Dietary patterns related to cardiovascular disease based on reduced rank regression analysis of healthy middle-aged Koreans: data from the community-based Korean Genome and Epidemiology Study (KoGES) cohort

Abstract

Background: Dietary patterns (DPs) provide a comprehensive picture of the foods consumed by an individual. Objectives: Using 12-y follow-up data from the Korean Genome Epidemiology Study (KoGES), we determined the associations of DPs with incident cardiovascular disease (CVD) using reduced rank regression (RRR). Methods: This study analyzed the data of 7354 CVD-free subjects aged 40-69 y drawn from the community-based KoGES cohort. Based on the daily intake of 26 food groups at baseline, we identified DPs based on retinol, vitamin B-2 (riboflavin), and vitamin B-3 (niacin) intakes using RRR. The effects of the DPs on incident CVD were assessed using HRs with 95% CIs. Furthermore, using a marginal structural model, the association between DPs and incident CVD was evaluated after adjusting for time-varying confounders. Results: The incidence of CVD during the follow-up period was 3.7 per 1000 person-years (n = 274). The identified DP accounted for 28.99% of the variation in the response variables (i.e., the intake amounts of all 3 nutrients) and was characterized by high intakes of eggs, fish, milk, and dairy products. The effect of DP quintile on incident CVD differed by sex (Pinteraction = 0.03); the highest DP quintile was associated with a protective effect against the development of CVD in women (HR: 0.44; 95% CI: 0.22, 0.89), but not in men (HR: 1.57; 95% CI: 0.82, 3.00), compared with the lowest quintile. Even after adjusting for time-dependent variables, the effect of DP on incident CVD was significant in women (HR: 0.43; 95% CI: 0.22, 0.84), but not in men (HR: 1.49; 95% CI: 0.71, 3.10). Conclusions: In this study, we identified DPs related to CVD, and a DP characterized by high intakes of eggs, fish, milk, and dairy products protected against incident CVD in women.