Dietary Patterns, Cardiometabolic Risk Factors, and the Incidence of Cardiovascular Disease in Severe Obesity

ObjectiveThe longitudinal associations between a dietary pattern (DP) and cardiometabolic risk factors and cardiovascular disease (CVD) incidence were investigated in a cohort of adults with severe obesity. MethodsThe analysis included 2,037 individuals with severe obesity (>34 and >38 kg/m(2) for men and women, respectively) from the Swedish Obese Subjects study repeatedly followed up for 10 years. Reduced rank regression was used to identify a DP characterized by dietary energy density, saturated fat intake, and fiber density. Mixed models examined relationships between repeated measures of DP z-scores and cardiometabolic risk factors. Cox proportional hazards models assessed relationships between DP scores and CVD incidence. ResultsAn energy-dense, high-saturated-fat, and low-fiber DP was derived. A one-unit increase in the DP z-score between follow-ups was associated with an increase in weight [ (SE)] (1.710.10 kg), waist circumference (1.49 +/- 0.07 cm), BMI (0.60 +/- 0.34 kg/m(2)), serum cholesterol (0.06 +/- 0.01 mmol/l), and serum insulin (1.22 +/- 0.17 mmol/l; all P<0.0001), as well as in serum triglycerides (0.05 +/- 0.02 mmol/l; P<0.05), systolic blood pressure (1.05 +/- 0.27 mmHg; P<0.001), and diastolic blood pressure (0.55 +/- 0.16 mmHg; P<0.05). No significant association was observed between repeated measures of the DP z-scores and CVD incidence (HR=0.96; 95% CI=0.83-1.12). ConclusionsAn energy-dense, high-saturated-fat, and low-fiber DP was longitudinally associated with increases in cardiometabolic risk factors in severe obesity but not with CVD incidence.