Dietary patterns, subclinical inflammation, incident coronary heart disease and mortality in middle-aged men from the MONICA/KORA Augsburg cohort study

Abstract

Background/Objectives: We aimed to identify dietary patterns associated with inflammatory markers and to examine their impact on the incidence of coronary heart disease (CHD) and all-cause mortality, as subclinical inflammation is a risk factor for these outcomes. Subjects/Methods: The study population comprised 981 middle-aged men participating in the first or third 'MONItoring of Trends and Determinants in CArdiovascular Diseases' (MONICA) Augsburg surveys who completed 7-day dietary records. Subjects were followed up until 2002 for CHD and until 2007 for mortality. Dietary patterns were derived using reduced rank regression (RRR) with C-reactive protein, interleukin (IL)-6 and IL-18 as responses. Alternatively, partial least squares and principal components regression were used. Results: A high score of the RRR-derived pattern was characterised by high intakes of meat, soft drinks and beer and low intakes of vegetables, fresh fruit, chocolates, cake, pastries, wholemeal bread, cereals, muesli, curd, condensed milk, cream, butter, nuts, sweet bread spread and tea. This score was associated with a higher risk for CHD (hazard ratio ¼ 1.33, 95% confidence interval: 1.06-1.67, P ¼ 0.013) and mortality (hazard ratio ¼ 1.34, 1.17-1.53, Po0.001) after multivariable adjustment. However, for CHD and CHD mortality the significant association disappeared after further adjustment for smoking status; for all-cause mortality it was attenuated but remained significant (hazard ratio ¼ 1.16, 1.00-1.33, P ¼ 0.046). Patterns derived from the other methods resembled the RRR pattern showing similar results regarding disease outcomes. Conclusions: Participants exhibiting higher dietary pattern scores had higher levels of inflammatory markers and higher risk for CHD and all-cause mortality, however, smoking was an important confounder, especially for CHD outcomes.

Nutrition and healthy ageing: the key ingredients

“…In contrast, dietary patterns rich in red meat and sugar-rich foods have been associated with an increased risk of mortality, type 2 diabetes mellitus and CHD in studies that defined these patterns a posteriori (17)(18)(19)(20)25,28,31,32,35,(37)(38)(39) . There is a general agreement on the potential deleterious effect of higher intakes of these two food items and most of the dietary guidelines and scores designate these foods as unfavourable components (Table 1).…”

Dietary Patterns, Smoking, and Cardiovascular Diseases: A Complex Association

“…Greater consumption of a comparable pattern derived by reduced rank regression (high in meat, soft drinks, beer and lower in vegetables, fruits, whole-meal bread, cereals, dairy products) increased risk for CAD and CVD mortality in a German cohort. In this study, adjustment for smoking status, which was considered as a confounder, attenuated the findings; however, stratified analyses were not conducted [91].…”

“…First, it is well established that smoking confounds the association between diet and CVD. Thus, all studies reviewed adjusted for smoking in their analysis [35,[64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][87][88][89][90][91][92][93][94][95][96][97] and showed that the effect of diet is attenuated when smoking is considered [73,91]. However, as discussed, smoking may interact with diet and modify the effect of diet on CVD, which has been an increasing focus of more recent studies.…”

“…Most of the studies that examined relationships of smoking status and a posteriori patterns with CVDs were in the United States and Europe [65,[87][88][89][90][91][92][93][94][95][96][97]. Three cross-sectional studies evaluated the interrelationships of dietary patterns and smoking status with subclinical CVD and hypertension [87][88][89].…”

“…To elucidate the relationships, nine studies prospectively assessed the associations of empirical patterns and smoking status on subclinical heart disease, CAD, stroke, and cardiovascular mortality [65,[90][91][92][93][94][95][96][97] (Table 2). Stratified analyses were conducted based on a priori hypotheses in three studies [90,92,93].…”