title: Stability-based validation of dietary patterns obtained by cluster analysis.
abstract: Cluster analysis is a data-driven method used to create clusters of individuals sharing similar dietary habits. However, this method requires specific choices from the user which have an influence on the results. Therefore, there is a need of an objective methodology helping researchers in their decisions during cluster analysis. The objective of this study was to use such a methodology based on stability of clustering solutions to select the most appropriate clustering method and number of clusters for describing dietary patterns in the NESCAV study (Nutrition, Environment and Cardiovascular Health), a large population-based cross-sectional study in the Greater Region (N = 2298).
  
  
  
  Clustering solutions were obtained with K-means, K-medians and Ward's method and a number of clusters varying from 2 to 6. Their stability was assessed with three indices: adjusted Rand index, Cramer's V and misclassification rate.
  
  
  
  The most stable solution was obtained with K-means method and a number of clusters equal to 3. The "Convenient" cluster characterized by the consumption of convenient foods was the most prevalent with 46% of the population having this dietary behaviour. In addition, a "Prudent" and a "Non-Prudent" patterns associated respectively with healthy and non-healthy dietary habits were adopted by 25% and 29% of the population. The "Convenient" and "Non-Prudent" clusters were associated with higher cardiovascular risk whereas the "Prudent" pattern was associated with a decreased cardiovascular risk. Associations with others factors showed that the choice of a specific dietary pattern is part of a wider lifestyle profile.
  
  
  
  This study is of interest for both researchers and public health professionals. From a methodological standpoint, we showed that using stability of clustering solutions could help researchers in their choices. From a public health perspective, this study showed the need of targeted health promotion campaigns describing the benefits of healthy dietary patterns.
authors.affiliation: Luxembourg Institute of Health (LIH), CCMS (Competence center in methodology and statistics), 1A rue Thomas Edison, L-1445, Strassen, Luxembourg. nicolas.sauvageot@lih.lu.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sauvageot
authors.affiliation: Luxembourg Institute of Health (LIH), CCMS (Competence center in methodology and statistics), 1A rue Thomas Edison, L-1445, Strassen, Luxembourg.
authors.forename: Anna
authors.initials: A
authors.lastname: Schritz
authors.affiliation: Ministry of Health, Luxembourg, Service épidémiologie & statistique, Allée Marconi, Villa Louvigny, L-2120, Luxembourg city, Luxembourg.
authors.forename: Sonia
authors.initials: S
authors.lastname: Leite
authors.affiliation: Luxembourg Institute of Health (LIH), CCMS (Competence center in methodology and statistics), 1A rue Thomas Edison, L-1445, Strassen, Luxembourg.
authors.forename: Ala'a
authors.initials: A
authors.lastname: Alkerwi
authors.affiliation: Luxembourg Institute of Health (LIH), CCMS (Competence center in methodology and statistics), 1A rue Thomas Edison, L-1445, Strassen, Luxembourg.
authors.forename: Saverio
authors.initials: S
authors.lastname: Stranges
authors.affiliation: Département des maladies cardiovasculaires, Hypertension Unit, Centre Hospitalier Universitaire, 5, Rue du Morvan, 54500, Vandœuvre-lès-Nancy, France.
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: Ecole de Santé Publique, Université de Liège, 7, Place du 20 Août, 4000, Liège, Belgium.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Streel
authors.affiliation: Ecole de Santé Publique, Université de Liège, 7, Place du 20 Août, 4000, Liège, Belgium.
authors.forename: Axelle
authors.initials: A
authors.lastname: Hoge
authors.affiliation: Ecole de Santé Publique, Université de Liège, 7, Place du 20 Août, 4000, Liège, Belgium.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Donneau
authors.affiliation: Ecole de Santé Publique, Université de Liège, 7, Place du 20 Août, 4000, Liège, Belgium.
authors.forename: Adelin
authors.initials: A
authors.lastname: Albert
authors.affiliation: Ecole de Santé Publique, Université de Liège, 7, Place du 20 Août, 4000, Liège, Belgium.
authors.forename: Michèle
authors.initials: M
authors.lastname: Guillaume
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004032:Diet; D015444:Exercise; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D015203:Reproducibility of Results; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cluster analysis; Dietary patterns; Stability