title: Dietary patterns matter: diet beverages and cardiometabolic risks in the longitudinal Coronary Artery Risk Development in Young Adults (CARDIA) Study.
abstract: BACKGROUND
  Although diet beverages are typically consumed to promote weight control, positive associations with increased cardiometabolic risk have been reported.
  
  
  OBJECTIVE
  The objective was to examine the joint and independent association between dietary pattern and diet beverage consumption with 20-y cardiometabolic risk.
  
  
  METHODS
  We analyzed a prospective 20-y cohort of young adults from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. With the use of cluster analysis, we identified 2 baseline (year 0) dietary patterns [Prudent (higher intakes of fruit, whole grains, milk, and nuts and seeds; n = 1778) and Western (higher intakes of fast food, meat and poultry, pizza, and snacks; n = 2383)] and examined the interaction with diet beverage consumption (Consumers compared with Nonconsumers) by using proportional hazards regression models.
  
  
  RESULTS
  Among Consumers, 66% were classified as having a Prudent diet. In fully adjusted models, being a Nonconsumer with a Prudent diet was independently associated with a lower risk of the metabolic syndrome through year 20. Lower risk in the Prudent than in the Western dietary pattern was maintained after stratification by diet beverage consumption: Prudent Nonconsumers had the lowest risk of high waist circumference (HR: 0.78; 95% CI: 0.62, 0.97), high triglycerides (HR: 0.72; 95% CI: 0.56, 0.93), and the metabolic syndrome (HR: 0.64; 95% CI: 0.50, 0.82) compared with Western Consumers.
  
  
  CONCLUSIONS
  Our results suggest that both overall dietary pattern and diet beverage consumption are important, to various degrees, for different metabolic outcomes. This covariation and interaction may partially explain differences in the relation between diet beverage consumption and cardiometabolic health observed in previous studies.
authors.affiliation: Department of Nutrition, Gillings Global School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA. kduffey@unc.edu
authors.forename: Kiyah J
authors.initials: KJ
authors.lastname: Duffey
authors.forename: Lyn M
authors.initials: LM
authors.lastname: Steffen
authors.forename: Linda
authors.initials: L
authors.lastname: Van Horn
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Barry M
authors.initials: BM
authors.lastname: Popkin
mesh_terms: D000293:Adolescent; D000328:Adult; D001628:Beverages / Q000009:adverse effects*; D016000:Cluster Analysis; D015331:Cohort Studies; D004038:Diet, Reducing / Q000009:adverse effects*; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects*; D006801:Humans; D015228:Hypertriglyceridemia / Q000209:etiology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D014481:United States / Q000453:epidemiology; D055105:Waist Circumference; D055815:Young Adult