Dietary patterns, subclinical inflammation, incident coronary heart disease and mortality in middle-aged men from the MONICA/KORA Augsburg cohort study

Abstract

We aimed to identify dietary patterns associated with inflammatory markers and to examine their impact on the incidence of coronary heart disease (CHD) and all-cause mortality, as subclinical inflammation is a risk factor for these outcomes. The study population comprised 981 middle-aged men participating in the first or third 'MONItoring of Trends and Determinants in CArdiovascular Diseases' (MONICA) Augsburg surveys who completed 7-day dietary records. Subjects were followed up until 2002 for CHD and until 2007 for mortality. Dietary patterns were derived using reduced rank regression (RRR) with C-reactive protein, interleukin (IL)-6 and IL-18 as responses. Alternatively, partial least squares and principal components regression were used. A high score of the RRR-derived pattern was characterised by high intakes of meat, soft drinks and beer and low intakes of vegetables, fresh fruit, chocolates, cake, pastries, wholemeal bread, cereals, muesli, curd, condensed milk, cream, butter, nuts, sweet bread spread and tea. This score was associated with a higher risk for CHD (hazard ratio=1.33, 95% confidence interval: 1.06-1.67, P=0.013) and mortality (hazard ratio=1.34, 1.17-1.53, P<0.001) after multivariable adjustment. However, for CHD and CHD mortality the significant association disappeared after further adjustment for smoking status; for all-cause mortality it was attenuated but remained significant (hazard ratio=1.16, 1.00-1.33, P=0.046). Patterns derived from the other methods resembled the RRR pattern showing similar results regarding disease outcomes. Participants exhibiting higher dietary pattern scores had higher levels of inflammatory markers and higher risk for CHD and all-cause mortality, however, smoking was an important confounder, especially for CHD outcomes.