Dietary Diversity and Nutritional Adequacy among an Older Spanish Population with Metabolic Syndrome in the PREDIMED-Plus Study: A Cross-Sectional Analysis

Abstract

Dietary guidelines emphasize the importance of a varied diet to provide an adequate nutrient intake. However, an older age is often associated with consumption of monotonous diets that can be nutritionally inadequate, increasing the risk for the development or progression of diet-related chronic diseases, such as metabolic syndrome (MetS). To assess the association between dietary diversity (DD) and nutrient intake adequacy and to identify demographic variables associated with DD, we cross-sectionally analyzed baseline data from the PREDIMED-Plus trial: 6587 Spanish adults aged 55–75 years, with overweight/obesity who also had MetS. An energy-adjusted dietary diversity score (DDS) was calculated using a 143-item validated semi-quantitative food frequency questionnaire (FFQ). Nutrient inadequacy was defined as an intake below 2/3 of the dietary reference intake (DRI) forat least four of 17 nutrients proposed by the Institute of Medicine (IOM). Logistic regression models were used to evaluate the association between DDS and the risk of nutritionally inadequate intakes. In the higher DDS quartile there were more women and less current smokers. Compared with subjects in the highest DDS quartile, those in the lowest DDS quartile had a higher risk of inadequate nutrient intake: odds ratio (OR) = 28.56 (95% confidence interval (CI) 20.80–39.21). When we estimated food varietyfor each of the food groups, participants in the lowest quartile had a higher risk of inadequate nutrient intake for the groups of vegetables, OR = 14.03 (95% CI 10.55–18.65), fruits OR = 11.62 (95% CI 6.81–19.81), dairy products OR = 6.54 (95% CI 4.64–9.22) and protein foods OR = 6.60 (95% CI 1.96–22.24). As DDS decreased, the risk of inadequate nutrients intake rose. Given the impact of nutrient intake adequacy on the prevention of non-communicable diseases, health policies should focus on the promotion of a healthy varied diet, specifically promoting the intake of vegetables and fruit among population groups with lower DDS such as men, smokers or widow(er)s.

Dietary Strategies for Metabolic Syndrome: A Comprehensive Review

“…Metabolic syndrome (MetS) is a clinical condition characterized by a clustering of metabolic risk factors, which is defined by the simultaneous occurrence of at least three of the following components: central obesity, dyslipidemia, impaired glucose metabolism, elevated blood pressure (BP), and low levels of high-density lipoprotein cholesterol (HDL-c), according to the consensual definition of the International Diabetes Federation, the American Heart Association, and the National Heart, Lung and Blood Institute [ 4 ]. In developed countries, the prevalence of MetS has risen up to 20–25% in the adult population, and its incidence continues to increase over time [ 5 , 6 , 7 , 8 ]. In Spain, the prevalence of MetS is currently reaching epidemic proportions, affecting approximately 22.7% of the population, taking into account that its incidence increases with age [ 5 ].…”

“…In developed countries, the prevalence of MetS has risen up to 20–25% in the adult population, and its incidence continues to increase over time [ 5 , 6 , 7 , 8 ]. In Spain, the prevalence of MetS is currently reaching epidemic proportions, affecting approximately 22.7% of the population, taking into account that its incidence increases with age [ 5 ]. In addition, MetS increases the risk of T2DM onset and major cardiovascular events by two-fold and five-fold, respectively, and other chronic disease such as cancer, neurodegenerative diseases, non-alcoholic fatty liver disease, the risk of reproductive, lipid and circulatory disorders, atherosclerosis, and all cause-mortality are also increased [ 8 , 9 , 10 , 11 , 12 , 13 ].…”

Dietary Diversity and Prostate Cancer in a Spanish Adult Population: CAPLIFE Study

“…The dietary diversity score (DDS) was calculated using the method originally developed by Kant et al [23], which has recently been used by Farhangi et al [34] and Cano-Ibáñez et al [26,35]. Five food groups were considered in the construction of the DDS: vegetables, fruits, cereals, dairy products, and the protein food group.…”

“…The DDS cut-off points were Q1: 4.7, Q2: 5.7, Q3: 6.6, and Q4: 8.5 points. On the other hand, the variety within each food group was classified into four categories (C) of diversity intake, defined a priori, which have been recently used in the literature [26,39]: C1 = 0 points, C2 > 0 to < 0.5 points, C3 ≥ 0.5 to < 1 point and C4 ≥ 1 point for vegetable and cereal groups; C1 = 0 points, C2 > 0 to < 1 point, C3 ≥ 1 to < 1.5 points and C4 ≥ 1.5 points for protein, fruit, and dairy products groups.…”

“…The DDS can be considered a global indicator of the quality of the diet and its ability to meet our nutrient needs [24]. Furthermore, according to the current dietary guidelines, an adequate dietary pattern should include a wide variety of food, in order to meet micronutrient requirements in adults, through a diverse and nutrient-dense diet [25,26], factors included as part of DDS. The relationship between DDS and PCa has not been explored previously, and it may be an opportunity to identify possible modifiable risk factors to prevent PCa.…”