Abstract
PurposeWe examined if data-driven food-patterns associate with weight change, incidence of type 2 diabetes (T2D), coronary events (CE) and stroke.MethodsThe study included 20,487 individuals (61% women) from the Malmö Diet and Cancer cohort, 45–74 years, without diabetes and CVD at baseline (1991–1996) and who did not report dietary changes. Diet was measured with a modified diet history method. During 15 years follow-up, 2206 T2D, 1571 CE and 1332 stroke cases were identified. Data on weight change after 16.7 years were available in 2627 individuals.ResultsFrom principal component analysis, we identified six food-patterns which were similar in women and men. The first pattern, explaining 7% of the variance, was characterized by high intake of fibre-rich bread, breakfast cereals, fruits, vegetables, fish and low-fat yoghurt, and by low intake of low-fibre bread. This health conscious pattern was associated with lower T2D risk (HR comparing highest quintile with lowest: 0.75; 95% CI 0.61–0.92, 0.82; 95% CI 0.68–1.00 in women and men, respectively, P trends = 0.003, 0.01) and CE (HR 0.77; 95% CI 0.58–1.02, HR 0.83; 95% CI 0.68–1.01, P trends = 0.05, 0.07), and in men also with lower risk of ischemic stroke (HR 0.69; 95% CI 0.54–0.88; P trend = 0.001) and less pronounced weight gain (0.93 kg/10 years, P trend = 0.03). A low-fat product pattern was associated with increased T2D risk in gender combined analyses (P trend = 0.03) and a pattern characterized by dressing and vegetables with lower CE risk in men (P trend = 0.02).ConclusionsOur main finding was that a dietary pattern indicating health conscious food choices was associated with lower risk of cardiometabolic diseases in both genders.
Highlights
The prevalence of obesity, type 2 diabetes (T2D) and cardiovascular disease is increasing globally
The “health conscious” pattern was associated with decreased incidence of stroke (HR comparing the highest quintile with the lowest: 0.69; 95% CI 0.54–0.88; P for trend across quintiles = 0.001, full multivariable model) (Table 4) in men, but no such tendencies were seen in women
A dietary pattern characterized by health-conscious food choices, such as plant foods, fish and low-fat yoghurt, was associated with decreased incidence of T2D and coronary events in both genders
Summary
The prevalence of obesity, type 2 diabetes (T2D) and cardiovascular disease is increasing globally. Diet is an extremely complex exposure and during the last decades, the value of examining intake of foods or food patterns, in addition to nutrients, has been highlighted [1]. Correlations and interactions between food components may not be satisfactorily taken into account in observational studies on single dietary components [1], which complicates the interpretation of findings in nutritional epidemiology. It is difficult to isolate the effect of specific nutrients or foods. We do not eat single nutrients or foods, but combinations of these, and it is, of great value to capture overall dietary patterns that could be translated into relevant food-based dietary guidelines. One option is to use data-driven statistical methods to reduce intake data on a number of single foods or food groups into meaningful eating patterns reflecting how foods are commonly consumed together
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