Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort

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Abstract

Introduction

Epidemiological studies have shown that dietary behaviour is an important aetiological factor in various chronic diseases. We used principal component factor analysis to identify dietary patterns and to examine the associations of these patterns with health-related variables in a sample of elderly (≥60 years) Italians participating in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Methods and results

Exploratory factor analysis was applied to the intake of food groups as estimated by semi-quantitative food questionnaires. Individual participants were assigned factor scores, indicating the extent to which their diet conformed to each of the four dietary patterns identified: prudent (cooked vegetables, pulses, cabbage, seed oil and fish); pasta & meat (pasta, tomato sauce, red meat, processed meat, bread and wine); olive oil & salad (raw vegetables, olive oil, soup and chicken); and sweet & dairy (sugar, cakes, ice cream, coffee and dairy). Highly educated people had high scores on prudent and low scores on pasta & meat. The pasta & meat and prudent patterns were strongly positively associated with body mass index (BMI) and waist-to-hip ratio (WHR) in men and women. Hyperlipidaemic men and women consumed more of the prudent and olive oil & salad patterns and less of the sweet & dairy pattern than those with normal lipids. The olive oil & salad was significantly higher and the pasta & meat and sweet & dairy patterns significantly lower in men and women who had dieted over the previous year, suggesting awareness of the health consequences of these patterns.

Conclusions

Dietary pattern analysis provides a characterization of recurrent dietary behaviour in elderly people, and can be used to provide tangible dietary advice to elderly people.

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

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