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. 2024 Jun 15;8(7):103797.
doi: 10.1016/j.cdnut.2024.103797. eCollection 2024 Jul.

Examining Generalizability across Different Surveys: Comparing Nutrient-Based Food Patterns and Their Cross-Sectional Associations with Cardiometabolic Health in the United States Hispanic/Latino Adults

Jeanette J Varela  1 , Josiemer Mattei  2 , Daniela Sotres-Alvarez  3 , Yasmin Mossavar-Rahmani  4 , Amanda C McClain  5 , Luis E Maldonado  6 , Martha L Daviglus  7 , Briana Jk Stephenson  1
Affiliations

Examining Generalizability across Different Surveys: Comparing Nutrient-Based Food Patterns and Their Cross-Sectional Associations with Cardiometabolic Health in the United States Hispanic/Latino Adults

Jeanette J Varela et al. Curr Dev Nutr. .

Abstract

Background: Ethnicity, cultural background, and geographic location differ significantly within the United States Hispanic/Latino population. These variations can greatly define diet and its relationship with cardiometabolic disease, thus influencing generalizability of results.

Objectives: We aimed to examine nutrient-based food patterns (NBFPs) of Hispanic/Latino adults and their association with cardiometabolic risk factors (dyslipidemia, hypertension, obesity, diabetes) across 2 United States population-based studies with differing sampling strategies.

Methods: Data were collected from Mexican or other Hispanic adult participants from 2007-2012 National Health and Nutrition Examination Survey (NHANES) (n = 3605) and 2007-2011 Hispanic Community Health Survey/Study of Latinos (HCHS/SOL, n = 14,416). NBFPs were derived using factor analysis on nutrient intake data estimated from 24-h dietary recalls and interpreted using common foods in which these nutrients are prominent. Cross-sectional associations between NBFPs (quintiles) and cardiometabolic risk factors, defined by clinical measures and self-report, were estimated using survey-weighted multivariable-adjusted logistic models, accounting for multiple testing.

Results: Five NBFPs were identified in both studies: 1) meats, 2) grains/legumes, 3) fruits/vegetables, 4) dairy, and 5) fats/oils. Associations with cardiometabolic risk factors differed by NBFP and study. In HCHS/SOL, the odds of diabetes were lower for persons in the highest quintile of meats NBFP (odds ratio [OR]: 0.73; 95% confidence interval [CI]: 0.58, 0.92) and odds were higher for those in the lowest quintile of fruits/vegetables (OR: 0.71; 95% CI: 0.55, 0.93) compared to those in the third (moderate intake) quintile. Those in the fourth quintile of dairy NBFP had higher odds of hypertension than those in the third quintile (OR: 1.31; 95% CI: 1.01, 1.70). In NHANES, the odds of hypertension were higher for those in the fourth quintile of dairy (OR: 1.88; 95% CI: 1.10, 3.24) than those in the third quintile.

Conclusions: Diet-disease relationships among Hispanic/Latino adults vary according to 2 population-based studies. These differences have research and practical implications when generalizing inferences on heterogeneous underrepresented populations.

Keywords: HCHS/SOL; Hispanic/Latino diets; NHANES; dietary patterns; factor analysis; nutrient intake.

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Figures

FIGURE 1
FIGURE 1
Heatmap of factor loading values for the 5 retained factors in NHANES and HCHS/SOL. Proportions of explained variance in nutrient intake for NHANES factors 1–5 are 15.9, 14.6, 14.2,11.9, and 11.6, respectively, while in HCHS/SOL, factors 1–5 are 24.6, 13.5, 13.2, 12.5, and 0.4, respectively. F, factor; HCHS/SOL, Hispanic Community Health Study/Study of Latinos; LCSFA, long-chain saturated fatty acid; MCSFA, medium-chain saturated fatty acid; NHANES, National Health and Nutritional Examination Survey; SFA4, saturated fatty acid 4:0 (butyric acid).
FIGURE 2
FIGURE 2
Forest plots of single factor models (OR and 95% CI) by NBFPs and cardiometabolic risk factors for NHANES (n = 3605) and HCHS/SOL (n = 14,416) respondents. The third quintile, calculated separately for each study sample and each NBFP, is the defined referent category. Conditions were defined for dyslipidemia (total cholesterol ≥240 mg/dL, LDL cholesterol ≥160 mg/dL, HDL cholesterol <40 mg/dL, self-reported use of cholesterol-lowering medication, or self-reported hypercholesterolemia), diabetes (fasting >8 h plasma glucose ≥126 mg/dL, fasting 8 h plasma glucose ≥200 mg/dL, or post-OGTT glucose ≥200 mg/dL; HbA1c ≥6.5%; self-reported medication use; or self-reported physician diagnosis), hypertension (BP ≥140/90 mm Hg or medication use), obesity (BMI ≥30 kg/m2 for age 20–44 y; waist circumference >88 cm [women] or >102 cm [men] for age 45–74 y), Framingham CVD 10-year risk score (derived using laboratory predictors based on the Framingham Study criterion), and hypertension (systolic blood pressure >140 mm Hg, diastolic blood pressure ≥90 mm Hg, or self-reported medication use). BMI, body mass index; CI, confidence interval; HCHS/SOL, Hispanic Community Health Study/Study of Latinos; HbA1c, glycated hemoglobin; HDL, high-density lipoprotein; LDL, low-density lipoprotein; NBFP, nutrient-based food pattern; NHANES, National Health and Nutritional Examination Survey; OGTT, oral glucose tolerance test; OR, odds ratio; Q, quintile.
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