A Snack Dietary Pattern Increases the Risk of Hypercholesterolemia in Northern Chinese Adults: A Prospective Cohort Study
August
A Snack Dietary Pattern Increases the Risk of Hypercholesterolemia in Northern Chinese Adults: A Prospective Cohort Study
Lixin Na 0 1
Tianshu Han 0 1
Wei Zhang 0 1
Xiaoyan Wu 0 1
Guanqiong Na 0 1
Shanshan Du 0 1
Ying Li 0 1
Changhao Sun 0 1
0 Department of Nutrition and Food Hygiene, Public Health College, Harbin Medical University , Harbin , China
1 Editor: Qinghua Sun, The Ohio State University , UNITED STATES
The evidence about the effect of dietary patterns on blood cholesterol from cohort studies was very scarce. The study was to identify the association of dietary patterns with lipid profile, especially cholesterol, in a cohort in north China. Using a 1-year food frequency questionnaire, we assessed the dietary intake of 4515 adults from the Harbin People's Health Study in 2008, aged 20-74 years. Principle component analysis was used to identify dietary patterns. The follow-up was completed in 2012. Fasting blood samples were collected for the determination of blood lipid concentrations. Logistic regression models were used to evaluate the association of dietary patterns with the incidence of hypercholesterolemia, hypertriglyceridemia, and low-HDL cholesterolemia. Five dietary patterns were identified (“staple food”, “vegetable, fruit and milk”, “potato, soybean and egg”, “snack”, and “meat”). The relative risk (RR) between the extreme tertiles of the snack dietary pattern scores was 1.72 (95% CI = 1.14, 2.59, P = 0.004) for hypercholesterolemia, 1.39 (1.13, 1.75, P = 0.036) for hypertriglyceridemia, after adjustment for age, sex, education, body mass index, smoking, alcohol consumption, energy intake, exercise and baseline lipid concentrations. There was a significant positive association between the snack dietary pattern scores and fasting serum total cholesterol (SRC (standardized regression coefficient) = 0.262, P = 0.025), LDL-c (SRC = 0.324, P = 0.002) and triglycerides (SRC = 0.253, P = 0.035), after adjustment for the multiple variables above. Moreover, the adjusted RR of hypertriglyceridemia between the extreme tertiles was 0.73 (0.56, 0.94, P = 0.025) for the vegetable, fruit and milk dietary pattern, and 1.86 (1.33, 2.41, P = 0.005) for the meat dietary pattern. The snack dietary pattern was a newly emerged dietary pattern in northern Chinese adults. It appears conceivable that the risk of hypercholesterolemia can be reduced by changing the snack dietary pattern.
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Funding: This work was supported by funds from the
National Natural Science Foundation of China
(81130049) received by CHS, the National Natural
Science Foundation of China (81202188) received by
LXN, the National Natural Science Foundation of
China (81202282) received by XYW, Danone
Research and Education grant (DIC2013-01)
received by LXN, and the Wu Liande Grant of Harbin
Medical University (WLD-QN1406) received by LXN.
The funders had no role in study design, data
collection and analysis, decision to publish, or
preparation of the manuscript.
Competing Interests: The authors have declared
that no competing interests exist.
Elevation of blood cholesterol concentrations has been recognized as a major risk factor for
cardiovascular diseases [1]. Control of the increase in blood cholesterol is one of the important
strategies for the prevention of cardiovascular diseases. Since the 1960s, recommendation to
restrict dietary cholesterol has been adopted by many countries as dietary cholesterol was
thought contributed to the blood cholesterol concentrations [2]. However, many
epidemiological surveys in recent years have shown that there was no relationship between dietary
cholesterol intake and coronary heart disease or blood cholesterol concentrations in various
populations [3–5]. Therefore, the strategy of dietary prevention for hypercholesterolemia
needs to be reconsidered.
In fact, blood cholesterol depends on many dietary factors, for example, dietary saturated
fatty acids and fibers, at the same time [6]. These dietary factors collectively influence intestinal
cholesterol absorption, hepatic cholesterol synthesis, and biliary excretion and cellular use.
Investigation of single dietary cholesterol intake is inadequate for taking into account
complicated interactions among all the nutrients or foods and their cumulative effects on blood
cholesterol in studies of free-living people. In addition, people choose foods and combinations of
foods rather than isolated nutrients, advice on nutrients intake has little practical effect for
them. Dietary pattern analysis addresses the effect of diet as a whole and thus provides insight
beyond the effects of single nutrient or food [7]. It can give the public more practical advice for
the application of dietary prevention for hypercholesterolemia.
Some cross-sectional studies have addressed the association of dietary pattern with
hypercholesterolemia or blood cholesterol. For example, a meat and fast-food pattern score was
found associated with higher LDL-c in Korea [8]. In D (...truncated)