Abstract MP19: Specific Dietary Patterns are Associated with Risk of Acute Coronary Heart Disease in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Introduction: Dietary patterns may be more relevant to actual dietary intake than isolated nutrients when studying associations between diet and disease incidence. We assessed the hypothesis that dietary patterns are associated with risk of incident acute CHD, defined as nonfatal MI or fatal CHD, in REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants free of CHD at baseline.
Methods: From 2003-2007, REGARDS enrolled 30,239 community-dwelling black and white men and women aged 45 years or older across the continental US, with oversampling in southeastern states. Usual diet was assessed at baseline with the Block 98 food frequency questionnaire (FFQ). Individual line items on the FFQ were collapsed into 56 food groups based on similar nutrient content and previous reports. Principal components analysis was used to assess underlying dietary patterns using these food groups in 20,480 participants who completed the FFQ. Five patterns emerged: Convenience (characterized by Chinese and Mexican foods, pasta, pizza, other mixed dishes), Plant-based (fruits, vegetables, legumes, fruit juice), Southern (fried foods, organ meats, sweetened beverages), Sweets (desserts, added sugars, sweetened breakfast foods), and Alcohol and Salad (beer, wine, liquor, fats, vegetables). Incident cases of CHD were captured by participant report and adjudicated by experts. Participant scores on the dietary patterns (divided into quartiles) were considered as predictors of incident acute CHD using Cox regression.
Results: Participants with the highest adherence to the Southern pattern were more likely to be male, black, and a resident of the Southeast than those with the lowest adherence to this pattern. A total of 444 cases of acute CHD were adjudicated over a mean of 4.6 years of follow-up. After adjustment for age, race, sex, income, education, region, energy, smoking, and physical activity, participants with the highest adherence to the Southern pattern experienced a 66% increased risk of acute CHD (comparing Q4 to Q1: HR = 1.66; 95% CI: 1.21, 2.28; P for trend across quartiles <0.001). Adding BMI, waist circumference, and history of hypertension, dyslipidemia, and diabetes to the model attenuated the association, but only modestly (comparing Q4 to Q1: HR = 1.39; 95% CI: 1.00, 1.94; P for trend = 0.01). The Sweets pattern also was positively associated with acute CHD risk in the fully adjusted model, but with no obvious trend: 1.42 (1.06, 1.92), 1.44 (1.06, 1.96), and 1.37 (0.97, 1.95) comparing Q2-Q4 to Q1, respectively; P for trend = 0.08. The Convenience, Healthy, and Alcohol and Salad patterns were not associated with acute CHD risk.
Conclusions: A Southern dietary pattern, characterized by fried foods, organ meats, and sweetened beverages, and a Sweets pattern were positively associated with risk of acute CHD in this population-based random sample of black and white adults in the US.
- © 2013 by American Heart Association, Inc.