Differences in US Adult Dietary Patterns by Cardiovascular Health and Socioeconomic Vulnerability

Background: Naturally occurring dietary patterns, a major contributor to health, are not well described among those with cardiovascular disease (CVD) - particularly in light of socioeconomic vulnerability. We sought to identify major dietary patterns in the US and their distribution by CVD, social risk factors, and Supplemental Nutrition Assistance Program (SNAP) participation. Methods: This was a cross-sectional study among 32,498 noninstitutionalized adults from the National Health and Nutrition Examination Survey (2009-2020). We used principal component analysis to identify common dietary patterns. Individuals were assigned to the pattern for which they had the highest component score. Using multinomial logit regression, we estimated the percentage whose diets aligned with each pattern in population subgroups stratified by CVD, social risk factors, and SNAP. Analyses were adjusted for age, gender, race and ethnicity, total energy intake, and year, with sampling weights to provide nationally representative estimates. Results: Four dietary patterns were identified among US adults: American (33.7%; high in solid fats, added sugars, and refined grains), Prudent (22.6%; high in vegetables, nuts/seeds, oils, seafood, and poultry), Legume (15.8%), and Fruit/Whole Grain/Dairy (27.9%), that together explained 29.2% of dietary variance. More adults with prevalent CVD (37.1%) than without (33.3%, p=0.005) aligned with the American Pattern, with no differences among other patterns. Each additional social risk factor associated with more adults aligned with American (2.5% absolute increase) and Legume (1.3%), and fewer aligned with Prudent (-1.9%) and Fruit/Whole Grain/Dairy (-1.9%) patterns (p<0.001 each). Analysis of dietary patterns across SNAP participation showed higher proportion of SNAP participants and income-eligible SNAP non-participants compared to non-eligible adults for the American (40.2% [38.1, 42.3%], 35.1% [32.7, 37.5%], 31.9% [31.0, 32.8%], respectively) and Legume patterns (17.2% [15.6, 18.8%], 17.8% [16.1, 19.5%]), 15.4% [14.6,16.1%], respectively) and less for Prudent (17.0% [15.5, 18.6%], 20.2% [18.2, 22.3%], 24.2% [23.3, 25.1%], respectively) and Fruit/Whole Grain/Dairy Patterns (25.6% [23.8%, 27.3%], 26.9%[27.6%,29.5%], 28.6% [27.6%, 29.5%], respectively). Conclusions: Empirical dietary patterns vary by CVD and socioeconomic vulnerability. Initiatives to improve nutrition in at-risk individuals should consider these naturally occurring dietary patterns and their variation in key subgroups.