Healthy eating index patterns in adults by sex and age predict cardiometabolic risk factors in a cross-sectional study

Authors: Artegoitia Etchev, Virginia; KRISHNAN, SRIDEVI - University Of California, Davis; BONNEL, ELLEN - University Of California, Davis; Stephensen, Charles; Keim, Nancy; Newman, John

Submitted to: BMC Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/13/2021
Publication Date: 6/22/2021
Citation: Artegoitia Etchev, V.M., Krishnan, S., Bonnel, E.L., Stephensen, C.B., Keim, N.L., Newman, J.W. 2021. Healthy eating index patterns in adults by sex and age predict cardiometabolic risk factors in a cross-sectional study. Biomed Central (BMC) Nutrition. 7. Article 30. https://doi.org/10.1186/s40795-021-00432-4.
DOI: https://doi.org/10.1186/s40795-021-00432-4

Interpretive Summary: Associations between diet and cardiometabolic disease (CMD) risk may vary in men and women owing to sex differences in eating habits and physiology. Here we sought to determine if sex differences in dietary patterns could alone discriminate adults with or without CMD risk factors (CMDrf) and if this was influenced by age. To accomplish this, diet patterns and quality were evaluated using 24h recall-based Healthy Eating Index (HEI-2015) in free-living apparently healthy men (n =184) and women (n =209) 18 - 65 y of age with body mass indexes (BMI) ranging from normal weight to obese. Participants were stratified into low- and high-CMDrf groups based on the presence/absence of at least one CMDrf: an over wieght to obese BMI; elevated fasting triglycerides; low HDL cholesterol; low insulin sensitivity. Sex by age dietary patterns were stratified and associated with risk factors using stepwise discriminant analysis. Diet quality was found to increase with age in both sexes (P <0.01), however women ate more fruits, vegetables and saturated fats as a percentage of total energy intake (P <0.05). The total-HEI score (i.e. diet quality) was lower in the high-CMDrf group (P =0.01), however, diet quality parameters predicted CMDrf presence more accurately when separated by sex. Lower ‘total vegetable’ intake was observed in the high-CMDrf groups of both sexes, while high-CMDrf men also had lower, ‘greens and beans’ intake, and high-CMDrf women had lower ‘total fruits’, ‘whole-fruits’, ‘seafood and plant-proteins’, ‘fatty acids’, and ‘saturated fats’ intakes (P <0.05). Moreover, ‘dairy’ intake was higher in high-CMDrf women but not in men (sex by ’dairy’ interaction P =0.01). Sex by age diet pattern models predicted CMDrf with a 93% and 89% sensitivity and 84% and 92% specificity in women and men, respectively. In conclusion, sex and age differences in dietary patterns classified participants with and without accepted cardiometbolic disease risk factors, supporting an association between specific diet components and CMD risk that differs by sex. Including sex specific dietary patterns into health assessments may provide targeted nutritional guidance to reduce the burden of cardiovascular disease.

Technical Abstract: Background: Associations between diet and cardiometabolic disease (CMD) risk may vary in men and women owing to sex differences in eating habits and physiology. The current secondary analysis sought to determine the ability of sex differences in dietary patterns to discriminate groups with or without CMD risk factors (CMDrf) in the adult population and if this was influenced by age. Methods: Diet patterns and quality were evaluated using 24h recall-based Healthy Eating Index (HEI-2015) in free-living apparently healthy men (n =184) and women (n =209) 18 - 65 y of age with BMIs of 18 - 44 kg/m2. Participants were stratified into low- and high-CMDrf groups based on the presence/absence of at least one CMDrf: BMI >25 kg/m²; fasting triglycerides >150 mg/dL; HDL cholesterol <50 mg/dL-women or <40 mg/dL-men; HOMA >2; HbA1c >5.7. Sex by age dietary patterns were stratified by multivariate analyses, with metabolic variable associations established by stepwise discriminant analysis. Results: Diet quality increased with age in both sexes (P <0.01), while women showed higher fruit, vegetable and saturated fat intake as a percentage of total energy (P <0.05). The total-HEI score (i.e. diet quality) was lower in the high-CMDrf group (P =0.01), however, diet quality parameters predicted CMDrf presence more accurately when separated by sex. Lower ‘total vegetable’ intake in the high-CMDrf group in both sexes, while high-CMDrf men also had lower ‘total vegetables’, ‘greens and beans’ intake, and high-CMDrf women had lower ‘total fruits’, ‘whole-fruits’, ‘total vegetables’, ‘seafood and plant-proteins’, ‘fatty acids’, and ‘saturated fats’ intakes (P <0.05). Moreover, ‘dairy’ intake was higher in high-CMDrf women but not in men (sex by ’dairy’ interaction P =0.01). Sex by age diet pattern models predicted CMDrf with a 93% and 89% sensitivity and 84% and 92% specificity in women and men, respectively. Conclusions: Sex and age differences in dietary patterns classified participants with and without accepted CMDrfs, supporting an association between specific diet components and CMD risk that differs by sex. Including sex specific dietary patterns into health assessments may provide targeted nutritional guidance to reduce the burden of cardiovascular disease.