Dietary patterns in India and their association with obesity and central obesity.
ABSTRACT: OBJECTIVE:Obesity is a growing problem in India, the dietary determinants of which have been studied using an 'individual food/nutrient' approach. Examining dietary patterns may provide more coherent findings, but few studies in developing countries have adopted this approach. The present study aimed to identify dietary patterns in an Indian population and assess their relationship with anthropometric risk factors. DESIGN:FFQ data from the cross-sectional sib-pair Indian Migration Study (IMS; n 7067) were used to identify dietary patterns using principal component analysis. Mixed-effects logistic regression was used to examine associations with obesity and central obesity. SETTING:The IMS was conducted at four factory locations across India: Lucknow, Nagpur, Hyderabad and Bangalore. SUBJECTS:The participants were rural-to-urban migrant and urban non-migrant factory workers, their rural and urban resident siblings, and their co-resident spouses. RESULTS:Three dietary patterns were identified: 'cereals-savoury foods' (cooked grains, rice/rice-based dishes, snacks, condiments, soups, nuts), 'fruit-veg-sweets-snacks' (Western cereals, vegetables, fruit, fruit juices, cooked milk products, snacks, sugars, sweets) and 'animal-food' (red meat, poultry, fish/seafood, eggs). In adjusted analysis, positive graded associations were found between the 'animal-food' pattern and both anthropometric risk factors. Moderate intake of the 'cereals-savoury foods' pattern was associated with reduced odds of obesity and central obesity. CONCLUSIONS:Distinct dietary patterns were identified in a large Indian sample, which were different from those identified in previous literature. A clear 'plant food-based/animal food-based pattern' dichotomy emerged, with the latter being associated with higher odds of anthropometric risk factors. Longitudinal studies are needed to further clarify this relationship in India.
Project description:BACKGROUND:Dietary patterns (DPs) in India are heterogenous. To date, data on association of indigenous DPs in India with risk factors of nutrition-related noncommunicable diseases (cardiovascular disease and diabetes), leading causes of premature death and disability, are limited. We aimed to evaluate the associations of empirically-derived DPs with blood lipids, fasting glucose and blood pressure levels in an adult Indian population recruited across four geographical regions of India. METHODS:We used cross-sectional data from the Indian Migration Study (2005-2007). Study participants included urban migrants, their rural siblings and urban residents and their urban siblings from Lucknow, Nagpur, Hyderabad and Bangalore (n?=?7067, mean age 40.8 yrs). Information on diet (validated interviewer-administered, 184-item semi-quantitative food frequency questionnaire), tobacco consumption, alcohol intake, physical activity, medical history, as well as anthropometric measurements were collected. Fasting-blood samples were collected for estimation of blood lipids and glucose. Principal component analysis (PCA) was used to identify major DPs based on eigenvalue>?1 and component interpretability. Robust standard error multivariable linear regression models were used to investigate the association of DPs (tertiles) with total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides, fasting-blood glucose (FBG), systolic and diastolic blood pressure (SBP and DBP) levels. RESULTS:Three major DPs were identified: 'cereal-savoury' (cooked grains, rice/rice-based dishes, snacks, condiments, soups, nuts), 'fruit-vegetable-sweets-snacks' (Western cereals, vegetables, fruit, fruit juices, cooked milk products, snacks, sugars, sweets) and 'animal food' (red meat, poultry, fish/seafood, eggs) patterns. High intake of the 'animal food' pattern was positively associated with levels of TC (??=?0.10 mmol/L; 95% CI: 0.02, 0.17 mmol/L; p-trend?=?0.013); LDL-C (??=?0.07 mmol/L; 95% CI: 0.004, 0.14 mmol/L; p-trend?=?0.041); HDL-C (??=?0.02 mmol/L; 95% CI: 0.004, 0.04 mmol/L; p-trend?=?0.016), FBG: (??=?0.09 mmol/L; 95% CI: 0.01, 0.16 mmol/L; p-trend?=?0.021) SBP (??=?1.2 mm/Hg; 95% CI: 0.1, 2.3 mm/Hg; p-trend?=?0.032); DBP: (??=?0.9 mm/Hg; 95% CI: 0.2, 1.5 mm/Hg; p-trend?=?0.013). The 'cereal-savoury' and 'fruit-vegetable-sweets-snacks' patterns showed no association with any parameter except for a positive association with diastolic blood pressure for high intake of 'fruits-vegetables-sweets-snacks' pattern. CONCLUSION:Our results indicate positive associations of the 'animal food' pattern with cardio-metabolic risk factors in India. Further longitudinal assessments of dietary patterns in India are required to validate the findings.
Project description:Cereals are an important component of the Indian diet, providing 47% of the daily dietary energy intake. Dwindling groundwater reserves in India especially in major cereal-growing regions are an increasing challenge to national food supply. An improved understanding of interstate cereal trade can help to identify potential risks to national food security. Here, we quantify the trade between Indian states of five major cereals and the associated trade in virtual (or embedded) water. To do this, we modelled interstate trade of cereals using Indian government data on supply and demand; calculated virtual water use of domestic cereal production using state- and product-specific water footprints and state-level data on irrigation source; and incorporated virtual water used in the production of internationally-imported cereals using country-specific water footprints. We estimate that 40% (94 million tonnes) of total cereal food supply was traded between Indian states in 2011-12, corresponding to a trade of 54.0 km<sup>3</sup> of embedded blue water, and 99.4 km<sup>3</sup> of embedded green water. Of the cereals traded within India, 41% were produced in states with over-exploited groundwater reserves (defined according to the Central Ground Water Board) and a further 21% in states with critically depleting groundwater reserves. Our analysis indicates a high dependency of Indian cereal consumption on production in states with stressed groundwater reserves. Substantial changes in agricultural practices and land use may be required to secure future production, trade and availability of cereals in India. Diversifying production systems could increase the resilience of India's food system.
Project description:<b>Background: </b>Rapid simultaneous increases in ultra-processed food sales and obesity prevalence have been observed worldwide, including in Australia. Consumption of ultra-processed foods by the Australian population was previously shown to be systematically associated with increased risk of intakes of nutrients outside levels recommended for the prevention of obesity. This study aims to explore the association between ultra-processed food consumption and obesity among the Australian adult population and stratifying by age group, sex and physical activity level.<br><br><b>Methods: </b>A cross-sectional analysis of anthropometric and dietary data from 7411 Australians aged ?20 years from the National Nutrition and Physical Activity Survey 2011-2012 was performed. Food consumption was evaluated through 24-h recall. The NOVA system was used to identify ultra-processed foods, i.e. industrial formulations manufactured from substances derived from foods and typically added of flavours, colours and other cosmetic additives, such as soft drinks, confectionery, sweet or savoury packaged snacks, microwaveable frozen meals and fast food dishes. Measured weight, height and waist circumference (WC) data were used to calculate the body mass index (BMI) and diagnosis of obesity and abdominal obesity. Regression models were used to evaluate the association of dietary share of ultra-processed foods (quintiles) and obesity indicators, adjusting for socio-demographic variables, physical activity and smoking.<br><br><b>Results: </b>Significant (P-trend ??0.001) direct dose-response associations between the dietary share of ultra-processed foods and indicators of obesity were found after adjustment. In the multivariable regression analysis, those in the highest quintile of ultra-processed food consumption had significantly higher BMI (0.97?kg/m<sup>2</sup>; 95% CI 0.42, 1.51) and WC (1.92?cm; 95% CI 0.57, 3.27) and higher odds of having obesity (OR?=?1.61; 95% CI 1.27, 2.04) and abdominal obesity (OR?=?1.38; 95% CI 1.10, 1.72) compared with those in the lowest quintile of consumption. Subgroup analyses showed that the trend towards positive associations for all obesity indicators remained in all age groups, sex and physical activity level.<br><br><b>Conclusion: </b>The findings add to the growing evidence that ultra-processed food consumption is associated with obesity and support the potential role of ultra-processed foods in contributing to obesity in Australia.
Project description:Few studies have derived data-driven dietary patterns in youth in the USA. This study examined data-driven dietary patterns and their associations with BMI measures in predominantly low-income, racial/ethnic minority US youth. Data were from baseline assessments of the four Childhood Obesity Prevention and Treatment Research (COPTR) Consortium trials: NET-Works (534 2-4-year-olds), GROW (610 3-5-year-olds), GOALS (241 7-11-year-olds) and IMPACT (360 10-13-year-olds). Weight and height were measured. Children/adult proxies completed three 24-h dietary recalls. Dietary patterns were derived for each site from twenty-four food/beverage groups using k-means cluster analysis. Multivariable linear regression models examined associations of dietary patterns with BMI and percentage of the 95th BMI percentile. Healthy (produce and whole grains) and Unhealthy (fried food, savoury snacks and desserts) patterns were found in NET-Works and GROW. GROW additionally had a dairy- and sugar-sweetened beverage-based pattern. GOALS had a similar Healthy pattern and a pattern resembling a traditional Mexican diet. Associations between dietary patterns and BMI were only observed in IMPACT. In IMPACT, youth in the Sandwich (cold cuts, refined grains, cheese and miscellaneous) compared with Mixed (whole grains and desserts) cluster had significantly higher BMI (β = 0·99 (95 % CI 0·01, 1·97)) and percentage of the 95th BMI percentile (β = 4·17 (95 % CI 0·11, 8·24)). Healthy and Unhealthy patterns were the most common dietary patterns in COPTR youth, but diets may differ according to age, race/ethnicity or geographic location. Public health messages focused on healthy dietary substitutions may help youth mimic a dietary pattern associated with lower BMI.
Project description:Although low socioeconomic groups have the highest risk of noncommunicable diseases in Estonia, national dietary guidelines and nutrition recommendations do not consider affordability. This study aims to help develop nutritionally adequate, health-promoting, and culturally acceptable dietary guidelines at an affordable price. Three food baskets (FBs) were optimised using linear programming to meet recommended nutrient intakes (RNIs), or Estonian dietary guidelines, or both. In total, 6255 prices of 422 foods were collected. The Estonian National Dietary Survey (ENDS) provided a proxy for cultural acceptability. Food baskets for a family of four, earning minimum wage, contain between 73 and 96 foods and cost between 10.66 and 10.92 EUR per day. The nutritionally adequate FB that does not follow Estonian dietary guidelines deviates the least (26% on average) from ENDS but contains twice the sugar, sweets, and savoury snacks recommended. The health-promoting FB (40% deviation) contains a limited amount of sugar, sweets, and savoury snacks. However, values for vitamin D, iodine, iron, and folate are low compared with RNIs, as is calcium for women of reproductive age. When both the RNIs and dietary guidelines are enforced, the average deviation (73%) and cost (10.92 EUR) are highest. The composition of these FBs can help guide the development of dietary guidelines for low income families in Estonia.
Project description:OBJECTIVE: The aim of dietary modification, as a cornerstone of type 2 diabetes (T2DM) management, is to optimise metabolic control and overall health. This study describes food and nutrient intake in a sample of adults with T2DM, and compares this to recommendations, and to intake in age, sex, body mass index (BMI) and social-class matched adults without T2DM. DESIGN: A cross-sectional analysis of food and nutrient intake in 124 T2DM individuals (64% male; age 57.4±5.6 years, BMI 32.5±5.8?kg?m(-2)) and 124 adults (age 57.4±7.0 years, BMI 31.2±5.0?kg?m(-2)) with no diabetes (ND) was undertaken using a 4-day semiweighed food diary. Biochemical and anthropometric variables were also measured. RESULTS: While reported energy intake was similar in T2DM vs ND (1954 vs 2004?kcal per day, P=0.99), T2DM subjects consumed more total-fat (38.8% vs 35%, P?0.001), monounsaturated-fat (13.3% vs 12.2%; P=0.004), polyunsaturated-fat (6.7% vs 5.9%; P<0.001) and protein (18.6% vs 17.5%, P?0.01). Both groups exceeded saturated-fat recommendations (14.0% vs 13.8%). T2DM intakes of carbohydrate (39.5% vs 42.9%), non-milk sugar (10.4% vs 15.0%) and fibre (14.4 vs 18.9?g) were significantly lower (P<0.001). Dietary glycaemic load (GL) was also lower in T2DM (120.8 vs 129.2; P=0.02), despite a similar glycaemic index (59.7 vs 60.1; P=0.48). T2DM individuals reported consuming significantly more wholemeal/brown/wholegrain breads, eggs, oils, vegetables, meat/meat products, savoury snacks and soups/sauces and less white breads, breakfast cereals, cakes/buns, full-fat dairy, chocolate, fruit juices, oily fish and alcohol than ND controls. CONCLUSION: Adults with T2DM made different food choices to ND adults. This resulted in a high saturated-fat diet, with a higher total-fat, monounsaturated-fat, polyunsaturated-fat and protein content and a lower GL, carbohydrate, fibre and non-milk sugar content. Dietary education should emphasise and reinforce the importance of higher fibre, fruit, vegetable and wholegrain intake and the substitution of monounsaturated for saturated-fat sources, in energy balanced conditions.
Project description:Taste preferences guide food choices and dietary behaviours, yet few studies have shown a relationship between sweet and savoury taste preference and differences in dietary intakes or energy consumed from different "taste clusters". We investigated differences in psycho-hedonic responses to sweet and savoury tastes and their association with energy intake, proportion of energy from macronutrients and energy intake from different "taste clusters". In addition, we evaluated correspondence between two methods to classify "sweet-liker" status and the overlap between sweet and savoury taste preferences. Psycho-hedonic responses to sweet and savoury tastes of female participants (n = 66) were captured via staircase paired preference and the "sweet-liker phenotype" classification method. Quantitative dietary energy and macronutrient intakes were measured using three-day food diary, and the relative contributions of specific taste clusters to energy intake were derived for each participant. All participants completed anthropometric assessments measuring body mass index (BMI) and adiposity. Results showed no association between sweet and savoury preferences with dietary energy or macronutrient intakes, though there was a trend towards higher sweet food consumption among "sweet-likers". A higher preference for savouriness was not associated with differences in daily energy intake, energy intake from protein, BMI or adiposity levels. There was little overlap in sweet and savoury preferences, suggesting a bi-modal split in taste preferences. "Sweet-likers" preferred a higher mean sucrose concentration than sweet "dislikers" (p < 0.001) indicating agreement between the two approaches. Future studies should consider comparing taste-liker differences using food choice tasks to address the current gap between taste preference measures and actual dietary behaviours.
Project description:Food insecurity is an important contributor to health and a factor in both underweight and malnutrition, and overweight and obesity. Countries where both undernutrition and overweight and obesity coexist are said to be experiencing a double burden of malnutrition. India is one example of a country experiencing this double burden. Women have been found to experience the negative impacts of food insecurity and obesity, however, the reasons that women experience the impact of malnutrition more so than men are complex and are under-researched. This current research employed a mixed methods approach to begin to fill this gap by exploring the dietary intake, anthropometric characteristics, and food security status of rural Indian women. In total, 78 household were surveyed. The average waist measurement, waist to hip ratio, and BMI were all above WHO recommendations, with two thirds of participants categorized as obese. Contributing to these findings was a very limited diet, high in energy, and low in protein and iron. The findings of this research suggest that the rural Indian women in this study have a lack of diet diversity and may be at risk of a range of non-communicable diseases.
Project description:Abnormal gestational weight gain (GWG) is associated with adverse pregnancy outcomes. We examined whether dietary patterns are associated with GWG. Participants included 3374 pregnant women from a population-based cohort in the Netherlands. Dietary intake during pregnancy was assessed with food-frequency questionnaires. Three a posteriori-derived dietary patterns were identified using principal component analysis: a "Vegetable, oil and fish", a "Nuts, high-fiber cereals and soy", and a "Margarine, sugar and snacks" pattern. The a priori-defined dietary pattern was based on national dietary recommendations. Weight was repeatedly measured around 13, 20 and 30 weeks of pregnancy; pre-pregnancy and maximum weight were self-reported. Normal weight women with high adherence to the "Vegetable, oil and fish" pattern had higher early-pregnancy GWG than those with low adherence (43 g/week (95% CI 16; 69) for highest vs. lowest quartile (Q)). Adherence to the "Margarine, sugar and snacks" pattern was associated with a higher prevalence of excessive GWG (OR 1.45 (95% CI 1.06; 1.99) Q4 vs. Q1). Normal weight women with higher scores on the "Nuts, high-fiber cereals and soy" pattern had more moderate GWG than women with lower scores (-0.01 (95% CI -0.02; -0.00) per SD). The a priori-defined pattern was not associated with GWG. To conclude, specific dietary patterns may play a role in early pregnancy but are not consistently associated with GWG.
Project description:BACKGROUND:Assessment of single nutrients or foods does not normally reflect the diet of population groups. Dietary pattern analyses are useful in understanding the overall diet and its relationship with disease conditions. The objective of the present study was to determine the dietary patterns and associated factors among schooling adolescents in Northern Ghana. METHODS:A cross-sectional study involving 366 pupils in 10 junior high schools in the Tamale metropolis was conducted. A Food Frequency Questionnaire (FFQ) which consisted of 60 commonly consumed foods was used to assess pupils' 7-day intake. Foods grouped (14) from FFQ data based on shared nutritional value were used to identify dietary patterns using principal component analysis (PCA). Bivariate and multivariate logistic regression analyses were used to determine the association between identified patterns and sociodemographic, anthropometric status, and household characteristics of pupils. RESULTS:Half of the pupils were female (50.3%) and average age was 15.6?±?2.0?years. PCA identified two dietary patterns which in total explained 49.7% of the variability of the diet of pupils. The patterns were sweet tooth pattern (STP) with high factor loadings for sugar sweetened snacks, energy and soft drinks, sweets, tea and coffee, and milk and milk products, and a traditional pattern (TP) which showed high factor loadings for cereals and grains, local beverages, nuts, seeds and legumes, vegetables, and fish and seafood. Logistic regression showed that pupils who lived with their parents [AOR?=?1.95; 95% CI (1.1-3.4); p?=?0.019], those who went to school with pocket money [AOR?=?4.73; 95% CI (1.5-15.0); p?=?0.008], and those who lived in the wealthiest homes [AOR?=?3.4; 95% CI (1.6-7.5); p?=?0.002)] had higher odds of following the STP. The TP was associated with high dietary diversity (p?=?0.035) and household wealth [AOR?=?3.518; 95% CI (1.763-7.017); p?<?0.001)]. None of the patterns was associated with anthropometric status of pupils. CONCLUSION:Adolescents in the present study followed a sweet tooth or a traditional diet pattern which associated more with household- and individual-level factors but not anthropometric status.