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PubMed2006

Low-fat dietary pattern and risk of invasive breast cancer: the Women's Health Initiative Randomized Controlled Dietary Modification Trial.

CONTEXT: The hypothesis that a low-fat dietary pattern can reduce breast cancer risk has existed for decades but has never been tested in a controlled intervention trial. OBJECTIVE: To assess the effects of undertaking a low-fat dietary pattern on breast cancer incidence. DESIGN AND SETTING: A randomized, controlled, primary prevention trial conducted at 40 US clinical centers from 1993 to 2005. PARTICIPANTS: A total of 48,835 postmenopausal women, aged 50 to 79 years, without prior breast cancer, including 18.6% of minority race/ethnicity, were enrolled. INTERVENTIONS: Women were randomly assigned to the dietary modification intervention group (40% [n = 19,541]) or the comparison group (60% [n = 29,294]). The intervention was designed to promote dietary change with the goals of reducing intake of total fat to 20% of energy and increasing consumption of vegetables and fruit to at least 5 servings daily and grains to at least 6 servings daily. Comparison group participants were not asked to make dietary changes. MAIN OUTCOME MEASURE: Invasive breast cancer incidence. RESULTS: Dietary fat intake was significantly lower in the dietary modification intervention group compared with the comparison group. The difference between groups in change from baseline for percentage of energy from fat varied from 10.7% at year 1 to 8.1% at year 6. Vegetable and fruit consumption was higher in the intervention group by at least 1 serving per day and a smaller, more transient difference was found for grain consumption. The number of women who developed invasive breast cancer (annualized incidence rate) over the 8.1-year average follow-up period was 655 (0.42%) in the intervention group and 1072 (0.45%) in the comparison group (hazard ratio, 0.91; 95% confidence interval, 0.83-1.01 for the comparison between the 2 groups). Secondary analyses suggest a lower hazard ratio among adherent women, provide greater evidence of risk reduction among women having a high-fat diet at baseline, and suggest a dietary effect that varies by hormone receptor characteristics of the tumor. CONCLUSIONS: Among postmenopausal women, a low-fat dietary pattern did not result in a statistically significant reduction in invasive breast cancer risk over an 8.1-year average follow-up period. However, the nonsignificant trends observed suggesting reduced risk associated with a low-fat dietary pattern indicate that longer, planned, nonintervention follow-up may yield a more definitive comparison. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT00000611.

Aged↗
PubMed2004

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.

Adult↗
PubMed2005

Dietary patterns of young, low-income US children.

OBJECTIVE: The purpose of this study was to identify dietary patterns of young, low-income US children, describe differences in diet quality between identified patterns, and make targeted food recommendations to improve diet quality. DESIGN: Dietary patterns were assessed using dietary variables from the Pyramid Servings Database within the Continuing Survey of Food Intakes by Individuals 1994-1996, 1998. Healthy Eating Index (HEI) scores were used to validate identified dietary patterns. SUBJECTS/SETTING: Two subsamples of low-income children, aged 2 to 3 years (n = 1,242) and 4 to 8 years (n = 1,506), were selected from the Continuing Survey of Food Intakes by Individuals data. STATISTICAL ANALYSIS: Cluster analysis was performed to determine unique dietary patterns within the two subsamples. Linear regression analyses were used to compare energy intake, discretionary fat, added sugars, and HEI scores across cluster groups. Descriptive statistics were computed for each cluster. RESULTS: Cluster analysis identified six and seven distinct dietary patterns for the younger and older children, respectively. Four patterns were similar for both age groups. For the 2- to 3-year-old children, energy intake, overall HEI scores, and nine of the 10 HEI component scores differed among the four most prevalent dietary patterns. Among the older children, energy intake and six of the HEI component scores differed between the four most prevalent clusters but not overall HEI. CONCLUSIONS: Neither age group had a cluster of children who followed a balanced/moderate diet pattern consistent with Food Guide Pyramid recommendations. Children consuming almost every pattern identified could benefit by reducing added sugars and discretionary fat and increasing low-fat, low-sugar options from the vegetables, fruits, meat, and milk groups.

Child↗
PubMed2007

Dietary patterns throughout adult life are associated with body mass index, waist circumference, blood pressure, and red cell folate.

Dietary patterns are important in the prevention of chronic disease; however, there are few studies that include repeat measures of dietary patterns. The objective of this study was to assess the relations between dietary patterns during adult life (at ages 36, 43, and 53 y) and risk factors for chronic disease at age 53 y. Participants of a longitudinal study of health completed a 5-d food diary at 3 occasions during adult life (n = 1265). Factor analysis was used to identify dietary patterns and a pattern score was calculated from the consumption of the food items in each dietary pattern. Means and 95% CI for dietary pattern scores were calculated for each risk factor category using random effects models adjusted for socio-demographic and health-related behaviors. In women, the fruit, vegetables, and dairy pattern was inversely associated with BMI (P < 0.004), waist circumference (P = 0.0007), blood pressure (P = 0.02), and was positively associated with red cell folate (P < 0.03). The ethnic foods and alcohol pattern was also inversely associated with blood pressure (P = 0.008), whereas the meat, potatoes and sweet foods pattern was positively associated with glycated hemoglobin (P = 0.01). In men, a mixed pattern was inversely associated with waist circumference (P = 0.02) and blood pressure (P = 0.01), whereas there were no significant associations with the ethnic foods and alcohol pattern. Specific dietary patterns throughout adult life were associated with chronic disease risk factors.

Adult↗
PubMed2026

Infant Dietary Patterns and Early Childhood Weight Outcomes: A Secondary Analysis from the Starting Early Program Trial.

BACKGROUND: The Starting Early Program (StEP) promotes healthy nutrition during early life and leads to healthier child weight, but whether dietary patterns contribute to weight or mediate StEP weight outcomes has not been studied. OBJECTIVES: This secondary analysis identified infant dietary patterns in StEP, determined associations between dietary patterns and child weight outcomes, and examined whether dietary patterns mediated the relationship between StEP and child weight. METHODS: Data were from 377 mother-infant dyads in a randomized trial testing the efficacy of StEP. Dietary patterns at 10 months were identified using latent class analysis. Child weights were abstracted from medical records at 12, 24, and 36 months. Associations between infant dietary patterns and weight-for-age z-score (WFAz) and likelihood of being classified as overweight (WFA &#x2265;85th percentile) were assessed using linear and logistic multivariable regression models. Mediation was used to assess intervention effects on WFAz via impacts on infant dietary patterns. RESULTS: Four classes of infant dietary patterns were identified: Breastfed-High variety, Formula fed-High variety, Formula fed-Low variety, and Mixed fed-Low variety. Compared to the Breastfed-High variety class, infants in the Formula fed-Low variety class had higher WFAz and were more likely to be classified as overweight at 24 and 36 months. Participation in StEP increased membership in Breastfed-High variety, which mediated the association between StEP and lower WFAz at 24 months. CONCLUSIONS: Infant dietary patterns were identified, and some were associated with child overweight. StEP was associated with a dietary pattern most consistent with guidelines, which mediated intervention effects on child weight.

Humans↗
PubMed1992

Dietary patterns and colon cancer in western New York.

Seven dietary patterns were identified among control subjects in the Western New York Diet Study (1975-1986) by application of principal components analysis to data from a 95-item food frequency interview. The results of case-control analyses of colon cancer risk for these patterns are presented. Cases were matched with neighborhood controls on the bases of age and sex; 205 colon case-control male and 223 female pairs were obtained. The dietary patterns and intakes of energy, total fat, and dietary fiber were examined with logistic regression for their individual contributions to risk. In males, three of these dietary patterns were associated positively with fat and energy consumption; they elevated risk for colon cancer and accounted for more risk than did the specific nutrients. Control for energy and fat intakes allowed the protective influences of additional dietary patterns to be expressed. No patterns elevated risk in women; two patterns were protective for colon cancer. Controlling for energy and fat intake enhanced the protection afforded by one of these patterns but had no influence on that of the other. Measures of foods rather than single nutrients may be more inclusive of dietary exposures to risk as well as being related more directly to underlying health behaviors. Therefore they may be better able to account for risk in diseases with multiple causation.

Case-Control Studies↗
PubMed2003

Dietary patterns of Hispanic elders are associated with acculturation and obesity.

The association of dietary patterns and obesity, particularly in Hispanics, is relatively poorly understood. This large U.S. population subgroup has a high prevalence of obesity and associated chronic conditions, and Hispanics are changing their dietary practices as they acculturate. Our objectives were 1) to identify dietary patterns among elderly Hispanics in Massachusetts, compared with those of non-Hispanic whites; 2) to associate dietary patterns with acculturation; and 3) to associate dietary patterns with total and central obesity. We used a representative sample of 449 Puerto Rican and 133 Dominican elders and a neighborhood-based sample of 243 non-Hispanic white elders, aged 60 to 92 y, from the cross-sectional Massachusetts Hispanic Elders Study. Obesity and central obesity were assessed with BMI (kg/m2) and waist circumference measurement, respectively. Acculturation was assessed by evaluating language use. Usual diet was assessed with a food frequency questionnaire specifically designed for use with this population. Dietary patterns were defined by cluster analysis of food group variables. We identified five clusters of individuals by dietary pattern, with proportionately greater energy intake from 1) fruit and breakfast cereal, 2) starchy vegetables, 3) rice, 4) whole milk and 5) sweets, respectively. Hispanics were less likely to follow the fruit and cereal or sweets patterns, and more likely to follow the starchy vegetables or milk patterns, than were non-Hispanic whites. Only Hispanics followed the rice pattern. Among Hispanics, acculturation was positively associated with the fruit and cereal pattern, and negatively with the rice pattern. Total and central obesity were positively associated with the rice pattern. Longitudinal studies are needed to clarify the causal nature of these associations.

Acculturation↗
PubMed2005

Dietary patterns and survival after breast cancer diagnosis.

PURPOSE: There is little prior study of major dietary patterns and breast cancer survival. METHODS: Patients included 2,619 Nurses' Health Study participants who were diagnosed with invasive breast cancer between 1982 and 1998 and completed a dietary questionnaire more than 1 year after diagnosis. Participants were followed through 2002 (median = 9 years). During follow-up, 414 patients died of any cause, 242 patients died of breast cancer, and 172 patients died from causes other than breast cancer. Women with in situ or metastatic disease at diagnosis were excluded. We used Cox proportional hazards models to evaluate prospective associations of prudent and Western dietary patterns assessed both before and after diagnosis with time to event after diagnosis. RESULTS: In multivariate-adjusted analyses assessed after diagnosis, the Western and prudent dietary patterns were unrelated to all-cause or breast cancer mortality. However, compared with women with the lowest intake of the prudent dietary pattern, the relative risks (and 95% CIs) of death from causes other than breast cancer were 0.85 (95% CI, 0.53 to 1.35), 0.74 (95% CI, 0.45 to 1.21), 0.70 (95% CI, 0.42 to 1.17), and 0.54 (95% CI, 0.31 to 0.95; P = .03, from lowest to highest quintile of intake). In contrast, the Western dietary pattern was positively associated with this outcome (P = .04). Results for the assessment of dietary patterns before diagnosis were similar, except the prudent dietary pattern was unrelated to mortality. CONCLUSION: A higher intake of the prudent pattern and a lower intake of the Western pattern may protect against mortality from causes unrelated to breast cancer.

Adult↗
PubMed2003

Dietary patterns associated with risk factors for cardiovascular disease in healthy US adults.

BACKGROUND: Certain nutrients are well established as dietary risk factors for cardiovascular disease (CVD), but dietary patterns may be a better predictor of CVD risk. OBJECTIVE: This study tested the hypothesis that the complex dietary behaviors of US adults can be grouped into major dietary patterns that are related to risk factors for CVD. DESIGN: With the use of food-frequency questionnaire data from the third National Health and Nutrition Examination Survey, dietary patterns of healthy US adults (>/or =20 y old; n = 13 130) were identified by factor analysis. Log-transformed biomarker data were associated with major dietary patterns after control for confounding variables in regression analyses. All statistical analyses accounted for the survey design and sample weights. RESULTS: Of 6 dietary patterns identified, 2 patterns emerged as the most predominant: the Western pattern was characterized by high intakes of processed meats, eggs, red meats, and high-fat dairy products, and the American-healthy pattern was characterized by high intakes of green, leafy vegetables; salad dressings; tomatoes; other vegetables (eg, peppers, green beans, corn, and peas); cruciferous vegetables; and tea. The Western pattern was associated (P < 0.05) positively with serum C-peptide, serum insulin, and glycated hemoglobin and inversely with red blood cell folate concentrations after adjustment for confounding variables. The American-healthy pattern had no linear relation with any of the biomarkers examined. CONCLUSIONS: The identification of common dietary patterns among free-living persons is promising for characterizing high-risk groups at the US population level. The dietary patterns identified here are similar to those reported in other nonrepresentative samples and are associated with biomarkers of CVD risk, which confirms that dietary pattern analysis can be a valuable method for assessing dietary intakes when predicting CVD risk.

Adult↗
PubMed2002

Diversity of dietary patterns observed in the European Prospective Investigation into Cancer and Nutrition (EPIC) project.

OBJECTIVE: To describe the diversity in dietary patterns existing across centres/regions participating in the European Prospective Investigation into Cancer and Nutrition (EPIC). DESIGN AND SETTING: Single 24-hour dietary recall measurements were obtained by means of standardised face-to-face interviews using the EPIC-SOFT software. These have been used to present a graphic multi-dimensional comparison of the adjusted mean consumption of 22 food groups. SUBJECTS: In total, 35 955 men and women, aged 35-74 years, participating in the EPIC nested calibration study. RESULTS: Although wide differences were observed across centres, the countries participating in EPIC are characterised by specific dietary patterns. Overall, Italy and Greece have a dietary pattern characterised by plant foods (except potatoes) and a lower consumption of animal and processed foods, compared with the other EPIC countries. France and particularly Spain have more heterogeneous dietary patterns, with a relatively high consumption of both plant foods and animal products. Apart from characteristics specific to vegetarian groups, the UK 'health-conscious' group shares with the UK general population a relatively high consumption of tea, sauces, cakes, soft drinks (women), margarine and butter. In contrast, the diet in the Nordic countries, The Netherlands, Germany and the UK general population is relatively high in potatoes and animal, processed and sweetened/refined foods, with proportions varying across countries/centres. In these countries, consumption of vegetables and fruit is similar to, or below, the overall EPIC means, and is low for legumes and vegetable oils. Overall, dietary patterns were similar for men and women, although there were large gender differences for certain food groups. CONCLUSIONS: There are considerable differences in food group consumption and dietary patterns among the EPIC study populations. This large heterogeneity should be an advantage when investigating the relationship between diet and cancer and formulating new aetiological hypotheses related to dietary patterns and disease.

Adult↗
PubMed2005

Dietary patterns and the metabolic syndrome in obese and non-obese Framingham women.

OBJECTIVES: To examine the relationship between habitual dietary patterns and the metabolic syndrome (MetS) in women and to identify foci for preventive nutrition interventions. RESEARCH METHODS AND PROCEDURES: Dietary patterns, nutrient intake, cardiovascular disease (CVD), and MetS risk factors were characterized in 1615 Framingham Offspring-Spouse Study (FOS) women. Dietary pattern subgroups were compared for MetS prevalence and CVD risk factor status using logistic regression and analysis of covariance. Analyses were performed overall in women and stratified on obesity status; multivariate models controlled for age, apolipoprotein E (APOE) genotypes, and CVD risk factors. RESULTS: Food and nutrient profiles and overall nutritional risk of five non-overlapping habitual dietary patterns of women were identified including Heart Healthier, Lighter Eating, Wine and Moderate Eating, Higher Fat, and Empty Calories. Rates of hypertension and low high-density lipoprotein levels were high in non-obese women, but individual MetS risk factor levels were substantially increased in obese women. Overall MetS risk varied by dietary pattern and obesity status, independently of APOE and CVD risk factors. Compared with obese or non-obese women and women overall with other dietary patterns, MetS was highest in those with the Empty Calorie pattern (contrast p value: p<0.05). DISCUSSION: This research shows the independent relationship between habitual dietary patterns and MetS risk in FOS women and the influence of obesity status. High overall MetS risk and the varying prevalence of individual MetS risk factors in female subgroups emphasize the importance of preventive nutrition interventions and suggest potential benefits of targeted behavior change in both obese and non-obese women by dietary pattern.

Abdomen↗
PubMed2006

Dietary patterns and associated lifestyles in individuals with and without familial history of obesity: a cross-sectional study.

BACKGROUND: Familial history of obesity (FHO) and certain dietary habits are risk factors for obesity. The objectives of this cross-sectional study were 1) to derive dietary patterns using factor analysis in a population of men and women with and without FHO; 2) to compare mean factor scores for each dietary pattern between individuals with and without FHO; and 3) to examine the association between these patterns and anthropometric, lifestyle and sociodemographic variables. METHODS: A total of 197 women and 129 men with a body mass index <30 kg/m2 were recruited. A positive FHO (FHO+) was defined as having at least one obese first-degree relative and a negative FHO (FHO-) as no obese first-degree relative. Dietary data were collected from a food frequency questionnaire. Factor analysis was performed to derive dietary patterns. Mean factor scores were compared using general linear model among men and women according to FHO. Regression analyses were performed to study the relationship between anthropometric, lifestyle and sociodemographic variables, and each dietary pattern. RESULTS: Two dietary patterns were identified in both men and women : the Western pattern characterized by a higher consumption of red meats, poultry, processed meats, refined grains as well as desserts, and the Prudent pattern characterized by greater intakes of vegetables, fruits, non-hydrogenated fat, and fish and seafood. Similar Western and Prudent factor scores were observed in individual with and without FHO. In men with FHO+, the Western pattern is negatively associated with age and positively associated with physical activity, smoking, and personal income. In women with FHO-, the Prudent pattern is negatively associated with BMI and smoking and these pattern is positively associated with age and physical activity. CONCLUSION: Two dietary patterns have been identified among men and women with and without FHO. Although that FHO does not seem to influence the adherence to dietary patterns, results of this study suggest that anthropometric, lifestyle and sociodemographic variables associated with dietary patterns differ according to FHO and gender.

Journal Article↗
PubMed2006

Dietary patterns and survival in older Dutch women.

BACKGROUND: The need to gain insight into prevailing eating patterns and their health effects is evident. OBJECTIVE: This study aimed to identify dietary patterns and their relation to total mortality in older Dutch women. DESIGN: A principal component analysis of 22 food groups was used to identify dietary patterns in 5427 women aged 60-69 y who were included in the Dutch European Prospective Investigation into Cancer and Nutrition-Elderly cohort (follow-up: approximately 8.2 y). Mortality ratios for 3 major principal components were assessed by using Cox proportional hazard analysis. RESULTS: The most relevant principal components were a Mediterranean-like dietary pattern (high intakes of vegetable oils, pasta and rice, sauces, fish, and wine), a Traditional Dutch dinner dietary pattern (high intakes of meat, potatoes, vegetables, and alcoholic beverages), and a Healthy Traditional Dutch dietary pattern (healthy variant of the Traditional Dutch dinner dietary pattern; high intakes of vegetables, fruit, nonalcoholic drinks, dairy products, and potatoes). Differences in mean intakes between the highest and lowest tertiles of the 3 patterns were greatest for fruit, dairy products, potatoes, and alcoholic beverages. Consumption of Mediterranean foods, such as fish and oils, was relatively low overall. Two hundred seventy-seven deaths occurred in 44,667 person-years. Independent of age, education, and other lifestyle factors, only the Healthy Traditional dietary pattern score was associated with a lower mortality rate. Women in the highest tertile of this pattern experienced a 30% reduction in mortality risk. CONCLUSION: A Healthy Traditional Dutch diet, rather than a Mediterranean diet, appears beneficial for longevity and feasible for health promotion in older Dutch women. This diet is comparable with other reported healthy or prudent diets that have been shown to be protective against morbidity or mortality.

Aged↗
PubMed2001

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.

Adult↗
PubMed2006

Dietary patterns in the Southampton Women's Survey.

OBJECTIVE: Dietary pattern analysis is receiving increasing attention as a means of summarizing the multidimensional nature of dietary data. This research aims to compare principal component analysis (PCA) and cluster analysis using dietary data collected from young women in the UK. DESIGN: Diet was assessed using a 100-item interviewer-administered food frequency questionnaire. PCA and cluster analysis were used to examine dietary patterns. SETTING: Southampton, UK. SUBJECTS: A total of 6125 non-pregnant women aged 20-34 years. RESULTS: PCA identified two important patterns: a 'prudent' diet and a 'high-energy' diet. Cluster analysis defined two clusters, a 'more healthy' and a 'less healthy' cluster. There was a strong association between the prudent diet score and the two clusters, such that the mean prudent diet score in the less healthy cluster was -0.73 standard deviations and in the more healthy cluster was +0.83 standard deviations; the difference in the high-energy diet score between the two clusters was considerably smaller. CONCLUSIONS: Both approaches revealed a similar dietary pattern. The continuous nature of the outcome of PCA was considered to be advantageous compared with the dichotomy identified using cluster analysis. SPONSORSHIP: The study was funded by the Dunhill Medical Trust, the University of Southampton and the Medical Research Council.

Adult↗
PubMed2004

Dietary patterns, insulin sensitivity and adiposity in the multi-ethnic Insulin Resistance Atherosclerosis Study population.

Epidemiological investigations increasingly employ dietary-pattern techniques to fully integrate dietary data. The present study evaluated the relationship of dietary patterns identified by cluster analysis with measures of insulin sensitivity (SI) and adiposity in the multi-ethnic, multi-centre Insulin Resistance Atherosclerosis Study (IRAS, 1992-94). Cross-sectional data from 980 middle-aged adults, of whom 67 % had normal and 33 % had impaired glucose tolerance, were analysed. Usual dietary intake was obtained by an interviewer-administered, validated food-frequency questionnaire. Outcomes included SI, fasting insulin (FI), BMI and waist circumference. The relationship of dietary patterns to log(SI+1), log(FI), BMI and waist circumference was modelled with multivariable linear regressions. Cluster analysis identified six distinct diet patterns--'dark bread', 'wine', 'fruits', 'low-frequency eaters', 'fries' and 'white bread'. The 'white bread' and the 'fries' patterns over-represented the Hispanic IRAS population predominantly from two centres, while the 'wine' and 'dark bread' groups were dominated by non-Hispanic whites. The dietary patterns were associated significantly with each of the outcomes first at the crude, clinical level (P<0.001). Furthermore, they were significantly associated with FI, BMI and waist circumference independent of age, sex, race or ethnicity, clinic, family history of diabetes, smoking and activity (P<0.004), whereas significance was lost for SI. Studying the total dietary behaviour via a pattern approach allowed us to focus both on the qualitative and quantitative dimensions of diet. The present study identified highly consistent associations of distinct dietary patterns with measures of insulin resistance and adiposity, which are risk factors for diabetes and heart disease.

Adipose Tissue↗
PubMed2004

Prospective study of three major dietary patterns and risk of gastric cancer in Japan.

Dietary pattern analysis is an alternative and complementary approach to identify the relationship between diet and the risk of chronic disease. This study was aimed at investigating the associations between dietary patterns and the risk of gastric cancer in Japan. Using baseline data from a prospective study of 20,300 men and 21,812 women, we conducted factor analysis and identified 3 major dietary patterns, healthy, traditional and Western, and calculated the factor scores of each pattern for individuals. During 10 years of follow-up, 400 cases of gastric cancer were identified. We found an inverse association between the healthy pattern and gastric cancer risk in women [rate ratio for highest quartile (RR) = 0.56; 95% CI = 0.32-0.96; p for trend = 0.03], but not in men. In contrast, the traditional pattern was significantly associated with the increased risk of gastric cancer in both genders (for men, RR = 2.88, 95% CI = 1.76-4.72; for women, RR = 2.40, 95% CI = 1.32-4.35). The Western pattern was not associated with risk. These associations persisted in histologic subtypes. Our findings support the idea that the healthy pattern decreased the risk of gastric cancer among females, while the traditional pattern increased the risk in both genders.

Cohort Studies↗
PubMed2002

Dietary patterns predict the development of overweight in women: The Framingham Nutrition Studies.

OBJECTIVE: To investigate relationships between dietary patterns and the development of overweight. DESIGN: Longitudinal analyses during 12 years of follow-up involved the identification of dietary patterns at baseline using cluster analysis applied to a 145-item semiquantitative food frequency questionnaire. SUBJECTS/SETTING: 737 non-overweight women in the Framingham Offspring/Spouse cohort (mean age, 45 years). MAIN OUTCOME MEASURE: Development of overweight (BMI> or =25) at follow-up. STATISTICAL ANALYSES: Relative risks were calculated using Proc Genmod and multivariate models comprehensively considered potential confounders. RESULTS: Five dietary patterns were identified among the cohort at baseline: Heart Healthy, Light Eating, Wine and Moderate Eating, High Fat, and Empty Calorie. Over 12 years, the crude risk of becoming overweight was 29% overall, ranging from 22% of women in the Wine and Moderate Eating cluster to 41% of women in the Empty Calorie cluster. Compared with women who ate a lower-fat, nutritionally varied Heart Healthy diet, women who ate an Empty Calorie diet that was rich in sweets and fats with fewer servings of nutrient-dense fruits, vegetables, and lean food choices were at higher risk for developing overweight [RR 1.4, 95% CI (0.9, 2.2)] after adjusting for age, smoking status, physical activity, menopausal status, energy intake, intentional dieting, and usual weight pattern. Women who ate an Empty Calorie dietary pattern were also younger and were more likely to smoke. CONCLUSIONS: Behavioral interventions for weight management and obesity prevention may be enhanced by creatively targeting differences in eating patterns, dietary quality, and other lifestyle behaviors of distinct subgroups of the population.

Adult↗