Dietary Pattern Trajectories over Time and Diabetes among Chinese Adults

Dietary patterns, instead of single nutrients or foods, are a useful approach to study diet and diet-disease associations. However, most studies examine dietary patterns only at one point in time. The purpose of this dissertation was to identify the longitudinal changes or stability of dietary patterns and their association with Diabetes in the China Health and Nutrition Survey from 1991 to 2009 (7 waves of diet data). Aim 1: we derived two dietary patterns using factor analysis in each wave: a traditional southern pattern (rice, vegetables, meat, poultry and fish) and a modern high-wheat pattern (wheat products, nuts, fruits, eggs, milk and instant noodles/frozen dumpling). The structure of these patterns remained stable over time, but the tracking was lower and the adherence increased over time for the modern high-wheat. Aim 2: among 4,316 adults not previously diagnosed with diabetes the adjusted Odds Ratio for diabetes prevalence in 2009, comparing the highest versus the lowest dietary pattern score quartile in 2006, was 1.25 (0.78, 2.01) for the modern high-wheat pattern, 0.79 (0.51, 1.21) for the traditional southern pattern and 2.36 (1.55, 3.58) for a pattern derived with Reduced Rank Regression (with HbA1c, HOMA-IR and glucose as response variables). This pattern combined items of the modern high-wheat pattern (wheat products and soy milk) with items opposite to the traditional southern (low rice, poultry and fish). Aim 3: A score for the third dietary pattern was estimated for each subject at each wave and with Latent Class Trajectory Analysis subjects with similar trajectories of their dietary pattern's score over time were grouped in 5 classes. Among two classes with similar scores in 2006, the one with lower scores from 1991-2004, had significantly lower HbA1c [-1.64 (-3.17, -0.11)], and non-significantly lower odds of diabetes. All together our findings suggest that the popularity of a modern high-wheat pattern was increasing and that part of this pattern, when combined with low intake of rice, poultry, fish and legumes, was associated with diabetes. In addition, even if the diets were similar recently, the long-term trajectories of this dietary pattern were also associated.Doctor of Philosoph

First-Year Evaluation of Mexico’s Tax on Nonessential Energy-Dense Foods: An Observational Study

In an effort to prevent continued increases in obesity and diabetes, in January 2014, the Mexican government implemented an 8% tax on nonessential foods with energy density ≥275 kcal/100 g and a peso-per-liter tax on sugar-sweetened beverages (SSBs). Limited rigorous evaluations of food taxes exist worldwide. The objective of this study was to examine changes in volume of taxed and untaxed packaged food purchases in response to these taxes in the entire sample and stratified by socioeconomic status (SES)

Patterns of Red and Processed Meat Consumption Across North America: A Nationally Representative Cross-Sectional Comparison of Dietary Recalls from Canada, Mexico, and the United States

Close economic ties encourage production and trade of meat between Canada, Mexico, and the US. Understanding the patterns of red and processed meat consumption in North America may inform policies designed to reduce meat consumption and bolster environmental and public health efforts across the continent. We used nationally-representative cross-sectional survey data to analyze consumption of unprocessed red meat; processed meat; and total red and processed meat. Generalized linear models were used to separately estimate probability of consumption and adjusted mean intake. Prevalence of total meat consumers was higher in the US (73.6, 95% CI: 72.3–74.8%) than in Canada (65.6, 63.9–67.2%) or Mexico (62.7, 58.1–67.2%). Men were more likely to consume unprocessed red, processed, and total meat, and had larger estimated intakes. In Mexico, high wealth individuals were more likely to consume all three categories of meat. In the US and Canada, those with high education were less likely to consume total and processed meat. Estimated mean intake of unprocessed red, processed, and total meat did not differ across sociodemographic strata. Overall consumption of red and processed meat remains high in North America. Policies to reduce meat consumption are appropriate for all three countries

Using both principal component analysis and reduced rank regression to study dietary patterns and diabetes in Chinese adults

Abstract Objective We examined the association between dietary patterns and diabetes using the strengths of two methods: principal component analysis (PCA) to identify the eating patterns of the population and reduced rank regression (RRR) to derive a pattern that explains the variation in glycated Hb (HbA1c), homeostasis model assessment of insulin resistance (HOMA-IR) and fasting glucose. Design We measured diet over a 3 d period with 24 h recalls and a household food inventory in 2006 and used it to derive PCA and RRR dietary patterns. The outcomes were measured in 2009. Setting Adults ( n 4316) from the China Health and Nutrition Survey. Results The adjusted odds ratio for diabetes prevalence (HbA1c≥6·5 %), comparing the highest dietary pattern score quartile with the lowest, was 1·26 (95 % CI 0·76, 2·08) for a modern high-wheat pattern (PCA; wheat products, fruits, eggs, milk, instant noodles and frozen dumplings), 0·76 (95 % CI 0·49, 1·17) for a traditional southern pattern (PCA; rice, meat, poultry and fish) and 2·37 (95 % CI 1·56, 3·60) for the pattern derived with RRR. By comparing the dietary pattern structures of RRR and PCA, we found that the RRR pattern was also behaviourally meaningful. It combined the deleterious effects of the modern high-wheat pattern (high intakes of wheat buns and breads, deep-fried wheat and soya milk) with the deleterious effects of consuming the opposite of the traditional southern pattern (low intakes of rice, poultry and game, fish and seafood). Conclusions Our findings suggest that using both PCA and RRR provided useful insights when studying the association of dietary patterns with diabetes

Energy, added sugar, and saturated fat contributions of taxed beverages and foods in Mexico

Objective. To estimate the dietary contribution of taxed beverages and foods. Materials and methods. Using 24-hour diet recall data from the Ensanut 2012 (n=10 096), we estimated the contribution of the items which were taxed in 2014 to the total energy, added sugar, and saturated fat intakes in the entire sample and by sociodemographic characteristics. Results. The contributions for energy, added sugar, and saturated fat were found to be 5.5, 38.1, and 0.4%, respectively, for the taxed beverages, and 14.4, 23.8, and 21.4%, respectively, for the taxed foods. Children and adolescents (vs. adults), medium and high socioeconomic status (vs. low), urban area (vs. rural), and North and Center region (vs. South) had higher energy contribution of taxed beverages and foods. The energy contribution was similar between males and females. Conclusions. These taxes covered an important proportion of Mexicans’ diet and therefore have the potential to improve it meaningfully

Dietary pattern trajectories during 15 years of follow-up and HbA1c, insulin resistance and diabetes prevalence among Chinese adults

Most research on dietary patterns and health outcomes does not include longitudinal exposure data. We used an innovative technique to capture dietary pattern trajectories and their association with hemoglobin A1c (HbA1c), homeostasis model of insulin resistance (HOMA-IR), and prevalence of newly diagnosed diabetes

Food Acculturation Drives Dietary Differences among Mexicans, Mexican Americans, and Non-Hispanic Whites

Our aim was to examine the effects of food acculturation on Mexican Americans’ (MA) diets, taking the Mexican diet as reference. We used nationally representative samples of children (2–11 y) and female adolescents and adults (12–49 y) from the Mexican National Nutrition Survey 1999 and NHANES 1999–2006 to compare the diets of Mexicans (n = 5678), MA born in Mexico (MAMX) (n = 1488), MA born in the United States (MAUS) (n = 3654), and non-Hispanic white Americans (NH-White) (n = 5473). One 24-h diet recall was used to examine the percentage consuming and percentage energy consumed from selected food groups. Most of the food groups analyzed displayed a fairly linear increase or decrease in percent energy/capita intake in this order: Mexican, MAMX, MAUS, NH-White. However, few significant differences were observed among the US subpopulations, especially among MAUS and NH-Whites. Overall, compared to Mexicans, the US subpopulations had greater intakes of saturated fat, sugar, dessert and salty snacks, pizza and French fries, low-fat meat and fish, high-fiber bread, and low-fat milk, as well as decreased intakes of corn tortillas, low-fiber bread, high-fat milk, and Mexican fast food. Furthermore, the patterns were similar in all age groups. Although we found a mix of positive and negative aspects of food acculturation, the overall proportion of energy obtained from unhealthy foods was higher among the US subpopulations. Our findings indicate that within one generation in the US, the influence of the Mexican diet is almost lost. In addition, our results reinforce the need to discourage critical unhealthful components of the American diet among MA

Sodium Intake from Various Time Frames and Incident Hypertension Among Chinese Adults

Although it is clear that there are short-term effects of sodium intake on blood pressure, little is known about the most relevant timing of sodium exposure for the onset of hypertension. This question can only be addressed in cohorts with repeated measures of sodium intake

Dietary patterns and diet quality during pregnancy and low birthweight: The PRINCESA cohort

Although the isolated effects of several specific nutrients have been examined, little is known about the relationship between overall maternal diet during pregnancy and fetal development and growth. This study evaluates the association between maternal diet and low birthweight (LBW) in 660 pregnant women from the Pregnancy Research on Inflammation, Nutrition,& City Environment: Systematic Analyses (PRINCESA) cohort in Mexico City. Using prior day dietary intake reported at multiple prenatal visits, diet was assessed prospectively using a priori (Maternal Diet Quality Score [MDQS]) and a posteriori (dietary patterns extracted by factor analysis) approaches. The association between maternal diet and LBW was investigated by logistic regression, controlling for confounders. Adherence to recommended guidelines (higher MDQS) was associated with a reduced risk of LBW (OR, 0.22; 95% confidence interval [0.06, 0.75], P < .05, N = 49) compared with the lowest adherence category (reference group), controlling for maternal age, education, height, marital status, pre- pregnancy body mass index, parity, energy intake, gestational weight gain, and preterm versus term birth; a posteriori dietary patterns were not associated with LBW risk. Higher adherence to MDQS was associated with a lower risk of having an LBW baby in this sample. Our results support the role of advocating a healthy overall diet, versus individual foods or nutrients, in preventing LBW.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155934/1/mcn12972_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155934/2/mcn12972.pd

Longitudinal analysis of dietary patterns in Chinese adults from 1991 to 2009

Our aims were to identify the changes or stability in the structure of dietary patterns and the tracking, trends and factors related to the adherence of these patterns in China from 1991 to 2009. We used seven waves of the China Health and Nutrition Survey and included 9,253 adults with ≥3 waves complete. Diet was measured over a 3-day period with 24-hr recalls and a household food inventory. Using factor analysis in each wave we found that the structure of the two dietary patterns identified, remained stable over the studied period. The traditional southern pattern was characterized by high intake of rice, fresh leafy vegetables, low-fat red meat, pork, organ meats, poultry and fish/seafood and low intakes of wheat flour, corn/coarse grains; and the modern high-wheat pattern was characterized by high intake of wheat buns/breads, cakes/cookies/pastries, deep-fried wheat, nuts/seeds, starchy roots/tubers products, fruits, eggs/eggs products, soy milk, animal-based milk and instant noodles/frozen dumplings. Temporal tracking (maintenance of a relative position over time) was higher for the traditional southern, whereas adherence to the modern high-wheat had an upward trend over time. Higher income, education and urbanicity level were positively associated with both dietary patterns, but the association became smaller in the later years. These results suggest that even in the context of rapid economic changes in China; the way people chose to combine their foods remained relatively stable. However, the increasing popularity of the modern high-wheat pattern, a pattern associated with several energy-dense foods is cause of concern