Brazilian dietary patterns and the dietary approaches to stop hypertension (DASH) diet-relationship with metabolic syndrome and newly diagnosed diabetes in the ELSA-Brasil study

Michele Drehmer, Andrew O Odegaard, Maria Inês Schmidt, Bruce B Duncan, Letícia de Oliveira Cardoso, Sheila M Alvim Matos, Maria Del Carmen B Molina, Sandhi M Barreto, Mark A Pereira, Michele Drehmer, Andrew O Odegaard, Maria Inês Schmidt, Bruce B Duncan, Letícia de Oliveira Cardoso, Sheila M Alvim Matos, Maria Del Carmen B Molina, Sandhi M Barreto, Mark A Pereira

Abstract

Background: Studies evaluating dietary patterns, including the DASH diet, and their relationship with the metabolic syndrome and diabetes may help to understand the role of dairy products (low fat or full fat) in these conditions. Our aim is to identify dietary patterns in Brazilian adults and compare them with the (DASH) diet quality score in terms of their associations with metabolic syndrome and newly diagnosed diabetes in the Brazilian Longitudinal Study of Adult Health-the ELSA-Brasil study.

Methods: The ELSA-Brasil is a multicenter cohort study comprising 15,105 civil servants, aged 35-74 years at baseline (2008-2010). Standardized interviews and exams were carried out, including an OGTT. We analyzed baseline data for 10,010 subjects. Dietary patterns were derived by principal component analysis. Multivariable logistic regression investigated associations of dietary patterns with metabolic syndrome and newly diagnosed diabetes and multivariable linear regression with components of metabolic syndrome.

Results: After controlling for potential confounders, we observed that greater adherence to the Common Brazilian meal pattern (white rice, beans, beer, processed and fresh meats), was associated with higher frequencies of newly diagnosed diabetes, metabolic syndrome and all of its components, except HDL-C. Participants with greater intake of a Common Brazilian fast foods/full fat dairy/milk based desserts pattern presented less newly diagnosed diabetes. An inverse association was also seen between the DASH Diet pattern and the metabolic syndrome, blood pressure and waist circumference. Diet, light foods and beverages/low fat dairy pattern was associated with more prevalence of both outcomes, and higher fasting glucose, HDL-C, waist circumference (among men) and lower blood pressure. Vegetables/fruit dietary pattern did not protect against metabolic syndrome and newly diagnosed diabetes but was associated with lower waist circumference.

Conclusions: The inverse associations found for the dietary pattern characterizing Brazilian fast foods and desserts, typically containing dairy products, with newly diagnosed diabetes, and for the DASH diet with metabolic syndrome, support previously demonstrated beneficial effects of dairy products in metabolism. The positive association with metabolic syndrome and newly diagnosed diabetes found for the pattern characterizing a typical Brazilian meal deserves further investigation, particularly since it is frequently accompanied by processed meat. Trial registration NCT02320461. Registered 18 December 2014.

Keywords: Cohort study; Diabetes; Dietary patterns; Metabolic syndrome.

Figures

Fig. 1
Fig. 1
Adjusted* means for fasting glucose (mg/dL), triglycerides (mg/dL), systolic and diastolic blood pressure according to quintiles of adherence to the four dietary patterns identified and to the DASH-diet. ELSA-Brasil 2008–2010 (n = 9835). *Means obtained through multiple linear regression adjusting for: race, age, sex, education, study center, menopause, occupational status, family history of diabetes, BMI, physical activity, smoking, alcohol, calories/day
Fig. 2
Fig. 2
Adjusted* means for waist circumference (cm) in men and women and HDL cholesterol (mg/dL) in men and women according to quintiles of adherence to the four dietary patterns identified and to the DASH-diet. ELSA-Brasil 2008–2010 (n = 9835). *Means obtained through multiple linear regression adjusting for: race, age, sex, education, study center, menopause, occupational status, family history of diabetes, BMI, physical activity, smoking, alcohol, calories/day

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