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Clustering eating habits: frequent consumption of different dietary patterns among the Italian general population in the association with obesity, physical activity, sociocultural characteristics and psychological factors

  • Francesca Denoth
  • Marco Scalese
  • Valeria Siciliano
  • Laura Di Renzo
  • Antonino De Lorenzo
  • Sabrina Molinaro
Original Article

Abstract

Purpose

(a) To identify clusters of eating patterns among the Italian population aged 15–64 years, focusing on typical Mediterranean diet (Med-diet) items consumption; (b) to examine the distribution of eating habits, as identified clusters, among age classes and genders; (c) evaluate the impact of: belonging to a specific eating cluster, level of physical activity (PA), sociocultural and psychological factors, as elements determining weight abnormalities.

Methods

Data for this cross-sectional study were collected using self-reporting questionnaires administered to a sample of 33,127 subjects participating in the Italian population survey on alcohol and other drugs (IPSAD®2011). The cluster analysis was performed on a subsample (n = 5278 subjects) which provided information on eating habits, and adapted to identify categories of eating patterns. Stepwise multinomial regression analysis was performed to evaluate the associations between weight categories and eating clusters, adjusted for the following background variables: PA levels, sociocultural and psychological factors.

Results

Three clusters were identified: “Mediterranean-like”, “Western-like” and “low fruit/vegetables”. Frequent consumption of Med-diet patterns was more common among females and elderly. The relationship between overweight/obesity and male gender, educational level, PA, depression and eating disorders (p < 0.05) was confirmed. Belonging to a cluster other than “Mediterranean-like” was significantly associated with obesity.

Conclusion

The low consumption of Med-diet patterns among youth, and the frequent association of sociocultural, psychological issues and inappropriate lifestyle with overweight/obesity, highlight the need for an interdisciplinary approach including market policies, to promote a wider awareness of the Mediterranean eating habit benefits in combination with an appropriate lifestyle.

Keywords

Eating habits Dietary patterns Obesity Overweight Population survey Cluster analysis 

List of abbreviation

AIC

Akaike information criterion

BIC

Bayesian information criteria

BMI

Body mass index

CAGE

The name of the questionnaire is an acronym of its four questions:

Have you ever felt you needed to cut down on your drinking? (cut down)

Have people annoyed you by criticizing your drinking? (annoyed)

Have you ever felt guilty about drinking? (guilty)

Have you ever felt you needed a drink first thing in the morning to steady your nerves or to get rid of a hangover? (eye-opener)

CHD

Coronary heart disease

CI

Confidence interval

CIDI-SF

Composite international diagnostic interview, short form

CKD

Chronic kidney disease

CNR

National Research Council (Italy)

CVD

Cardiovascular disease

DSM-IV

Diagnostic and statistical manual of mental disorders, version IV

EAT-26

Eating attitude test, 26 items version

EMCDDA

European Monitoring Centre for Drug and Drug Addiction

F/V

Fruit and vegetables

IFC

Institute of Clinical Physiology

IMOD

Italian Mediterranean organic diet

IPSAD®

Italian population survey on alcohol and other drugs

MCA

Multiple correspondence analysis

Med-Diet

Mediterranean diet

MONICA

Multinational MONItoring of trends and determinants in CArdiovascular disease project

OR

Odds ratio

PA

Physical activity

SPSS

Statistical Package for Social Science software

VRS

Rapid stress assessment scale

WHO

World Health Organization

Notes

Acknowledgments

The authors would like to thank Prof. Michael Liebman for his valuable suggestions and helpful comments to the manuscript. The authors would like to thank Dr. Elisa Benedetti for the valuable help.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedure performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

As IPSAD® is an anonymous survey, signed consent form is not necessary because the fact that participants complete and return the survey questionnaire provides a passive consent.

References

  1. 1.
    Sofi F, Abbate R, Gensini GF, Casini A (2012) Which diet for an effective cardiovascular prevention? Monaldi Arch Chest Dis 78:60–65PubMedGoogle Scholar
  2. 2.
    Di Daniele N, Petramala L, Di Renzo L, Sarlo F, Della Rocca DG, Rizzo M, Fondacaro V, Iacopino L, Pepine CJ, De Lorenzo A (2012) Body composition changes and cardiometabolic benefits of a balanced Italian Mediterranean diet in obese patients with metabolic syndrome. Acta Diabetol 50:409–416. doi: 10.1007/s00592-012-0445-7 CrossRefPubMedGoogle Scholar
  3. 3.
    McKeown PP, Logan K, McKinley MC, Young IS, Woodside JV (2010) Session 4: CVD, diabetes and cancer, Session 4: evidence for the use of the Mediterranean diet in patients with CHD. Proc Nutr Soc 69:45–60. doi: 10.1017/S0029665109991856 CrossRefPubMedGoogle Scholar
  4. 4.
    Razquin C, Alfredo Martinez J, Martinez-Gonzalez MA, Corella D, Santos JM, Marti A (2009) The Mediterranean diet protects against waist circumference enlargement in 12Ala carriers for the PPARgamma gene: 2 years’ follow-up of 774 subjects at high cardiovascular risk. Br J Nutr 102:672–679. doi: 10.1017/S0007114509289008 CrossRefPubMedGoogle Scholar
  5. 5.
    Jones JL, Park Y, Lee J, Lerman RH, Fernandez ML (2011) Mediterranean-style, low-glycemic-load diet reduces the expression of 3-hydroxy-3-methylglutaryl-coenzyme A reductase in mononuclear cells and plasma insulin in women with metabolic syndrome. Nutr Res 31:659–664. doi: 10.1016/j.nutres.2011.08.011 CrossRefPubMedGoogle Scholar
  6. 6.
    Gouveri ET, Tzavara C, Drakopanagiotakis F, Tsaoussoglou M, Marakomichelakis GE, Tountas Y, Diamantopoulos EJ (2011) Mediterranean diet and metabolic syndrome in an urban population: the Athens Study. Nutr Clin Pract 26:598–606. doi: 10.1177/0884533611416821 CrossRefPubMedGoogle Scholar
  7. 7.
    Parkinson L, Keast (2014) Oleocanthal, a phenolic derived from virgin olive oil: a review of the beneficial effects on inflammatory disease. Int J Mol Sci 15:12323–12334. doi: 10.3390/ijms150712323 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Sexton P, Black P, Metcalf P, Wall CR, Ley S, Wu L, Sommerville F, Brodie S, Kolbe J (2013) Influence of Mediterranean diet on asthma symptoms, lung function, and systemic inflammation: a randomized controlled trial. J Asthma 50:75–81. doi: 10.3109/02770903.2012.740120 CrossRefPubMedGoogle Scholar
  9. 9.
    Schroder H (2007) Protective mechanisms of the Mediterranean diet in obesity and type 2 diabetes. JNB 18(3):149–160. doi: 10.1016/j.jnutbio.2006.05.006 PubMedGoogle Scholar
  10. 10.
    Togo P, Osler M, Sorensen TI, Heitmann BL (2001) Food intake patterns and body mass index in observational studies. Int J Obes Relat Metab Disord 25:1741–1751. doi: 10.1038/sj.ijo.0801819 CrossRefPubMedGoogle Scholar
  11. 11.
    Heidemann C, Hoffmann K, Spranger J, Klipstein-Grobusch K, Möhlig M, Pfeiffer AF, Boeing H (2005) A dietary pattern protective against type 2 diabetes in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study cohort. Diabetologia 48:1126–1134. doi: 10.1007/s00125-005-1743-1 CrossRefPubMedGoogle Scholar
  12. 12.
    Montonen J, Knekt P, Härkänen T, Järvinen R, Heliövaara M, Arpo Aromaa A, Reunanen A (2005) Dietary patterns and the incidence of type 2 diabetes. Am J Epidemiol 161:219–227. doi: 10.1093/aje/Kwi039 CrossRefPubMedGoogle Scholar
  13. 13.
    van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB (2002) Dietary patterns and risk for type 2 diabetes mellitus in US men. Ann Intern Med 136:201–209. doi: 10.2337/dc09-1621 CrossRefPubMedGoogle Scholar
  14. 14.
    Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, Djordjevlc BS, Dontas AS, Fidanza F, Keys MH, Kromhout D, Nedeljkovic S, Punsar S, Seccareccia F, Toshima H (1986) The diet and 15-year death rate in the seven countries study. Am J Epidemiol 124:903–915PubMedGoogle Scholar
  15. 15.
    Tunstall-Pedoe H, Kuulasmaa K, Mähönen M, Tolonen H, Ruokokoski E, Amouyel P (1999) Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations. Lancet 353:1547–1557. doi: 10.1016/S0140-6736(99)04021-0 CrossRefPubMedGoogle Scholar
  16. 16.
    Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA (2006) Mediterranean Diet, Alzheimer disease, and vascular mediation. Arch Neurol 63:1709–1717. doi: 10.1001/archneur.63.12.noc60109 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Williams MS (2012) Development of the Nutrition4Kids Website. Stud Health Technol Inform 172:174–179. doi: 10.3233/978-1-61499-088-8-174 PubMedGoogle Scholar
  18. 18.
    Larson N, Laska MN, Story M, Neumark-Sztainer D (2012) Predictors of fruit and vegetable intake in young adulthood. J Acad Nutr Diet 112:1216–1222. doi: 10.1016/j.jand.2012.03.035 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    IPSAD®: Italian Population Survey on Alcohol and other Drugs. https://www.epid.ifc.cnr.it/epidnewENG/index.php?option=com_content&view=article&id=107&Itemid=197. Accessed 24 Sept 2015
  20. 20.
    DPA (Dipartimento per le Politiche Antidroga) Presidenza del Consiglio dei Ministri. (2008) Relazione Annuale al Parlamento sullo Stato delle Tossicodipendenze In Italia 2007. http://www.governo.it/GovernoInforma/Dossier/relazione_droga_2007/
  21. 21.
    Panagiotakos DB, Pitsavos C, Stefanadis C (2006) Dietary patterns: a Mediterranean diet score and its relation to clinical and biological markers of cardiovascular disease risk. Nutr Metab Cardiovasc Dis 16:559–568. doi: 10.1016/j.numecd.2005.08.006 CrossRefPubMedGoogle Scholar
  22. 22.
    Dotti A, Lazzari R (1998) Validation and reliability of the Italian EAT-26. Eat Weight Disorder 3(4):188–194. doi: 10.1007/BF03340009 CrossRefGoogle Scholar
  23. 23.
    Lorenzo Tarsitani, Massimo Biondi (1999) Development and validation of the VRS, a rating scale for rapid stress assessment. Medicina Psicosom 44:163–177Google Scholar
  24. 24.
    Patten SB (1997) Performance of the composite international diagnostic interview short form for major depression in community and clinical samples. Chronic Dis Can 18:109–112PubMedGoogle Scholar
  25. 25.
    Mayfield D, McLeod G, Hall P (1974) The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry 131:1121–1123PubMedGoogle Scholar
  26. 26.
    Zhang T, Ramakrishnan R, Livny M (1996) BIRCH: An efficient data clustering method for very large databases. In: Proceedings of the 1996 ACM SIGMOD International Conference on management of data, Montreal, pp 103–114. doi: 10.1145/233269.233324
  27. 27.
    Keel PK, Crow S, Davis TL, Mitchell JE (2002) Assessment of eating disorders: comparison of interview and questionnaire data from a long-term follow-up study of bulimia nervosa. J Psychosom Res 53:1043–1047. doi: 10.1016/S0022-3999(02)00491-9 CrossRefPubMedGoogle Scholar
  28. 28.
    Leatherdale ST, Laxer RE (2013) Reliability and validity of the weight status and dietary intake measures in the COMPASS questionnaire: are the self-reported measures of body mass index (BMI) and Canada’s food guide servings robust? Int J Behav Nutr Phys Act 5:10–42. doi: 10.1186/1479-5868-10-42 Google Scholar
  29. 29.
    Keith NR, Clark DO, Stump TE, Miller DK, Callahan CM (2014) Validity and reliability of the self-reported physical fitness (SRFit) survey. J Phys Act Health 11:853–859. doi: 10.1123/jpah.2012-0264 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Costacou T, Bamia C, Ferrari P, Riboli E, Trichopoulos D, Trichopoulou A (2003) Tracing the Mediterranean diet through principal components and cluster analyses in the Greek population. Eur J Clin Nutr 57:1378–1385. doi: 10.1038/sj.ejcn.1601699 CrossRefPubMedGoogle Scholar
  31. 31.
    Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, Trichopoulos D (1995) Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr 61(Suppl):1402S–1406SPubMedGoogle Scholar
  32. 32.
    Dansinger ML, Gleason JA, Schaefer EJ (2005) Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial. JAMA 293:43–54. doi: 10.1001/jama.293.1.43 CrossRefPubMedGoogle Scholar
  33. 33.
    Bravata DM, Sanders L, Huang J, Krumholz HM, Olkin I, Gardner CD, Bravata DM (2003) Efficacy and safety of low-carbohydrate diets: a systematic review. JAMA 289:1837–1850. doi: 10.1001/jama.289.14.1837 CrossRefPubMedGoogle Scholar
  34. 34.
    Segura-García C, Ammendolia A, Procopio L, Papaianni MC, Sinopoli F, Bianco C, De Fazio P, Capranica L (2010) Body uneasiness, eating disorders, and muscle dysmorphia in individuals who overexercise. JSCR 24:3098–3104. doi: 10.1519/JSC.0b013e3181d0a575 Google Scholar
  35. 35.
    Wang Y, Beydoun MA (2009) Meat consumption is associated with obesity and central obesity among US adults. Int J Obes 33:621–628. doi: 10.1038/ijo.2009.45 CrossRefGoogle Scholar
  36. 36.
    Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK (2009) Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 41:459–471. doi: 10.1249/MSS.0b013e3181949333 CrossRefPubMedGoogle Scholar
  37. 37.
    Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BW, Zitman FG (2010) Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry 67:220–229. doi: 10.1001/archgenpsychiatry CrossRefPubMedGoogle Scholar
  38. 38.
    Beydoun MA, Wang Y (2010) Pathways linking socioeconomic status to obesity through depression and lifestyle factors among young US adults. J Affect Disord 123:52–63. doi: 10.1016/j.jad.2009.09.021 CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Molarius A, Seidell JC, Sans S, Tuomilehto J, Kuulasmaa K (2000) Educational level, relative body weight, and changes in their association over 10 years: an international perspective from the WHO MONICA project. Am J Public Health 90:1260–1268. doi: 10.2105/AJPH.90.8.1260 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Wadden TA, Butrynx Butryn ML, Byrne KJ, Byrne KJ (2004) Efficacy of lifestyle modification for long-term weight control. Obes Res 12(Suppl):151–162. doi: 10.1038/oby.2004.282 CrossRefGoogle Scholar
  41. 41.
    Martinez-Gonzalez MA, Sanchez-Villegas A (2004) The emerging role of Mediterranean diets in cardiovascular epidemiology: monounsaturated fats, olive oil, red wine or the whole pattern? Eur J Epidemiol 19:9–13CrossRefPubMedGoogle Scholar
  42. 42.
    Dai J, Miller AH, Bremner JD, Goldberg J, Jones L, Shallenberger L, Buckham R, Murrah NV, Veledar E, Wilson PW, Vaccarino V (2008) Adherence to the Mediterranean diet is inversely associated with circulating interleukin-6 among middleaged men: a twin study. Circulation 117:169–175. doi: 10.1161/CIRCULATIONAHA.107.710699 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Robertson RM, Smaha L (2001) Can a Mediterranean style diet reduce heart disease? Circulation 103:1821–1822. doi: 10.1161/01.CIR.103.13.1821 CrossRefPubMedGoogle Scholar
  44. 44.
    Andoh A, Bamba T, Sakasi M (1999) Physiological and anti-inflammatory roles of dietary fiber and butyrate in intestinal functions. J Parenter Enteral Nutr 23(Suppl 5):70–73CrossRefGoogle Scholar
  45. 45.
    Kris-Etherton PM, Harris WS, Appel LJ (2002) Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 106:2747–2757. doi: 10.1161/01.CIR.0000038493.65177.94 CrossRefPubMedGoogle Scholar
  46. 46.
    De Lorgeril M, Salen P (2006) The Mediterranean-style diet for the prevention of cardiovascular diseases. Public Health Nutr 9:118–123. doi: 10.1079/PHN2005933 CrossRefPubMedGoogle Scholar
  47. 47.
    Lichtenstein AH, Ausman LM, Jalbert SM, Vilella-Bach M, Jauhiainen M, McGladdery S, Erkkilä AT, Ehnholm C, Frohlich J, Schaefer EJ (2002) Efficacy of a therapeutic lifestyle change/step 2 diet in moderately hypercholesterolemic middle-aged and elderly female and male subjects. J Lipid Res 43:264–273PubMedGoogle Scholar
  48. 48.
    Bonaccio M, Di Castelnuovo A, Costanzo S, De Lucia F, Olivieri M, Donati MB, de Gaetano G, Iacoviello L, Bonanni A (2013) Nutrition knowledge is associated with higher adherence to Mediterranean diet and lower prevalence of obesity. Results from the Moli-sani study. Appetite 68:139–146. doi: 10.1016/j.appet.2013.04.026 CrossRefPubMedGoogle Scholar
  49. 49.
    De Lorenzo A, Noce A, Bigioni M, Calabrese V, Della Rocca DG, Di Daniele N, Tozzo C, Di Renzo L (2010) The Effects of Italian Mediterranean organic diet (IMOD) on health status. Curr Pharm Des 16:814–824. doi: 10.2174/138161210790883561 CrossRefPubMedGoogle Scholar
  50. 50.
    Drewnowski A, Hann C (1999) Food preferences and reported frequencies of food consumption as predictors of current diet in young women. Am J Clin Nutr 70:28–36PubMedGoogle Scholar
  51. 51.
    Simonelli-Muñoz Agustin J (2012) Dietary habits of patients with schizophrenia: a self-reported questionnaire survey. Int J Ment Health Nurs 21:220–228. doi: 10.1111/j.1447-0349.2012.00821.x CrossRefPubMedGoogle Scholar
  52. 52.
    Templeton AJ, Thuurlimann B, Baumann M, Mark M, Stoll S, Schwizer M, Dietrich D, Ruhstaller T (2013) Cross-sectional study of self-reported physical activity, eating habits and use of complementary medicine in breast cancer survivors. BMC Cancer 13:153. doi: 10.1186/1471-2407-13-153 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Brener ND, Billy John OG, Grady William R (2003) Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. J Adolesc Health 33:436–457. doi: 10.1016/S1054-139X(03)00052-1 CrossRefPubMedGoogle Scholar
  54. 54.
    Pitsavos C, Panagiotakos DB, Tzima N, Chrysohoou C, Economou M, Zampelas A, Stefanadis C (2005) Adherence to the Mediterranean diet is associated with total antioxidant capacity in healthy adults: the ATTICA study. Am J Clin Nutr 82:694–699PubMedGoogle Scholar
  55. 55.
    Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, Corella D, Covas MI, Schröder H, Arós F, Gómez-Gracia E, Fiol M, Ruiz-Gutiérrez V, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Muñoz MA, Wärnberg J, Ros E, Estruch R (2012) A 14-Item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial. PLoS One 7(8):e43134. doi: 10.1371/journal.pone.0043134 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Francesca Denoth
    • 1
    • 2
  • Marco Scalese
    • 1
  • Valeria Siciliano
    • 1
  • Laura Di Renzo
    • 2
  • Antonino De Lorenzo
    • 2
  • Sabrina Molinaro
    • 1
  1. 1.Institute of Clinical PhysiologyCNR (Italian National Research Council)PisaItaly
  2. 2.Section of Clinical Nutrition and Nutrigenomic, Faculty of Medicine and Surgery, Department of Biomedicine and PreventionUniversity of Rome Tor VergataRomeItaly

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