Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort
Introduction
Epidemiological studies have shown that the risk of many chronic diseases varies with diet: dietary behaviour is an aetiological factor in various types of cancer [1], [2], [3], [4], [5], [6], cardiovascular [7], [8], [9], [10], [11] and metabolic [12], [13] diseases. However, the variability of diet, and the complexity of ways in which individual food items may be associated with other items and different dietary habits, make it difficult to identify the effects of individual dietary components on health and disease. The difficulty in describing this complexity may be one reason why studies that have sought to relate individual nutrients or food items to the risk of a disease have produced inconsistent results [14], [15], [16].
In addition, studies on diet typically use complex questionnaires listing a large number of foods, food components and other dietary variables, analysis of which carries the risk that significant associations may arise by chance alone resulting in false associations between diet and disease. There is also the risk that concentration on the minutia of dietary components may result in missing associations between more general characteristics of diet and disease.
Delineating associations between diet and health is even more challenging in elderly people, since dietary behaviour is likely to have been recently modified due to age-related difficulties in mastication, digestion, etc., or following the diagnosis of a disease. For these reasons it is important to be able to identify key combinations of foods, less prone to modification compared to individual components of diet, and more likely to reflect long-term eating behaviour.
Exploratory factor analysis has recently emerged as a method of examining dietary behaviour and relationships between diet and the risk of disease [17], [18]. It is a statistical method that analyses the covariate structure of a range of variables to identify a restricted number of underlying variables. The method was first developed and applied in the field of psychology, but has been extended to etiological studies on cardiovascular diseases [19], [20], diabetes [21] and cancer [22], [23], [24]. When applied to the analysis of food group consumption, exploratory factor analysis reduces data into patterns based upon correlations between dietary items [25], thus making it possible to summarise in a few variable scores the characteristics of diet, and allowing classification of people according to their overall dietary behaviour.
Exploratory factor analysis is being used in nutritional epidemiology because of limitations in the traditional single food item approach (which include inability to account for interactions between foods) and because its findings can be used to provide tangible dietary advice.
Factor analysis has also been used recently to assess diet and its relationships to health status in the elderly [26], [27], [28]. In the present study we used exploratory factor analysis to identify dietary patterns in a sample of elderly subjects. We then examined the relations of these patterns to socio-economic, demographic and anthropometric variables. The subjects were Italians aged 60 and over participating in the ongoing EPIC-ELDERLY study, part of the European Prospective Investigation into Cancer and Nutrition (EPIC) [29].
Section snippets
Subjects
EPIC is being conducted in ten European countries on populations which differ markedly in terms of dietary habits and cancer risk. The Italian EPIC cohort consists of 47,749 people recruited in the study centres of Ragusa, Florence, Turin, Naples (women only) and Varese. Detailed information on this cohort is available elsewhere [30]. The climate, environment, history, and wealth of these centres differ considerably and contribute to the variations in diet, eating behaviour, lifestyle and
Results
Four dietary patterns that explained 21% of the variance in the original dietary variables were identified; their characteristics are summarised in Table 1. The first dietary pattern, which we called prudent, was characterised by high loadings of cooked vegetables, legumes, cabbage and fish, and also seed oil as added fat. The second pattern, pasta & meat had high loadings of pasta, tomato sauce, red meat, processed meat, bread and wine. The third pattern, olive oil & salad, was characterised
Discussion
We identified four major dietary patterns in our sample of Italian elderly. Two of these patterns, prudent and olive oil & salad, are variants of the traditional Mediterranean diet. The third, pasta & meat is an Italian variant of a western type energy-dense diet. The fourth, sweet & dairy reflects a preference for sweet, dairy and easily prepared foods.
The prudent pattern is characterised by high consumption of cooked vegetables including cabbage and pulses, with significant consumption also
Acknowledgements
The authors wish to thank all who participated in or collaborated with EPIC Italy. Thanks are also due to Don Ward for helping with the English and to Sara Grioni for critical reading. EPIC Italy is supported by a generous grant from the Associazione Italiana per la Ricerca sul Cancro (AIRC, Milan). EPIC is also supported by the European Union.
This study was supported in part by the Quality of Life and Management of Living resources Programme of the European Commission (DG Research, contract No
Reference (76)
- et al.
Dietary patterns associated with colon and rectal cancer: results from the Dietary Patterns and Cancer (DIETSCAN) Project
Am J Clin Nutr
(2004) - et al.
Dietary patterns, smoking, and subclinical heart disease in women: opportunities for primary prevention from the Framingham Nutrition Studies
J Am Diet Assoc
(2004) - et al.
Dietary lycopene, tomato-based food products and cardiovascular disease in women
J Nutr
(2003) - et al.
Fruit and vegetable intake and risk of cardiovascular disease: the Women's Health Study
Am J Clin Nutr
(2000) - et al.
Comparison of dietary intakes associated with metabolic syndrome risk factors in young adults: the Bogalusa Heart Study
Am J Clin Nutr
(2004) - et al.
Are imprecise methods obscuring a relation between fat and breast cancer?
Lancet
(2003) - et al.
Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk
Am J Clin Nutr
(2001) - et al.
Prospective study of major dietary patterns and risk of coronary heart disease in men
Am J Clin Nutr
(2000) - et al.
The relation of dietary patterns to future survival, health, and cardiovascular events in older adults
J Clin Epidemiol
(2003) - et al.
Beyond the traditional interpretation of Mediterranean diet
Nutr Metab Cardiovasc Dis
(2003)
Effects of different dietary fats on plasma-lipid levels
Lancet
The dietary pyramid: does the foundation need repair?
Am J Clin Nutr
Common and country-specific dietary patterns in four European cohort studies
J Nutr
Mediterranean diet pyramid: a cultural model for healthy eating
Am J Clin Nutr
Cereals, legumes, and chronic disease risk reduction: evidence from epidemiologic studies
Am J Clin Nutr
Phytic acid added to white-wheat bread inhibits fractional apparent magnesium absorption in humans
Am J Clin Nutr
Influence of vegetable protein sources on trace element and mineral bioavailability
J Nutr
The effect of phytic acid on in vitro rate of starch digestibility and blood glucose response
Am J Clin Nutr
Actual causes of death in the United States, 2000
J Am Med Assoc
Red meat consumption and risk of cancers of the proximal colon, distal colon and rectum: The Swedish Mammography Cohort
Int J Cancer
Red meat, chicken, and fish consumption and risk of colorectal cancer
Cancer Epidemiol Biomarkers Prev
Carbohydrates and the risk of breast cancer among Mexican women
Cancer Epidemiol Biomarkers Prev
Diet, nutrition and the prevention of hypertension and cardiovascular diseases
Public Health Nutr
Dietary fiber and cardiovascular disease: experimental and epidemiologic advances
Curr Atheroscler Rep
Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial
J Am Med Assoc
Dietary fat and breast cancer risk revisited: a meta-analysis of the published literature
Br J Cancer
Research strategies and the use of nutrient biomarkers in studies of diet and chronic disease
Public Health Nutr
A life course approach to diet, nutrition and the prevention of chronic diseases
Public Health Nutr
Dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease
Curr Atheroscler Rep
Dietary patterns and risk for type 2 diabetes mellitus in U.S. men
Ann Intern Med
Eating patterns and risk of colon cancer
Am J Epidemiol
Prospective study of major dietary patterns and colorectal cancer risk in women
Am J Epidemiol
Major dietary patterns and the risk of colorectal cancer in women
Arch Intern Med
Empirically derived eating patterns using factor or cluster analysis: a review
Nutr Rev
Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project
J Am Med Assoc
Dietary patterns of rural older adults are associated with weight and nutritional status
J Am Geriatr Soc
The EPIC Project: rationale and study design. European Prospective Investigation into Cancer and Nutrition
Int J Epidemiol
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