Differences in United States Adult Dietary Patterns by Cardiometabolic Health and Socioeconomic Vulnerability

Abstract

Background: Naturally occurring dietary patterns are not well described among individuals with cardiovascular disease (CVD) or cardiometabolic risk factors (i.e., diabetes, hypertension, obesity, and dyslipidemia), particularly considering socioeconomic vulnerability.

Objectives: We investigated major dietary patterns in the United States and their distribution by prevalent CVD, cardiometabolic risk factors, and socioeconomic vulnerability.

Methods: This cross-sectional study analyzed data from 32,498 noninstitutionalized adults who participated in the National Health and Nutrition Examination Survey (2009-2020). We used principal component analysis to identify dietary patterns. Using multiple linear regression, we tested the association of prevalent CVD, cardiometabolic risk factors, and socioeconomic vulnerability [number of social risk factors and Supplemental Nutrition Assistance Program (SNAP) participation status] with each pattern.

Results: Four dietary patterns were identified: processed/animal foods (high-refined grains, added sugars, meats, and dairy), prudent (high vegetables, nuts/seeds, oils, seafood, and poultry), legume, and fruit/whole grain/dairy, which together explained 29.2% of the dietary variance. After adjustment for age, gender, race and ethnicity, cohort year, and total energy intake, the processed/animals foods pattern associated (β-coefficient for difference in principal component score) positively with diabetes [0.08 (0.01, 0.14)], hypertension [0.11 (0.06, 0.16)], obesity [0.15 (0.11, 0.19)], higher social risk score (P-trend < 0.001), income-eligible SNAP nonparticipation [0.16 (0.09, 0.23)], and SNAP participation [0.23 (0.17, 0.29)]. The prudent pattern associated negatively with hypertension [-0.09 (-0.14, -0.04)], obesity [-0.11 (-0.16, -0.06)], higher social risk score (P-trend < 0.001), income-eligible SNAP nonparticipation [-0.14 (-0.21, -0.06)], and SNAP participation [-0.30 (-0.35, -0.24)]. The legume pattern was associated negatively with CVD [-0.09 (-0.15, -0.02)] and obesity [-0.08 (-0.12, -0.04)], and positively with income-eligible SNAP nonparticipation [0.11 (0.04, 0.18)]. The fruit/whole grain/dairy pattern was associated positively with diabetes [0.08 (0.01, 0.15)] and negatively with hypertension [-0.21 (-0.26, -0.15)], obesity [-0.23 (-0.28, -0.18)], higher social risk score (P-trend < 0.001), and SNAP participation [-0.19 (-0.25, -0.12)].

Conclusions: Empirical dietary patterns in the United States vary by CVD, cardiometabolic risk factors, and socioeconomic vulnerability. Initiatives to improve nutrition should consider these naturally occurring dietary patterns and their variation in key subgroups.

Keywords: cardiovascular disease; food assistance; nutrition; policy; social determinants of health.

FIGURE 1

Association of dietary patterns (principal components score) with cardiovascular disease and cardiometabolic risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 1

Association of dietary patterns (principal components score) with cardiovascular disease and cardiometabolic risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 1

Association of dietary patterns (principal components score) with cardiovascular disease and cardiometabolic risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 1

Association of dietary patterns (principal components score) with cardiovascular disease and cardiometabolic risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 2

Association of dietary patterns (principal components score) with number of social risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 2

Association of dietary patterns (principal components score) with number of social risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 2

Association of dietary patterns (principal components score) with number of social risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 2

Association of dietary patterns (principal components score) with number of social risk factors for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 3

Association of dietary patterns (principal components score) with Supplemental Nutrition Assistance Program participation status for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 3

Association of dietary patterns (principal components score) with Supplemental Nutrition Assistance Program participation status for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 3

Association of dietary patterns (principal components score) with Supplemental Nutrition Assistance Program participation status for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.

FIGURE 3

Association of dietary patterns (principal components score) with Supplemental Nutrition Assistance Program participation status for the entire cohort and by race and ethnicity. (A) Entire cohort; (B) non-Hispanic White individuals; (C) non-Hispanic Black individuals; (D) Hispanic individuals; (E) non-Hispanic Asian individuals. P values are indicated as follows: ∗P < 0.05; ∗∗P < 0.01; ∗∗∗P < 0.001. Note: Values are β-coefficient for difference in principal component score. Positive values indicate positive association with the principal components score. Models were individual linear regression models with each principal components score as the outcome variable. All models were adjusted for age, gender, race and ethnicity, total energy intake, and NHANES survey cycle; and included the predictors of cardiovascular disease, cardiometabolic risk factors, social risk score, and Supplemental Nutrition Assistance Program (SNAP) status simultaneously to account for their interrelated effects.