1/2-4 1/2 years

OBJECTIVE

Using a nationally representative sample, to identify groups among British children aged 1 1/2-4 1/2 years who report similar patterns of diet.

DESIGN

Nationally representative dietary survey, using 4 d weighed dietary records, of girls and boys aged 1 1/2-4 1/2 years living in private households in Great Britain in 1992-1993. Cluster analysis was used to aggregate individuals into diet groups.

SETTING

Great Britain.

PARTICIPANTS

Eight hundred and forty-eight boys and 827 girls.

RESULTS

Three clusters were identified for girls and three for boys. Among boys the most prevalent cluster was 'Healthy Diet' (52.3%), the second was 'Convenience Diet' (38.3%) and the third was 'Traditional Diet' (9.3%). Among girls, the most prevalent dietary cluster was 'Healthy Diet' (58.7%), followed by a 'Convenience Diet' (36.6%) and 'Traditional Diet' (4.3%). There were important differences in nutrient profile, sociodemographic and behavioural characteristics between clusters.

CONCLUSIONS

Cluster analysis identified three groups among both girls and boys which differed not only in terms of reported dietary intake, but also with respect to nutrient intake, social and behavioural characteristics. The groups identified could provide a useful basis for the development, monitoring and targeting of public health nutrition policy for pre-school children in the UK. Further research is needed on the consequences for chronic disease in the future for these children.

Prospective study of dietary patterns and colorectal cancer among Singapore Chinese

An influence of Western diet and lifestyle factors observed among Singapore Chinese may contribute to the population's marked rise in colorectal cancer incidence over the past two decades. Thus far, however, there is little evidence for individual nutrients and foods as major contributing factors in this population. We evaluated whether patterns of food intake were associated with colorectal cancer in a population-based cohort of 61,321 Singapore Chinese that was established in 1993–98. Two dietary patterns, meat–dim sum and vegetable–fruit–soy, were previously identified by principal components analysis using baseline dietary data from a validated 165-item food frequency questionnaire. As of 31 December 2005, 961 incident colorectal cancer cases were diagnosed. Proportional hazards regression was used to calculate adjusted hazard ratios. Using nearly 10 years of follow-up data, we observed no association with either the meat–dim sum or vegetable–fruit–soy pattern for colorectal cancer. In conclusion, neither individual nutrients or foods nor dietary patterns appear to explain the rise in colorectal cancer among Singapore Chinese population.

Dietary patterns in pregnancy and associations with socio-demographic and lifestyle factors

OBJECTIVE

To obtain distinct dietary patterns in the third trimester of pregnancy using principal components analysis (PCA); to determine associations with socio-demographic and lifestyle factors.

DESIGN AND METHODS

A total of 12 053 pregnant women partaking in a population-based cohort study recorded current frequency of food consumption via questionnaire in 1991-1992. Dietary patterns identified using PCA were related to social and demographic characteristics and lifestyle factors.

RESULTS

Five dietary patterns were established and labelled to best describe the types of diet being consumed in pregnancy. The 'health conscious' component described a diet based on salad, fruit, rice, pasta, breakfast cereals, fish, eggs, pulses, fruit juices, white meat and non-white bread. The 'traditional' component loaded highly on all types of vegetables, red meat and poultry. The 'processed' component was associated with high-fat processed foods. The 'confectionery' component was characterized by snack foods with high sugar content and the final 'vegetarian' component loaded highly on meat substitutes, pulses, nuts and herbal tea and high negative loadings were seen with red meat and poultry. There were strong associations between various socio-demographic variables and all dietary components; in particular, a 'health conscious' diet was positively associated with increasing education and age and non-white women. There was a negative association with increased parity, single, non-working women, those who smoked and who were overweight pre-pregnancy. Opposite associations were seen with the 'processed' component.

CONCLUSIONS

Distinct dietary patterns in pregnancy have been identified. There is clear evidence of social patterning associated with the dietary patterns, these social factors need to be accounted for in future studies using dietary patterns. This study will form the basis for further work investigating pregnancy outcome.

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

RATIONALE

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

OBJECTIVE

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

METHODS

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

MAIN RESULTS

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

CONCLUSION

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

Multivariate analysis of diet in children at four and seven years of age and associations with socio-demographic characteristics

AIM

We have previously reported on distinct dietary patterns obtained from principal components analysis (PCA) of food frequency questionnaires from 3-y-old children. In this study, we repeat these analyses at 4 and 7 y of age.

DESIGN

As part of regular self-completion questionnaires, the primary source of data collection in the Avon Longitudinal Study of Parents and Children, parents were asked to record the frequency of consumption of 57 different food types for their children. A total of 9550 subjects (68% of original cohort) were available from the 4-y data sweep and 8286 (59%) from the 7-y.

METHODS

Distinct dietary patterns were identified at each age using PCA. These were then related to social and demographic characteristics of the parent and child.

RESULTS

Three dietary patterns were established cross-sectionally at both 4 and 7 y of age to best describe the types of diet being consumed. One component at both time points described a diet based on 'junk'-type foods with high-fat and sugar content, processed and convenience foods. A second described the 'traditional' British diet based on meat, potatoes and vegetables. The final, a 'health-conscious' pattern was associated with vegetarian style foods, rice, pasta, salad and fruit. At both time points, the 'junk' pattern was significantly more likely in white children, where maternal education level was low and where the child had more siblings. The 'traditional' pattern was more likely in girls, where the mother had a partner and in nonvegetarians (both mother and child). The 'health-conscious' pattern was more likely with increasing levels of education and increasing maternal age.

CONCLUSION

We have demonstrated consistent dietary patterns in cross-sectional analyses at two ages in these children with similar socio-demographic associations evident at each age. Future analyses will track these dietary patterns over time and form a basis for the study of a variety of childhood outcomes.

Dietary patterns and the risk of colorectal adenoma recurrence in a European intervention trial

The relations between individual foods and nutrients to colorectal tumours are conflicting. Few studies have taken into account the interdependence between individual components of diet and their possible interactions. The aim of the study was to examine the associations between dietary patterns and the risk of colorectal adenoma recurrence in the European fibre-calcium intervention trial. Among the 640 patients with confirmed adenomas at the index colonoscopy, 592 had an initial dietary assessment using a diet history questionnaire. The present analysis was restricted to 277 men and 165 women without history of adenoma prior to the index colonoscopy and who completed the study. The main end point was the 3-year recurrence of adenomas. Principal component analysis was used to identify dietary patterns from 50 food groups. Ninety-two patients presented new colorectal adenomas at the 3-year colonoscopy (65 men and 27 women). In men, three meaningful dietary patterns emerged from analysis, explaining 21.3% of variability. They were called 'Mediterranean', 'Sweets and snacks' and 'High fat and proteins' patterns. None of them were significantly related to the overall recurrence of colorectal adenomas either in univariate or multivariate analyses. Among women, the 'Mediterranean', the 'Western' and the 'Snacks' patterns explained 21.9% of variability. The 'Mediterranean' pattern characterized by a high consumption of olive oil, vegetables, fruit, fish and lean meat significantly reduced adenoma recurrence [second tertile: adjusted odds ratio (OR)=0.50, 95% confidence interval (CI)=0.18-1.42; third tertile: adjusted OR=0.30, 95% CI=0.09-0.98; P for linear trend=0.04]. The 'Western' and 'Snacks' patterns were not associated with recurrence among women. In conclusion, this study suggests that the Mediterranean dietary pattern may reduce the recurrence of colorectal adenomas, at least in women. These exploratory results need to be confirmed by larger studies.

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

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

A longitudinal study of food intake patterns and obesity in adult Danish men and women

OBJECTIVE

The aim of this study was to test the hypothesis that specific food intake patterns or changes in food intake patterns were related to future changes in body mass index (BMI).

DESIGN

Longitudinal observational study, with clinical and questionnaire examinations at baseline and two follow-up surveys, after 5 and 11 years.

SUBJECTS

In all, 3785 men and women attended at baseline, of which 2436 aged 30-60 y attended all three examinations.

MEASUREMENTS

A 26-item food frequency questionnaire, standardised measurements of height and weight and a lifestyle questionnaire. Food intake patterns were identified by factor analysis. Regression models including: scores on each factor, BMI, smoking, leisure time physical activity, education, parity, age; and as outcomes: baseline BMI, BMI change between baseline, 5- and 11-y follow-up and obesity at 11-y follow-up, respectively.

RESULTS

For men, three factors labelled 'Green', 'Sweet' and 'Traditional', and for women, two factors labelled 'Green' and 'Sweet-Traditional' were identified. Scores on the 'Sweet' and 'Sweet-Traditional' factors were inversely associated with baseline BMI. For men, baseline 'Traditional' factor score and, for women, baseline 'Sweet-Traditional' factor score was inversely associated with subsequent 11- and 5-y BMI change, respectively. Using the three examinations, a more advanced longitudinal model, which included preceding changes in BMI and factor scores, was tested but no significant associations between factor scores, changes in factor scores and subsequent BMI changes or obesity were found.

CONCLUSION

In this longitudinal study of a Danish population, food intake factors could not consistently predict changes in BMI or obesity development.

Reproducibility and validity of major dietary patterns among Swedish women assessed with a food-frequency questionnaire

Defining dietary patterns by factor analysis is an alternative approach to dietary assessment that has been used recently to examine diet-disease relations. However, only 1 study evaluated the reproducibility and validity of this method. Our aim was to assess both the validity and reproducibility of major dietary patterns based on data from a 60-item FFQ. We chose 2 independent random samples among over 60,000 women aged 40-74 y participating in the Swedish Mammography Cohort (SMC). In the validation study, the FFQ was compared with 4 7-d dietary records (DRs) among 129 women. For the reproducibility study, the FFQ was administered twice, 1 y apart in 212 women. By conducting factor analysis, 3 major dietary patterns were identified: healthy (high in vegetables, fruits, fish, poultry, tomato, cereal, and low-fat dairy products), Western (processed meat, meat, refined grains, sweets, and fried potatoes), and drinker (beer, wine and liquor, snacks) pattern. These 3 patterns explained 29-34% of the total variance in these 2 studies. The Spearman correlation coefficients between FFQ1 and FFQ2 (reproducibility) for healthy, Western, and drinker pattern were 0.63, 0.68, and 0.73, respectively (all P < 0.0001). Correlation coefficients between the FFQ and DRs (validity) for these patterns were 0.59, 0.50, and 0.85, respectively (all P < 0.0001). Our results indicate that identification of dietary patterns through factor analysis is a reproducible and valid method. The dietary patterns approach might be used in nutritional epidemiology as an alternative method of dietary assessment.

Consistency of food intake factors by different dietary assessment methods and population groups

Several studies have used factor analysis to identify food intake patterns in epidemiological studies as an alternative to nutrient-based analyses, but few have validated the factors in a larger population. Our present objectives were: to compare the factor scores based on a food-frequency questionnaire (FFQ) with scores based on a 7 d diet record; to examine the consistency of the factor score correlations across strata of age, BMI, energy intake, education, physical activity and smoking and to compare factors identified in two sub-populations. In 879 men and 927 women, of the total population sample of 3785, scores on food intake factors, three for men ('green', sweet' and 'traditional') and two for women ('green' and 'sweet-traditional'), identified in data from the FFQ and the diet record, were compared. The loadings of foods on the factors were very similar and the correlations between the corresponding factor scores, based on the two dietary assessment methods, were: for men 'green' 0.61, 'sweet' 0.55, 'traditional' 0.34; for women, 'green' 0.61, 'sweet-traditional' 0.57. Stratification did not significantly modify the correlations, with a few inconsistent exceptions. Factors obtained in a different subsample of the population, for which there was only data from the FFQ, were almost identical to the factors found in the subsample, who provided both FFQ and diet record information with regard to food loadings and model fit. In conclusion, the food intake factors identified were reproducible using two different dietary assessment methods and, furthermore, independent of stratification.

Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population

BACKGROUND

Few studies have examined food consumption patterns in relation to biological risk factors for cardiovascular disease.

OBJECTIVE

The objective of the study was to describe food consumption patterns in the general Dutch population and their association with cardiovascular risk factors.

DESIGN

We performed a cross-sectional study of 19 750 randomly selected men and women aged 20-65 y from 3 Dutch municipalities. Food consumption patterns were identified with the use of factor analysis of data from a validated food-frequency questionnaire.

RESULTS

Three food consumption patterns were identified: the "cosmopolitan" pattern (greater intakes of fried vegetables, salad, rice, chicken, fish, and wine), the "traditional" pattern (greater intakes of red meat and potatoes and lesser intakes of low-fat dairy and fruit), and the "refined-foods" pattern (greater intakes of French fries, high-sugar beverages, and white bread and lesser intakes of whole-grain bread and boiled vegetables). Higher scores for the traditional pattern were associated with older age, and higher scores for the refined-foods pattern were associated with younger age, but both were associated with lower educational level, cigarette smoking, less physical activity, and higher body mass index. Independent of other lifestyle factors and body mass index, the cosmopolitan-pattern score was significantly associated with lower blood pressure and higher HDL-cholesterol concentrations, and the traditional-pattern score was associated with higher blood pressure and higher concentrations of HDL cholesterol, total cholesterol, and glucose. The refined-foods-pattern score was associated with higher total cholesterol concentrations and lower intakes of micronutrients.

CONCLUSION

In this Dutch population, food consumption patterns were independently associated with blood pressure and plasma glucose and cholesterol concentrations.

An approach to construct simplified measures of dietary patterns from exploratory factor analysis

Exploratory factor analysis might work well in elucidating the major dietary patterns prevailing in specific study populations. However, patterns extracted in one study population and their associations with disease risk cannot be reproduced with this data-specific method in other study populations. To construct less population-dependent pattern variables of similar content as original exploratory patterns, we proposed to derive so-called simplified pattern variables. They represent the sum of the unweighted standardised food variables which loaded high at the pattern of interest. Data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study suggest that these simplified pattern variables might adequately approximate factor analysis-based dietary patterns. A simplified pattern variable based on the six highest loading food variables showed a correlation >0.95 with the originally derived factor score, which consisted of forty-seven food variables. Moreover, simplified pattern variables might adequately approximate patterns across different study populations. A simplified pattern variable showed similar factor loadings, ranging from 0.34 to 0.52, as well as similar associations with nutrient intake as a 'western' pattern originally reported from an US study population. These simplified pattern variables can subsequently be used to study pattern associations with disease risk, especially in multi-centre studies. It is therefore an approach that might overcome one of the most frequently claimed limitations of factor analyses applied in epidemiology: their non-comparable risk estimates.

Effects of ethnicity, family income, and education on dietary intake among adolescents

BACKGROUND

The aim of the study is to describe the overall diet and potential effects of gender, ethnicity, family income, and parents' education on dietary patterns in adolescents aged 11 to 20 years who participated in a cohort study in 12 Southern California communities.

METHODS

A validated 131-item youth/adolescent food frequency questionnaire was administrated among 3,201 participants in the Children's Health Study at follow-up visits between 1998 and 2000. Sociodemographic characteristics included ethnicity, family income, and parents' education. Stratified analysis and analysis of covariance were used to describe the intakes of selected nutrients and food groups.

RESULTS

Mean intakes for all nutrients except calcium met 100% of the Recommended Dietary Allowances. Average daily food intakes were below the minimum recommended number of servings for all major food groups. The majority of subjects had an excessive intake of added sugar. A gender difference was found in intakes of energy, total fat (TF), saturated fat (SF), monounsaturated fat (MUSF), and calcium (P < 0.05). Non-Hispanic Whites had the lowest intakes of fruits while Blacks and Asians had significantly higher intakes of vegetables (P < 0.05). Subjects from higher income families had significantly higher intakes of polyunsaturated fat, protein, calcium, and folate and more frequently consumed dairy products. Intakes of TF, SF, MUSF, and cholesterol decreased as parents' education levels increased. Subjects from families with parents who had higher educational attainment were more likely to meet the recommendations of dairy products, fruits, and vegetables.

CONCLUSION

Overall, subjects in our study did not have healthy eating habits. Dietary patterns varied by sex, ethnicity, income, and education.

Food intake patterns and risk of coronary heart disease: a prospective cohort study examining the use of traditional scoring techniques

OBJECTIVE

This study analyses the risk of coronary heart disease (CHD) associated with food intake patterns.

DESIGN

A cohort study with follow-up in 1996 for first admission to hospital for a CHD diagnosis or death caused by CHD (280 cases). Three food patterns were identified from a food frequency questionnaire: (1) a predefined healthy food index; (2) a prudent diet (reflecting frequent intakes of wholemeal cereals, fruit and vegetables); and (3) a Western food pattern (reflecting frequent intakes of meat products, butter and white bread) derived by factor analysis. Both factor scores had a mean of zero and a standard deviation of 1.

SETTING

Copenhagen County, Denmark.

SUBJECTS

A random sample of 7316 adults participated in health examinations conducted either in 1982-1984, 1987, or 1991-1992.

RESULTS

The healthy food index and the Western pattern were not associated with CHD. The prudent pattern was associated with a decreased risk of CHD (Hazard ratio (HR per score unit increase)=0.85; 95% confidence intervals (CI), 0.75, 0.96), but the association vanished (HR=1.06; 95% CI, 0.93, 1.21) after controlling for confounding. Body mass index (BMI) modified the effect of the prudent and the Western patterns on CHD risk, suggesting an inverse association between both patterns and CHD in persons with low BMI, while the risk of CHD seemed to be positively related to the prudent and the Western pattern in those with high BMIs.

CONCLUSIONS

This study showed no association between dietary patterns and CHD risk, but suggests that BMI modifies the relation between diet and CHD risk.

Dietary patterns of Australian adults and their association with socioeconomic status: results from the 1995 National Nutrition Survey

OBJECTIVE

To describe dietary patterns among men and women in the Australian population, and to explore how these varied according to socioeconomic status (SES).

DESIGN

A cross-sectional self-report population survey, the 1995 Australian National Nutrition Survey (NNS), was used.

SETTING

Private dwelling sample, covering urban and rural areas across Australia.

SUBJECTS

Data provided by 6680 adults aged 18-64 who participated in the NNS were used in the analyses.

METHODS

Factor analyses were used to analyse data from a Food Frequency Questionnaire (FFQ) completed by participants. Associations between SES and dietary pattens were assessed using ANOVA.

RESULTS

Separate factor analyses of the FFQ data for men and women revealed 15 factors, accounting for approximately 50% of the variance in both men's and women's dietary patterns. Several gender and SES differences in food patterns were observed. Lower SES males more frequently consumed 'tropical fruits', 'protein foods', and 'offal and canned fish', while high SES males more often ate 'breakfast cereals' and 'wholemeal bread'. Lower SES females more often ate 'traditional vegetables', 'meat dishes' and 'pasta, rice and other mixed foods', while high SES females more frequently ate 'ethnic vegetables' and 'breakfast cereal/muesli'.

CONCLUSIONS

These findings contribute to a better understanding of the dietary patterns that underscore gender-specific SES differences in nutrient intakes. Analyses of the type employed in this study will facilitate the development of interventions aimed at modifying overall eating patterns, rather than specific components of the diet.

Dietary pattern analysis: a new direction in nutritional epidemiology

Recently, dietary pattern analysis has emerged as an alternative and complementary approach to examining the relationship between diet and the risk of chronic diseases. Instead of looking at individual nutrients or foods, pattern analysis examines the effects of overall diet. Conceptually, dietary patterns represent a broader picture of food and nutrient consumption, and may thus be more predictive of disease risk than individual foods or nutrients. Several studies have suggested that dietary patterns derived from factor or cluster analysis predict disease risk or mortality. In addition, there is growing interest in using dietary quality indices to evaluate whether adherence to a certain dietary pattern (e.g. Mediterranean pattern) or current dietary guidelines lowers the risk of disease. In this review, we describe the rationale for studying dietary patterns, and discuss quantitative methods for analysing dietary patterns and their reproducibility and validity, and the available evidence regarding the relationship between major dietary patterns and the risk of cardiovascular disease.

Food intake patterns and body mass index in observational studies

OBJECTIVE

To review studies of patterns of food intake, as assessed by diet index, factor analysis or cluster analysis, and their associations with body mass index or obesity (BMI/Ob).

DESIGN

Systematic literature review MEDLINE search with crosscheck of references.

STUDIES

Thirty observational studies relating food intake patterns to anthropometric information were identified and reviewed. Food intake patterns were defined using a diet index, factor or cluster analysis in 12, nine and nine studies, respectively. Measures of body mass were made concurrently with the diet assessment in all studies, and only in a few cases were the primary outcomes related to BMI/Ob.

RESULTS

The food intake patterns identified could, in most factor or cluster analysis studies, be categorised as: (a) meat, fatty, sweet or energy dense foods; (b) vegetables, fruit, whole grain and low-fat foods; or (c) by high alcohol consumption. The diet indexes were designed to capture a high diversity and/or food combinations matching the recommendations. The relationships with BMI/Ob were inconsistent-ten studies found that intake patterns, which we categorised as fatty, sweet or energy dense were positively associated with BMI/Ob, while similar patterns in four other studies were negatively associated with BMI. The significant associations between diet index score and BMI/Ob were consistently negative, while the associations between factor scores or cluster membership and BMI/Ob were less clear in terms of food intake pattern. Men and women had similar food intake patterns, but food intake patterns were less often positively associated with BMI/Ob in women. In 11 studies, there were no significant associations between food intake pattern and BMI/Ob.

CONCLUSION

This review showed that no consistent associations could be identified between BMI or Ob and food intake patterns, derived from diet index, factor analysis or cluster analysis. However, the heterogeneity of food intake patterns identified by such analyses and the lack of gold standards for the application of these techniques hampers consistent analysis of a relation between food intake patterns and health.

Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study

Dietary pattern analysis has recently received growing attention, as it might be more appropriate in studies of diet-disease associations than the single food or nutrient approach that has dominated past epidemiological research. Factor analysis is a technique which is commonly used to identify dietary patterns within study populations. However, the ability of factor solutions to account for variance of food and nutrient intake has so far remained unclear. The present study therefore explored the statistical properties of dietary patterns with regard to the explained variance. Food intake of 8975 men and 13 379 women, assessed by a food-frequency questionnaire, was aggregated into forty-seven separate food groups. Dietary patterns were identified by principal component analysis and subsequent varimax rotation. Seven factors were retained for both men and women, which accounted for about 31 % of the total variance. The explained variance was relatively high (>40 %) for cooked vegetables, sauce, meat, dessert, cake, bread other than wholemeal, raw vegetables, processed meat, high-fat cheese, butter and margarine. Factor scores were used to investigate associations between the factors and nutrient intake. The patterns accounted for relatively large proportions of variance of energy and macronutrient intake, but for less variance of alcohol and micronutrient intake, especially of retinol, beta-carotene, vitamin E, Ca and ascorbic acid. In addition, factors were related to age, BMI, physical activity, education, smoking and vitamin and mineral supplement use.

Dietary patterns and mortality in Danish men and women: a prospective observational study

The analysis of dietary patterns emerged recently as a possible approach to examining diet-disease relation. We analysed the risk of all-cause and cardiovascular mortality associated with dietary patterns in men and women, while taking a number of potential confounding variables into account. Data were from a prospective cohort study with follow-up of total and cause-specific mortality. A random sample of 3698 men and 3618 women aged 30-70 years and living in Copenhagen County, Denmark, were followed from 1982 to 1998 (median 15 years). Three dietary patterns were identified from a twenty-eight item food frequency questionnaire, collected at baseline: (1) a predefined healthy food index, which reflected daily intakes of fruits, vegetables and wholemeal bread, (2) a prudent and (3) a Western dietary pattern derived by principal component analysis. The prudent pattern was positively associated with frequent intake of wholemeal bread, fruits and vegetables, whereas the Western was characterized by frequent intakes of meat products, potatoes, white bread, butter and lard. Among participants with complete information on all variables, 398 men and 231 women died during follow-up. The healthy food index was associated with reduced all-cause mortality in both men and women, but the relations were attenuated after adjustment for smoking, physical activity, educational level, BMI, and alcohol intake. The prudent pattern was inversely associated with all-cause and cardiovascular mortality after controlling for confounding variables. The Western pattern was not significantly associated with mortality. This study partly supports the assumption that overall dietary patterns can predict mortality, and that the dietary pattern associated with the lowest risk is the one which is in accordance with the current recommendations for a prudent diet.

Dietary patterns among a national random sample of British adults

STUDY OBJECTIVES

To identify groups within the UK male and female population who report similar patterns of diet.

DESIGN

National representative dietary survey, using seven day weighed dietary records, of men and women aged 16-64 years living in private households in Great Britain in 1986-7. Cluster analysis was used to aggregate participants into diet groups.

SETTING

Great Britain.

PARTICIPANTS

1087 men and 1110 women.

RESULTS

93% of men and 86% of women fell into one of four distinct diet groups. Among men the most prevalent diet group was "beer and convenience food" (34% of the male population); second was "traditional British diet" (18%); third was "healthier but sweet diet" (17.5%) and fourth was "healthier diet " (17%). Among women, the most prevalent diet group was " traditional British diet" (32%); second, was "healthy cosmopolitan diet" (25%); third was a "convenience food diet" (21%); and fourth was "healthier but sweet diet" (15%). There were important differences in nutrient profile, sociodemographic and behavioural characteristics between diet groups.

CONCLUSIONS

Cluster analysis identified four diet groups among men and four among women, which differed not only in terms of reported dietary intakes, but also with respect to nutrient, social and behavioural profiles. The groups identified could provide a useful basis for development, monitoring and targeting of public health nutrition policy in the UK.

Patterns of health-related behaviour and their cross-cultural validity--a comparative study on two populations of young people

The study aimed at exploring health-related behaviour patterns among young people. The approach was cross-cultural and the study was focused on identifying culturally valid behaviour patterns in two countries, Finland (F) and Switzerland (CH). Data came from two surveys and included 16- and 18-year-old respondents (F: study year 1993, n = 280, CH: study year 1992/3, n = 272). Three intake behaviours--eating, drinking and smoking--were analysed by means of cluster and logistic regression analyses. Three cross-culturally valid behaviour clusters emerged: a healthy, an unhealthy and a mixed pattern where unhealthy eating behaviours were combined with non-smoking and low alcohol use. The determinants of the patterns were tested by comparing the two countries in relation to the socio-demographic characteristics of the young people that belonged in the same cluster. In both countries the structure of the determinants was almost identically indicating high cross-cultural stability. The study suggests that among young people of this age there is clear and cross-culturally consistent patterning of health-related behaviours.

Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire

BACKGROUND

Recently, the analysis of dietary patterns has emerged as a possible approach to examining diet-disease relations.

OBJECTIVE

We examined the reproducibility and validity of dietary patterns defined by factor analysis using dietary data collected with a food-frequency questionnaire (FFQ).

DESIGN

We enrolled a subsample of men (n = 127) from the Health Professionals Follow-up Study in a diet-validation study in 1986. A 131-item FFQ was administered twice, 1 y apart, and two 1-wk diet records and blood samples were collected during this 1-y interval.

RESULTS

Using factor analysis, we identified 2 major eating patterns, which were qualitatively similar across the 2 FFQs and the diet records. The first factor, the prudent dietary pattern, was characterized by a high intake of vegetables, fruit, legumes, whole grains, and fish and other seafood, whereas the second factor, the Western pattern, was characterized by a high intake of processed meat, red meat, butter, high-fat dairy products, eggs, and refined grains. The reliability correlations for the factor scores between the 2 FFQs were 0.70 for the prudent pattern and 0.67 for the Western pattern. The correlations (corrected for week-to-week variation in diet records) between the 2 FFQs and diet records ranged from 0.45 to 0.74 for the 2 patterns. In addition, the correlations between the factor scores and nutrient intakes and plasma concentrations of biomarkers were in the expected direction.

CONCLUSIONS

These data indicate reasonable reproducibility and validity of the major dietary patterns defined by factor analysis with data from an FFQ.

Dietary patterns of adults in Québec and their nutritional adequacy

The purpose of this study was to identify dietary patterns among adults in Québec and to determine their relationship to nutritional adequacy of the diet. We used 24-hour food recall data on 2,104 adults from the Québec nutrition survey (1990). Nutritional adequacy was assessed based on the 1990 Nutrition Recommendations for Canadians; dietary patterns were assessed via a factor analysis of the 30 food groups consumed. The three major patterns identified ('high-energy density', 'traditional' and 'health-conscious') explained 18% of the variation in food intake. Only the 'health-conscious' pattern correlated positively with the four chosen indicators of nutritional adequacy. Generally, men scored positively on the 'high-energy density' and the 'traditional' pattern whereas women scored positively on the 'health-conscious' pattern. Aside from sex, scoring was most related to age and education. The use of these patterns to define and target nutrition interventions should be tested in the aim of improving the effectiveness of health promotion.

Longitudinal dietary changes between 1984-5 and 1991-2 in British adults: association with socio-demographic, lifestyle and health factors

The study aimed to examine dietary changes and their associations with demographic, lifestyle and health variables in a random sample of British adults. The Health and Lifestyle Survey of 1984-5 (HALS1) identified four main dietary components by principal component analysis from food frequency data. Comparison of the HALS1 dietary component scores with those of the follow-up survey of 1991-2 (HALS2) for the same individuals revealed increases on component 1 (high weightings for fresh fruit, salads, 'brown' bread, fruit juice and green vegetables but low weightings for chips, fried food and processed meat). There were substantial decreases on component 2 (high weightings for puddings/pies, cake, potatoes, biscuits, preserves, pulses and meat), small increase on component 3 (high weightings for crisps, soft drinks and chips) and increases on component 4 (high weightings for confectionery, biscuits and cake and low weightings for vegetables of all kinds). Except for women on component 3 the changes were all significant, P < 0.001. Unadjusted score changes were smallest in elderly respondents for all components. Differences in score changes between groups were based on an analysis of covariance adjusting for the HALS1 score. On component 1 the largest score increases were associated with non-manual groups, improvements in lifestyle and good health. For component 2 the greatest changes in score were associated with changes in household size, smoking habit and heavy drinking. Score increases on component 3 were also associated with heavy drinking, whilst the largest rises on component 4 were amongst the non-manual, the non-drinkers and the non-smokers and, for women only, those who had few malaise symptoms or who lived in Scotland. The results show that there have been overall dietary changes and that changes have been associated with longitudinal alterations in socio-demographic, lifestyle and health circumstances.

Nutrient intake according to education, smoking, and alcohol in Italian women

The control group of a hospital-based case-control study on breast cancer was used to assess the relationships between education, smoking habits, alcohol consumption, and intake of selected macro- and micronutrients in Italian women. The study subjects were 2,588 women admitted to a network of hospitals in various Italian regions for nonneoplastic, acute diseases unrelated to long-term changes in the diet. Although relatively few differences were observed, less educated subjects consumed more linoleic acid and polyunsaturated fats than did more educated women. Smoking habits were associated with the largest differences in selected antioxidant vitamins. Significant differences were observed for beta-carotene and vitamin C intake, with an 11% higher intake of beta-carotene and a 12% higher intake of vitamin C in ex-smokers than in current smokers. Heavier alcohol drinkers tended to consume more retinol and iron but less beta-carotene than did moderate or nondrinkers. Thus the differences in macro- and micronutrient intake were generally moderate across categories of education, smoking, and alcohol consumption in this data set of Italian women. Nonetheless, they confirm the importance of allowing for these variables in analyzing the relationship between nutritional factors and disease risk.

Dietary survey "HEUREKA" 1991: dietary intake of a Swiss collective assessed by a self-administered 24-hour recall questionnaire

Food consumption (divided into 10 food groups) as well as energy and main nutrient intake of a Swiss collective (n = 3653) aged 7 years and older was studied. The caloric density was much improved for all five age groups considered as compared with findings in former studies. Carbohydrates gained and alcohol lost significance as main energy suppliers. These results indicate a positive trend in the dietary habits of the collective and suggest an improvement in the dietary habits of the Swiss population as a whole.

Dietary patterns and their associations with demographic, lifestyle and health variables in a random sample of British adults

The present study aimed to identify dietary patterns, from the frequency of consumption of food items and some semi-quantitative data, in a random sample of 9003 British adults, and to examine the associations of the main dietary patterns with demographic factors, lifestyle habits, measures of self-reported health and mortality. Principal component analysis was used to identify four main dietary patterns, and analysis of variance employed to examine the characteristics associated with them. The four components explained, respectively, 10.2, 7.3, 5.1 and 4.9% of the total dietary variation. Component 1, frequent fruit, salad and vegetable consumption with infrequent consumption of high-fat foods, was associated with middle age, non-manual socio-economic groups, non- and ex-smokers, 'sensible' drinkers, small households, the south of the country, and self-assessed 'excellent' or 'good' health. Component 2, frequent consumption of high-starch foods, most vegetables and meat, was popular with young men, older men and women, large households, non-smokers, non-drinkers and those who viewed themselves as healthy. Component 3, frequent consumption of high-fat foods, was predominantly consumed by young people, smoking women, 'high-risk' drinkers, and men reporting many illness and/or malaise symptoms. Component 4, high positive loadings for sweets, biscuits and cakes, with negative weightings for vegetables, was most favoured by students, the elderly, those living alone, residents in Scotland, but not those in central England, and those who did not smoke. For women only the first component was associated with low all-cause mortality, and the third component with excess mortality.

Dietary behaviours and sociocultural demographics in Northern Ireland

Subjects aged 16-64 years (592; 258 men and 334 women), randomly selected from the population of Northern Ireland, kept a 7 d weighed record of all food and drink consumed. Social, personal and anthropometric data were also collected. From the weighed records food consumption was described in terms of forty-one food groups. Using principal components analysis, four distinct dietary patterns were generated which were identified as a traditional diet, a cosmopolitan diet, a convenience diet and a 'meat and two veg' diet. These dietary patterns were then correlated with sociocultural, lifestyle and anthropometric variables. It is clear that dietary behaviour is influenced by a number of inter-related sociocultural demographics and that identifiable population groups in Northern Ireland have different dietary behaviours.