Analysis of Dietary Patterns in Relation to Cardiovascular Risk Factors

Background: Compared to the examination of food and nutrient intakes, the identification of dietary patterns provides an overall picture of our diet considering combinations foods and meals, and contextualizing diet in relation to other lifestyle factors. Due to the inherent heterogeneity in people’s eating preferences, accurate characterization of dietary patterns remains a challenge. Efficient strategies to reduce complex and multidimensional nutritional data into meaningful dietary patterns are needed, in particular to study the association between diet and chronic disease. Aims and objectives: The overall aim of this work is to identify dietary patters and their association with prevalent cardiometabolic risk factors in different populations. For this, two objectives were defined: 1) To apply “a-priori” and “a-posteriori” dietary and meal pattern analyses to characterise the nutritional quality of the diet, 2) To quantity the impact of the adherence to distinctive dietary patterns, the type and frequency of meals, eating occasions, and synergistic associations of multiple lifestyles on traditional cardio-metabolic biomarkers, and particularly the presence and extent of subclinical atherosclerosis in asymptomatic adults. Materials and methods: Analyses were carried out using baseline data from two observational prospective cohorts and a National-representative survey. The Aragon Workers Health Study (AWHS) and the Progression of Early Subclinical Atherosclerosis (PESA) study, both involved populations of middle aged men and women and aimed to assess the determinants of subclinical atherosclerosis progression. The National Adult Nutrition Survey (NANS), measured habitual food and beverage consumption, lifestyle and health status among a National representative sample of adults living in the republic of Ireland. Results: “A-posteriori” (Principal Components Analysis, Cluster Analysis and Latent Class Analysis), “a-priori” (adherence to alternate Mediterranean Diet Index) dietary patterns analyses, and quantification of dietary intakes at specific eating occasions (breakfast) were used to describe diet. A Western Dietary Pattern (WDP), characterised by higher intakes of red meat, fast food, dairy and cereals, was associated with lower high-density lipoprotein cholesterol (HDL-c) and apolipoprotein A1 levels. A Mediterranean Dietary Pattern (MDP), characterised by higher intakes of vegetables, fruits, fish, white meat, nuts and olive oil was observed to be related to a more favourable plasma lipid profile and was significantly associated with lower prevalence of plaques in femoral arteries independently of the presence of other conventional risk factors. Higher adherence to MDP combined with non-smoking, and moderate alcohol consumption resulted in a further reduction in the risk of subclinical atherosclerosis. A Social-Business eating pattern, characterised by high consumption of red meat, pre-made foods, snacks, alcohol, and sugar sweetened beverages, frequent eating out behaviour was associated with a worse CVD risk profile and significantly higher prevalence and extension of subclinical atherosclerosis. Dietary habits significantly differed on weekends. Thus those participants who preferred meat and eggs for breakfast rather than having a cereal, and skipped light meal later during the day, were more likely to follow unhealthy overall dietary pattern, have higher diastolic blood pressure and increased serum ferritin. Moreover, skipping breakfast is not only a marker of overall unhealthy dietary pattern and lifestyle, it is also significantly associated with increased prevalence of non-coronary and generalized atherosclerosis. On the other hand regular breakfast consumption was associated with higher overall dietary quality. Conclusion: “A-posteriori” and “a-priori” analyses of dietary patterns are useful techniques to characterise the dietary habits commonly followed within a given population and their relationship with CVD markers. In combination with the investigation of daily meal consumption and at specific eating occasions, this approach could lead to improved public health guidelines and recommendations to improve diet, and overall lifestyle and curb the increasing burden of CVD

Analysis of the National Adult Nutrition Survey (Ireland) and the Food4Me Nutrition Survey Databases to Explore the Development of Food Labelling Portion Sizes for the European Union

The present study set out to explore the option of developing food portion size for nutritional labelling purposes using two European Union (EU) dietary surveys. The surveys were selected as they differed in (a) methodologies (food diary versus food frequency questionnaire), (b) populations (Irish National Adult Nutrition Survey (NANS) versus a seven-country survey based on the pan EU study Food4Me), (c) food quantification (multiple options versus solely photographic album) and (d) duration (4 consecutive days versus recent month). Using data from these studies, portion size was determined for 15 test foods, where portion size was defined as the median intake of a target food when consumed. The median values of the portion sizes derived from both the NANS and Food4Me surveys were correlated (r = 0.823; p < 0.00) and the mean of the two survey data sets were compared to US values from the Recognized as Customarily Consumed (RACC) database. There was very strong agreement across all food categories between the averaged EU and the US portion size (r = 0.947; p < 0.00). It is concluded that notwithstanding the variety of approaches used for dietary survey data in the EU, the present data supports using a standardized approach to food portion size quantification for food labelling in the EU

Association Between a Social-Business Eating Pattern and Early Asymptomatic Atherosclerosis

BACKGROUND The importance of a healthy diet in relation to cardiovascular health promotion is widely recognized. Identifying specific dietary patterns related to early atherosclerosis would contribute greatly to inform effective primary prevention strategies. OBJECTIVES This study sought to quantify the association between specific dietary patterns and presence and extent of subclinical atherosclerosis in a population of asymptomatic middle-aged adults. METHODS The PESA (Progression of Early Subclinical Atherosclerosis) study enrolled 4,082 asymptomatic participants 40 to 54 years of age (mean age 45.8 years; 63\% male) to evaluate the presence of subclinical atherosclerosis in multiple vascular territories. A fundamental objective of this cohort study was to evaluate the life-style-related determinants, including diet, on atherosclerosis onset and development. We conducted a cross-sectional analysis of baseline data, including detailed information on dietary habits obtained as part of the overall life-style and risk factor assessment, as well as a complete vascular imaging study that was performed blinded to the clinical information. RESULTS Most PESA participants follow a Mediterranean (40\% of participants) or a Western (41\%) dietary pattern. A new pattern, identified among 19\% of participants, was labeled as a social-business eating pattern, characterized by a high consumption of red meat, pre-made foods, snacks, alcohol, and sugar-sweetened beverages and frequent eating-out behavior. Participants following this pattern presented a significantly worse cardiovascular risk profile and, after adjustment for risk factors, increased odds of presenting subclinical atherosclerosis (odds ratio: 1.31; 95\% confidence interval: 1.06 to 1.63) compared with participants following a Mediterranean diet. CONCLUSIONS A new social-business eating pattern, characterized by high consumption of red and processed meat, alcohol, and sugar-sweetened beverages, and by frequent snacking and eating out as part of an overall unhealthy life-style, is associated with an increased prevalence, burden, and multisite presence of subclinical atherosclerosis. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318) (C) 2016 by the American College of Cardiology Foundation.This study was supported by a noncompetitive unrestricted grant shared between the National Center for Cardiovascular Research Carlos III (CNIC) and the Bank of Santander. The PESA study is a noncommercial study independent of the health care and pharmaceutical industry. The CNIC is supported by the Spanish Ministry of Economy and Competitiveness (MINECO) and the Pro-CNIC Foundation, and is a Severo Ochoa Center of Excellence (MINECO award SEV-2015-0505). Dr. Vedanthan is supported by the Fogarty International Center of the National Institutes of Health under award K01 TW 009218-05. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Bueno has received advisory/speaking fees from AstraZeneca, Bayer, Bristol-Myers Squibb-Pfizer, Novartis, and Servier; has received a research grant from AstraZeneca; has received advisory fees from Abbott; and has received speaking fees from Ferrer. Frank B. Hu, MD, served as Guest Editor for this paper

Association Between a Social-Business Eating Pattern and Early Asymptomatic Atherosclerosis.

BACKGROUND: The importance of a healthy diet in relation to cardiovascular health promotion is widely recognized. Identifying specific dietary patterns related to early atherosclerosis would contribute greatly to inform effective primary prevention strategies. OBJECTIVES: This study sought to quantify the association between specific dietary patterns and presence and extent of subclinical atherosclerosis in a population of asymptomatic middle-aged adults. METHODS: The PESA (Progression of Early Subclinical Atherosclerosis) study enrolled 4,082 asymptomatic participants 40 to 54 years of age (mean age 45.8 years; 63% male) to evaluate the presence of subclinical atherosclerosis in multiple vascular territories. A fundamental objective of this cohort study was to evaluate the life-style-related determinants, including diet, on atherosclerosis onset and development. We conducted a cross-sectional analysis of baseline data, including detailed information on dietary habits obtained as part of the overall life-style and risk factor assessment, as well as a complete vascular imaging study that was performed blinded to the clinical information. RESULTS: Most PESA participants follow a Mediterranean (40% of participants) or a Western (41%) dietary pattern. A new pattern, identified among 19% of participants, was labeled as a social-business eating pattern, characterized by a high consumption of red meat, pre-made foods, snacks, alcohol, and sugar-sweetened beverages and frequent eating-out behavior. Participants following this pattern presented a significantly worse cardiovascular risk profile and, after adjustment for risk factors, increased odds of presenting subclinical atherosclerosis (odds ratio: 1.31; 95% confidence interval: 1.06 to 1.63) compared with participants following a Mediterranean diet. CONCLUSIONS: A new social-business eating pattern, characterized by high consumption of red and processed meat, alcohol, and sugar-sweetened beverages, and by frequent snacking and eating out as part of an overall unhealthy life-style, is associated with an increased prevalence, burden, and multisite presence of subclinical atherosclerosis. (Progression of Early Subclinical Atherosclerosis [PESA]; NCT01410318)

Analysis of dietary patterns in relation to caardiovascular risk factors

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Bioquímica. Fecha de lectura: 20-07-2018Esta tesis tiene embargado el acceso al texto completo hasta el 20-01-202

Regularity of Breakfast Consumption and Diet: Insights from National Adult Nutrition Survey

Breakfast is considered to be one of the most important meals of the day. Its omission has been reported to be associated with increased disease risk, such as obesity, diabetes, and coronary heart disease, as well as unhealthy lifestyle and lower dietary quality. Using data from the National Adult Nutrition Survey (NANS)&#8212;a food consumption survey conducted among 1500 Irish men and women over 18 years of age, residing in the Republic of Ireland at the time the survey was conducted&#8212;we aimed to characterize breakfast regularity, identify dietary patterns associated with regular breakfast consumption, and assess the nutritional quality of such dietary patterns, using the nutrient-rich food index score NRF9.3. We determined two breakfast regularity categories and assessed dietary quality, by means of adherence to the principal component analysis derived dietary patterns and the NRF9.3 dietary index. Regular breakfast consumers were identified as those who consumed breakfast 3&#8315;4 times out of the 4 days of the collection period; such consumers comprised the majority of the population (94.4%). They had the highest adherence to healthier dietary patterns, namely, the &#8220;vegetarian&#8222; (odds ratio (OR): 2.59: 95% Confidence Interval (CI): 1.40, 4.77), &#8220;fish and vegetables&#8222; (OR: 2.88: 95% CI: 1.63, 5.10), and &#8220;breakfast cereals&#8222; (OR: 4.62: 95% CI: 2.43, 8.79) dietary patterns. Breakfast significantly contributed to the daily micronutrient intake by providing, on average, 24% of dietary fiber, 32% of iron, 30% of calcium, 32% of folate, and 37% of riboflavin. The importance of regular breakfast consumption on those who skip breakfast should be highlighted, in order to improve compliance with nutritional recommendations and adherence to a healthy lifestyle

Generic Meal Patterns Identified by Latent Class Analysis: Insights from NANS (National Adult Nutrition Survey)

Nutritional data reduction methods are widely applied in nutrition epidemiology in order to classify individuals into meaningful groups with similar dietary patterns. To date, none of the existing studies have applied latent class analysis to examine dietary patterns which include meal types consumed throughout a day. We investigated main meal patterns followed on weekend and weekdays, and evaluated their associations with cardio-metabolic biomarkers. The analyses were performed within the NANS (National Adult Nutrition Survey) a cross-sectional national food consumption survey of 1500 nationally representative Irish adults. A total number of seven dietary patterns were identified using latent class analysis. The typical meal pattern followed by the majority of the population was characterized by consumption of cereal or toast for breakfast, skipping or consuming a sandwich for light meal, and meat or fish with potatoes, pasta or vegetables for the main meal. Eating patterns differed on weekends, and those participants who consumed meat and eggs for breakfast instead of breakfast cereal and skipped light meal were more likely to have an unhealthier dietary pattern, a higher diastolic blood pressure, and increased serum ferritin. The application of data reduction techniques to simplify the multifaceted nature of dietary data is a useful approach to derive patterns, which might shed further light on the typical dietary patterns followed by populations

Analysis of the National Adult Nutrition Survey (Ireland) and the Food4Me Nutrition Survey Databases to Explore the Development of Food Labelling Portion Sizes for the European Union

The present study set out to explore the option of developing food portion size for nutritional labelling purposes using two European Union (EU) dietary surveys. The surveys were selected as they differed in (a) methodologies (food diary versus food frequency questionnaire), (b) populations (Irish National Adult Nutrition Survey (NANS) versus a seven-country survey based on the pan EU study Food4Me), (c) food quantification (multiple options versus solely photographic album) and (d) duration (4 consecutive days versus recent month). Using data from these studies, portion size was determined for 15 test foods, where portion size was defined as the median intake of a target food when consumed. The median values of the portion sizes derived from both the NANS and Food4Me surveys were correlated (r = 0.823; p < 0.00) and the mean of the two survey data sets were compared to US values from the Recognized as Customarily Consumed (RACC) database. There was very strong agreement across all food categories between the averaged EU and the US portion size (r = 0.947; p < 0.00). It is concluded that notwithstanding the variety of approaches used for dietary survey data in the EU, the present data supports using a standardized approach to food portion size quantification for food labelling in the EU