Dietary patterns and the risk of CVD and all-cause mortality in older British men.

Janice L Atkins,Lucy T Lennon,Peter H Whincup,Olia Papacosta,Richard W Morris,S Goya Wannamethee

doi:10.1017/s0007114516003147

Abstract

Dietary patterns are a major risk factor for cardiovascular morbidity and mortality; however, few studies have examined this relationship in older adults. We examined prospective associations between dietary patterns and the risk of CVD and all-cause mortality in 3226 older British men, aged 60-79 years and free from CVD at baseline, from the British Regional Heart Study. Baseline FFQ data were used to generate thirty-four food groups. Principal component analysis identified dietary patterns that were categorised into quartiles, with higher quartiles representing higher adherence to the dietary pattern. Cox proportional hazards examined associations between dietary patterns and risk of all-cause mortality and cardiovascular outcomes. We identified three interpretable dietary patterns: 'high fat/low fibre' (high in red meat, meat products, white bread, fried potato, eggs), 'prudent' (high in poultry, fish, fruits, vegetables, legumes, pasta, rice, wholemeal bread, eggs, olive oil) and 'high sugar' (high in biscuits, puddings, chocolates, sweets, sweet spreads, breakfast cereals). During 11 years of follow-up, 899 deaths, 316 CVD-related deaths, 569 CVD events and 301 CHD events occurred. The 'high-fat/low-fibre' dietary pattern was associated with an increased risk of all-cause mortality only, after adjustment for confounders (highest v. lowest quartile; hazard ratio 1·44; 95 % CI 1·13, 1·84). Adherence to a 'high-sugar' diet was associated with a borderline significant trend for an increased risk of CVD and CHD events. The 'prudent' diet did not show a significant trend with cardiovascular outcomes or mortality. Avoiding 'high-fat/low-fibre' and 'high-sugar' dietary components may reduce the risk of cardiovascular events and all-cause mortality in older adults.

Highlights

Diet is a well-established major modifiable risk factor for cardiovascular morbidity and mortality and may be important in older adults, who are at higher risk of chronic disease[1,2,3,4]
A total of three interpretable a posteriori dietary patterns identified by principal component analysis explained 20·8 % of the total variance in diet
The dietary pattern defined by the first principal component was labelled ‘high fat/low fibre’, and explained 7·9 % of the total variance

Summary

Introduction

Diet is a well-established major modifiable risk factor for cardiovascular morbidity and mortality and may be important in older adults, who are at higher risk of chronic disease[1,2,3,4]. Studies investigating the associations between diet and risk of CVD or mortality have focused on single food items or specific dietary nutrients[3,4,5]; more recently, research has tended to focus on overall dietary patterns to reflect the complex multidimensional nature of diets consumed in the population and to examine the combined effects of the consumption of various foods/nutrients[6,7,8]. CVD and mortality in older men Principal component analysis is one common method of deriving a posteriori dietary patterns and is a data-reduction technique, which identifies foods that are frequently consumed together and aggregates food items or groups on the basis of the degree of correlation with one another[7,9]. It has been suggested that principal component analysis may generate more meaningful and interpretable dietary patterns than cluster analysis (an alternative a posteriori method that separates individuals into mutually exclusive groups based on the differences in dietary intake) as it has higher statistical power and is less influenced by extreme values[8,13]

Objectives

Methods

Results

Conclusion