Introdução: A microbiota intestinal possui grande diversidade de bactérias, predominantemente dos filos Bacteroidetes e Firmicutes, com múltiplas funções. A alimentação pode alterar sua composição e função. Alto teor de gordura saturada altera a permeabilidade intestinal, eleva os lipopolissacarídeos e predispõe à inflamação subclínica crônica. Dieta rica em fibras, como a vegetariana, induz elevação de ácidos graxos de cadeia curta e benefícios metabólicos. Objetivos: Para analisar a composição da microbiota intestinal de adventistas com diferentes hábitos alimentares e associá-los à inflamação subclínica e resistência à insulina, esta tese incluiu: 1) revisão dos mecanismos que associam a alimentação à microbiota intestinal e ao risco cardiometabólico; 2) verificação da composição da microbiota intestinal segundo diferentes hábitos alimentares e de associações com biomarcadores de doenças cardiometabólicas; 3) avaliação da associação entre a abundância de Akkermansia muciniphila e o metabolismo da glicose; 4) análise da presença de enterótipos e de associações com características clínicas. Métodos: Este estudo transversal incluiu 295 adventistas estratificados segundo hábitos alimentares (vegetariano estrito, ovo-lacto-vegetariano e onívoro). Foram avaliadas associações com dados clínicos, bioquímicos e inflamatórios. O perfil da microbiota foi obtido por sequenciamento do gene 16S rRNA (Illumina® Miseq). Resultados: 1) Há evidências de que as relações entre dieta, inflamação, resistência à insulina e risco cardiometabólico são em parte mediadas pela composição da microbiota intestinal. 2) Vegetarianos apresentaram melhor perfil clínico quando comparados aos onívoros. Confirmou-se maior abundância de Firmicutes e Bacteroidetes, que não diferiram segundo a adiposidade corporal. Entretanto, vegetarianos estritos apresentaram mais Bacteroidetes, menos Firmicutes e maior abundância do gênero Prevotella quando comparados aos outros dois grupos de hábitos alimentares. Entre os ovo-lactovegetarianos verificou-se maior proporção de Firmicutes especialmente do gênero Faecalibacterium. Nos onívoros, houve super-representação do filo Proteobacteria (Succinivibrio e Halomonas) comparados aos vegetarianos. 3) Indivíduos normoglicêmicos apresentaram maior abundância de Akkermansia muciniphila que aqueles com glicemia alterada. A abundância desta bactéria correlacionou-se inversamente à glicemia e hemoglobina glicosilada. 4) Foram identificados três enterótipos (Bacteroides, Prevotella e Ruminococcaceae), similares àqueles previamente descritos. As concentrações de LDL-C foram menores no enterótipo 2, no qual houve maior frequência de vegetarianos estritos. Discussão: 1) Conhecimentos sobre participação da microbiota na fisiopatologia de doenças poderão reverter em estratégias para manipulá-la para promover saúde. 2) Apoia-se a hipótese de que hábitos alimentares se associam favorável ou desfavoravelmente a características metabólicas e inflamatórias do hospedeiro via alterações na composição da microbiota intestinal. Sugerimos que a exposição a alimentos de origem animal possa impactar negativamente nas proporções de comunidades bacterianas. 3) Sugerimos que a abundância da Akkermansia muciniphila possa participar do metabolismo da glicose. 4) Reforçamos que a existência de três enterótipos não deva ser específica de certas populações/continentes. Apesar de desconhecido o significado biológico destes agrupamentos, as correlações com o perfil lipídico podem sugerir sua utilidade na avaliação do risco cardiometabólico. Conclusões: Nossos achados fortalecem a ideia de que a composição da microbiota intestinal se altera mediante diferentes hábitos alimentares, que, por sua vez, estão associados a alterações nos perfis metabólicos e inflamatórios. Estudos prospectivos deverão investigar o potencial da dieta na prevenção de distúrbios cardiometabólicos mediados pela microbiota. / Introduction: The gut microbiota has great bacterial diversity, predominantly of the phyla Bacteroidetes and Firmicutes, with multiple functions. Diet can alter their composition and function. High amount of saturated fat alters intestinal permeability, raises the lipopolysaccharides and predisposes to low-grade inflammation. High-fiber diet, such as the vegetarian, induces the elevation of short-chain fatty acids and metabolic benefits. Objectives: To analyze the composition of gut microbiota of Adventists with diverse dietary patterns and associate them to the low grade inflammation and insulin resistance this thesis included: 1) review of underlying mechanisms of the association of diet, gut microbiota composition and cardiometabolic risk; 2) analysis of the gut microbiota composition according to different dietary patterns and associations with biomarkers of cardiometabolic diseases; 3) evaluation of the association between the Akkermansia muciniphila abundance and glucose metabolism; 4) analysis of the presence of enterotypes and associations with clinical characteristics. Methods: This cross-sectional study included 295 Adventists stratified according to dietary patterns (strict vegetarian, lacto-ovo-vegetarian and omnivore). Their associations with clinical, biochemical and inflammatory data were evaluated. The microbiota profile was obtained by sequencing 16S rRNA genes (Illumina® Miseq). Results: 1) There are evidences that the relationship among diet, inflammation, insulin resistance and cardiometabolic risk are partly mediated by the gut microbiota. 2) Vegetarians showed better clinical profile when compared to omnivores. It was confirmed greater abundance of Firmicutes and Bacteroidetes, which did not differ according to adiposity. However, strict vegetarians had more Bacteroidetes, fewer Firmicutes and higher abundance of genus Prevotella when compared to the other two groups of dietary patterns. The lacto-ovo-vegetarians had higher proportion of Firmicutes especially the genus Faecalibacterium. In the omnivores, there was overrepresentation of the Gammaproteobacteria (Succinivibrio and Halomonas) compared to vegetarians. 3) Normoglycemic individuals had higher abundance of Akkermansia muciniphila compared to those with abnormal glycemic profile. The abundance of this bacterium was inversely correlated to fasting glucose and glycated hemoglobin. 4) Three enterotypes were identified (Bacteroides, Prevotella and Ruminococcaceae), similar to those previously described. LDL-C concentrations were lower in enterotype 2, in which a higher frequency of strict vegetarians was found. Discussion: 1) Knowledge on the involvement of the microbiota in the pathophysiology of diseases could reverse on strategies to manipulate it to promote health. 2) Our data support the hypothesis that dietary patterns could be favorably or unfavorably associated with metabolic and inflammatory processes, via changes in the gut microbiota composition. We suggest that exposure to animal food could negatively impact on the proportions of bacterial communities. 3) We also suggest that the abundance of Akkermansia muciniphila can participate in the glucose metabolism. 4) We reinforce that the existence of three enterotypes should not be specific to certain populations/continents. Although the biological significance of these clusters remains unknown, the correlations with lipid profile may suggest their usefulness in the assessment of the cardiometabolic risk. Conclusions: Our findings reinforce the idea that the gut microbiota composition is altered by different dietary patterns, which, in turn, are associated with changes in metabolic and inflammatory profiles. Prospective studies should investigate the potential of diet to prevent microbiota-mediated cardiometabolic disorders.

Introdução: A hipertensão, doença cardiovascular de alta prevalência, tem influência relevante na morbi-mortalidade da população, e a dieta é um de seus principais fatores de risco modificáveis. Objetivos: Verificar a validade da hipertensão auto-referida e a associação entre os padrões da dieta e a hipertensão auto-referida em residentes do município de São Paulo. Métodos: Foram utilizados dados do estudo transversal de base populacional ISA - Capital 2008, referentes à amostra probabilística de residentes do município de São Paulo com 20 anos ou mais, de ambos os sexos. A coleta de dados ocorreu em 2008 e 2010, por meio de duas visitas domiciliares e inquérito telefônico. Foram coletados dados socioeconômicos, antropométricos, de estilo de vida, inquérito alimentar, e a pressão arterial foi aferida. A validade da hipertensão auto-referida foi verificada pela sensibilidade, especificidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e coeficiente kappa. Estimou-se o consumo alimentar por dois recordatórios de 24 horas, ajustando-se a variabilidade pelo Multiple Source Method. Os padrões da dieta foram obtidos pela análise fatorial por componentes principais. A regressão de Poisson foi utilizada para verificar as associações. Resultados: A sensibilidade da hipertensão auto-referida foi 71,1%, especificidade 80,5%, VPP 73,7%, VPN 78,5% e kappa 0,52. Índice de massa corporal (IMC) e escolaridade foram independentemente associados à sensibilidade (IMC 25 kg/m : RP=1,42; escolaridade 9 anos: RP=0,71). Foram obtidos três padrões da dieta: prudente, tradicional, e contemporâneo. Hipertensão, sexo, idade, renda, plano de saúde, cor da pele, consumo de bebida alcoólica e escolaridade associaram-se à aderência aos padrões da dieta. Os hipertensos apresentaram maior probabilidade de aderência ao padrão prudente e probabilidade menor de aderência ao padrão tradicional. Conclusões: A hipertensão auto-referida é válida na população estudada do município de São Paulo. Sobrepeso está positivamente associado à validade da hipertensão auto-referida, e escolaridade negativamente associada. A aderência aos padrões da dieta associou-se a hipertensão e a fatores demográficos, socioeconômicos, de estilo de vida, bem como à presença de plano de saúde. Esses resultados sugerem a existência de públicos-alvo para o planejamento e execução de políticas públicas em alimentação e nutrição para a prevenção e controle da hipertensão. / Introduction: Hypertension, prevalent cardiovascular disease, has influenced the morbidity and mortality rates, and the diet is a important modifiable risk factors. Objectives: To assess the validity of self-reported hypertension, and the association between dietary patterns and self-reported hypertension among residents in São Paulo. Methods: The study considered data from cross-sectional populationbased ISA - 2008 Capital with random sample of residents of São Paulo aged above 20 years and both sexes. In 2008 and 2010, a structured questionnaire with information about socioeconomic, anthropometric, lifestyle, dietary was colleted, and blood pressure was measured. The validity of self-reported hypertension was evaluated with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and kappas coefficient. The food intake was estimated by two 24-hour recalls, adjusting the variability with Multiple Source Method. The dietary patterns were obtained by principal component factor analysis and Poisson regression was used to assess relationships. Results: The sensitivity of self-reported hypertension was 71.1%, specificity 80.5%, PPV 73.7%, NPV 78.5% and kappa 0.52. Body mass index (BMI) and education level were independently associated with sensitivity (BMI 25 kg/m2: PR=1.42; education 9 years: PR=0.71). Three dietary patterns were obtained: prudent, traditional, and modern. Hypertension, sex, age, income, health insurance, skin color, alcohol intake and education level, were associated with adherence to dietary patterns. Hypertensives showed higher adherence to prudent pattern and lower to traditional pattern. Conclusions: The self-reported hypertension is valid in the studied population of São Paulo. Positive association of overweight and negative association of education level with validity of self-reported hypertension were observed. The adherence to dietary patterns associated with hypertension and demographic, socioeconomic, lifestyle, and the presence of a health insurance. These results suggest there is evidence of risk groups and possible public policies related to diet for prevention and control of hypertension in target groups.

Excessive intake of sodium, sugar, fats, and other unhealthy dietary patterns significantly contribute to cardiovascular disease (CVD) risk and, among those with diagnosed CVD, to deleterious outcomes. Taste perception is one of the most important factors influencing dietary intake and there are many factors that can alter it such as medication and genetic variations. Yet there has been relatively little research on influences of taste perception on self-management of CVD and CVD risk. The purpose of this dissertation is to examine the association of various factors and taste perception in order to add to our understanding of what may or may not influence dietary consumption behaviors among persons at-risk for or with diagnosed CVD. The specific aims of this dissertation were to 1) examine the association between dietary sodium consumption and antihypertensive medication regimen in patients with heart failure (HF); 2) examine the associations between variants of the TAS2R38 haplotype and dietary intake patterns of salt, sugar, fat, alcohol and vegetables in community dwelling adults in Appalachia Kentucky with 2 or more CVD risk factors; and 3) examine associations between the TAS2R38 haplotype and salt taste sensitivity and sodium consumption in patients with HF and their family caregivers. Specific aim one was addressed by evaluating whether prescribed diuretic, beta blocker, angiotensin II receptor blockers (ARBs), and angiotensin converting enzyme (ACE) inhibitors predicted sodium consumption as evidenced by sodium density in a sample of patients with HF when controlling for age, gender, ethnicity, smoking status, New York Heart Association (NYHA) class and body mass index (BMI). The results of this study indicate that, among patients with HF, prescribed ACE inhibitor is predictive of higher sodium consumption but not prescribed diuretics, beta blockers and angiotensin receptor blockers. To address specific aim two, a secondary analysis of data of a sample of adults living in rural Appalachia with 2 or more CVD risk factors was conducted. We examined if having one or two PAV haplotypes was predictive of patterns of salt, sugar, fat, alcohol and vegetable consumption, controlling for age, gender, smoking status, BMI, and prescribed ACE and ARB. There were no associations between TAS2R38 haplotype and any of these dietary intake patterns. Specific aim three was addressed in a study to examine the associations between the TAS2R38 haplotype and salt taste sensitivity and sodium consumption as indicated by 24-hour urinary sodium excretion in patients with HF and their family caregivers, controlling for age, gender, ethnicity, smoking status, and fungiform papillae number. Our outcomes indicated that haplotype did not predict salt taste sensitivity but did predict 24-hour urinary sodium excretion, with significantly less levels of urinary sodium excretion among participants who were homozygous for the PAV haplotype compared to those who were heterozygous for the PAV haplotype or homozygous for the AVI haplotype. The results of these studies, separately and in concert, provide greater understanding of influences of taste perception on self-management among people who are at-risk for or who have diagnosed CVD.

From conception the dynamic balance between nutritional and activity factors play a role in the accumulation of risk for future disease. Maternal nutrient balance and the subsequent dietary pattern of the family set the path for the growth and development of the individual and therefore also for their offspring. There is strong evidence from studies in India that mothers who have a low vitamin B12 status, but high folate, will have children with higher adiposity and more cardiovascular risk factors than those with adequate B12. The B12 status is closely linked to the dietary pattern particularly the consumption of red meat which has a high B12 content. In New Zealand there are an increasing number of Indian migrants. Vegetarianism is also practiced by an increasing number including young women. In addition, there is a high rate (up to 60%) of unplanned pregnancies in New Zealand. In the 1997 New Zealand National Nutrition Survey (NNS97) report, vitamin B12 intake appeared adequate for the New Zealand population and breakfast cereals were reported as one major dietary source of B12. Cereals in New Zealand however, were not fortified with B12 and there was an error in the FOODfile™ data entries for B12 in some cereals. The raw data of reported B12 intakes in the 24-hour diet recall (24HDR) of NNS97 was reanalysed at the individual level by subtracting the B12 derived from breakfast cereals and applying the 2005 revised estimated average requirement (EAR) value. The possible prevalence of B12 insufficiency was 2.4 times that originally reported by the NNS97, translating into a prevalence of up to 27% of the population sampled. This analysis was limited as it was not adjusted for day-to-day variance or to the New Zealand population. This apparently high prevalence of risk for inadequate B12 intake in the surveyed individuals required confirmation that the B12 intake from 24HDR and also a 7-day diet diary (7DDD) was a valid assessment of B12 status. The group of particular interest is women of childbearing age (18-50y) with a range of eating patterns. Thirty eight women aged 19-48y; 12 non-red-meat-eaters (5 Indians vs. 7 non-Indians) and 26 red-meat-eaters (1 Indian vs. 25 non-Indians) participated in this validation study. Anthropometry and hand-to-foot bioelectrical impedance (BIA) were measured on the same day as a 24HDR was recorded. Fasting serum lipids, glucose, haematological parameters, and serum B12, holotranscobalamin II (holo-TC II, a specific B12 biomarker), and folate concentrations were measured. Foods eaten and time spent in physical activity during the following 7 days were extracted from 7DDD and 7-day physical activity diary (7DPAD). There was no significant correlation between dietary intake (24HDR or 7DDD) and biomarkers for B12 status. Indians reported lower mean daily B12 intakes in 7DDD than non-Indians (1.6 vs. 4.5 μg/day, p<0.001) and this was confirmed by Indians’ significantly low serum B12 (203 vs. 383 pmol/L, p=0.04) and holo-TC II (35 vs. 72 pmol/L, p=0.02) concentrations compared to non-Indians. A similar pattern was found between non-red-meat-eaters and red-meat-eaters in daily B12 intake in 7DDD (2.3 vs. 4.8 μg/day, p<0.001) and in B12 biomarkers (serum B12, 263 vs. 397 pmol/L, p=0.01; holo-TC II, 43 vs. 77 pmol/L, p<0.005). Non-red-meat-eaters reported significantly higher daily folate intake in 7DDD (359 vs. 260 μg/day, p=0.01) than red-meat-eaters but no significant difference was found in serum folate concentration between these groups (29 vs. 24 pmol/L, p=0.10). Indians/non-red-meat-eaters also reported lower daily protein intake and higher percentage of total energy from carbohydrate in 7DDD compared to non-Indians/red-meat-eaters but total reported energy intake tended to be under-reported and physical activity over-reported when assessed against estimated basal metabolic rate (BMR). Body composition varied by dietary pattern. Indians/non-red-meat-eaters had higher body fat percentage (BF %) and weaker grip strength than non-Indians/red-meat-eaters. In addition, Indians had a significantly higher waist-to-hip ratio (WHR) than non-Indians. Overall, the whole group reported that they were inactive. The median time spent in moderate, high and maximal intensity activities was only 19 minutes a day, which did not meet the NZ guideline for adults of 30 minutes a day. In this small study nutrient analysis of diet by 24HDR or 7DDD, was not a reliable or accurate way to assess B12 insufficiency. Questions about dietary patterns such as “do you eat red meat”, and taking ethnicity into account could more easily identify the at risk population. Supplementation and/or fortification of B12 should be considered before pregnancy.

Background: Contribution of dietary sources to vitamin D status is not clearly known. Some studies have shown that dietary intake of certain vitamin D rich foods had a significant positive influence on serum 25-hydroxyvitamin D [25(OH)D] concentrations, whereas other studies have shown no effect. Although sunlight exposure is a major source of circulating serum 25(OH)D, children and adolescents have been advised on the dangers of sun exposure. Diet may therefore be an important contributor of circulating serum 25(OH)D in absence of or reduced sunlight exposure. Objective: The aim of this study was to determine whether serum 25(OH)D concentrations were associated with any specific dietary patterns in US children and adolescents using assay-adjusted serum 25(OH)D data from National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006. Methods: Data from 2 cycles of the NHANES 2003-2004 and 2005-2006 for individuals aged 2 to ≤19 y, were used to study the association between dietary patterns and serum 25(OH)D. Dietary patterns were established using factor analysis based on food-frequency questionnaire data. Eigenvalues and Scree plot were used to derive 2 major principal factors. They were labeled as High Fat Low Vegetable (HFLV) and Prudent dietary patterns. Results: Serum 25(OH)D was significantly lower in HFLV dietary pattern group compared to Prudent dietary pattern group (25.1 vs 27.0 ng/mL; P=0.001). The highest serum 25(OH)D concentrations for all subjects were in the low-intake HFLV group or medium and high-intake Prudent groups (P=0.003 and P=0.012, respectively). In multivariate adjusted analysis, children with higher Prudent dietary contribution scores to overall diet showed a significant positive relation with serum 25(OH)D (β=62.01, P=0.016). When data were stratified by sex, a significant positive relation was observed in girls who consumed the Prudent diet (β=86.34, P=0.014) and a significant negative relation was observed in girls who consumed the HFLV diet (β=-84.32, P=0.022). Conclusion: Overall, serum 25(OH)D concentrations were associated with Prudent dietary pattern but not with HFLV dietary pattern in US children and adolescents. When stratified by sex, the relation between dietary patterns and serum 25(OH)D was confined to only girls. Children consuming HFLV pattern diet may benefit from vitamin D supplementation and sunlight exposure (outdoor activities), and should be encouraged to consume more vitamin D fortified foods.

Type 2 diabetes (T2DM) is a growing concern worldwide, particularly among Aboriginal Canadians. Diet has been associated with diabetes risk, and dietary pattern analysis (DPA) provides a method in which whole dietary patterns may be explored in relation to disease. Factor analysis (FA) and reduced rank regression (RRR) of data from the Sandy Lake Health and Diabetes Project identified patterns associated with incident T2DM at follow-up. A RRR-derived pattern characterized by tea, hot cereal, and peas, and low intake of high-sugar foods and beef was positively associated with diabetes; however, the relationship was attenuated with adjustment for age and other covariates. A FA-derived pattern characterized by processed foods was positively associated with incident T2DM in a multivariate model (OR=1.38; CIs: 1.02, 1.86 per unit), suggesting intake of processed foods may predict T2DM risk.

At the end of the 10th century the first Swedish town Sigtuna was founded, which can be recognized as the beginning of urbanization in the Mälaren valley. Christianity was growing strong and the administrative power was probably concentrated to a few magnates gathered around a king. Though, Sigtuna played an important religious and political role, the time of prosperity was short and at the end of the 13th-early 14th century the importance of the town declined. The ambition with the present thesis has been to investigate the demography of the human skeletal material excavated in Sigtuna during the period 1983-1999. The skeletons from 528 individuals from six cemeteries dated to the end of 10th century to the early 16th century have been analysed. The material was subdivided into three chronological development phases synonymous with the establishment, the peak of prosperity and the decline of the town. Well-recognized anthropological techniques were applied together with a health index and chemical tests such as stable isotopes and trace elements. The main aims were to investigate: 1) differences in the material between contemporary inhabitants in Sigtuna, 2) differences in the material between the different chronological phases, 3) differences between the osteological results achieved from Sigtuna and results from other skeletal materials and 4) if the results can be connected to the indications of urbanization. The results showed that: - Some differences between contemporary cemeteries are discernable. Variations in stable isotopes suggest dietary differences between the women at different cemeteries. Furthermore, differences in age- and sex distribution, and mean stature are discernable between some of the contemporary samples and even within a cemetery. The discrepancies may be related to prevailing social structures in Sigtuna. - A decline in health through time is demonstrated. The negative trend is particularly marked for women. In addition demographic changes suggest an increased migration of adults to Sigtuna. The health deterioration may be connected to e.g. increased population density and an increased risk of infections. - In comparison with other materials the anthropological results, including the health index, suggests that the inhabitants in Sigtuna showed an urban pattern and that the quality of life, at least in the initial phase, was relatively good. - The sex distribution shows a generally male dominance possibly caused by selective excavations except at the oldest site without an adherent church. The uneven sex distribution may, alternatively, be a result of the urban character of Sigtuna i.e. a Christian and political administrative centre. The osteological results are in line with the archaeological and historical data. It is suggested that the consequences of urbanization such as immigration, deterioration of health and social ranking, implied by several osteological parameters and the chemical analysis, acted differently through the gender lines. / <p>Revised 2014.</p>

The primary objective of this study was to assess the relationship between dietary patterns with diabetes and mortality risk from all-cause and cardiovascular disease while controlling for the confounding effects of fitness. The secondary objective was to examine the combined effects of dietary patterns and fitness on chronic disease and mortality risk. Participants consisted of 13,621 men and women from the Aerobics Center Longitudinal Study who completed a standardized medical examination and 3-day diet record between 1987 and 1999. Reduced rank regression was used to identify dietary patterns that were predictive of unfavorable profiles of cholesterol, white blood cell count, glucose, mean arterial pressure, HDL-cholesterol, uric acid, triglycerides, and body mass index. One primary dietary pattern emerged, which was labeled the “Unhealthy Eating Index”. This pattern was characterized by a large consumption of processed meat, red meat, white potato products, non-whole grains, added fat, and a small consumption of non-citrus fruits. After adjustment for covariates, the odds ratio for diabetes and the hazard ratio for all-cause mortality were 2.55 (95% confidence interval: 1.81-3.58) and 1.40 (1.02-1.91) in the highest quintile of the Unhealthy Eating Index when compared to the lowest quintile, respectively. After controlling for fitness, these risk estimates were reduced by 51.6% and 55.0%. The Unhealthy Eating Index was not a significant predictor of cardiovascular disease mortality before or after controlling for fitness. Examining the combined effects of dietary patterns and fitness revealed that both variables were independent predictors of diabetes (Ptrend <0.0001), while fitness (Ptrend <0.0001) but not unhealthy eating (Ptrend=0.071) significantly predicted all-cause mortality risk. These results suggest that both diet and fitness must be considered when studying disease. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-07-08 07:11:06.809

Background: Contribution of dietary sources to vitamin D status is not clearly known. Some studies have shown that dietary intake of certain vitamin D rich foods had a significant positive influence on serum 25-hydroxyvitamin D [25(OH)D] concentrations, whereas other studies have shown no effect. Although sunlight exposure is a major source of circulating serum 25(OH)D, children and adolescents have been advised on the dangers of sun exposure. Diet may therefore be an important contributor of circulating serum 25(OH)D in absence of or reduced sunlight exposure. Objective: The aim of this study was to determine whether serum 25(OH)D concentrations were associated with any specific dietary patterns in US children and adolescents using assay-adjusted serum 25(OH)D data from National Health and Nutrition Examination Survey (NHANES) 2003-2004 and 2005-2006. Methods: Data from 2 cycles of the NHANES 2003-2004 and 2005-2006 for individuals aged 2 to ≤19 y, were used to study the association between dietary patterns and serum 25(OH)D. Dietary patterns were established using factor analysis based on food-frequency questionnaire data. Eigenvalues and Scree plot were used to derive 2 major principal factors. They were labeled as High Fat Low Vegetable (HFLV) and Prudent dietary patterns. Results: Serum 25(OH)D was significantly lower in HFLV dietary pattern group compared to Prudent dietary pattern group (25.1 vs 27.0 ng/mL; P=0.001). The highest serum 25(OH)D concentrations for all subjects were in the low-intake HFLV group or medium and high-intake Prudent groups (P=0.003 and P=0.012, respectively). In multivariate adjusted analysis, children with higher Prudent dietary contribution scores to overall diet showed a significant positive relation with serum 25(OH)D (β=62.01, P=0.016). When data were stratified by sex, a significant positive relation was observed in girls who consumed the Prudent diet (β=86.34, P=0.014) and a significant negative relation was observed in girls who consumed the HFLV diet (β=-84.32, P=0.022). Conclusion: Overall, serum 25(OH)D concentrations were associated with Prudent dietary pattern but not with HFLV dietary pattern in US children and adolescents. When stratified by sex, the relation between dietary patterns and serum 25(OH)D was confined to only girls. Children consuming HFLV pattern diet may benefit from vitamin D supplementation and sunlight exposure (outdoor activities), and should be encouraged to consume more vitamin D fortified foods.

Type 2 diabetes (T2DM) is a growing concern worldwide, particularly among Aboriginal Canadians. Diet has been associated with diabetes risk, and dietary pattern analysis (DPA) provides a method in which whole dietary patterns may be explored in relation to disease. Factor analysis (FA) and reduced rank regression (RRR) of data from the Sandy Lake Health and Diabetes Project identified patterns associated with incident T2DM at follow-up. A RRR-derived pattern characterized by tea, hot cereal, and peas, and low intake of high-sugar foods and beef was positively associated with diabetes; however, the relationship was attenuated with adjustment for age and other covariates. A FA-derived pattern characterized by processed foods was positively associated with incident T2DM in a multivariate model (OR=1.38; CIs: 1.02, 1.86 per unit), suggesting intake of processed foods may predict T2DM risk.