Association between empirically driven dietary patterns and cardiometabolic disease risk factors: a cross-sectional analysis in disease-free adults.

Background: Although links between dietary patterns (DPs) and cardiometabolic disease (CMD) risk markers have been identified in UK populations, these studies often rely on less quantitative measures of dietary assessment and include only a limited number of risk markers.

Objective: This cross-sectional analysis aimed to identify DP in self-reported disease-free adults using weighed diet diaries and explore relationships with a broad range of CMD risk factors and diet quality.

Methods: Data were collated from five studies conducted in adults living in the UK (2009-2019) and DPs were a posteriori extracted from habitual dietary intake data using principal component analysis. Associations between quartiles (Q) of adherence to the DPs with CMD risk markers, nutrient intakes and the Alternative Healthy Eating Index (AHEI-2010) were evaluated using ANCOVA.

Results: In our cohort [n = 646, 58.4% female, mean (SD) age 44 (14) years, and body mass index (BMI) 25.2 (4.0) kg/m] two DPs explained 12% of the variance in habitual food intake. Highest adherence to DP1 (Q4), characterised by diets rich in fermented dairy, fruits, vegetables, wholegrains, nuts/seeds, unsaturated fats/oils and milk and lower in red meat dishes and processed meat, was associated with a lower BMI, waist circumference, diastolic blood pressure, fasting triacylglycerol, non-high-density lipoprotein-cholesterol, remnant-like particle-cholesterol, and total cholesterol:HDL-C ratio and a higher HDL-C and AHEI-2010 score versus Q1 (all P ≤ 0.006). In contrast, Q4 vs Q1 of DP2, high in refined carbohydrates, milk and unsaturated fats/oils and low in cruciferous vegetables/spinach, and nuts/seeds, was only associated with a lower HDL-C (P = 0.006) and AHEI-2010 score (P < 0.001).

Conclusions: In disease-free adults, greater adherence to DP1, which broadly aligned with UK food-based dietary guidelines, was favourably associated with diet quality and CMD risk markers. Our findings could contribute to the evidence base for future food-based dietary recommendations, particularly highlighting the importance of fermented dairy foods.