title: Dietary patterns and risk of nonfatal acute myocardial infarction in Costa Rican adults.
abstract: OBJECTIVE
  To investigate the association between dietary patterns and risk of a first nonfatal acute myocardial infarction (MI) in Costa Rican adults.
  
  
  METHODS
  Population-based case-control study.
  
  
  METHODS
  A total of 496 incident MI cases and 518 population-based randomly selected controls matched to the cases by age (+/-5 years), gender, and county of residence. Subjects were interviewed with a validated food frequency questionnaire. Dietary patterns were identified by factor analysis. Odds ratios (OR) and 95% confidence intervals (CI) were obtained using multivariate conditional logistic regression adjusted for several recognized risk factors for MI.
  
  
  RESULTS
  Two diet patterns were identified, 'vegetable' characterized by increased intake of vegetables and fruits, and 'staple', characterized by an increased use of palm oil for cooking, and intake of refined grains (mostly white rice and white bread), legumes, coffee, added sugar, and red meat. Compared to the lowest quintile of the staple diet pattern, the highest quintile was associated with an increased risk of MI (OR: 3.70, 95% CI: 2.30-5.97). Adjusting for potential confounders did not change the results (OR: 3.53, 95% CI: 1.98-6.31). Consistently, an increasing staple pattern score was associated with lower HDL cholesterol (P for trend <0.02) and alpha-linolenic acid in adipose tissue (P for trend <0.0001). The vegetable pattern was not associated with MI.
  
  
  CONCLUSIONS
  The staple dietary pattern of Costa Rican adults is associated with low plasma HDL cholesterol, low alpha-linolenic acid in adipose tissue, and increased risk of MI.
authors.affiliation: Escuela de Nutrición Humana, Universidad de Costa Rica, San Pedro de Montes de Oca, Costa Rica.
authors.forename: J A
authors.initials: JA
authors.lastname: Martínez-Ortiz
authors.forename: T T
authors.initials: TT
authors.lastname: Fung
authors.forename: A
authors.initials: A
authors.lastname: Baylin
authors.forename: F B
authors.initials: FB
authors.lastname: Hu
authors.forename: H
authors.initials: H
authors.lastname: Campos
mesh_terms: D000208:Acute Disease; D000273:Adipose Tissue / Q000378:metabolism*; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000097:blood; D016001:Confidence Intervals; D003364:Costa Rica / Q000453:epidemiology; D004032:Diet; D005163:Factor Analysis, Statistical; D005260:Female; D005638:Fruit; D038321:Glycemic Index; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology*; D016017:Odds Ratio; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014675:Vegetables; D017962:alpha-Linolenic Acid / Q000378:metabolism
chemical_list: D008076:Cholesterol, HDL; D017962:alpha-Linolenic Acid