Dietary patterns in India: a systematic review

BackgroundNutrition transition refers to changes in diets and physical activity patterns as countries undergo economic growth, urbanisation with increased reliance on the global food supply. It is associated with a rapid increase in obesity and diet-related non-communicable diseases (NCDs). Although NCDs are increasing worldwide, the rise in low- and middle-income countries (LMICs) has become more rapid, with greater implications because of the double burden of diseases with the concurrent burden of infectious diseases. In high income or developed countries this phenomenon is well established. Unfortunately, information from LIMCs are more limited and are intertwined with food insecurity issues. In Papua New Guinea (PNG) studies that explore such important issues are scarce especially at this crucial period when the country is experiencing rapid transformation due to economic development. This research explores the nutrition transition in PNG by investigating dietary and physical activity patterns to provide an insight into characteristics of changes and their effects on health outcomes.Processes and Methods of Data CollectionThere are two main components to this research. The first is development and validation of data collection methods and confirmation of survey processes. The second component is a population survey of adults that explored the diets, physical activity (PA) and food insecurity across sites selected to provide a sample of populations (Highland and Coastal, rural and peri-urban) affected to a varying extent by major projects and economic development.The first component was undertaken in four study sites (Asaro, Karkar, Hides/Komo and Hiri) to document dietary patterns and practices, and develop the dietary data collection methods and interview aids. This included participatory and in-depth interviews to establish a rich base of qualitative dietary data on diet. The 24-hour recall method was trialled for quantitative dietary data collection and protocols developed. This component also included a tracing study of adult participants in the Asaro and Hiri sites was undertaken to establish common activities to construct the PNG-Physical Activity Questionnaire (PNG-PAQ). This was validated in a separate sample against an accelerometer. The food insecurity questions were based on the eight-statement food insecurity measure for Maori and Pacific Islanders in New Zealand and tested across the four sites.The second component was undertaken in a representative sample of adults from Asaro, Karkar, and Hiri. The 24-hour recall method, PNG-PAQ and food insecurity questions were asked through interview. Demographic and socio-economic data were available through the routine demographic surveillance undertaken for these sites. ResultsThe qualitative diet study showed that rural populations continue traditional diets that consist largely of garden foods, while contribution of store-bought foods was higher in the peri-urban site. In the rural Asaro and peri-urban Hiri, inclusion of vegetable oil was common and among Hiri participants snacking of store-bought foods was becoming common. The 24-hour recall method was shown to be an appropriate method with survey aids created for use in the study, which enabled observations of diet variation across populations incorporated in the study.The PA tracing study resulted in 44 activity classifications which were categorised under five domains (cash earning/schooling, subsistence farming/cash cropping, home chores, transport, and leisure) to develop the 26-question PNG-PAQ. The validation study showed an acceptable level of validity in measuring moderate to vigorous PA (MVPA) while the soundness of measuring sedentary activities was weaker.Intakes of total energy, protein, fat, carbohydrate, iron and vitamin A were assessed to reflect diet quality. All sites reported inadequate nutrient intakes, apart from iron, in comparison with Estimated Average Requirements. This was consistent with the low levels of obesity observed.Physical activity results showed a subsistence-oriented pattern in the rural sites, with addition of household chores associated with permanent housing and introduction of cash cropping activities. In the peri-urban population paid employment was included along with subsistence activities. Across the sites some modern labour-saving tools have been incorporated, particularly with the use of powered boats and vehicles to travel long distances, though these are more common in the peri-urban population.Analyses showed site differences in diet and PA that were not explained by wealth and education, key indicators of socio-economic development. Food insecurity is a reality at the household level, with the main risks related to failure in the gardens shifting towards income-based food insecurity in households more dependent on store-bought foods.ConclusionThe nutrition transition appears to be in early stages in much of PNG with gradual change in rural areas, but more evident in peri-urban and urban areas. The changes vary across sites and overall the rate of changes is slower compared to patterns reported in the neighbouring Pacific Island Countries and Territories. Understanding these patterns of change assists with development of appropriate and effective prevention measures for both NCDs and infectious diseases.

There is an increasing burden of noncommunicable diseases (NCDs) in India which may be related to changing dietary patterns. We aimed to assess dietary patterns in children since they have time to change unhealthy patterns before NCDs develop. Participants were 665 children, 9–12 years old, born with low birth weight and 77 similarly aged normal birth weight controls. We collected data on sociodemography, anthropometry, body composition, and markers of risk for NCDs: grip strength, long jump, hemoglobin A1c (HbA1c). A food frequency questionnaire was used to collect dietary data from which dietary patterns were derived using principal component analysis (PCA). Fourteen food groups were included in the PCA analysis, resulting in three components: ‘fruits and vegetables’, ‘protein’, and ‘sugar and fat’. Higher socioeconomic status and maternal education were associated with lower adherence to the fruit and vegetable pattern and higher adherence to the protein and sugar and fat patterns. Adherence to the fruits and vegetables pattern was associated with lower height‐for‐age, whereas the fat and sugar pattern was associated with higher indicators of body fat. In linear regression analyses adjusted for age, sex, religion, socioeconomic status, maternal education, and season of data collection, adherence to the ‘fruits and vegetables’ pattern was associated with lower grip strength, shorter long jump, and lower HbA1c. Adherence to the other patterns was not associated with NCD risk factors. Higher consumption of fruits and vegetables, achievable even by poorer families in the cohort, may lower HbA1c, a risk factor for diabetes.

Several studies have demonstrated that dietary patterns identified by a posteriori and hybrid methods are associated with gastrointestinal (GI) cancer risk and mortality. These studies applied different methods for analyzing dietary data and reported inconsistent findings. This systematic review and meta-analysis were aimed to determine the association between dietary patterns, derived using principal component analysis (PCA) and reduced rank regression (RRR), and GI cancer risk and GI cancer-caused mortality. Articles published up to June 2023 in English were eligible for inclusion. The Medline, SCOPUS, Cochrane Library, CINHAL, PsycINFO, ProQuest, and Web of Sciences databases were used to identify prospective studies. The Preferred Reporting Item for Systematic Review and Meta-analysis Protocol 2020 was used to report results. A total of 28 studies were eligible for inclusion. Varied approaches to deriving dietary patterns were used, including PCA (n = 22), RRR (n = 2), combined PCA and RRR (n = 1), cluster analysis (CA; n = 2) and combined PCA and CA (n = 1). Two dietary patterns, "healthy" and "unhealthy," were derived using PCA and RRR. The healthy dietary pattern was characterized by a higher intake of fruits, whole grains, legumes, vegetables, milk, and other dairy products, whereas the unhealthy dietary pattern was characterized by a higher intake of red and processed meat, alcohol, and both refined and sugar-sweetened beverages. The findings indicated that the PCA-derived healthy dietary pattern was associated with an 8% reduced risk (relative risk [RR], 0.92; 95% CI, 0.87-0.98), and the unhealthy dietary pattern was associated with a 14% increased risk (RR, 1.14; 95% CI, 1.07-1.22) of GI cancers. Similarly, the RRR-derived healthy dietary pattern (RR, 0.83; 95% CI, 0.61-1.12) may be associated with reduced risk of GI cancers. In contrast, the RRR-derived unhealthy dietary pattern (RR, 0.93; 95% CI, 0.57-1.52) had no association with a reduced risk of GI cancers. Similarly, evidence suggested that PCA-derived healthy dietary patterns may reduce the risk of death from GI cancers, whereas PCA-derived unhealthy dietary patterns may increase the risk. Findings from prospective studies on the association of PCA-derived dietary patterns and the risk of GI cancers support the evidence of healthy and unhealthy dietary patterns as either protective or risk-increasing factors for GI cancers and for survivorship, respectively. The findings also suggest that the RRR-derived healthy dietary pattern reduces the risk of GI cancers (albeit with low precision), but no association was found for the RRR-derived unhealthy dietary pattern. Prospective studies are required to further clarify disparities in the association between PCA- and RRR-derived dietary patterns and the risk of GI cancers. Systematic review registration: PROSPERO registration no. CRD42022321644.

Dietary and social behaviour are non-medical factors that influence health outcomes. Non-communicable diseases are related to dietary patterns. To date, little is known about how social behaviour is associated with health-related dietary patterns, and, in particular, we lack information about the role of sex within this possible relation. Our cross-sectional study investigated associations between dietary patterns and social behaviour including personality traits (self-control, risk taking), political preferences (conservative, liberal, ecological, social) and altruism (willingness to donate, club membership, time discounting) in men and women. We performed sex-specific correlation analyses to investigate relationships between dietary patterns based on self-reported protocols from the Mediterranean Diet Adherence Screener (MEDAS) and the validated Healthy Eating Index (HEI) from the EPIC Study and a self-reported social behaviour questionnaire. In linear regression models, we analysed associations between dietary and social behaviour patterns. Sex differences were measured by interaction analysis for each social behaviour item. The study sample consisted of N = 102 low-risk individuals. The median age of the study participants was 62.4 (25th/75th percentile 53.6, 69.1) years, and 26.5% were women. Analyses showed that a lower HEI score was correlated with a higher BMI in both women and men. MEDAS and HEI showed a positive correlation with each other in men. In men, a higher MEDAS showed a positive correlation when they estimated their ability as high, with the same for self-control and preference for ecological politics and MEDAS. A weak negative correlation has been shown between men with a preference for conservative politics and MEDAS. HEI showed a positive significant correlation with age in men. Male participants without club membership scored significantly higher in the HEI compared to non-members. A negative correlation was shown for time discounting in men. Linear regression models showed positive associations between preferences for ecological-oriented politics and nutrition for both HEI and MEDAS. No sex interactions were observed. We faced a few limitations, such as a small sample size, particularly for women, and a limited age spectrum in a European cohort. However, assuming that individuals with a preference for ecological-oriented politics act ecologically responsibly, our findings indicate that ecological behaviour in low-risk individuals might determine, at least in part, a healthy diet. Furthermore, we observed dietary patterns such as higher alcohol consumption in men or higher intake of butter, margarine and cream in women that indicate that women and men may have different needs for nutritional improvement. Thus, further investigations are needed to better understand how social behaviour affects nutrition, which could help to improve health. Our findings have the potential to inform researchers and practitioners who investigate the nature of the relationship between social behaviour and dietary patterns to implement strategies to create first-stage changes in health behaviour for individuals with a low cardiovascular risk profile.

BackgroundThe aim of this study is to assess the current status of non-communicable disease (NCD) risk factors amongst adolescents in Bangladesh. We also critically reviewed the existing policy responses to NCD risk among adolescents in Bangladesh.MethodsThis study used a mixed method approach. To quantify the NCD risk burden, we used data from the Global School-based Student Health Survey conducted in Bangladesh. To understand policy response, we reviewed NCD-related policy documents introduced by the Government of Bangladesh between 1971 and 2018 using the WHO recommended NCD Action Plan 2013–2020as study framework. Information from the policy documents was extracted using a matrix, mapping each document against the six objectives of the WHO 2013–2020 Action Plan.ResultsAlmost all adolescents in Bangladesh had at least one NCD risk factor, and there was a high prevalence of concurrent multiple NCD risk factors; 14% had one NCD risk factor while 22% had two, 29% had three, 34% had four or more NCD risk factors. Out of 38 policy documents, eight (21.1%) were related to research and/or surveys, eight (21.1%) were on established policies, and eleven (29%) were on legislation acts. Three policy documents (7.9%) were related to NCD guidelines and eight (21.1%) were strategic planning which were introduced by the government and non-government agencies/institutes in Bangladesh.ConclusionsThe findings emphasize the needs for strengthening NCD risk factors surveillance and introducing appropriate intervention strategies targeted to adolescents. Despite the Government of Bangladesh introducing several NCD-related policies and programs, the government also needs more focus on clear planning, implementation and monitoring and evaluation approaches to preventing NCD risk factors among the adolescents in Bangladesh.

The analysis of dietary patterns has recently drawn considerable attention as a method of investigating the association between the overall whole diet and the risk of colorectal cancer. However, the results have yielded conflicting findings. Here, we carried out a meta-analysis to identify the association between dietary patterns and the risk of colorectal cancer. A total of 40 studies fulfilled the inclusion criteria and were included in this meta-analysis. The highest category of 'healthy' dietary pattern compared with the lowest category was apparently associated with a decreased risk for colorectal cancer [odds ratio (OR)=0.75; confidence interval (CI): 0.68-0.83; P<0.00001]. An increased risk of colorectal cancer was shown for the highest compared with the lowest category of a 'western-style' dietary pattern (OR=1.40; CI: 1.26-1.56; P<0.00001). There was an increased risk of colorectal cancer in the highest compared with the lowest category of 'alcohol-consumption' pattern (OR=1.44; CI: 1.13-1.82; P=0.003). The results of this meta-analysis indicate that a 'healthy' dietary pattern may decrease the risk of colorectal cancer, whereas 'western-style' and 'alcohol-consumption' patterns may increase the risk of colorectal cancer.

BackgroundDietary pattern (DP) analysis is a statistical method used to evaluate the comprehensive effect of the diet on health. The aim of the study was to assess the relationship between DPs derived in selected population of Lower Silesia and the prevalence of metabolic syndrome (MS) and its components.MethodsStudy group consisted of 1634 individuals enrolled in the Prospective Urban and Rural Epidemiological Study Poland. Dietary intake was estimated using the data from the Food Frequency Questionnaire. DPs were identified using principal component analysis. MS prevalence was evaluated based on the criteria accepted by International Diabetes Federation, American Heart Association and National Heart, Lung and Blood Institute in 2009.ResultsThree DPs were identified. The percentage of individuals with MS was lower in the upper quartile (Q) of the ‘fruit & vegetables’ DP in comparison with Q1 (40.4 vs. 48.9%). Inverse relationship was observed for ‘Western’ (Q4 vs. Q1: 50.7 vs. 40.8%) and ‘traditional’ DPs (51.0 vs. 38.3%). After adjusting for potential confounders, in Q4 of ‘traditional’ DP higher risk for central obesity was observed compared to Q1 (OR 1.52; 95% CI: 1.10–2.12). Individuals in Q3 of ‘fruit & vegetables’ DP had lower risk for raised blood pressure in comparison with the bottom Q (OR 0.54; 95% CI: 0.36–0.82).ConclusionsDP analysis allows to evaluate the synergistic effect of the diet on the MS prevalence. ‘Fruit & vegetables’ DP, in contrast to ‘Western’ and ‘traditional’ DPs, was negatively associated with the prevalence of MS and its components in the study group.

To describe and analyze the dietary pattern and nutritional status in Hubei province, we used a subpopulation aged 18–45 years old in Hubei province from an ongoing cohort study, China Health and Nutrition Survey. Trained nutritionists collected detailed diet data by using weighing method in combination with 3 consecutive 24‐hour recalls. Experienced physicians collected anthropometric data. We applied factor analysis to define major dietary patterns. The prevalence of underweight and overweight was 5.2 % and 32.3 % in Hubei residents in 2009, respectively. Fruit and dairy consumption remained at very low levels over this period while the consumption of dietary fat and added salt remained at very high levels. Residents in urban areas consumed more meat and meat products than those in rural areas, while residents in both urban and rural areas reduced fish and seafood intake. Energy and protein intakes levels were above the Chinese reference nutrient intake (RNI) while fat intake was excessive in all subpopulations. Urban residents consumed more energy, protein and fat from animal foods. Inadequate levels of thiamine, riboflavin and calcium were found. Overall these dietary changes are linked with a major increase in obesity in Hubei.This study was supported by NIH (R01‐HD30880) and Fogarty International Center, NIH (5D43TW007709).

To investigate associations between dietary patterns and suboptimal iron status in premenopausal women living in Auckland, New Zealand. Premenopausal women (n = 375; 18-44 years) were included in this cross-sectional analysis. Suboptimal iron status was defined as serum ferritin <20 μg/L. Participants completed a 144-item iron food frequency questionnaire (FeFFQ) and a questionnaire on dietary practices to assess dietary intake over the past month. Factor analysis was used to determine dietary patterns from the FeFFQ. Logistic regression was used to determine associations between these dietary patterns and iron status. Seven dietary patterns were identified: refined carbohydrate and fat; Asian; healthy snacks; meat and vegetable; high tea and coffee; bread and crackers; and milk and yoghurt. Logistic regression suggested that following a "meat and vegetable" dietary pattern reduced the risk of suboptimal iron status by 41 % (95 % CI: 18, 58 %; P = 0.002) and following a "milk and yoghurt" pattern increased the risk of suboptimal iron status by 50 % (95 % CI: 15, 96 %; P = 0.003). These results suggest that dietary patterns characterized by either a low intake of meat and vegetables or a high intake of milk and yoghurt are associated with an increased risk of suboptimal iron status. Dietary pattern analysis is a novel and potentially powerful tool for investigating the relationship between diet and iron status.

SummaryBackgroundModifiable non-communicable disease (NCD) risk factors are becoming increasingly common among adolescents, with clustering of these risk factors in individuals of particular concern. The aim of this study was to assess global status of clustering of common modifiable NCD risk factors among adolescents.MethodsWe used latest available data from nationally representative survey for 140 countries, namely the Global School-based Student Health Survey, the Health Behaviour in School-Aged Children and the longitudinal study of Australian Children. Weighted mean estimates of prevalence with corresponding 95% confidence intervals of nine NCD risk factors - physical inactivity, sedentary behaviour, insufficient fruits and vegetable consumption, carbonated soft drink consumption, fast food consumption, tobacco use, alcohol consumption and overweight/obesity - were calculated by country, region and sex.FindingsOver 487,565 adolescents, aged 11–17 years, were included in this study. According to trend analysis, prevalence of four or more NCD risk factors increased gradually over time. Prevalence of four or more NCD risk factors was 14.8% in 2003–2007 and increased to 44% in 2013–2017, an approximately three-fold increase (44.0%). Similar trends were also observed for three and two risk factors. Large variation between countries in the prevalence of adolescents with four or more risk factors was found in all regions. The country level range was higher in the South-East Asia Region (minimum Sri Lanka = 8%, maximum Myanmar = 84%) than Western Pacific Region (minimum China = 3%, maximum Niue = 72%), European Region (minimum Sweden = 13.9%, maximum Ireland = 66.0%), African Region (minimum Senegal = 0.8%, maximum Uganda = 82.1%) and Eastern Mediterranean Region (minimum Libya = 0.2%, maximum Lebanon = 80.2%). Insufficient vegetable consumption, insufficient fruit consumption and physically inactivity were three of the four most prevalent risk factors in all regions.InterpretationOur results suggest a high prevalence of four or more NCD risk factors in adolescents globally, although variation was found between countries. Results from our study indicate that efforts to reduce adolescent NCD risk factors and the associated health burden need to be improved. These findings can assist policy makers to target the rollout of country- specific interventions.FundingNone.

Although several nutrients and foods have been suggested to be preventive for constipation, all previous studies have examined a single nutrient or food in each analysis. In contrast, analysis of dietary patterns may provide new insights into the influence of diet on functional constipation. We conducted a cross-sectional examination of the association between dietary pattern and functional constipation in 3,770 Japanese female dietetic course students aged 18-20 y from 53 institutions in Japan. Diet was assessed with a validated self-administered diet history questionnaire with 148 food items, from which 30 food groups were created and entered into a factor analysis. Functional constipation was defined using the Rome I criteria, which has previously been used in several epidemiologic studies on constipation. The prevalence of functional constipation was 26.0% (n=979). Four dietary patterns were identified: (1) "Healthy", (2) "Japanese traditional", (3) "Western," and 4) "Coffee and dairy products." After adjustment for several confounding factors, the "Japanese traditional" pattern, characterized by a high intake of rice, miso soup, and soy products and a low intake of bread and confectionaries, was associated with a significantly lower prevalence of functional constipation. In comparison with the lowest quintile, the multivariate adjusted odds ratio (95% confidence interval) was 0.52 (0.41-0.66) in the highest quintile (p for trend < 0.0001). Other dietary patterns were not associated with functional constipation. The Japanese traditional dietary pattern, characterized by a high intake of rice and a low intake of bread and confectionaries, may be beneficial in preventing functional constipation in young Japanese women.

BackgroundMost previous studies of diet and lung function focus on individual nutrients and/or foods. Dietary pattern analysis is a strong alternative approach, but very few studies examine the dietary pattern—lung function decline association.MethodsThe association between dietary patterns and decline of forced expiratory volume in 1 s (FEV1) was investigated in 2,560 male adults. Dietary patterns were derived from food frequency data using principal component analysis, and linear mixed‐effects models examined these patterns with FEV1 decline over ~3 years, adjusting for confounders. Given the importance of smoking, dietary pattern × smoking interactions were tested.ResultsA more prudent pattern (higher intake of fruits, vegetables and whole grains) was associated with a slower decline in FEV1 in smokers only (top vs. bottom tertile of pattern: +37.8 mL/y; trend Pinteraction = 0.0008). A more Western pattern (higher intake of meat, potatoes and snacks) was associated with a lower FEV1 at study baseline (top vs. bottom quintile: −162.4 mL; P for trend = 0.001), but not with FEV1 decline either overall or by smoking.ConclusionsIn males, a prudent dietary pattern was associated with a slower decline in lung function in smokers only, and a Western dietary pattern was associated with lower levels of lung function, but not change over time.Grant Funding Source: NHLBI R01HL071022 (PAC), and, in part, NCI/DCP CA37429, NCCAM.

The combinations of food consumed together (dietary patterns) may have a greater influence on health than nutrients or food groups consumed independently. This study investigated the relationship between dietary patterns, body composition and metabolic biomarkers of premenopausal New Zealand women from three ethnic groups. In total, 408 New Zealand European, Māori and Pacific women aged 16–45 years participated in the Women’s EXPLORE (EXamining Predictors Linking Obesity Related Elements) study. Participants completed a 220-item food frequency questionnaire. Several body composition parameters and metabolic biomarkers were measured. Dietary patterns were extracted by principal component analysis and dietary pattern scores were categorised into tertiles to assess links with other measured parameters. Women with higher scores for the ‘refined and processed’ pattern were younger, had higher body mass index, total body fat, plasma leptin and plasma insulin (p < 0.001), and lower plasma ghrelin levels (p < 0.05) than women with lower scores. In addition, more Māori (51%) and Pacific (68%) women followed the ‘refined and processed’ pattern, while more New Zealand European women (40%) followed the ‘sweet and savoury snacking’ pattern. These data show that dietary pattern analysis is a useful tool to assess links between diet and metabolic health. It further reveals interesting ethnic group-specific differences in dietary pattern use.

P4-076: Dietary patterns during early adult life associated with Alzheimer's disease: A population based-study (BERCAL)

Noncommunicable diseases have become the main causes of death in several developing countries. There is a severe shortage of information about the risk factors for these diseases in Iraq. To explore the eating habits, physical activity, and sedentary behaviors of adolescents in Mosul City, Iraq, as risk factors for noncommunicable diseases. A multistage stratified sampling method was carried out on adolescents aged 15 to 18 years in Mosul City, Iraq. A pretested and validated questionnaire was used to obtain information on frequency of intake of certain foods, physical activity, and screen time (television, video, and computer). Weight and height were measured to obtain the body composition status. The total sample included 723 adolescents (350 boys and 373 girls). There were significant differences between boys and girls in most eating habits and activity behaviors. The frequency of skipping breakfast and the intakes of fruits and vegetables, french fries, and sweets and chocolates were significantly higher among girls than boys (p < .001). Boys were significantly more likely to consume fast foods, sugar-sweetened drinks, and energy drinks than girls. Boys spent more time in physical activity (p < .001) and looking at screens than girls. The health authorities of Iraq should focus not only on interventions for undernutrition among adolescents, but also on behavioral risk factors for diet-related noncommunicable diseases.