Link of dietary patterns with metabolic syndrome: analysis of the National Health and Nutrition Examination Survey

Abstract

Background: Population-based interventions aimed at halting the increasing prevalence of metabolic syndrome (MetS) require thorough understanding of dietary interplays. Objective is to identify the independent dietary nutrients associated with MetS and its components using dietary pattern identification and the single-nutrient approaches in The United States.

Methods: This is a cross-sectional observation. Participants are selected from the National Health and Nutrition Examination Survey (NHANES) with available dietary intake, biochemical and anthropometrical data from 2001 to 2012. Exposure is diet obtained from 24-h dietary recall. Main outcome measure is MetS and its components.

Results: Overall, 23 157 eligible individuals including 6561 with MetS were included in the final analysis. Using principle component analysis, we identified three food patterns that explained 50.8% of the variance of the dietary nutrient consumption. The highest quartile of the factor score representative of saturated/monounsaturated fatty acids or the first dietary pattern was associated with 1.27-fold (95% confidence interval (CI): 1.10-1.46, P=0.001) higher odds of association with MetS when compared with the first quartile. The second pattern representative of vitamins and trace elements had an odds ratio of 0.79 (95% CI: 0.70-0.89, P<0.001) for association with MetS, and the third pattern representative of polyunsaturated fatty acids did not have any association with MetS. The nutrient-by-nutrient approach showed that mild alcohol intake and lower consumption of total saturated fatty acids and sodium were associated with lower risk of MetS.

Conclusions: Application of multiple complementary analytic approaches reveals more comprehensive dietary determinants of MetS and its components as potential intervening targets.

Figure 1

Comparing adjusted odds ratio of the quartiles of each principle component with the fourth quartile as reference to predict metabolic syndrome (MetS) and its constituents (adjusted for age, sex and race).

Figure 2

Comparing age-, sex- and race-adjusted odds ratio of the first to third quartiles of the nutrients with the fourth quartile as reference by metabolic syndrome (right panel) and its components (left panel), using multiple logistic regression analysis in a nutrient-by-nutrient approach. TSFA, total saturated fatty acids. P-values pertain to the comparison of each quartile to the fourth quartile except for alcohol intake which is compared with no alcohol intake.