Dietary patterns associated with risk factors for cardiovascular disease in United States adults

Dietary intake of specific nutrients, foods, and food groups are well-established dietary risk factors for cardiovascular disease (CVD). As dietary patterns encompass the dietary intake of individuals within the context of lifestyles, we tested the hypotheses that complex dietary behaviors can be systematically classified into dietary patterns that are associated with nutrient intakes and risk factors for CVD. This study utilized data from the third National Health and Nutrition Examination Survey (NHANES III) and all statistical analyses accounted for the survey design and sample weights and controlled for confounding variables (age, gender, ethnicity, income, smoking status, alcohol intake, vitamin/mineral supplement use, BMI, and physical activity level) in regression analyses.; Using the food-frequency questionnaire and collapsing the 64 food groups available into 35, dietary patterns of healthy U.S. adults (≥20y; n = 13,130) were identified by factor analysis. Of six dietary patterns identified, two patterns emerged most prominently and were characterized by high intakes of (1) processed meats, eggs, red meats, and high-fat dairy products (“Western”); and (2) green, leafy vegetables, salad dressings, tomatoes, other vegetables, cruciferous vegetables, and tea (“American-healthy”). The Western pattern was associated (p < 0.05) positively with serum C-peptide, serum insulin, and glycosylated hemoglobin and inversely with RBC folate concentrations after adjusting for confounding variables. The American-healthy pattern had no linear relationships with any of the biomarkers examined.; Using the 24-h dietary recall, meal and snack patterns of U.S. adults (≥20 y; n = 15,978) were described in relation to nutrient intakes. Daily eating frequency was associated (p < 0.05) positively with carbohydrate (% energy), folic acid, vitamin C, calcium, magnesium, iron, potassium, and fiber intakes and inversely related to protein (% energy), total fat (% energy), cholesterol, and sodium intakes. In additional analyses (n = 10,427), daily eating frequency was associated positively with serum C-peptide concentrations (p < 0.05). Daily eating frequency was associated positively with an “American-healthy” dietary pattern but not with a “Western” dietary pattern. After further controlling for the American-healthy dietary pattern, the relationship between daily eating frequency and serum C-peptide concentrations was no longer statistically significant (p = 0.09).; We identified common dietary patterns among free-living persons that characterize high-risk groups at the U.S. population level. These dietary patterns are remarkably similar to those reported in other subgroups and are correspondingly related to health risks. Our findings confirm the hypothesis that dietary pattern analysis is a reliable method for assessing dietary intake that predicts CVD risk, and that meal and snack patterns are predictive of nutrient intake and selected biomarkers. The concept of the “total diet” inclusive of both food intakes and dietary behaviors should be considered in investigations of dietary intake and health outcomes.