Analysis of dietary pattern effects on metabolic risk factors using structural equation modeling

Abstract

Background: This study aimed to investigate the effects of dietary patterns on metabolic cardiovascular disease (CVD) risk factors in a Nordic population.

Methods: The study sample comprised 9,988 participants aged 40-79 years from the seventh Tromsø study (Norway). Available data included food intake values collected by a food frequency questionnaire. Exploratory structural equation models were utilized to analyse direct, indirect, and total effects of dietary patterns on metabolic CVD risk factors, using obesity as a mediator. The CVD risk factors included CRP, HDL-cholesterol, triglycerides, glycated hemoglobin, and blood pressure. All structural equations were adjusted for available lifestyle and demographic variables.

Results: Three common dietary patterns for women and men were identified, named Snacks and Meat, Health-conscious, and a Processed Dinner pattern. Additionally, a Porridge pattern was identified for women and a Cake pattern for men. The Health-conscious pattern showed a direct favorable effect on HDL-cholesterol (both sexes) and triglycerides (women). The Snacks and Meat pattern showed an unfavorable direct effect on triglycerides (men), while the Cake pattern had a favorable effect. All patterns, except the Health-conscious pattern for women, had direct effects on obesity, indirect effects on all metabolic risk factors, and a total effect on CRP. Snacks and Meat and the Processed Dinner patterns had unfavorable total effects on HDL-cholesterol (both sexes).

Conclusion: Dietary patterns showed direct associations with HDL-cholesterol and triglycerides. Obesity was an important mediator in explaining the indirect effects of dietary patterns on all metabolic risk factors.

Keywords: CVD risk factors; Tromsø Study; cross-sectional study; dietary patterns; exploratory structural equation models; mediation analysis.

Figure 1

Simplified path diagram illustrating the assumed theoretical structure of the model. Circles represent latent variables, while squares represent observed values. BMI, body mass index; WC, waist circumference; CRP, C-reactive protein; HDL-C, high density lipoprotein cholesterol; TG, triglycerides; HbA1c, hemoglobin A1c; DBP, diastolic blood pressure; SBP, systolic blood pressure.

Figure 2

Significant effects between dietary patterns and metabolic CVD risk factors including obesity as a mediator. Diet 1: Snacks and Meat pattern, Diet 2: Health-conscious pattern, Diet 3: Processed Dinner pattern, Diet 4a: Porridge pattern, Diet 4b: Cake pattern.