Prospective investigation of major dietary patterns and risk of cardiovascular mortality in Bangladesh

Yu Chen, Tyler R. McClintock, Stephanie Segers, Faruque Parvez, Tariqul Islam, Alauddin Ahmed, Muhammad Rakibuz-Zaman, Rabiul Hasan, Golam Sarwar, Habibul Ahsan

Research output: Contribution to journalArticle

Abstract

Background: Dietary pattern analysis is emerging as a practical, effective tool for relating comprehensive dietary intake to risk of cardiovascular disease mortality. However, no studies have applied this technique to a population outside of the developed world. Methods: We conducted prospective cohort analyses in 11,116 participants enrolled in the Health Effects of Arsenic Study in Araihazar, Bangladesh, measuring deaths attributable to disease of circulatory system, heart disease, and cerebrovascular disease. Participants were enrolled in 2000 and followed up for an average of 6.6 years. Dietary information was obtained through a previously validated food-frequency questionnaire at baseline. Results: Principal component analysis based on our comprehensive, 39 item FFQ yielded 3 dietary patterns: (i) a balanced pattern, comprised of steamed rice, red meat, fish, fruit and vegetables; (ii) an animal protein diet, which was more heavily weighted towards eggs, milk, red meat, poultry, bread, and vegetables; and (iii) a gourd and root vegetable diet that heavily relied on a variety of gourds, radishes, pumpkin, sweet potato, and spinach. We observed a positive association between increasing adherence to the animal protein diet and risk of death from both disease of the circulatory system and heart disease; the hazard ratios were 1.13 (95% CI, 1.00-1.28, p = 0.05) and 1.17 (95% CI, 0.99-1.38, p = 0.07), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern, after controlling for age, sex, body mass index, smoking status, and energy intake. The positive association was more significant among ever smokers; the hazard ratios (95% CI) for deaths from disease of the circulatory system and heart disease were 1.17 (1.02-1.34) and 1.20 (1.00-1.45), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern. Conclusions: An animal protein-rich diet in rural Bangladesh may increase risk of heart disease mortality, especially among smokers. This emphasizes the need to further explore and address the impact of dietary patterns on cardiovascular disease in populations undergoing epidemiologic transition.

Original languageEnglish (US)
Pages (from-to)1495-1501
Number of pages7
JournalInternational Journal of Cardiology
Volume167
Issue number4
DOIs
StatePublished - Aug 20 2013

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Bangladesh
Diet
Mortality
Heart Diseases
Cardiovascular System
Vegetables
Proteins
Cardiovascular Diseases
Ipomoea batatas
Raphanus
Cerebrovascular Disorders
Cucurbita
Spinacia oleracea
Bread
Arsenic
Poultry
Principal Component Analysis
Energy Intake
Eggs
Population

Keywords

  • Bangladesh
  • Cardiovascular disease
  • Coronary heart disease
  • Dietary patterns
  • Epidemiologic transition

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prospective investigation of major dietary patterns and risk of cardiovascular mortality in Bangladesh. / Chen, Yu; McClintock, Tyler R.; Segers, Stephanie; Parvez, Faruque; Islam, Tariqul; Ahmed, Alauddin; Rakibuz-Zaman, Muhammad; Hasan, Rabiul; Sarwar, Golam; Ahsan, Habibul.

In: International Journal of Cardiology, Vol. 167, No. 4, 20.08.2013, p. 1495-1501.

Research output: Contribution to journalArticle

Chen, Y, McClintock, TR, Segers, S, Parvez, F, Islam, T, Ahmed, A, Rakibuz-Zaman, M, Hasan, R, Sarwar, G & Ahsan, H 2013, 'Prospective investigation of major dietary patterns and risk of cardiovascular mortality in Bangladesh', International Journal of Cardiology, vol. 167, no. 4, pp. 1495-1501. https://doi.org/10.1016/j.ijcard.2012.04.041
Chen, Yu ; McClintock, Tyler R. ; Segers, Stephanie ; Parvez, Faruque ; Islam, Tariqul ; Ahmed, Alauddin ; Rakibuz-Zaman, Muhammad ; Hasan, Rabiul ; Sarwar, Golam ; Ahsan, Habibul. / Prospective investigation of major dietary patterns and risk of cardiovascular mortality in Bangladesh. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 4. pp. 1495-1501.
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abstract = "Background: Dietary pattern analysis is emerging as a practical, effective tool for relating comprehensive dietary intake to risk of cardiovascular disease mortality. However, no studies have applied this technique to a population outside of the developed world. Methods: We conducted prospective cohort analyses in 11,116 participants enrolled in the Health Effects of Arsenic Study in Araihazar, Bangladesh, measuring deaths attributable to disease of circulatory system, heart disease, and cerebrovascular disease. Participants were enrolled in 2000 and followed up for an average of 6.6 years. Dietary information was obtained through a previously validated food-frequency questionnaire at baseline. Results: Principal component analysis based on our comprehensive, 39 item FFQ yielded 3 dietary patterns: (i) a balanced pattern, comprised of steamed rice, red meat, fish, fruit and vegetables; (ii) an animal protein diet, which was more heavily weighted towards eggs, milk, red meat, poultry, bread, and vegetables; and (iii) a gourd and root vegetable diet that heavily relied on a variety of gourds, radishes, pumpkin, sweet potato, and spinach. We observed a positive association between increasing adherence to the animal protein diet and risk of death from both disease of the circulatory system and heart disease; the hazard ratios were 1.13 (95{\%} CI, 1.00-1.28, p = 0.05) and 1.17 (95{\%} CI, 0.99-1.38, p = 0.07), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern, after controlling for age, sex, body mass index, smoking status, and energy intake. The positive association was more significant among ever smokers; the hazard ratios (95{\%} CI) for deaths from disease of the circulatory system and heart disease were 1.17 (1.02-1.34) and 1.20 (1.00-1.45), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern. Conclusions: An animal protein-rich diet in rural Bangladesh may increase risk of heart disease mortality, especially among smokers. This emphasizes the need to further explore and address the impact of dietary patterns on cardiovascular disease in populations undergoing epidemiologic transition.",
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AU - Ahmed, Alauddin

AU - Rakibuz-Zaman, Muhammad

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N2 - Background: Dietary pattern analysis is emerging as a practical, effective tool for relating comprehensive dietary intake to risk of cardiovascular disease mortality. However, no studies have applied this technique to a population outside of the developed world. Methods: We conducted prospective cohort analyses in 11,116 participants enrolled in the Health Effects of Arsenic Study in Araihazar, Bangladesh, measuring deaths attributable to disease of circulatory system, heart disease, and cerebrovascular disease. Participants were enrolled in 2000 and followed up for an average of 6.6 years. Dietary information was obtained through a previously validated food-frequency questionnaire at baseline. Results: Principal component analysis based on our comprehensive, 39 item FFQ yielded 3 dietary patterns: (i) a balanced pattern, comprised of steamed rice, red meat, fish, fruit and vegetables; (ii) an animal protein diet, which was more heavily weighted towards eggs, milk, red meat, poultry, bread, and vegetables; and (iii) a gourd and root vegetable diet that heavily relied on a variety of gourds, radishes, pumpkin, sweet potato, and spinach. We observed a positive association between increasing adherence to the animal protein diet and risk of death from both disease of the circulatory system and heart disease; the hazard ratios were 1.13 (95% CI, 1.00-1.28, p = 0.05) and 1.17 (95% CI, 0.99-1.38, p = 0.07), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern, after controlling for age, sex, body mass index, smoking status, and energy intake. The positive association was more significant among ever smokers; the hazard ratios (95% CI) for deaths from disease of the circulatory system and heart disease were 1.17 (1.02-1.34) and 1.20 (1.00-1.45), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern. Conclusions: An animal protein-rich diet in rural Bangladesh may increase risk of heart disease mortality, especially among smokers. This emphasizes the need to further explore and address the impact of dietary patterns on cardiovascular disease in populations undergoing epidemiologic transition.

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