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Br J Nutr. 2016 May;115(9):1586-97. doi: 10.1017/S0007114516000556. Epub 2016 Mar 2.

Examining associations between dietary patterns and metabolic CVD risk factors: a novel use of structural equation modelling.

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1Department of Nutrition,School of Public Health,University of São Paulo,PO Box 01246-904,715 São Paulo,Brazil.
2Department of Epidemiology and Biostatistics,Institute of Collective Health,Federal Fluminense University,PO Box 24030210,303 Niterói,Rio de Janeiro,Brazil.


The association between dietary patterns and metabolic cardiovascular risk factors has long been addressed but there is a lack of evidence towards the effects of the overall diet on the complex net of biological inter-relationships between risk factors. This study aimed to derive dietary patterns and examine their associations with metabolic cardiovascular risk factors following a theoretic model for the relationship between them. Participants included 417 adults of both sexes, enrolled to the cross-sectional population-based study performed in Brazil. Body weight, waist circumference, high-sensitivity C-reactive protein, blood pressure, total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio, fasting plasma glucose and serum leptin were evaluated. Food consumption was assessed by two non-consecutive 24-h dietary recalls adjusted for the within-person variation of intake. A total of three dietary patterns were derived by exploratory structural equation modelling: 'Traditional', 'Prudent' and 'Modern'. The 'Traditional' pattern had a negative and direct effect on obesity indicators (serum LEP, body weight and waist circumference) and negative indirect effects on total cholesterol:HDL-cholesterol ratio, TAG:HDL-cholesterol ratio and fasting plasma glucose. The 'Prudent' pattern had a negative and direct effect on systolic blood pressure. No association was observed for the 'Modern' pattern and metabolic risk factors. In conclusion, the 'Traditional' and 'Prudent' dietary patterns were negatively associated with metabolic cardiovascular risk factors among Brazilian adults. Their apparent protective effects against obesity and high blood pressure may be important non-pharmacological strategies for the prevention and control of obesity-related metabolic disorders and CVD.


24-HDR 24-h dietary recall; BP blood pressure; BW body weight; CFI comparative fit index; CVD; Cross-sectional analyses; DBP diastolic blood pressure; Dietary patterns; ESEM exploratory structural equation modelling; FPG fasting plasma glucose; LEP leptin; LRT log-likelihood ratio test; RMSEA residual mean square error of approximation; Risk factors; SBP systolic blood pressure; SEM structural equation model; SRMR standardised root mean square residual; Structural equation modelling; TLI Tucker–Lewis index; WC waist circumference; pTEE predicted energy intake

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