Associations between dietary patterns and cardiovascular disease risk in Canadian adults: a comparison of partial least squares, reduced rank regression and the simplified dietary pattern technique

Am J Clin Nutr. 2022 May 2;nqac117. doi: 10.1093/ajcn/nqac117. Online ahead of print.

Abstract

Background: Hybrid methodologies have gained continuing interest as unique data reduction techniques for establishing a direct link between dietary exposures and clinical outcomes.

Objectives: We aimed to compare partial least squares (PLS) and reduced rank regression (RRR) in identifying a dietary pattern associated with a high cardiovascular disease (CVD) risk in Canadian adults, construct PLS- and RRR-based simplified dietary patterns, and assess associations between the four dietary pattern scores and CVD risk.

Design: Data were collected from 24-hour dietary recalls of adult respondents in the two cycles of the nationally representative Canadian Community Health Survey (CCHS)-Nutrition: CCHS 2004 linked to health administrative databases (n = 12,313) and CCHS 2015 (n = 14,020). Using 39 food groups, PLS and RRR were applied for the identification of an energy-dense (ED), high-saturated-fat (HSF) and low-fiber-density (LFD) dietary pattern. Associations of the derived dietary pattern scores with lifestyle characteristics and CVD risk were examined using weighted multivariate regression and weighted multivariable-adjusted Cox-proportional hazard models, respectively.

Results: PLS and RRR identified highly similar ED, HSF, LFD dietary patterns with common high positive loadings for fast food, carbonated drinks, salty snacks and solid fats, and high negative loadings for fruit, dark green vegetables, red and orange vegetables, other vegetables, whole grains, legumes and soy (≥|0.17|). Food groups with the highest loadings were summed to form simplified pattern scores. Although the dietary patterns were not significantly associated with CVD risk, they were positively associated with 402 kcal/d higher energy intake (P-trends <0.05) and higher obesity risk [PLS (OR: 2.09; 95% CI: 1.62, 2.7) and RRR (OR: 1.76; 95% CI: 1.44, 2.17)] (P-trends <0.0001) in the fourth quartiles.

Conclusion: PLS and RRR were shown to be equally effective for the derivation of a high-CVD-risk dietary pattern among Canadian adults. Further research is warranted on the role of major dietary components in cardiovascular health.

Keywords: cardiovascular disease; dietary patterns; hybrid methods; incidence; mortality; partial least squares; reduced rank regression; simplified dietary pattern.