Identification of dietary patterns associated with elevated blood pressure among Lebanese men: A comparison of principal component analysis with reduced rank regression and partial least square methods

Dietary insulin index, dietary insulin load and dietary patterns and the risk of metabolic syndrome in Hoveyzeh Cohort Study

Postprandial insulin secretion has been associated with metabolic disorders such as hyperlipidemia and type 2 diabetes. Therefore, we aimed to explore the relationship between dietary insulin indices and dietary pattern with the risk of Metabolic Syndrome (MetS). The participants of the present cross-sectional study were included among the individuals who participated in the Hoveyzeh Cohort Study (HCS). A total of 3905 Iranian adults, aged 35-70 years, are included in the current analysis. The Food Frequency Questionnaire (FFQ) is used to calculate the dietary Insulin Index (DII), Insulin Load (DIL), and dietary pattern. Dietary pattern was derived using Reduced-Rank Regression (RRR) based on intake of protein (g/day), fiber (g/day), fat (g/day), magnesium (mg/day), and dietary insulin index were considered as response variables. The Generalized Linear Model was used to obtain the odds ratio (OR) and 95% confidence interval (CI) for MetS based on gender, while considering quartiles of DIL, DII scores, and dietary pattern, adjusted for potential confounders. The mean ± SD of age and BMI of the participants in the top quartile of DIL were 45.72 ± 8.05 years and 28.25 ± 5.02 kg/m2, respectively. The mean ± SD of DII was 40.53 ± 4.06 and the mean ± SD of DIL was 117,986.1 ± 30,714.06. A significant positive association was observed between DIL and MetS in women after adjusting for confounding factors (OR: 1.51; 95% CI 1.16; 1.96). No significant association was seen between DIL, DII, and MetS among men. A derived dietary pattern characterized by high intakes of fruits, sugar, sweet deserts, Whole Grains, and dairy was associated with an increased risk of MetS in adjusted model2 among women (OR: 1.41; 95% CI 1.13; 1.75) and men in the same model (OR: 2.09; 95% CI 1.35; 3.21).However, the final model was significant just for men (OR: 2.08; 95% CI 1.35; 3.21) and not for women (OR: 1.24; 95% CI 0.96; 1.60). Our findings showed that adherence to a diet with a high insulin load can increase the risk of MetS in women. In addition, a derived dietary pattern by RRR indicated that a diet rich in fruits, sugar, sweet deserts, whole Grains, and dairy is related to increased risk of MetS in both men and women.

Dietary patterns and associations with metabolic risk factors for non-communicable disease

Unhealthy dietary habit is a major contributor to the burden of non-communicable diseases such as cardiovascular diseases, diabetes, and hypertension, especially the increased burden in low- and middle-income countries. Evidence of the association between specific dietary patterns and health outcomes is scarce in sub-Saharan African countries. This study aimed to identify principal dietary patterns and evaluate associations with metabolic risk factors including hypertension, overweight/obesity, and abdominal obesity in Northwest Ethiopia. A community-based cross-sectional survey was conducted among adults in Bahir Dar, Northwest Ethiopia, from 10 May 2021 to 20 June 2021. Dietary intake was collected using a validated food frequency questionnaire. Anthropometric (weight, height, hip/waist circumference) and blood pressure measurements were performed using standardized tools. Principal component analysis was conducted to derive dietary patterns. Chi-square and logistic regression analyses were used to examine the association between dietary patterns and metabolic risk factors and with sociodemographic and individual risk factors. This study derives two types of dietary patterns: 'westernized' dietary pattern, which is positively correlated with consumption of meat, dairy, fast foods, alcohol, fish, sweet/sugary foods, and fruits, and 'traditional' dietary pattern, which is positively correlated with intake of cereals, vegetables, legumes, roots/tubers, coffee, and oils. The prevalence of hypertension was significantly lower in adults with higher quantiles of westernized dietary pattern (AOR = 0.28, 95% CI 0.13 to 0.60; p < 0.01; quantile three); and (AOR = 0.35, 95% CI 0.17, 0.75; p < 0.01; quantile four). Younger, married, and middle-income adults were associated with the highest quantile of the westernized pattern. Being females and having middle income associated with the highest quantile of traditional dietary patterns (p < 0.05). This study suggested two types of dietary patterns, westernized and traditional, among adults in Northwest Ethiopia and revealed a significant association with metabolic risk factors like hypertension. Identifying the main dietary patterns in the population could be informative to consider local-based dietary recommendations and interventions to reduce metabolic risk factors.

Association of the Protective Dietary Pattern for Blood Pressure with Elevated Blood Pressure and Hypertension among Chinese Children and Adolescents Aged 6-17 Years Old: Data from China Nutrition and Health Surveillance (2015-2017)

Studies focused on the association between dietary patterns and elevated blood pressure (BP) and hypertension (HTN) among children and adolescents remain insufficient. This study aimed to explore a dietary pattern that could be helpful for the prevention of abnormal BP and to investigate the association between this dietary pattern and elevated BP and HTN among Chinese children and adolescents. A total of 52,080 Chinese children and adolescents aged 6~17 years old from the China Nutrition and Health Surveillance (CNHS) 2015-2017 were included in the current study. The reduced rank regression (RRR) method was applied to derive a dietary pattern that is associated with BP. Multivariable logistic regression was used to assess the association between dietary pattern (DP) and elevated BP and HTN. The Dietary Approach to Stop Hypertension (DASH) score was also calculated for each participant as a comparative method to validate the dietary pattern derived with the RRR method. A protective dietary pattern (PDP) for BP among Chinese children and adolescents was derived, which was characterized by high intakes of dairy products, mushrooms/edible fungi, fresh vegetables, fresh fruits, fresh eggs, aquatic products, mixed legumes, soybeans and related products, offal, dried fruits, and coarse cereals, with low intakes of refined grains. After multiple adjustments, there were significant inverse associations between PDP scores and the odds of elevated BP and HTN (elevated BP: Q5 vs. Q1, OR = 0.849, 95%CI = 0.755-0.931, P-trend < 0.05; HTN: Q5 vs. Q1, OR = 0.795, 95%CI = 0.694-0.911, P-trend < 0.05). The DASH diet was also observed to have protective effects on elevated BP in model I (Q5 vs. Q1, OR = 0.899, 95%CI = 0.828-0.975, P-trend < 0.05), but was not observed to have protective effects on HTN (HTN: Q5 vs. Q1, OR = 0.958, 95%CI = 0.876-1.048, P-trend > 0.05). The current study suggested that greater adherence to the PDP for BP among Chinese children and adolescents might be associated with lower odds of elevated BP and HTN.

Comparison of data-driven identified hypertension-protective dietary patterns among Chinese adults: based on a nationwide study

PURPOSE

Diet pattern (DP) is a key modifiable and cost-effective factor in hypertension (HTN) management. The current study aimed to identify and compare the hypertension-protective DPs among Chinese adults.

METHODS

52,648 participants aged over 18 years were included from China Nutrition and Health Surveillance (CNHS) 2015-2017. Reduced rank regression (RRR) and partial least square regression (PLS) was applied to identify the DPs. Multivariable-adjusted logistic regression was used to assess the association between the DPs and HTN.

RESULTS

DPs derived by RRR and PLS were both featured by higher consumption of fresh vegetables and fruits, mushrooms and edible fungi, seaweeds, soybeans and related products, mixed legumes, dairy products, fresh eggs, and lower of refined grain consumption. Compared to the lowest quintile, participants in the highest quintile had lower odds of HTN (RRR-DP: OR = 0.77, 95% CI = 0.72-0.83; PLS-DP: OR = 0.76, 95% CI = 0.71-0.82; all p < 0.0001). Simplified DP scores were observed the same protective tendencies (Simplified RRR-DP: OR = 0.81, 95% CI = 0.75-0.87; Simplified PLS-DP: OR = 0.79, 95% CI = 0.74-0.85; all p < 0.0001) and showed effective extrapolation in subgroups defined by gender, age, location, lifestyle, and different metabolic conditions.

CONCLUSIONS

The identified DPs had high conformity with East Asian dietary habits, and significantly negative associations with HTN among Chinese adults. The simplified DP technique also indicated the potential for improving the extrapolation of the results of DP analysis related to HTN.

The association of dietary patterns with muscle mass and strength in old age: The Hordaland Health Study

PURPOSE

The single nutrient approach in nutrition research lacks the ability to account for synergistic relationships between dietary components. Current evidence suggests that diet quality, reflecting overall dietary intake, may influence muscle health. In a community-based observational study in Western Norway, we examined dietary patterns in relation to muscle mass and strength at age 67-70.

METHODS

The current analysis was conducted in men and women of The Hordaland Health Study (HUSK), who participated in both the second (HUSK2) and third study wave (HUSK3). Dietary patterns were extracted by principal component analysis (PCA) on food frequency questionnaire (FFQ) data. Individual dietary pattern scores (DPS) for HUSK2 (age 46-49) and HUSK3 (age 67-70), and overall DPS (oDPS) were calculated. Outcome variables were appendicular skeletal muscle mass (ASMM) and handgrip strength (HGS) measured in HUSK3. The relationships of HUSK3 DPS and oDPS with ASMM and HGS were assessed by multivariate linear regression analysis adjusted for potential confounding factors.

RESULTS

We identified three distinct dietary patterns, labelled 'Western', 'Healthy', and 'Sweets-focused'. A significant positive association was observed between the oDPS for the 'Healthy' dietary pattern and ASMM in both men and women at age 67-70. No significant associations were found between HUSK3 DPS or oDPS for any of the identified dietary patterns and HGS in our population.

CONCLUSION

Higher oDPS on a dietary pattern predominantly rich in fish, vegetables, nuts and seeds, fruit and berries, and eggs was associated with better ASMM at age 67-70. To establish the influence of diet quality on muscle health, further long-term studies with repeated dietary assessments are warranted.

The dietary patterns derived by reduced-rank regression in association with Framingham risk score and lower DASH score in Hoveyzeh cohort study

The relationship between dietary patterns (DPs) and cardiovascular disease (CVD) has been the subject of much research, but given the significance of this disease, studying the factors affecting it through different methodological considerations is of utmost importance. This study aimed to investigate the association between the four dietary patterns (DPs) derived from reduced-rank regression (RRR) and the risk of CVD predicted by the Framingham Risk Score (FRS) in the Arab residence of Khuzestan, Iran. Furthermore, the predefined Dietary Approaches to Stop Hypertension (DASH) would be used as a comparative model to assess the validity of the extracted DPs. In this cross-sectional study, 5799 individuals aged 35-70 without a CVD diagnosis were selected among the participants of the Hoveyzeh cohort study (HCS). The Risk of CVD was assessed using the FRS model. A semi-quantitative food frequency questionnaire evaluated dietary intake. Four DPs were derived using RRR with 28 food groups as predictors and total protein (g/d), fiber(g/d), fat(g/d), and magnesium intake (mg/d) as response variables. Multinomial and binary logistic regression were used to assess the relationship of DPs with intermediate (10-20%) and high (> 20%) levels of FRS and lower DASH scores (< 4.5), respectively. Four primary DPs were derived, which explained 89.10 of the total explained variance in participants' dietary intake. Multinomial regression was applied between FRS (10-20%) and (> 20%) across quartiles of four identified DPs. After adjustment for potential confounders, higher tendency to 1st and 2nd DPs in Model 1, OR = 4.67 (95% CI 3.65; 6.01), OR = 1.42 (95% CI 1.13; 1.79) were presented accordingly. The 1st DP, characterized by higher intake of refined grains and lower intake of vegetables oil, sugar, mayonnaise and artificial juices, the 2nd DP characterized by higher intake of hydrogenated fat and lower consumption of tomato sauce and soft drink was associated with greater odds of CVD with the intermediate level of FRS. However, higher adherence to the 3rd DP, characterized by higher intake of fruits, vegetables and legumes and lower intake of fish, egg, red meat, processed meat, mayonnaise, sugar and artificial juices, the 4th DP characterized by higher intake of coffee, nuts and lower intake of sugar, mayonnaise and artificial juices was associated with a lower risk of FRS. Moreover, lower DASH score considered in binary logistic regression across quartiles of four identified dietary patterns. 1st and 2nd DPs were directly related to lower DASH scores, while 3rd and 4th DPs had high comparability with the DASH diet and inversely contributed to the lower DASH score. Total DASH score was significantly correlated to four derived DPs. Our findings confirm the current knowledge regarding the beneficial effects of healthy plant-based DPs and the avoidance of high-fat and processed foods to prevent CVD.

A comparison of principal component analysis, partial least-squares, and reduced-rank regressions in the identification of dietary patterns associated with hypertension: YaHS-TAMYZ and Shahedieh cohort studies

Limited data exist on the advantage of data reduction hybrid methodologies for evaluating the relationship between dietary patterns (DPs) and chronic diseases and they have led to inconsistent results. This study aimed to investigate the association between DPs extracted using principal component analysis (PCA), partial least-squares (PLS), and reduced-rank regressions (RRRs) in identifying DPs associated with hypertension (HTN) risk. The current study was conducted in the context of two cohort studies accomplished in Iran. DPs were generated using PCA, PLS, and RRR methods. Log-binomial logistic regression test was used to assess the association between DPs and the risk of HTN. From a total of 12,403 included participants aged 20-70 years, 507 incident cases of confirmed HTN were identified. The PCA-DP2 was associated with HTN in the fully adjusted model (T3 vs. T1: RR: 0.737, 95% CI: 0.57-0.93, P _trend = 0.013). The PLS-DP2 and HTN risk were inversely associated in the multivariate model (T3 vs. T1: RR: 0.704, 95% CI: 0.54-0.91, P _trend = 0.013). The RRR-DP2 was associated with an increased risk of HTN (T3 vs. T1: RR: 1.412, 95% CI: 1.11-1.80, P _trend = 0.007). Our findings suggest that the RRR method reveals stronger results in association with HTN risk. However, further investigations are required to confirm the association between DPs derived by PLS and RRR methods by incorporating biomarkers related to HTN as the response variables.

A Review on Dietary Patterns and Double Burden of Malnutrition: Knowledge Gaps for Future Research

Nutrition transition is characterized by shifts in dietary patterns (DPs) and is one of the factors associated with the double burden of malnutrition (DBM). Evidence indicates correlations between DPs and obesity, diabetes, and cardiovascular diseases. However, little is known on how DP influences DBM. This mini-review examined DP-DBM relationship among adults along with different DP approaches and DBM definitions. A structured search of peer-reviewed articles was performed from Web of Science. Keywords related to "dietary patterns," "double burden of malnutrition," and "adults" were used. A total of 133 studies were included. Results showed that factor analysis was the predominant DP analysis method. DBM was frequently assessed at the national level and defined as the coexistence of overweight/obesity and underweight. From the 133 studies, only four articles investigated DP-DBM association and suggested that healthier DPs positively improved DBM. Significant knowledge gaps remain, including (1) application of a combination of DP approaches, (2) evaluation of individual-level and household-level DBM, and (3) inconsistency of micronutrient deficiencies and non-communicable disease indicators in DBM definition. This review revealed paucity of studies on the nexus of DPs and DBM. Future research is imperative to establish evidence on the link between food patterns and multiple burdens of malnutrition.

Association between a priori and a posteriori dietary patterns and the risk of type 2 diabetes: a representative cohort study in Taiwan

The present study aimed to investigate the relationship between dietary patterns and the risk of type 2 diabetes mellitus (T2DM) among Taiwanese individuals. Data were collected using a nationwide cohort study (2001-15) from the Triple-High Database. Dietary intake was assessed using the twenty-group food frequency questionnaire and used to calculate alternate Mediterranean diet (aMED) and Dietary Approaches to Stop Hypertension (DASH) scores. Principal component analysis (PCA) and partial least-squares (PLS) regression were used to derive dietary patterns, with incident T2DM as the outcome. Multivariable-adjusted hazard ratios and 95 % confidence intervals were calculated using time-dependent Cox proportional hazards (Cox PH) regression analysis, and subgroup analyses were performed. A total of 4705 participants were enrolled in the study, and 995 had newly developed T2DM during the median 5⋅28-year follow-up period (30⋅7 per 1000 person-years). Six dietary patterns were extracted (PCA: Western, prudent, dairy and plant-based; PLS: health-conscious, fish-vegetable and fruit-seafood). The highest aMED score quartile had a 25 % (hazard ratio 0⋅75; 95 % CI 0⋅61, 0⋅92; P = 0⋅039) lower risk of T2DM than the lowest quartile. This association remained significant after adjustment (adjusted hazard ratio 0⋅74; 95 % CI 0⋅60, 0⋅91; P = 0⋅010), and no effect modifier was found for aMED. The DASH scores, PCA and PLS dietary patterns were not significant after adjustment. In conclusion, high adherence to a MED-type dietary pattern by Taiwanese foods was associated with a lower risk of T2DM in the Taiwanese population, regardless of unhealthy lifestyle habits.

The Obesity-Related Dietary Pattern Is Associated with Higher Risk of Sleep Disorders: A Cross-Sectional Study from NHANES

Evidence on the association between dietary patterns and sleep disorders is limited and controversial. In addition, studies evaluating the effect of dietary patterns on sleep disorders have seldom considered the critical role of obesity. We aimed to explore obesity-related dietary patterns and evaluate their impact on sleep disorders using data from the National Health and Nutrition Examination Survey 2005–2014. In total, 19,892 participants aged over 20 years with two-day dietary recalls were enrolled. Obesity-related dietary patterns explaining most variance in waist circumference and BMI simultaneously were extracted from twenty-six food groups by the using partial least squares method. Sleep disorder and sleep duration, which were defined by self-reported questions, were the primary and the secondary outcome, respectively. Generalized linear models were performed to estimate the association of sleep disorders and sleep duration with dietary patterns. Two types of dietary patterns were identified. The “high fats, refined grains, and meat” pattern was characterized by high intakes of solid fats, cured meat, potatoes, refined grains, meat, cheese, and added sugars. The “low whole grains, vegetables, and fruits” pattern was characterized by low intakes of oils, whole grains, nuts and seeds, milk, fruits, and several vegetables. Participants with the highest adherence to the “high fats, refined grains, and meat” pattern had a higher risk for sleep disorders (OR (95%CI): 1.43 (1.12, 1.84)) and shorter sleep duration (β (95%CI): −0.17 (−0.26, −0.08)) compared to those with the lowest adherence. The corresponding associations for the “low whole grains, vegetables, and fruits” pattern were only significant for sleep duration (β (95%CI): −0.26 (−0.37, −0.15)). Our results found that the dietary pattern characterized by high solid fats, cured meat, potatoes, refined grains, meat, cheese, and added sugars, was associated with a higher risk for sleep disorders and shorter sleep duration.

Dietary patterns before and during pregnancy and small for gestational age in Japan: a prospective birth cohort study

Background

Although small for gestational age (SGA) is a serious problem worldwide, the association of dietary patterns before and during pregnancy with SGA risk is unclear. We evaluated this association among Japanese pregnant women using three methods: reduced rank regression (RRR) and partial least squares (PLS), methods for extracting dietary patterns that can explain the variation of response variables, and principal component analysis (PCA), a method for extracting dietary patterns of the population.

Methods

Between July 2013 and March 2017, 22,493 pregnant women were recruited to the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study, a population-based prospective birth cohort study in Japan. Information on dietary intake was obtained using food frequency questionnaires, and dietary patterns were extracted using RRR, PLS, and PCA. Information on birth weight was obtained from obstetric records, and the birth weight SD score and SGA were defined by the method of the Japan Pediatric Society. The associations of dietary patterns with birth weight SD score and SGA risk were investigated using multiple linear regression and multiple logistic regression, respectively.

Results

A total of 17,728 mother-child pairs were included. The birth weight SD score was 0.15 ± 0.96, and the prevalence of SGA was 6.3%. The dietary patterns extracted by RRR and PLS were similar and characterized by a high intake of cereals and fruits and a low intake of alcoholic and non-alcoholic beverages in both pre- to early pregnancy and from early to mid-pregnancy. Higher adoption of the RRR and PLS patterns in both periods was associated with an increased birth weight SD score and lower risk of SGA. In contrast, the PCA1 pattern was not associated with birth weight SD score or SGA risk in either period. Although the PCA2 pattern was associated with increased birth weight SD score from early to mid-pregnancy, no other associations with birth weight SD score or SGA risk were observed.

Conclusions

The dietary pattern with a high intake of cereals and fruits and a low intake of alcoholic and non-alcoholic beverages before and during pregnancy was associated with a decreased SGA risk in Japan.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-022-00808-7.

Visceral adiposity-related dietary patterns and the risk of cardiovascular disease in Iranian adults: A population-based cohort study

Background

Visceral obesity is a significant predictor of cardiovascular disease (CVD). Diet may associate with CVD risk through its effects on visceral adiposity. This study aimed to find dietary patterns (DPs) related to indicators of visceral adiposity and to determine whether the DPs were associated with CVD risk.

Methods

This prospective study included 2,496 participants of the Tehran Lipid and Glucose Study (TLGS) without CVD, who were followed from the third study examination (2005–2008; baseline) to March 2018. DPs at baseline were determined using reduced rank regression (RRR) and partial least squares regression (PLS). The response variables were age and BMI-adjusted waist circumference (WC) and age-adjusted visceral adiposity index (VAI).

Results

Two and three DPs were retained with RRR and PLS, respectively. The first patterns of each method were mainly characterized by adjusted-WC (RRR: 10.8%, PLS: 8.6%); none of them were associated with CVD risk. The second pattern of RRR and the third pattern of PLS were mainly explained by adjusted-VAI (RRR: 3.3, PLS: 2.1%). After adjusting for CVD risk factors, the hazard ratios [95% confidence intervals (CI)] for CVD in the second and third tertiles of the RRR-pattern 2 were 1.76 (1.15, 2.69) and 1.55 (1.00, 2.43) vs. the first tertile (p-trend: 0.058). This pattern had high positive loadings for non-leafy vegetables, pickled vegetables, fried vegetables, and bread and high negative loadings for eggs, cakes, butter, jam-honey, red meat, poultry, fish, juice, non-fermented dairy, and fruits. Per one SD increase in PLS-pattern 3 score, the risk of CVD was 19% higher (95%CI = 3–38%). This positive association was also observed across tertiles of the pattern (p-trend: 0.032). This pattern was characterized by high intakes of leafy vegetables, non-leafy vegetables, organ meat, soft drinks, olive oil, pickled vegetables, fried vegetables, and bread and low intakes of biscuits, cakes, butter, eggs, and non-fermented dairy.

Conclusion

For each of the RRR and PLS approaches, a visceral-related DP that was positively linked to CVD was identified. These two patterns had a modest correlation. The pattern generated by PLS explained more variations in food groups and offered stronger evidence of association with CVD than the RRR-derived pattern.

Using Multiple Statistical Methods to Derive Dietary Patterns Associated with Cardiovascular Disease in Patients with Type 2 Diabetes: Results from a Multiethnic Population-Based Study

Background

There are few reports on the relationship between dietary patterns and cardiovascular disease (CVD) risk in patients with type 2 diabetes (T2D). This study aimed to explore relationships between dietary patterns and CVD risk in the T2D population using multiple statistical analysis methods.

Methods

A total of 2,984 patients with T2D from the Xinjiang Multi-Ethnic Cohort, 555 of whom were suffering from CVD, were enrolled in this study. Participants' dietary intake was measured by the semiquantitative food frequency questionnaire (FFQ). Three statistical methods were used to construct dietary patterns, including principal component analysis (PCA) method, reduced-rank regressions (RRR) method, and partial least-squares regression (PLS) method. Then, the association between dietary patterns and CVD risk in T2D patients was analyzed by logistic regression. After excluding participants with CVD, the associations between dietary patterns and 10-year CVD risk scores were subsequently evaluated to reduce reverse causality.

Results

In this study, four dietary patterns were identified by three methods. Adjustment for confounding factors, subjects with the highest scores on the "high-protein and high-carbohydrate" patterns derived from PCA, RRR, and PLS had higher odds of CVD than those with the lowest scores (OR: 2.89, 95% CI: 2.11-3.96, P _trend < 0.001; OR: 2.96, 95% CI: 2.17-4.03, P _trend < 0.001; OR: 2.01, 95% CI: 1.50-2.70, P _trend < 0.001, respectively). However, the dietary pattern of PCA-prudent was not significantly related to the odds of having CVD in T2D patients (adjusted OR_Q4vsQ1: 0.93, 95% CI: 0.70-1.24, P _trend =0.474). Interestingly, we also found significant associations between "high-protein and high-carbohydrate" patterns and the elevated predicted 10-year CVD risk in T2D patients (all P _trend < 0.05).

Conclusion

The positive correlation between "high-protein and high-carbohydrate" patterns and CVD risk in T2D patients was robust across all three data-driven approaches. These findings may have public health significance, encouraging an emphasis on food choices in the usual diet and promoting nutritional interventions for patients with T2D to prevent CVD.

The Association of Dietary Pattern with the Risk of Prehypertension and Hypertension in Jiangsu Province: A Longitudinal Study from 2007 to 2014

Hypertension is the most common chronic disease and the primary risk factor for cardiovascular diseases. Prehypertension is closely related to a variety of cardiovascular disease risk factors during the development of hypertension. The objective of this study was to explore the relationship between dietary patterns and hypertension in Jiangsu Province. Specifically, we included the participants from 2007 and then followed up in 2014 in the Jiangsu Province of China and collected information from food frequency questionnaires, anthropometric measurements, and disease self-reports. A total of 1762 women and men were included in the final analysis. We extracted four dietary patterns using factor analysis, calculated the pattern-specific factor scores, and divided the scores into quartiles, which increased from Q1 to Q4. Compared with participants in Q1, an increased risk of high diastolic blood pressure was found in Q4 of the snack dietary pattern. Additionally, participants in Q2–Q4 of the frugal dietary pattern were found to have a positive association with abnormal blood pressure. However, the results found in the frugal dietary pattern vanished after adjusting more confounders in Q4 of high systolic blood pressure. We found that some food items were associated with hypertension and prehypertension. The overconsumption of salt and alcohol are risk factors for both prehypertension and hypertension. Added sugar and saturated fatty acids are risk factors for hypertension, which may provide suggestions for the residents in China to change dietary habits to prevent prehypertension and hypertension.

Associations between dietary patterns and cardiovascular disease risk in Canadian adults: a comparison of partial least squares, reduced rank regression, and the simplified dietary pattern technique

BACKGROUND

Hybrid methodologies have gained continuing interest as unique data reduction techniques for establishing a direct link between dietary exposures and clinical outcomes.

OBJECTIVES

We aimed to compare partial least squares (PLS) and reduced rank regression (RRR) in identifying a dietary pattern associated with a high cardiovascular disease (CVD) risk in Canadian adults, construct PLS- and RRR-based simplified dietary patterns, and assess associations between the 4 dietary pattern scores and CVD risk.

METHODS

Data were collected from 24-h dietary recalls of adult respondents in the 2 cycles of the nationally representative Canadian Community Health Survey (CCHS)-Nutrition: CCHS 2004 linked to health administrative databases (n = 12,313) and CCHS 2015 (n = 14,020). Using 39 food groups, PLS and RRR were applied for identification of an energy-dense (ED), high-saturated-fat (HSF), and low-fiber-density (LFD) dietary pattern. Associations of the derived dietary pattern scores with lifestyle characteristics and CVD risk were examined using weighted multivariate regression and weighted multivariable-adjusted Cox proportional hazard models, respectively.

RESULTS

PLS and RRR identified highly similar ED, HSF, and LFD dietary patterns with common high positive loadings for fast food, carbonated drinks, salty snacks, and solid fats, and high negative loadings for fruit, dark green vegetables, red and orange vegetables, other vegetables, whole grains, and legumes and soy (≥|0.17|). Food groups with the highest loadings were summed to form simplified pattern scores. Although the dietary patterns were not significantly associated with CVD risk, they were positively associated with 402-kcal/d higher energy intake (P-trends < 0.05) and higher obesity risk (PLS: OR: 2.09; 95% CI: 1.62, 2.70; RRR: OR: 1.76; 95% CI: 1.44, 2.17) (P-trends < 0.0001) in the fourth quartiles.

CONCLUSIONS

PLS and RRR were shown to be equally effective for the derivation of a high-CVD-risk dietary pattern among Canadian adults. Further research is warranted on the role of major dietary components in cardiovascular health.

Dietary Patterns and Their Association with Sociodemographic and Lifestyle Factors in Filipino Adults

Recent studies have investigated dietary patterns to assess the overall dietary habits of specific populations. However, limited epidemiological research has been conducted to explore the unique dietary intakes in low and middle-income countries. This study aims to examine the dietary patterns of Filipino adults and their association with sociodemographic and lifestyle factors. A total of 10,025 adults (≥20 years old) who participated in the 2013 Philippine National Nutrition Survey were included in the analysis. Dietary patterns were derived using factor analysis of 18 food groups from the dietary survey component. Six dietary patterns were identified, namely (1) rice; (2) cereal, milk, sugar, and oil; (3) fruits and miscellaneous food; (4) fish; (5) vegetables and corn; and (6) meat and beverage. Generalized ordered logistic regression analysis indicated that the dietary patterns were associated with different factors, specifically sex, age, educational attainment, marital status, employment status, household size, wealth quintile, smoking status, alcohol consumption, and physical activity. Our findings showed distinct dietary patterns among Filipino adults that were influenced by various sociodemographic and lifestyle parameters. The results of this study have valuable public health implications and the dietary patterns generated can further be used to analyze the link between diet and health outcomes.

Association of maternal dietary patterns during pregnancy with small-for-gestational-age infants: Korean Mothers and Children's Environmental Health (MOCEH) study

BACKGROUND

Nutrients that support the desired growth and development of the fetus (i.e., micronutrients like folate, iron, and zinc) have been associated with birth outcomes, such as gestational age at delivery and birth weight.

OBJECTIVES

We characterized the maternal dietary patterns that explain the maximum variation in folate, iron, and zinc intakes in pregnant Korean women using reduced-rank regression (RRR) and investigated the association of these patterns with small-for-gestational-age (SGA) risk.

METHODS

A total of 1158 pregnant Korean women at 12-28 weeks of gestation and their newborns were recruited for the Mothers and Children's Environmental Health (MOCEH) study between 2006 and 2010. A semiquantitative FFQ was collected from the women, and RRR was used to derive their dietary patterns. Log-transformed maternal intakes of folate, iron, and zinc were selected as the intermediate response variables to extract dietary patterns. Infant birth outcome measurements were obtained from hospital records. Associations were assessed by logistic regression with adjustment for confounding factors.

RESULTS

Three dietary patterns were identified. Pattern 1, characterized by high intakes of grains, green/yellow and light-colored vegetables, kimchi, legumes, fruits, meat, eggs, fish, seaweeds, tofu/soymilk, yogurt, and nuts, was associated with a lower risk of SGA in the highest quartile than in the lowest quartile (OR: 0.36; 95% CI: 0.14, 0.94). Especially, maternal dietary pattern 1 was negatively related to high-sensitivity C-reactive protein in the blood and malondialdehyde concentrations in the urine. No association was observed between other dietary patterns and SGA.

CONCLUSION

Among pregnant Korean women, adherence to a dietary pattern characterized by high intakes of grains, green/yellow and light-colored vegetables, kimchi, legumes, fruits, meat, eggs, fish, seaweeds, tofu/soymilk, yogurt, and nuts is associated with a lower risk of delivering SGA infants.

Impact of Ramadan Fasting on Dietary Intakes Among Healthy Adults: A Year-Round Comparative Study

Religious rituals are considered among the principle factors that impact dietary behaviors and food selections. The main objective of this study is to characterize food intake among Lebanese adults observant of the fasting month of Ramadan and compare it to their intake of the rest of the year. During a year-round study, including the month of Ramadan, Lebanese adults (n = 62), completed multiple (9 to 13) 24-h dietary recalls. Information about sociodemographic and lifestyle characteristics was also obtained. Dietary intake was examined using food groups as well as energy, macro, and micronutrient consumption. Significant differences in dietary intakes were observed for 12 of the 19 food groups (expressed as a percent of total energy) during Ramadan as compared to the rest of the year. More specifically, the intakes of cereals, cereal-based products, pasta, eggs, nuts and seeds, milk and dairy, and fats and oils were lower, while vegetables, dried fruit, Arabic sweets, cakes and pastries, and sugar-sweetened-beverages intakes were higher during Ramadan as compared to the remainder of the year (p < 0.05). Such differences in food groups' intakes were reflected in nutrients intakes, including carbohydrates, cholesterol, calcium, beta-carotene, vitamin C, folate, and magnesium. The findings of this study highlighted major differences in dietary intakes between the fasting month as compared to the rest of the year. With the large number of adults who observe fasting during Ramadan, the particularities of dietary intake during Ramadan ought to be considered in the development of context and culture-specific dietary recommendations.

Identification of Salty Dietary Patterns of the Japanese Macroregion

Objective

The traditional Japanese dietary pattern, “Washoku,” is considered to provide an ideal nutritional balance. However, it tends to have a high salt intake. To reduce population-level salt intake, it is important to review the overall dietary patterns over a wide area.

Methods

To identify dietary patterns with high salt intake, partial least squares regression analysis was conducted using population-based household survey data from 52 cities. Annual salt consumption was set as the target variable, and the annual purchase weight of 109 foods was set as the explanatory variable.

Result

At least three dietary patterns (traditional, urban, and local) accounted for more than 90% of the variation in salt consumption and 29% of the explanatory variables (food purchases). Traditional patterns explained the salt consumption and regional differences in energy and protein consumption; however, their relationship to fat consumption was weak. The results reconfirmed that “Washoku” has an ideal nutritional balance but has high salt intake. The distribution of scores for traditional Japanese food patterns was high in northeast Japan and low in southwest Japan, with a geographical gradient. This pattern is thought to have formed over a long period of time because of the influence of environmental factors, such as local climate.

Inverse Association Between the Mediterranean Diet and COVID-19 Risk in Lebanon: A Case-Control Study

Background: Since 2019, the world is confronting the COVID-19 public health crisis that deeply impacted all aspects of life, from the health sector to economy. Despite the advancement of research targeting pandemic containment measures, more strategies are still needed to alleviate the burden caused by this novel disease. In particular, optimal nutrition was proposed as a possible mitigating factor in the context of COVID-19. Indeed, the light is shed on balanced diets, such as the Mediterranean diet, which present the finest nutritional quality to support the immune system and other physiologic functions. In contrast, less varied diets that lack the needed nutrients and favor inflammation have been correlated with adverse health effects, including a hindered immune response, such as the western diet.

Methods: This observational case control study aimed at exploring the possible associations between the different dietary patterns present among a sample of the Lebanese population and the COVID-19 occurrence and outcomes. An online survey collected information about the sociodemographic characteristics, health status, lifestyle, and dietary habits through the Mediterranean diet questionnaire and a semi-quantitative fod frequency questionnaire, and the COVID-19 infection and its burden. The sample consisted of 399 respondents divided into the case and control groups (37.6 and 62.4%, respectively) on the basis of the presence or absence of a COVID-19 infection history.

Results: The participants in the case and control groups had average adherence to the Mediterranean diet and their dietary intake was closer to the western diet. However, the cases had a lower mean of the MedDiet score (p = 0.009). Food groups consumption analysis showed that this significant difference within the overall similar dietary patterns was due to a higher consumption of poultry and a trend toward decreased consumption of olive oil and increased read meat and alcohol intake among the cases. Additionally, gender influenced the levels of different foods' consumption. Nonetheless, the dietary intake did not impact the COVID-19 burden.

Conclusion: It is recommended to adopt healthy food choices within the different dietary patterns for a better protection against COVID-19. These findings should be validated in larger-scale studies.

Use of a hybrid method to derive dietary patterns in 7 years olds with explanatory ability of body mass index at age 10

BACKGROUND/OBJECTIVES

The usual definition of dietary patterns only accounts for the explanation of dietary choices and not a specific health outcome. This could partially explain the lack of consistent associations between diet and related diseases. This study aims to identify dietary patterns in 7 years olds explaining body mass index (BMI) at age 10 and to assess their association with early-life factors (sociodemographic, birth, and infancy characteristics).

METHODS

Children from the birth cohort Generation XXI at ages 7 and 10 were included (n = 4698). Diet was assessed by a validated food-frequency questionnaire. Measured BMI z-scores (zBMI) were calculated. Principal component analysis (PCA) and partial least squares (PLS) were run to derive dietary patterns.

RESULTS

The component scores of PCA was able to explain 13.0% of food groups and only 0.2% of zBMI, while the PLS scores explained the variance of both food groups (10.1%) and zBMI at age 10 (4.2%). By using PLS, two dietary patterns were derived, but only one, higher in processed meats and energy-dense foods and lower in vegetable soup consumption, was significantly associated with an increased zBMI in 10 years olds (adjusted β̂ 0.032; 95% CI:0.017; 0.047). It was more likely followed by children from younger and less educated mothers and who were born heavier.

CONCLUSIONS

A dietary pattern higher in processed and energy-dense foods and with lower vegetable soup intake in 7 years olds significantly explained zBMI of 10 years olds, and was predicted by early-life characteristics. The other dietary patterns were not significantly associated with zBMI at age 10.

The association of priori and posteriori dietary patterns with the risk of incident hypertension: Tehran Lipid and Glucose Study

Background

The aim of this study was to investigate the association of dietary patterns with incident hypertension.

Materials/methods

This prospective study was conducted on 4793 individuals of Tehran lipid and glucose study participants, aged ≥ 18 years who were followed for a median of 6.3 years from 2008–2011 to 2016–2018. A valid and reliable semi-quantitative food frequency questionnaire was used to assess usual dietary intakes. Anthropometrics and blood pressure were assessed at baseline and during follow up examinations. Dietary patterns were derived using principal component analysis (PCA). Healthy eating index (HEI) and dietary approach to stop hypertension (DASH) score were measured based on dietary recommendations. Time-dependent Cox models adjusting for confounders were used to examine the association between dietary patterns and the risk of hypertension.

Results

During follow-up, a total of 727 incident cases of hypertension were identified. The mean ± SD age at baseline was 40.3 ± 13.5 and 37.9 ± 12.1 years in men and women, respectively. Two dietary patterns (the healthy and unhealthy) were extracted by PCA. Compared with participants in the first quartile, a 23% (HR: 1.23; 95%CI 1.00–1.53; P trend: 0.056) increased risk of hypertension was found in the fourth quartile of HEI score. This association was disappeared after further adjustment for confounders. Increasing DASH score, the healthy and unhealthy dietary pattern were not associated with risk of hypertension.

Conclusion

Our findings showed that higher adherences to the posteriori- and priori-dietary patterns were not associated with risk of hypertension in this population.

Comparing two methods for deriving dietary patterns associated with risk of metabolic syndrome among middle-aged and elderly Taiwanese adults with impaired kidney function

Background

Dietary patterns were associated with the risk of chronic disease development and outcome-related diseases. In this study, we aimed to compare the correlation between dietary patterns and metabolic syndrome (MetS) using two methods for identifying dietary patterns.

Methods

The participants (n = 25,569) aged ≥40 years with impaired kidney function were retrieved from Mei Jau (MJ) Health Screening database from 2008 to 2010. Dietary patterns were identified by principal component analysis (PCA) and reduced rank regression (RRR) from twenty-two food groups using PROC FACTOR and PROC PLS functions.

Results

We identified two similar dietary pattern characteristics (high intakes of deep fried foods, preserved or processed foods, dipping sauce, meat, sugary drinks, organ meats, jam/honey, fried rice/flour products, instant noodles and eggs) derived by PCA and RRR. Logistic regression analysis revealed that RRR-derived dietary pattern scores were positively associated with an odds ratio (OR = 1.70, 95% CI: 1.56, 1.86) of having MetS than PCA-derived dietary pattern scores (OR = 1.38, 95% CI: 1.27, 1.51). The correlations between RRR-derived dietary pattern scores and elevated systolic and diastolic blood pressure (OR = 1.30 for both) or low high density lipoprotein cholesterol in women (OR = 1.32) were statistically significant but not significant in PCA-derived dietary pattern scores.

Conclusions

Our findings suggest that RRR gives better results when studying behavior related dietary patterns in association with MetS. RRR may be more preferable to provide dietary information for developing dietary guidelines among people with MetS. Further studies with prospective measurements are needed to verify whether RRR is a useful analytic tool for the association between dietary patterns and other chronic diseases.

Comorbidity Risk Score in Association with Cancer Incidence: Results from a Cancer Screenee Cohort

The combined effects of comorbidities can cause cancer incidence, while the effects of individual conditions, alone, might not. This study was conducted to investigate the joint impact of comorbidities on cancer incidence. The dietary score for energy-adjusted intake was calculated by applying a Gaussian graphical model and was then categorized into tertiles representing light, normal, and heavy eating behaviors. The risk point for cancer, according to the statuses of blood pressure, total cholesterol, fasting glucose, and glomerular filtration rate was computed from a Cox proportional hazard model adjusted for demographics and eating behavior. The comorbidity risk score was defined as the sum of the risk points for four comorbidity markers. We finally quantified the hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the strata of the comorbidity risk score and cancer incidence. A total of 13,644 subjects were recruited from the Cancer Screenee Cohort from 2007–2014. The comorbidity risk score was associated with cancer incidence in a dose-dependent manner (HR = 2.15, 95% CI = 1.39, 3.31 for those scoring 16–30 vs. those scoring 0–8, P-trend < 0.001). Subgroup analysis still showed significant dose-dependent relationships (HR = 2.39, 95% CI = 1.18, 4.84 for males and HR = 1.99, 95% CI = 1.11, 3.59 for females, P-trend < 0.05). In summary, there was a dose-dependent impact of comorbidities on cancer incidence; Highlights: Previous studies have generally reported that hypertension, hypercholesterolemia, diabetes, and chronic kidney disease might predispose patients to cancer. Combining these chronic diseases into a single score, this study found a dose-dependent association between the data-driven comorbidity risk score and cancer incidence.

Identification of Dietary Pattern Networks Associated with Gastric Cancer Using Gaussian Graphical Models: A Case-Control Study

Gaussian graphical models (GGMs) are novel approaches to deriving dietary patterns that assess how foods are consumed in relation to one another. We aimed to apply GGMs to identify dietary patterns and to investigate the associations between dietary patterns and gastric cancer (GC) risk in a Korean population. In this case-control study of 415 GC cases and 830 controls, food intake was assessed using a 106-item semiquantitative food frequency questionnaire that captured 33 food groups. The dietary pattern networks corresponding to the total population contained a main network and four subnetworks. For the vegetable and seafood network, those who were in the highest tertile of the network-specific score showed a significantly reduced risk of GC both in the total population (OR = 0.66, 95% CI = 0.47-0.93, p for trend = 0.018) and in males (OR = 0.55, 95% CI = 0.34-0.89, p for trend = 0.012). Most importantly, the fruit pattern network was inversely associated with the risk of GC for the highest tertile (OR = 0.56, 95% CI = 0.38-0.81, p for trend = 0.002). The identified vegetable and seafood network and the fruit network showed a protective effect against GC development in Koreans.

Dietary patterns and their associations with gestational weight gain in the United Arab Emirates: results from the MISC cohort

Background

Suboptimum weight gain during pregnancy may carry long term health consequences for the infant or mother. Nutritional imbalances are well recognized as a determinant of gestational weight gain. Few studies examined the effect of dietary patterns on gestational weight gain, especially in countries undergoing nutrition transition, such as the United Arab Emirates.

Objectives

To characterize dietary patterns among pregnant women living in the UAE and examine their associations with gestational weight gain and gestational weight rate.

Methodology

Data were drawn from the Mother-Infant Study Cohort, a two-year prospective cohort study of pregnant women living in the United Arab Emirates, recruited during their third trimester (n = 242). Weight gain during pregnancy was calculated using data from medical records. The Institute of Medicine’s recommendations were used to categorize gestational weight gain and gestational weight gain rate into insufficient, adequate, and excessive. During face-to-face interviews, dietary intake was assessed using an 89-item culture-specific semi-quantitative food frequency questionnaire that referred to usual intake during pregnancy. Dietary patterns were derived by principal component analysis. Multiple logistic regression analyses were used to evaluate the associations of derived dietary patterns with gestational weight gain/gestational weight gain rate.

Results

Two dietary patterns were derived, a “Diverse” and a “Western” pattern. The “Diverse” pattern was characterized by higher intake of fruits, vegetables, mixed dishes while the “Western” pattern consisted of sweets and fast food. The “Western” pattern was associated with excessive gestational weight gain (OR:4.04,95% CI:1.07–15.24) and gestational weight gain rate (OR: 4.38, 95% CI:1.28–15.03) while the “Diverse” pattern decreased the risk of inadequate gestational weight gain (OR:0.24, 95% CI:0.06–0.97) and gestational weight gain rate (OR:0.28, 95% CI:0.09–0.90).

Conclusion

The findings of this study showed that adherence to a “Diverse” pattern reduced the risk of insufficient gestational weight gain/gestational weight gain rate, while higher consumption of the “Western” pattern increased the risk of excessive gestational weight gain/gestational weight gain rate. In view of the established consequences of gestational weight gain on the health of the mother and child, there is a critical need for health policies and interventions to promote a healthy lifestyle eating through a life course approach.