Dietary patterns and metabolic syndrome in US adults: Moderation by food security and sex

BackgroundMetabolic syndrome (MetS) comprises a cluster of cardiometabolic risk factors that are associated with dietary patterns and social conditions. Examining how dietary patterns and MetS are associated and whether assocations are moderated by food security and sex may inform targeted nutrition strategies for MetS prevention.AimTo examine associations between data-driven dietary patterns and MetS in a nationally representative sample of US adults and to assess whether associations differed by sex and household food security status.MethodsThis cross-sectional study analyzed data from 1333 adults aged ≥18 years in the 2015-2018 National Health and Nutrition Examination Survey. Dietary intake was assessed using two non-consecutive 24-h recalls, and survey-weighted principal components analysis identified dietary patterns from energy-adjusted intakes of 26 food groups. MetS was defined using National Cholesterol Education Program Adult Treatment Panel III criteria (≥3 of: Elevated waist circumference, blood pressure, fasting glucose, triglycerides, or reduced high-density lipoprotein cholesterol). Survey-weighted logistic regression estimated odds of MetS across tertiles of dietary pattern adherence, adjusting for potential confounders.ResultsThree major dietary patterns were identified in the overall sample, with greater adherence to a Prudent Seafood and Plant-Based pattern associated with lower MetS z-scores (p = 0.0019) and a lower odds of MetS (p = 0.0069). Among males, a Refined Grain, Tomato and Cheese pattern was associated with lower odds of MetS (p = 0.04), while an Oils, Nuts and Processed Meats pattern was associated with higher odds (p = 0.03). Food security status modified the association between the Whole Grain, Produce and Low-Fat Dairy pattern and MetS (p < 0.0001).ConclusionsIn a sample of US adults, data-driven dietary patterns showed differential associations with MetS, varying by sex and food security status. These findings indicate effect modification by sex and food security in the relationship between dietary patterns and MetS.