Top

03-07-2018 | Insulin glargine | Article

Association of dietary patterns with continuous metabolic syndrome in children and adolescents; a nationwide propensity score-matched analysis: the CASPIAN-V study

Journal: Diabetology & Metabolic Syndrome

Authors: Roya Kelishadi, Ramin Heshmat, Marjan Mansourian, Mohammad Esmaeil Motlagh, Hasan Ziaodini, Majzoubeh Taheri, Zeinab Ahadi, Tahereh Aminaee, Azam Goodarzi, Morteza Mansourian, Mostafa Qorbani, Nafiseh Mozafarian

Publisher: BioMed Central

Abstract

Objective

This study aims to determine the association of dietary patterns with metabolic syndrome (MetS) and its components in children and adolescents.

Methods

This nationwide study was conducted in 2015 among 4200 students aged 7–18 years, who lived in 30 provinces in Iran. The analysis was conducted based on the propensity score using a matched case–control study design. Three dietary patterns were obtained conducting a principal component analysis with a varimax rotation on 16 dietary groups. Continuous MetS score was computed by standardizing the residuals (z-scores) of MetS components by regressing them according to age and sex. The gold standard diagnosis of MetS was considered based on the International Diabetes Federation criteria. Moreover, for the purpose of data analysis, matched logistics analysis was used.

Results

The study participants consisted of 3843 children and adolescents (response rate 91.5%) with mean (SD) age of 12.45 (3.04) years. Totally 49.4% of students were girls and 71.4% lived in urban areas. Three dietary patterns were obtained: Healthy, Western, and Sweet. Prevalence of MetS was 5% (boy 5.5 and girl 4.5%). Results of multivariate analysis show that students with Sweet dietary patterns were at higher risk for abdominal obesity (OR 1.29; 95% CI 1.01–1.66), elevated blood pressure (OR 1.35; 95% CI 1.01–1.81) and MetS (OR 1.33; 95% CI 1.02–1.74). The two other dietary patterns were not associated with MetS and its components.

Conclusion

Sweet dietary pattern increase the risk of MetS and some its components in Iranian children and adolescents. This finding provides valuable information for effective preventive strategies of MetS based on diet rather than medication to maintain healthy lifestyle habits.

Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic syndrome a summary of the evidence. Diabetes Care. 2005;28(7):1769–78.CrossRefPubMed

Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112(20):3066–72.CrossRefPubMed

Kelishadi R. Childhood overweight, obesity, and the metabolic syndrome in developing countries. Epidemiol Rev. 2007;29(1):62–76.CrossRefPubMed

Halpern A, Mancini MC, Magalhães MEC, Fisberg M, Radominski R, Bertolami MC, et al. Metabolic syndrome, dyslipidemia, hypertension and type 2 diabetes in youth: from diagnosis to treatment. Diabetol Metab Synd. 2010;2(1):55.CrossRef

Duncan GE, Li SM, Zhou X-H. Prevalence and trends of a metabolic syndrome phenotype among US adolescents, 1999–2000. Diabetes Care. 2004;27(10):2438–43.CrossRefPubMed

Halpern A, Mancini M. Treatment of obesity: an update on anti-obesity medications. Obes Rev. 2003;4(1):25–42.CrossRefPubMed

Shafiee G, Kelishadi R, Qorbani M, Motlagh ME, Taheri M, Ardalan G, et al. Association of breakfast intake with cardiometabolic risk factors. J Pediatr. 2013;89(6):575–82. https://doi.org/10.1016/j.jped.2013.03.020.CrossRef

Mehrkash M, Kelishadi R, Mohammadian S, Mousavinasab F. Obesity and metabolic syndrome among a representative sample of Iranian adolescents southeast Asian. J Trop Med Public Health. 2012;43(3):756–63.

Kelishadi R, Hovsepian S, Djalalinia S, Jamshidi F, Qorbani M. A systematic review on the prevalence of metabolic syndrome in Iranian children and adolescents. J Res Med Sci. 2016;21:90.CrossRefPubMedPubMedCentral

10.

Lind PM, Riserus U, Salihovic S, Bavel B, Lind L. An environmental wide association study (EWAS) approach to the metabolic syndrome. Environ Int. 2013;55:1–8.CrossRefPubMed

11.

Vega GL. Obesity, the metabolic syndrome, and cardiovascular disease. Am Heart J. 2001;142(6):1108–16.CrossRefPubMed

12.

Kaikkonen JE, Mikkilä V, Magnussen CG, Juonala M, Viikari JS, Raitakari OT. Does childhood nutrition influence adult cardiovascular disease risk?—Insights from the Young Finns Study. Ann Med. 2013;45(2):120–8.CrossRefPubMed

13.

Hu FB. Dietary pattern analysis: a new direction in nutritional epidemiology. Curr Opin Lipidol. 2002;13(1):3–9.CrossRefPubMed

14.

Aekplakorn W, Satheannoppakao W, Putwatana P, Taneepanichskul S, Kessomboon P, Chongsuvivatwong V, et al. Dietary pattern and metabolic syndrome in Thai adults. J Nutr Metab. 2015;2015:468759.CrossRefPubMedPubMedCentral

15.

Woo HD, Shin A, Kim J. Dietary patterns of Korean adults and the prevalence of metabolic syndrome: a cross-sectional study. PLoS ONE. 2014;9(11):e111593.CrossRefPubMedPubMedCentral

16.

Xia Y, Gu Y, Yu F, Zhang Q, Liu L, Meng G, et al. Association between dietary patterns and metabolic syndrome in Chinese adults: a propensity score-matched case-control study. Sci Rep. 2016;6:347–8.

17.

Heidemann C, Scheidt-Nave C, Richter A, Mensink GB. Dietary patterns are associated with cardiometabolic risk factors in a representative study population of German adults. Br J Nutr. 2011;106(08):1253–62.CrossRefPubMed

18.

Lutsey PL, Steffen LM, Stevens J. Dietary Intake and the development of the metabolic syndrome the atherosclerosis risk in communities study. Circulation. 2008;117(6):754–61.CrossRefPubMed

19.

van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB. Dietary patterns and risk for type 2 diabetes mellitus in US men. Ann Intern Med. 2002;136(3):201–9.CrossRefPubMed

20.

Ambrosini GL, Huang R-C, Mori TA, Hands BP, O’Sullivan TA, de Klerk NH, et al. Dietary patterns and markers for the metabolic syndrome in Australian adolescents. Nutr Metab Cardiovasc Dis. 2010;20(4):274–83.CrossRefPubMed

21.

McNaughton SA, Ball K, Mishra GD, Crawford DA. Dietary patterns of adolescents and risk of obesity and hypertension. J Nutr. 2008;138(2):364–70.CrossRefPubMed

22.

Shang X, Li Y, Liu A, Zhang Q, Hu X, Du S, et al. Dietary pattern and its association with the prevalence of obesity and related cardiometabolic risk factors among Chinese children. PLoS ONE. 2012;7(8):e43183.CrossRefPubMedPubMedCentral

23.

Richter A, Rabenberg M, Truthmann J, Heidemann C, Roosen J, Thiele S, et al. Associations between dietary patterns and biomarkers of nutrient status and cardiovascular risk factors among adolescents in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS). BMC Nutr. 2017;3(1):4.CrossRef

24.

Rocha NP, Milagres LC, Longo GZ, Ribeiro AQ, de Novaes JF. Association between dietary pattern and cardiometabolic risk in children and adolescents: a systematic review. J Pediatr. 2017;93:214–22.CrossRef

25.

Shadman Z, Akhoundan M, Poorsoltan N, Larijani B, Qorbani M, Hedayati M, et al. Association of major dietary patterns with cardio-metabolic risk factors in type 2 diabetic patients. Iran J Public Health. 2016;45(11):1491.PubMedPubMedCentral

26.

Bagheri F, Siassi F, Koohdani F, Mahaki B, Qorbani M, Yavari P, et al. Healthy and unhealthy dietary patterns are related to pre-diabetes: a case–control study. Br J Nutr. 2016;116(5):874–81.CrossRefPubMed

27.

Aghapour B, Rashidi A, Dorosti-Motlagh A, Mehrabi Y. The association between major dietary patterns and overweight or obesity among Iranian adolescent girls. Iran J Nutr Sci Food Technol. 2013;7(5):289–99.

28.

Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willett WC. Dietary patterns, insulin resistance, and prevalence of the metabolic syndrome in women. Am J Clin Nutr. 2007;85(3):910–8.CrossRefPubMed

29.

Moslehi N, Hosseini-Esfahani F, Hosseinpanah F, Mirmiran P, Hojjat P, Azizi F. Adherence to a whole grain and legumes based dietary pattern and risk of type 2 diabetes. Iran J Diabetes Metab. 2016;15(2):120–9.

30.

Haghighatdoost F, Zaribaf F, Azadbakht L, Esmaillzadeh A. Association between major dietary patterns and risk factors for cardiovascular disease among women. Iran J Nutr Sci Food Technol. 2012;7(3):19–30.

31.

Motlagh ME, Ziaodini H, Qorbani M, Taheri M, Aminaei T, Goodarzi A, et al. Methodology and early findings of the fifth survey of childhood and adolescence surveillance and prevention of adult noncommunicable disease: The CASPIAN-V study. Int J Prev Med. 2017;8:4.CrossRefPubMedPubMedCentral

32.

Kelishadi R, Majdzadeh R, Motlagh ME, Heshmat R, Aminaee T, Ardalan G, et al. Development and evaluation of a questionnaire for assessment of determinants of weight disorders among children and adolescents: the Caspian-IV study. Int J Prev Med. 2012;3(10):699–705.PubMedPubMedCentral

33.

Knowles K, Paiva L, Sanchez S, Revilla L, Lopez T, Yasuda M, et al. Waist circumference, body mass index, and other measures of adiposity in predicting cardiovascular disease risk factors among Peruvian adults. Int J Hypertens. 2011;2011:931402.CrossRefPubMedPubMedCentral

34.

Eisenmann JC. Aerobic fitness, fatness and the metabolic syndrome in children and adolescents. Acta Paediatr. 2007;96(12):1723–9.CrossRefPubMed

35.

Zimmet P, Alberti G, Kaufman F, Tajima N, Silink M, Arslanian S, et al. The metabolic syndrome in children and adolescents. Lancet. 2007;369(9579):2059–61.CrossRefPubMed

36.

Perkins NJ, Schisterman EF. The inconsistency of “optimal” cutpoints obtained using two criteria based on the receiver operating characteristic curve. Am J Epidemiol. 2006;163(7):670–5.CrossRefPubMedPubMedCentral

37.

Moore LL, Singer MR, Bradlee ML, Daniels SR. Adolescent dietary intakes predict cardiometabolic risk clustering. Eur J Nutr. 2016;55(2):461–8.CrossRefPubMed

38.

Alavian S-M, Motlagh ME, Ardalan G, Motaghian M, Davarpanah AH, Kelishadi R. Hypertriglyceridemic waist phenotype and associated lifestyle factors in a national population of youths: CASPIAN Study. J Trop Pediatr. 2008;54(3):169–77.CrossRefPubMed

39.

Samadi M, Zeinaly F, Mohammadi SG, Alipour M, Samani HA. The relationship between obesity and dietary patterns: review on evidence. J Clin Exc. 2014;4:72–89.

40.

Parker ED, Liu S, Van Horn L, Tinker LF, Shikany JM, Eaton CB, et al. The association of whole grain consumption with incident type 2 diabetes: the Women’s Health Initiative Observational Study. Ann Epidemiol. 2013;23(6):321–7.CrossRefPubMedPubMedCentral

41.

Villegas R, Gao Y-T, Yang G, Li H-L, Elasy TA, Zheng W, et al. Legume and soy food intake and the incidence of type 2 diabetes in the Shanghai Women’s Health Study. Am J Clin Nutr. 2008;87(1):162–7.CrossRefPubMedPubMedCentral

42.

Ovaskainen M, Reinivuo H, Tapanainen H, Hannila M, Korhonen T, Pakkala H. Snacks as an element of energy intake and food consumption. Eur J Clin Nutr. 2006;60(4):494–501.CrossRefPubMed

43.

Kong A, Beresford SA, Alfano CM, Foster-Schubert KE, Neuhouser ML, Johnson DB, et al. Associations between snacking and weight loss and nutrient intake among postmenopausal overweight to obese women in a dietary weight-loss intervention. J Am Diet Assoc. 2011;111(12):1898–903.CrossRefPubMedPubMedCentral

44.

Hampl JS, Heaton C, Taylor CA. Snacking patterns influence energy and nutrient intakes but not body mass index. J Hum Nutr Diet. 2003;16(1):3–11.CrossRefPubMed

45.

Vergetaki A, Linardakis M, Papadaki A, Kafatos A. Presence of metabolic syndrome and cardiovascular risk factors in adolescents and University students in Crete (Greece), according to different levels of snack consumption. Appetite. 2011;57(1):278–85.CrossRefPubMed

46.

Barrio-Lopez MT, Martinez-Gonzalez MA, Fernandez-Montero A, Beunza JJ, Zazpe I, Bes-Rastrollo M. Prospective study of changes in sugar-sweetened beverage consumption and the incidence of the metabolic syndrome and its components: the SUN cohort. Br J Nutr. 2013;110(09):1722–31.CrossRefPubMed

47.

Phillips SM, Bandini LG, Naumova EN, Cyr H, Colclough S, Dietz WH, et al. Energy-dense snack food intake in adolescence: longitudinal relationship to weight and fatness. Obes Res. 2004;12(3):461–72.CrossRefPubMed

48.

Karatzi K, Moschonis G, Barouti A-A, Lionis C, Chrousos GP, Manios Y. Dietary patterns and breakfast consumption in relation to insulin resistance in children. The Healthy Growth Study. Public Health Nutr. 2014;17(12):2790–7.CrossRefPubMed

49.

Amini M, Dadkhah-Piraghaj M, Abtahi M, Abdollahi M, Houshiarrad A, Kimiagar M. Nutritional assessment for primary school children in Tehran: an evaluation of dietary pattern with emphasis on snacks and meals consumption. Inte J Prev Med. 2014;5(5):611.

50.

Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84(2):274–88.PubMedPubMedCentralCrossRef

51.

Loh D, Moy F, Zaharan N, Jalaludin M, Mohamed Z. Sugar-sweetened beverage intake and its associations with cardiometabolic risks among adolescents. Peadiatr Obes. 2016;12:1–5.

52.

Havel PJ. Dietary fructose: implications for dysregulation of energy homeostasis and lipid/carbohydrate metabolism. Nutr Rev. 2005;63(5):133–57.CrossRefPubMed

53.

Johnson RJ, Murray R. Fructose, exercise, and health. Curr Sports Med Rep. 2010;9(4):253–8.CrossRefPubMed

54.

Kelishadi R, Mansourian M, Heidari-Beni M. Association of fructose consumption and components of metabolic syndrome in human studies: a systematic review and meta-analysis. Nutrition. 2014;30(5):503–10.CrossRefPubMed

55.

Johnson RJ, Segal MS, Sautin Y, Nakagawa T, Feig DI, Kang D-H, et al. Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease. Am J Clin Nutr. 2007;86(4):899–906.PubMed

56.

Ford ES, Li C, Cook S, Choi HK. Serum concentrations of uric acid and the metabolic syndrome among US children and adolescents. Circulation. 2007;115(19):2526–32.CrossRefPubMed

57.

Nielsen SJ, Popkin BM. Changes in beverage intake between 1977 and 2001. Am J Prev Med. 2004;27(3):205–10.CrossRefPubMed

58.

Mattes RD. Dietary compensation by humans for supplemental energy provided as ethanol or carbohydrate in fluids. Physiol Behav. 1996;59(1):179–87.CrossRefPubMed

59.

Imamura F, Lichtenstein AH, Dallal GE, Meigs JB, Jacques PF. Generalizability of dietary patterns associated with incidence of type 2 diabetes mellitus. Am J Clin Nutr. 2009;90:1075–83.CrossRefPubMedPubMedCentral

60.

Qi L, Cornelis MC, Zhang C, van Dam RM, Hu FB. Genetic predisposition, Western dietary pattern, and the risk of type 2 diabetes in men. Am J Clin Nutr. 2009;89:1453–8.CrossRefPubMedPubMedCentral

Be confident that your patient care is up to date

Medicine Matters is being incorporated into Springer Medicine, our new medical education platform.

Alongside the news coverage and expert commentary you have come to expect from Medicine Matters diabetes, Springer Medicine's complimentary membership also provides access to articles from renowned journals and a broad range of Continuing Medical Education programs. Create your free account »