Dietary patterns associated with subclinical atherosclerosis: a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) study

Public Health Nutr. 2021 Oct;24(15):5006-5014. doi: 10.1017/S1368980020005340. Epub 2021 Jan 8.


Objective: To identify dietary patterns associated with subclinical atherosclerosis measured as coronary artery calcification (CAC).

Design: Cross-sectional analysis of data from the Brazilian Longitudinal Study of Adult Health. Dietary data were assessed using a FFQ, and a principal component factor analysis was used to derive the dietary patterns. Scree plot, eigenvalues > 1 and interpretability were considered to retain the factors. CAC was measured using a computed tomography scanner and an electrocardiography-gated prospective Ca score examination and was categorised into three groups based on the CAC score: 0, 1-100 and >100 Agatston units. Multinomial regression models were conducted for dietary patterns and CAC severity categories.

Setting: Brazil, São Paulo, 2008-2010.

Participants: Active and retired civil servants who lived in São Paulo and underwent a CAC exam were included (n 4025).

Results: Around 10 % of participants (294 men, 97 women) had a detectable CAC (>0), 6·5 % (182 men, 73 women) had a CAC of 1-100 and 3·5 % (110 men, 23 women) had a CAC > 100. Three dietary patterns were identified: convenience food, which was positively associated with atherosclerotic calcification; plant-based and dairy food, which showed no association with CAC; and the traditional Brazilian food pattern (rice, legumes and meats), which was inversely associated with atherosclerotic calcification.

Conclusions: Our results showed that a dietary pattern consisting of traditional Brazilian foods could be important to reducing the risk of atherosclerotic calcification and prevent future cardiovascular events, whereas a convenience dietary pattern was positively associated with this outcome.

Keywords: Atherosclerosis; Coronary artery calcification; Dietary pattern; Healthy eating.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Atherosclerosis* / epidemiology
  • Atherosclerosis* / etiology
  • Brazil / epidemiology
  • Coronary Artery Disease* / epidemiology
  • Coronary Artery Disease* / etiology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Prospective Studies
  • Risk Factors