Dietary and lifestyle factors associated with cardiovascular disease risk: a structural equation modeling approach

Cardiovascular diseases (CVDs), resulting from complex interactions among socioeconomic, behavioral, and dietary factors, remain a major global health challenge. This study utilized structural equation modeling (SEM) to assess the direct and indirect effects of these factors on CVD risk, with dietary indices-the Dietary Insulin Index (DII) and Dietary Glycemic Index (DGI)-acting as mediators, in a population from western Iran.

A cross-sectional analysis was conducted on 3,452 adults aged 35-70 years from the Dehgolan Prospective Cohort Study (DehPCS). Data collected included anthropometric measurements, socioeconomic status, lifestyle behaviors, chronic diseases, and dietary indices (DII and DGI). SEM was employed to examine pathways linking latent variables (socioeconomic status, personal habits, and chronic diseases) and mediators (DII, DGI) to CVD risk. Model fit was evaluated using the Comparative Fit Index (CFI), Root Mean Square Error of Approximation (RMSEA), and χ² statistics.

The model accounted for 11% of the variance in CVD risk (R² = 0.11). Higher socioeconomic status directly reduced CVD risk (β = -0.28, p < 0.001) and chronic disease burden (β = -0.21, p = 0.002). Favorable personal habits, including physical activity and adequate sleep, were associated with reduced CVD risk (β = -0.27, p < 0.001). Conversely, higher DII increased CVD risk (β = 0.15, p < 0.001), while higher DGI was associated with a modest reduction in risk (β = -0.03, p < 0.001). Indirectly, socioeconomic status (β = 0.086, p = 0.001), personal habits (β = 0.035, p = 0.001), and chronic diseases (β = 0.047, p = 0.001) influenced CVD risk through dietary patterns.

Dietary quality mediates the relationship between lifestyle, chronic conditions, and CVD risk, with socioeconomic disparities and chronic diseases amplifying this risk. Public health interventions should focus on promoting healthy dietary habits and ensuring equitable access to nutritious foods to mitigate cardiovascular risk.