title: Prospective investigation of major dietary patterns and risk of cardiovascular mortality in Bangladesh.
abstract: BACKGROUND
  Dietary pattern analysis is emerging as a practical, effective tool for relating comprehensive dietary intake to risk of cardiovascular disease mortality. However, no studies have applied this technique to a population outside of the developed world.
  
  
  METHODS
  We conducted prospective cohort analyses in 11,116 participants enrolled in the Health Effects of Arsenic Study in Araihazar, Bangladesh, measuring deaths attributable to disease of circulatory system, heart disease, and cerebrovascular disease. Participants were enrolled in 2000 and followed up for an average of 6.6 years. Dietary information was obtained through a previously validated food-frequency questionnaire at baseline.
  
  
  RESULTS
  Principal component analysis based on our comprehensive, 39 item FFQ yielded 3 dietary patterns: (i) a "balanced" pattern, comprised of steamed rice, red meat, fish, fruit and vegetables; (ii) an "animal protein" diet, which was more heavily weighted towards eggs, milk, red meat, poultry, bread, and vegetables; and (iii) a "gourd and root vegetable" diet that heavily relied on a variety of gourds, radishes, pumpkin, sweet potato, and spinach. We observed a positive association between increasing adherence to the animal protein diet and risk of death from both disease of the circulatory system and heart disease; the hazard ratios were 1.13 (95% CI, 1.00-1.28, p=0.05) and 1.17 (95% CI, 0.99-1.38, p=0.07), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern, after controlling for age, sex, body mass index, smoking status, and energy intake. The positive association was more significant among ever smokers; the hazard ratios (95% CI) for deaths from disease of the circulatory system and heart disease were 1.17 (1.02-1.34) and 1.20 (1.00-1.45), respectively, in relation to one standard deviation increase in the factor scores for the animal protein diet pattern.
  
  
  CONCLUSIONS
  An animal protein-rich diet in rural Bangladesh may increase risk of heart disease mortality, especially among smokers. This emphasizes the need to further explore and address the impact of dietary patterns on cardiovascular disease in populations undergoing epidemiologic transition.
authors.affiliation: Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA. yu.chen@nyumc.org
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.forename: Tyler R
authors.initials: TR
authors.lastname: McClintock
authors.forename: Stephanie
authors.initials: S
authors.lastname: Segers
authors.forename: Faruque
authors.initials: F
authors.lastname: Parvez
authors.forename: Tariqul
authors.initials: T
authors.lastname: Islam
authors.forename: Alauddin
authors.initials: A
authors.lastname: Ahmed
authors.forename: Muhammad
authors.initials: M
authors.lastname: Rakibuz-Zaman
authors.forename: Rabiul
authors.initials: R
authors.lastname: Hasan
authors.forename: Golam
authors.initials: G
authors.lastname: Sarwar
authors.forename: Habibul
authors.initials: H
authors.lastname: Ahsan
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000208:ethnology; D002318:Cardiovascular Diseases / Q000208:ethnology* / Q000401:mortality*; D015331:Cohort Studies; D015930:Diet Records; D004044:Dietary Proteins / Q000008:administration & dosage / Q000009:adverse effects*; D005247:Feeding Behavior / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D004044:Dietary Proteins