Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/6483
Analysis of Dietary Patterns in Relation to Cardiovascular Risk Factors
Uzhova, Irina CNIC
Penalvo, Jose L. CNIC
Date of defense
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.
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