Jessri Mahsa, Wolfinger Russell D, Lou Wendy Y, L'Abbé Mary R
Department of Nutritional Sciences, Faculty of Medicine, and.
Department of Statistics, North Carolina State University, Raleigh, NC; and.
Am J Clin Nutr. 2017 Mar;105(3):669-684. doi: 10.3945/ajcn.116.134684. Epub 2017 Feb 1.
Analyzing the effects of dietary patterns is an important approach for examining the complex role of nutrition in the etiology of obesity and chronic diseases. The objectives of this study were to characterize the dietary patterns of Canadians with the use of a priori, hybrid, and simplified dietary pattern techniques, and to compare the associations of these patterns with obesity risk in individuals with and without chronic diseases (unhealthy and healthy obesity). Dietary recalls from 11,748 participants (≥18 y of age) in the cross-sectional, nationally representative Canadian Community Health Survey 2.2 were used. A priori dietary pattern was characterized with the use of the previously validated 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Weighted partial least squares (hybrid method) was used to derive an energy-dense (ED), high-fat (HF), low-fiber density (LFD) dietary pattern with the use of 38 food groups. The associations of derived dietary patterns with disease outcomes were then tested with the use of multinomial logistic regression. An ED, HF, and LFD dietary pattern had high positive loadings for fast foods, carbonated drinks, and refined grains, and high negative loadings for whole fruits and vegetables (≥|0.17|). Food groups with a high loading were summed to form a simplified dietary pattern score. Moving from the first (healthiest) to the fourth (least healthy) quartiles of the ED, HF, and LFD pattern and the simplified dietary pattern scores was associated with increasingly elevated ORs for unhealthy obesity, with individuals in quartile 4 having an OR of 2.57 (95% CI: 1.75, 3.76) and 2.73 (95% CI: 1.88, 3.98), respectively (-trend < 0.0001). Individuals who adhered the most to the 2015 DGAI recommendations (quartile 4) had a 53% lower OR of unhealthy obesity (-trend < 0.0001). The associations of dietary patterns with healthy obesity and unhealthy nonobesity were weaker, albeit significant. Consuming an ED, HF, and LFD dietary pattern and lack of adherence to the recommendations of the 2015 DGAI were associated with a significantly higher risk of obesity with and without accompanying chronic diseases.
分析饮食模式的影响是研究营养在肥胖和慢性病病因中复杂作用的重要方法。本研究的目的是使用先验、混合和简化饮食模式技术来描述加拿大人的饮食模式，并比较这些模式与患有和未患有慢性病（不健康肥胖和健康肥胖）个体的肥胖风险之间的关联。使用了来自具有全国代表性的横断面加拿大社区健康调查2.2中11748名参与者（≥18岁）的饮食回忆数据。先验饮食模式通过使用先前验证的2015年美国膳食指南依从性指数（DGAI）来描述。加权偏最小二乘法（混合方法）用于通过38个食物组得出能量密集（ED）、高脂肪（HF）、低纤维密度（LFD）的饮食模式。然后使用多项逻辑回归测试得出的饮食模式与疾病结局之间的关联。ED、HF和LFD饮食模式对快餐、碳酸饮料和精制谷物具有高正负荷，对完整水果和蔬菜具有高负负荷（≥|0.17|）。对具有高负荷的食物组进行汇总以形成简化饮食模式得分。从ED、HF和LFD模式以及简化饮食模式得分的第一个（最健康）四分位数到第四个（最不健康）四分位数的变化与不健康肥胖的OR值逐渐升高相关，四分位数4中的个体的OR值分别为2.57（95%CI：1.75，3.76）和2.73（95%CI：1.88，3.98）（-趋势<0.0001）。最遵守2015年DGAI建议的个体（四分位数4）患不健康肥胖的OR值低53%（-趋势<0.0001）。饮食模式与健康肥胖和不健康非肥胖之间的关联较弱，尽管具有显著性。食用ED、HF和LFD饮食模式以及不遵守2015年DGAI的建议与伴有或不伴有慢性病的肥胖风险显著较高相关。
