Food consumption patterns, overweight and cardiovascular risk: a cross-sectional analysis of the <i>Pró-Saúde</i> Study, Brazil, 2013

Rocha, Thalita Fialho da; Curioni, Cíntia; Verly Junior, Eliseu; Bezerra, Flávia; Faerstein, Eduardo

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (4) • 2021 • https://doi.org/10.1590/S1679-49742021000400020 copy

Food consumption patterns, overweight and cardiovascular risk: a cross-sectional analysis of the Pró-Saúde Study, Brazil, 2013^* * Article derived from the Ph.D. thesis entitled ‘Dietary patterns and cardiovascular risk: The Pró-Saúde Study’, defended by Thalita Fialho da Rocha at the Postgraduate Program in Food, Nutrition and Health, Universidade do Estado do Rio de Janeiro, in 2017. FAPERJ Project - ‘Obesity epidemic, beyond the energy balance: contextual and prolonged factors in Rio de Janeiro’ - Process No. E-26/110.119/2013.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To identify food consumption patterns and association between overweight and risk of cardiovascular disease.

Methods

This was a cross-sectional study with staff of the Universidade do Estado do Rio de Janeiro, Brazil, who took part in the Pró-Saúde Study. Food consumption was investigated using a food frequency questionnaire. Association between dietary patterns (exposure) and overweight and cardiovascular risk (outcomes) was estimated using linear regression.

Results

Among the 520 staff assessed, four dietary patterns were found: ‘ultra-processed’, ‘healthy’, ‘meat’ and ‘traditional’. After adjustment, the ‘meat’ pattern was inversely associated with waist circumference (ß=-1.52 - 95%CI -2.66;-0.39), body mass index (ß=-0.56 - 95%CI -1.01;-0.11), and the Framingham Risk Score (ß=-0.36 - 95%CI -0.64;-0.09).

Conclusion

In view of excess weight, risk of cardiovascular disease and inverse association between the ‘meat’ food consumption pattern and BMI, it is important to conduct further investigations, with non-working groups, with the aim of gaining greater understanding of the health-disease process related to food consumption.

Keywords:
Eating; Cardiovascular Diseases; Risk Factors; Overweight

Food groups	Food items
Rice	Rice
Pasta	Spaghetti, lasagna, gnocchi or ravioli
Bread and salted biscuits	Mini baguette or loaf of bread and salted biscuits
Fruit	Orange or tangerine, banana, papaya, apple, water melon, melon, pineapple, mango, lime, passion fruit, grapes
Fresh greens and vegetables	Lettuce, kale, cabbage, cauliflower or broccolis, tomato, cucumber, choko, zucchini, pumpkin, carrot, beetroot, okra, French beans, garlic, onion and sweet pepper
Conserved vegetables	Palm hearts, olives, maize
Beef and offal	Beef, tripe, liver, gizzard, heart and barbecue
Pork	Pork
Processed meat and fish	Meat or fish conserved in salt, bacon or pork crackling, tinned sardines or tuna
Ultra-processed meat	Hamburger, hot dog sausage, sausage, mortadella, luncheon meat, ham and salami
Fresh fowl and fish	Fresh fish and chicken
Milk and milk products	Cheese, milk, yoghurt and cream cheese
Eggs	Eggs
Beans	Beans
Fat	Butter or margarine and mayonnaise
Confectionary	Cake, filled biscuit, sweet biscuit, ice cream, candies, milk-based confectionary, fruit-based confectionary, bar of chocolate or bonbon, powdered chocolate and sugar
Savories and pizzas	Pizza, rissole-type savories, deep fried savories
Coffee and infusions	Coffee, tea and matte
Soda drinks	Cola-based soda drinks and other soda drinks
Natural fruit juice	Fruit juice or pulp
Alcoholic drinks	Beer, wine and other alcoholic drinks
Snacks	French fries, potato crisps or straws, packet snacks, packet peanuts
Pulses	Lentils, peas, chickpeas
Cereals	Polenta or corn mash
Root vegetables and products	Potato or mashed potato, cassava and cassava flour

Variables	n	%
Sex
Female	270	51.9
Male	250	48.1
Age (years)
<35	29	5.6
35-44	71	13.7
45-49	115	22.1
50-54	128	24.6
55-59	82	15.8
≥60	95	18.2
Schooling
Up to complete elementary education	49	9.4
Complete high school education	184	35.3
Complete higher education or above	283	54.3
Per capita income (minimum wages)
<3	364	70.0
3-6	128	24.6
>6	28	5.4
Waist circumference
No risk	114	21.1
At risk	406	77.9
BMI^a
Underweight	20	3.8
Normal	154	29.6
Overweight	346	66.6
Framingham Risk Score (rating)
High	51	9.8
Intermediate	113	21.7
Low	356	68.5

Variables	Mean	Standard deviation
Total mass (kg)	77.6	15.3
Total fat mass (%)	36.2	8.3
Android fat mass (%)	9.3	1.8
Gynoid fat mass (%)	16.9	3.1
AFM%/GFM% ratio^a	0.6	0.2
BMI (kg/m²)^b	27.8	5.0
Waist circumference (cm)	97.2	12.4
Framingham Risk Score (rating)	6.5	7.0

Food groups	Factors (dietary patterns) identified
Food groups	Ultra-processed	Healthy	Meat	Traditional
Pasta	0.57	0.03	0.05	0.08
Bread and salted biscuits	0.42	0.25	-0.23	0.25
Fat	0.46	0.06	0.15	0.31
Confectionary	0.64	0.09	-0.14	0.04
Savories and pizzas	0.69	-0.09	0.18	-0.06
Soda drinks	0.54	-0.26	0.14	0.07
Snacks	0.58	0.03	0.21	-0.01
Ultra-processed meat	0.58	-0.07	0.35	0.04
Fruit	-0.09	0.69	0.10	0.16
Fresh greens and vegetables	-0.16	0.70	0.24	0.17
Fresh fowl and fish	0.08	0.32	0.04	0.08
Milk and milk products	0.17	0.62	-0.22	0.16
Coffee and infusions	0.14	0.45	0.29	0.00
Natural fruit juice	0.04	0.32	-0.20	0.17
Pulses	0.05	0.48	0.16	-0.15
Conserved vegetables	0.13	0.27	0.44	-0.15
Beef and offal	0.18	-0.03	0.56	0.25
Pork	0.14	-0.08	0.64	0.08
Processed meat and fish	0.21	0.15	0.48	0.13
Alcoholic drinks	0.01	0.07	0.49	-0.10
Rice	0.01	-0.09	0.02	0.74
Beans	-0.45	-0.01	-0.01	0.78
Cereals	0.15	0.21	-0.01	0.38
Roots, root vegetables and products	0.26	0.18	0.10	0.41
Eigenvalues	2.99	2.41	1.99	1.93
Explained variance (%)	11.95	9.63	7.97	7.73
Total explained variance (%)	37.3
KMO^a	0.752
Bartlett sphericity	0.001

Variables	Non-adjusted β	95%CI^a	p-value	Adjusted β^b	95%CI^a	p-value
Total fat mass (%)
‘Ultra-processed’ pattern	0.64	(-0.08;1.37)	0.082	0.06	(-0.84;0.96)	0.890
‘Healthy’ pattern	0.38	(-0.34;1.11)	0.303	0.06	(-0.70;0.83)	0.871
‘Meat’ pattern	-0.22	(-0.95;0.50)	0.551	-0.42	(-1.17;0.33)	0.275
‘Traditional’ pattern	0.70	(-0.02;1.43)	0.055	0.23	(-0.61;1.07)	0.586
Android fat mass (%)
‘Ultra-processed’ pattern	0.06	(-0.09;0.22)	0.439	-0.02	(-0.21;0.17)	0.833
‘Healthy’ pattern	0.08	(-0.06;0.24)	0.271	0.06	(-0.10;0.23)	0.461
‘Meat’ pattern	-0.10	(-0.26;0.04)	0.173	-0.14	(-0.31;0.01)	0.083
‘Traditional’ pattern	-0.10	(-0.26;0.04)	0.177	-0.15	(-0.33;0.03)	0.101
Gynoid fat mass (%)
‘Ultra-processed’ pattern	-0.11	(-0.38;0.15)	0.415	-0.22	(-0.56;0.10)	0.183
‘Healthy’ pattern	0.11	(-0.15;0.38)	0.394	0.02	(-0.25;0.31)	0.848
‘Meat’ pattern	0.17	(-0.08;0.44)	0.191	0.15	(-0.12;0.43)	0.279
‘Traditional’ pattern	0.22	(-0.04;0.49)	0.104	0.04	(-0.26;0.36)	0.761
AFM%/GFM% ratio^c
‘Ultra-processed’ pattern	0.01	(-0.07;0.02)	0.281	0.01	(-0.01;0.02)	0.496
‘Healthy’ pattern	0.01	(-0.01;0.01)	0.792	0.01	(-0.01;0.20)	0.733
‘Meat’ pattern	-0.01	(-0.02;0.02)	0.169	-0.01	(-0.02;0.01)	0.132
‘Traditional’ pattern	-0.01	(-0.03;0.02)	0.071	-0.01	(-0.03;0.01)	0.162
Waist circumference
‘Ultra-processed’ pattern	0.43	(-0.66;1.52)	0.430	0.06	(-1.29;1.42)	0.924
‘Healthy’ pattern	0.79	(-0.29;1.88)	0.151	0.69	(-0.46;1.85)	0.235
‘Meat’ pattern	-1.33	(-2.42;-0.24)	0.012	-1.52	(-2.65;-0.38)	0.009
‘Traditional’ pattern	-0.25	(-1.34;0.84)	0.656	-0.41	(-1.67;0.85)	0.522
BMI^d
‘Ultra-processed’ pattern	0.20	(-0.22;0.63)	0.351	0.10	(-0.43;0.64)	0.709
‘Healthy’ pattern	0.29	(-0.13;0.72)	0.182	0.23	(-0.22;0.69)	0.308
‘Meat’ pattern	-0.44	(-0.87;-0.01)	0.043	-0.56	(-1.00;-0.10)	0.015
‘Traditional’ pattern	-0.10	(-0.54;0.32)	0.638	-0.20	(-0.70;0.29)	0.427
Framingham Risk Score
‘Ultra-processed’ pattern	-0.52	(-1.01;-0.02)	0.040	0.11	(-0.21;0.44)	0.483
‘Healthy’ pattern	-0.24	(-0.73;0.25)	0.341	0.25	(-0.02;0.52)	0.072
‘Meat’ pattern	-0.00	(-0.50;0.49)	0.982	-0.36	(-0.63;-0.09)	0.009
‘Traditional’ pattern	-0.09	(-0.58;0.40)	0.724	0.16	(-0.13;0.46)	0.280

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence:
Thalita Fialho da Rocha - Rua São Francisco Xavier, nº 524, Pavilhão João Lyra Filho, 12º andar, Bloco D, Rio de Janeiro, RJ, Brazil. CEP: 20559-900. E-mail: thalitinha.nutri@hotmail.com