We assessed diet patterns and the presence of specific CVD risk factors among a national representative sample of women aged 50 years and older.
The diet pattern analysis evaluated dietary intake not by its nutrient composition but by the consumption of particular food groups. Cluster analysis to derive dietary patterns is gaining popularity in research studies. A recent review identified 35 studies using cluster analysis to evaluate food intake since 1980 (15
). These methods may help avoid issues of colinearity between nutrients (15
) that can confound diet–disease relationships. Grouping individuals according to the foods they consume may also facilitate the recognition of unhealthful food choices that will inevitably affect the nutrient content of the diet and the presence of CVD risk factors.
The diet patterns derived in this study indicate that women aged 50 years and older consume an average of 1,366 to 1,670 kcal/day. Consumption of fiber and n-3 fatty acids was inadequate in all diet patterns, based on the guidelines for CVD prevention (3
). The diet pattern with the lowest mean energy intake was the Beef, Starches, Fruits, and Milk cluster, which was also associated with the lowest probability of being overweight or obese. This pattern is characterized by consumption of a variety of foods, including fruits, legumes, vegetables, meats, and dairy and conforms more closely to the 2005 US Dietary Guidelines (22
) relative to the other patterns. Yet it showed significant associations with only one of the major CVD risk factors examined in this study; that is, being overweight or obese in the expected direction.
The Sweets dietary pattern consisted of 32% of the total sample followed by the Beef, Starches, Fruits, and Milk diet pattern (29%). A similar study (23
) also reported a “Sweets” diet pattern derived from cluster analysis among a sample of adult men and women. Interestingly it was also the cluster in that study where most of the study participants were grouped.
In our study, the Sweets diet pattern also showed the most significant associations to HDL and SBP risk as a protective factor. It is noteworthy that those who did not have HDL risk were also more likely to be Non-Hispanic African Americans and they were more likely to be classified in the Sweets diet pattern. Thus, the association of the Sweets pattern to the absence of HDL risk may be partly due to the lower risk for HDL levels below the recommended among non-Hispanic African Americans in this diet pattern. The mean amount of alcohol in the Sweets pattern was 6.66 g, which represents approximately half a standard drink. Even though this may not be a considerable amount of alcohol consumption to exert an influence on HDL cholesterol levels, it is possible that the alcohol content of the diet may also be partially responsible for its association with optimal HDL cholesterol levels because, as expected, the moderate alcohol consumption reported by participants was also a protective factor for HDL risk.
In contrast, the Sweets pattern also showed a protective effect on SBP risk that cannot be explained by the lifestyle factors included in this study nor by age or race and ethnic category.
Recent studies continue to confirm the importance of fiber intake and other nutrients to achieve a decrease in cholesterol level, triglyceride level, and body weight, all of which contribute to CVD risk (24
). Nevertheless, a recent clinical trial among postmenopausal women did not find a significant change in incidence of coronary heart events and very mild decrease in CVD risk factors after 8 years of dietary intervention to reduce fat intake and increase fruit and vegetable consumption (26
). These studies reflect the complexity of dietary intake and diet–disease associations, as well as the difficulties of dietary assessment in nutritional epidemiology. Compared to dietary intake, these studies highlight the overarching role other lifestyle factors may have on health.
Our results indicate there are significant associations between diet patterns and CVD risk factors even though they were limited to 1 day of dietary data among a multiethnic population of women aged 50 years and older. The uncharacteristic protective effect of a diet characterized by a large amount of its energy from desserts or pastries may be explained by the consumption of other nutrient sources, lifestyle factors not considered in this study, or even genetic factors. Taking into account the limitations of empirically defined diet patterns, the assessment of diet intake using different methods seems essential to thoroughly describe the complex association between diet and disease. Thus, the results from this study also support the importance of assessing different aspects of dietary intake (ie, food sources) combined with lifestyle factors to explain its association with CVD risk factors.
The CVD risk factors assessed for this study indicate that women aged 50 years and older would benefit from CVD prevention interventions that target lifestyle changes such as increased physical activity to increase HDL cholesterol levels and lower BMI. Dietary interventions to increase consumption of fruits and vegetables, milk and milk products, and polyunsaturated fats among postmenopausal women continue to be necessary. According to the diet patterns derived from this study among women aged 50 years and older, high-fiber foods and n-3 fatty acids food sources must also be increased to conform to recommendations of a heart-healthy diet.