Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-14T15:20:19.316Z Has data issue: false hasContentIssue false
  • English
  • Français

Dietary diversity score and cardiovascular risk factors in Tehranian adults

Published online by Cambridge University Press:  02 January 2007

Leila Azadbakht ,
Parvin Mirmiran ,
Ahmad Esmaillzadeh  and
Fereidoun Azizi
Leila Azadbakht
Affiliation:
Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, PO Box 19395-4763, Tehran, Islamic Republic of Iran
Parvin Mirmiran
Affiliation:
Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, PO Box 19395-4763, Tehran, Islamic Republic of Iran
Ahmad Esmaillzadeh
Affiliation:
Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, PO Box 19395-4763, Tehran, Islamic Republic of Iran
Fereidoun Azizi*
Affiliation:
Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, PO Box 19395-4763, Tehran, Islamic Republic of Iran
*
*Corresponding author: Email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Aim

To evaluate the relationship between dietary diversity score (DDS) and cardiovascular risk factors in Tehranian adults.

Methods

In this population-based cross-sectional study, a representative sample of 581 subjects (295 males and 286 females) aged over 18 years, residents of Tehran, participated. Hypercholesterolaemia, hypertriglyceridaemia and low high-density lipoprotein cholesterol were defined according to the Adult Treatment Panel III guidelines of the National Cholesterol Education Program. Diabetes was defined as fasting plasma glucose concentration ≥ 126 mg dl−1 or 2-h post challenge glucose concentration ≥ 200 mg dl−1. Hypertension was defined on the basis of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Dietary diversity was defined according to the Diet Quality Index revised.

Results

Mean (±standard deviation) DDS was 6.15 ± 1.02. The probability of having diabetes (odds ratio (OR) among quartiles: 1.45, 1.26, 1.11 and 1.00, respectively; P for trend = 0.04) and hypertriglyceridaemia (OR = 1.41, 1.23, 1.05 and 1.00, respectively; P for trend = 0.04) decreased with increasing quartile of the diversity score for whole grains. The probability of having obesity (OR among quartiles: 1.39, 1.06, 1.03 and 1.00, respectively; P for trend = 0.03), hypercholesterolaemia (OR = 1.46, 1.28, 1.11 and 1.00, respectively; P for trend = 0.03), hypertension (OR = 1.32, 1.17, 1.13 and 1.00, respectively; P for trend = 0.03) and high low-density lipoprotein cholesterol (LDL-C) (OR = 1.25, 1.12, 1.07 and 1.00, respectively; P for trend = 0.04) decreased with increasing quartile of the diversity score for vegetables. The probability of having hypercholesterolaemia, high LDL-C, hypertension and diabetes decreased with quartile of the DDS. But the probability of being obese increased with quartile of the DDS (P for trend = 0.03).

Conclusion

DDS was inversely associated with cardiovascular risk factors in this cross-sectional study. Increased diversity scores of diets, to increase the variety score for vegetables, may be emphasised in programmes attempting to bring about changes in lifestyle.

Keywords

Dietary diversity scoreCardiovascular risksVariety
Type
Research Article
Information
Public Health Nutrition , Volume 9 , Issue 6 , September 2006 , pp. 728 - 736
Copyright
Copyright © The Authors 2006

References

1Kromhout, D. Epidemiology of cardiovascular diseases in Europe; Public Health Nutrition 2001; 4: 441–57.CrossRefGoogle ScholarPubMed
2Azizi, F. Tehran Lipid and Glucose Study. The Final Report, 1st ed. Tehran: Endocrine Research Center, Shaheed Beheshti University of Medical Sciences, 2001; 49, 63, 91, 96, 98.Google Scholar
3Azizi, F, Ghanbarian, A, Madjid, M, Rahmani, M. Distribution of blood pressure and prevalence of hypertension in Tehran adult population: Tehran Lipid and Glucose Study (TLGS), 1999–2000; Journal of Human Hypertension 2002; 16: 305–12CrossRefGoogle ScholarPubMed
4Hollenberg, NK. Genetic versus environmental etiology of the metabolic syndrome among male and female twins; Current Hypertension Reports 2002; 4: 178.Google ScholarPubMed
5Rimm, EB, Willett, WC, Hu, FB, Sampson, L, Colditz, GA, Manson, JE, et al. Folate and vitamin B6 from diet and supplements in relation to risk of coronary heart disease among women. Journal of the American Medical Association 1998; 279: 359–64CrossRefGoogle ScholarPubMed
6Wolk, A, Manson, JE, Stampfer, MJ, Colditz, GA, Hu, FB, Speizer, FE, et al. Long-term intake of dietary fiber and decreased risk of coronary heart disease among women. Journal of the American Medical Association 1999; 281: 1998–2004.CrossRefGoogle ScholarPubMed
7Mirmiran, P, Azadbakht, L, Esmaillzadeh, A, Azizi, F. Dietary diversity score in adolescents – a good indicator of the nutritional adequacy of diets: Tehran Lipid and Glucose Study. Asia Pacific Journal of Clinical Nutrition 2004; 13: 56–60.Google ScholarPubMed
8Hatloy, A, Torheim, LE, Oshaug, A. Food variety – a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. European Journal of Clinical Nutrition 1998; 52: 891–8.CrossRefGoogle Scholar
9Drewnowski, A, Ahlstrom Henderson, S, Driscoll, A, Rolls, BJ. The dietary variety score: assessing diet quality in healthy young and older adults. Journal of the American Dietetic Association 1997; 97: 266–71.CrossRefGoogle ScholarPubMed
10Jorde, R, Bonaa, KH. Calcium from dairy products, vitamin D intake, and blood pressure: the Tromso Study. American Journal of Clinical Nutrition 2000; 71: 1530–5.CrossRefGoogle ScholarPubMed
11Azizi, F, Mirmiran, P, Azadbakht, L. Predictors of cardiovascular risk factors in Tehranian adolescents: Tehran Lipid and Glucose Study. International Journal for Vitamin and Nutrition Research 2004; 74: 307–12.CrossRefGoogle ScholarPubMed
12Weaver, CM, Heaney, RP. Calcium. In: Shils, ME, Olson, JA, Shike, M, Ross, AC, eds. Modern Nutrition in Health and Disease, 9th ed. Philadelphia, PA: Lippincott, Williams and Wilkins, 1998; 148.Google Scholar
13Raynor, HA, Epstein, LH. Dietary variety, energy regulation, and obesity. Psychological Bulletin 2001; 127: 325–41.CrossRefGoogle ScholarPubMed
14Kennedy, E. Dietary diversity, diet quality, and body weight regulation. Nutrition Reviews 2004; 62: S78–81.CrossRefGoogle ScholarPubMed
15Raynor, HA, Jeffery, RW, Tate, DF, Wing, RR. Relationship between changes in food group variety, dietary intake, and weight during obesity treatment. International Journal of Obesity and Related Metabolic Disorders 2004; 28: 813–20.CrossRefGoogle ScholarPubMed
16McCullough, ML, Feskanich, D, Stampfer, MJ, Giovannucci, EL, Rimm, EB, Hu, FB, et al. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. American Journal of Clinical Nutrition 2002; 76: 1261–71CrossRefGoogle ScholarPubMed
17Kant, AK, Schatzkin, A, Ziegler, RG. Dietary diversity and subsequent cause of specific mortality in the NHANES I epidemiologic follow up study. Journal of the American College of Nutrition 1995; 14: 233–8CrossRefGoogle ScholarPubMed
18Hodgson, JM, Hsu-Hage, BH, Wahlqvist, ML. Food variety as a quantitative descriptor of food intake. Ecology of Food and Nutrition 1994; 32: 137–48CrossRefGoogle Scholar
19Wahlqvist, ML, Lo, CS, Myers, KA. Food variety is associated with less macrovascular disease in those with type II diabetes and their healthy controls. Journal of the American College of Nutrition 1989; 8: 515–23CrossRefGoogle ScholarPubMed
20Miller, WL, Crabtree, BF, Evans, DK. Exploratory study of the relationship between hypertension and diet diversity among Saba Islanders. Public Health Reports 1992; 107: 426–32Google ScholarPubMed
21Azizi, F, Rahmani, M, Emami, H, Madjid, M. Tehran Lipid and Glucose Study: rationale and design. CVD Prevention 2000; 3: 242–7.Google Scholar
22Fung, TT, Rimm, EB, Spiegelman, D, Rifai, N, Tofler, GH, Willett, WC, et al. Association between dietary patterns and plasma biomarkers of obesity and cardiovascular diseases risk. American Journal of Clinical Nutrition 2001; 73: 61–7.CrossRefGoogle Scholar
23Kimiagar, SM, Ghaffarpour, M, Houshiar-Red, A, Hormozdyari, H, Zellipour, L. Food consumption pattern in the Islamic Republic of Iran and its relation to coronary heart disease. East Mediterranean Health Journal 1998; 4: 539–47.CrossRefGoogle Scholar
24Kimiagar, M. National Food Consumption Survey. Tehran: National Nutrition and Food Technology Research Institute, 1995.Google Scholar
25Rimm, EB, Giovannucci, EL, Stampfer, MJ, Colditz, GA, Litin, LB, Willett, WC. Reproducibility and validity of an expanded self-administered semiquantitative food frequency questionnaire among male health professionals. American Journal of Epidemiology 1992; 135: 1114–26.CrossRefGoogle ScholarPubMed
26Esmaillzadeh, A, Mirmiran, P, Azizi, F. Whole-grain intake and the prevalence of hypertriglyceridemic waist phenotype in Tehranian adults. American Journal of Clinical Nutrition 2005; 81: 55–63.CrossRefGoogle ScholarPubMed
27Ghafarpour, M, Houshiar-Rad, A, Kianfar, H. The Manual for Household Measures, Cooking Fields Factors and Edible Portion of Food. Tehran: Keshavarzi Press, 1999.Google Scholar
28US Department of Agriculture (USDA). Food Guide Pyramid. Washington, DC: USDA, 1996.Google Scholar
29Haines, PS, Siega-Riz, AM, Popkin, BM. The Diet Quality Index revised: a measurement instrument for populations. Journal of the American Dietetic Association 1999 99: 697–704.CrossRefGoogle ScholarPubMed
30Mirmiran, P, Esmaillzadeh, A, Azizi, F. Detection of cardiovascular risk factors by anthropometric measures in Tehran adults: receiver operating characteristic (ROC) curve analysis. European Journal of Clinical Nutrition 2004; 58: 1110–8.CrossRefGoogle ScholarPubMed
31Azizi, F, Rahmani, M, Ghanbarian, A, Emami, H, Salehi, P, Mirmiran, P, et al. Serum lipid levels in an Iranian adult population: Tehran Lipid and Glucose Study. European Journal of Epidemiology 2003; 18: 311–9.CrossRefGoogle Scholar
32World Health Organization (WHO) Expert Committee on Diabetes Mellitus. Second Report on Diabetes Mellitus. WHO Technical Report Series No. 646. Geneva: WHO, 1980.Google Scholar
33Friedewald, WT, Levy, RI, Fredrickson, DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of preparative ultracentrifuge. Clinical Chemistry 1972; 8: 499–502.CrossRefGoogle Scholar
34Azizi, F, Emami, H, Salehi, P, Ghanbarian, A, Mirmiran, P, Mirbolooki, M, et al. Cardiovascular risk factors in the elderly: the Tehran Lipid and Glucose Study. Journal of Cardiovascular Risk 2003; 10: 65–73.CrossRefGoogle ScholarPubMed
35Mirmiran, P, Mohammadi, F, Allahverdian, S, Azizi, F. Estimation of energy requirements for adults; Tehran Lipid and Glucose Study. International Journal for Vitamin and Nutrition Research 2003; 73: 193–200.CrossRefGoogle ScholarPubMed
36NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults. Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults – the evidence report. Obesity Research 1998; 6: 51S–209S.Google Scholar
37National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143–421.CrossRefGoogle Scholar
38Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997; 20: 1183–97.CrossRefGoogle Scholar
39Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Archives of Internal Medicine 1997; 157: 2413–46.CrossRefGoogle Scholar
40Bernstein, MA, Tucker, KL, Ryan, ND, O'Neill, EF, Clements, KM, Nelson, ME, et al. Higher dietary variety is associated with better nutritional status in frail elderly people. Journal of the American Dietetic Association 2002; 102: 1096–104.CrossRefGoogle ScholarPubMed
41Fernandez, E, Negri, E, La Vecchia, C, Franceschi, S. Diet diversity and colorectal cancer. Preventive Medicine 2000; 31: 11–14.CrossRefGoogle ScholarPubMed
42La Vecchia, C, Munoz, SE, Braga, C, Ferandez, E, Decarli, A. Diet diversity and the risk of colorectal cancer in northern Italy. Cancer Epidemiology, Biomarkers & Prevention 1996; 5: 433–6.Google Scholar
43Mirmiran, P, Esmaillzadeh, A, Azizi, F. Dairy consumption and body mass index: an inverse relationship. International Journal of Obesity and Related Metabolic Disorders 2005; 29: 115–21.CrossRefGoogle ScholarPubMed
44Osborne, CG, McTyre, RB, Dudek, J. A prospective study of nutritional factors and hypertension among US men. Circulation 1998; 89: 1475–84.Google Scholar
45Pereira, MA, Jacobs, DR Jr, Van Horn, L, Slattery, ML, Kartashov, AI, Ludwig, DS. Dairy consumption, obesity, and the insulin resistance syndrome in young adults: the CARDIA Study. Journal of the American Medical Association 2002; 287: 2081–9.CrossRefGoogle ScholarPubMed
46McKeown, NM, Meigs, JB, Liu, S, Wilson, PW, Jacques, PF. Whole-grain intake is favorably associated with metabolic risk factors for type 2 diabetes and cardiovascular diseases in the Framingham Off-spring Study. American Journal of Clinical Nutrition 2002; 76: 390–8.CrossRefGoogle Scholar
47Foote, JA, Murphy, SP, Wilkens, LR, Basiotis, PP, Carlson, A. Dietary variety increases the probability of nutrient adequacy among adults. Journal of Nutrition 2004; 134: 1779–85.CrossRefGoogle ScholarPubMed
48Willett, WC. Nutritional Epidemiology, 2nd ed. New York: Oxford University Press, 1998.CrossRefGoogle Scholar