Introduction: Distinct dietary behaviors and practices may influence cardiometabolic health, but there is limited research on how these correlated behaviors may cluster, and how patterns of dietary practices are associated with risk of cardiometabolic conditions. Hypothesis: We hypothesized that individual cooking and eating practices would form distinct patterns, and these patterns would be associated with 2-year cardiometabolic risk among adults in Puerto Rico, a population with high prevalence of these conditions. Methods: We analyzed baseline and 2-year follow-up data from 371 adults (30-75 y) in the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic disease Trends (PROSPECT) cohort with complete data and no baseline diabetes. Participants self-reported frequency of engaging in 12 individual cooking and eating practices. Patterns of dietary practices were derived using principal component analysis. Clinical measures and fasting blood samples were collected to define dysregulated components of the metabolic syndrome (MetS). Cox proportional hazard models estimated hazard ratios (HR; 95% CI) for MetS and its components by tertiles of practice pattern, adjusting for sociodemographics, behavioral factors, and diet quality. Results: Two-year MetS incidence was 40.4%. Four principal components (factors) emerged: Nutrient-focused (limit salt, fat, carbohydrates, portions); Dieting (count calories, follow popular diets, keep diet records); Health-conscious (prefer plant-based, buy organic, make meals healthier), and Social Eating (eat accompanied, avoid eating alone). The Dieting factor was consistently associated with higher cardiometabolic risk, including MetS (1.81; 1.17, 2.80), abdominal adiposity (1.93; 1.42, 2.63), low HDL (1.79; 1.16, 2.78), hypertension (2.10; 1.43, 3.06), and hyperglycemia (2.13; 1.20, 3.80) for adults in tertile 3 vs. 1. Similar associations were observed for tertile 2 (vs. 1) of the Health-conscious factor. Tertile 3 (vs. 1) of the Social Eating factor was associated with lower risk of MetS (0.61; 0.38, 0.98) and hypertriglyceridemia (0.46; 0.24, 0.87). Associations for the Nutrient-focused factor were null. Conclusions: Dieting behaviors may increase cardiometabolic risk, possibly reflecting restrictive or compensatory eating. In contrast, social eating appeared protective. Overall patterns of eating behaviors and practices may help explain the complex relationship between diet and cardiometabolic health.
Pacheco et al. (Tue,) studied this question.