Dietary pattern analysis, which reflects the complexity of dietary intake, has recently received considerable attention by nutritional epidemiologists. Two general approaches have been used to define these summary variables in observational studies. The so-called a posteriori approach builds on statistical exploratory methods, whereas the so-called a priori approach focuses on the construction of pattern variables that reflect hypothesis-oriented patterns based on available scientific evidence for specific diseases. Several studies, both observational and clinical, suggest that these measures of overall diet predict disease risk, and that its application might be especially valuable in the development of food-based dietary guidelines. In this review, we describe different patterning approaches and the available evidence regarding the relationships between dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
References and Recommended Reading
World Health Organization: The World Health Report 2000. Geneva, Switzerland: World Health Organization; 2000.
American Heart Association: 2001 Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association; 2000.
Hoffmann K, Schulze MB, Boeing H, Altenburg HP: Dietary patterns: report of an international workshop. Public Health Nutr 2002, 5:89–90.
Sacks FM, Obarzanek E, Windhauser MM, et al.: Rationale and design of the Dietary Approaches to Stop Hypertension trial (DASH). A multicenter controlled-feeding study of dietary patterns to lower blood pressure. Ann Epidemiol 1995, 5:108–118.
Jacques PF, Tucker KL: Are dietary patterns useful for understanding the role of diet in chronic disease? Am J Clin Nutr 2001, 73:1–2.
Hulshof KF, Valsta LM, Welten DC, Lowik MR: Analytical approaches to food-based dietary guidelines in the European setting. Public Health Nutr 2001, 4:667–672.
Trichopoulos D, Lagiou P: Dietary patterns and mortality. Br J Nutr 2001, 85:133–134.
Kouris-Blazos A, Gnardellis C, Wahlqvist ML, et al.: Are the advantages of the Mediterranean diet transferable to other populations? A cohort study in Melbourne, Australia. Br J Nutr 1999, 82:57–61.
Hatcher L: A Step-by-Step Approach to Using the SAS System for Factor Analysis and Structural Equation Modeling. Cary, North Carolina: SAS Institute; 1994.
Huijbregts PP, Feskens EJ, Kromhout D: Dietary patterns and cardiovascular risk factors in elderly men: the Zutphen Elderly Study. Int J Epidemiol 1995, 24:313–320.
Greenwood DC, Cade JE, Draper A, et al.: Seven unique food consumption patterns identified among women in the UK Women’s Cohort Study. Eur J Clin Nutr 2000, 54:314–320.
Pryer JA, Cook A, Shetty P: Identification of groups who report similar patterns of diet among a representative national sample of British adults aged 65 years of age or more. Public Health Nutr 2001, 4:787–795.
Wirfalt E, Hedblad B, Gullberg B, et al.: Food patterns and components of the metabolic syndrome in men and women: a cross-sectional study within the Malmo Diet and Cancer cohort. Am J Epidemiol 2001, 154:1150–1159.
Kant AK: Indexes of overall diet quality: a review. J Am Diet Assoc 1996, 96:785–791.
Kant AK, Schatzkin A, Graubard BI, Schairer C: A prospective study of diet quality and mortality in women. JAMA 2000, 283:2109–2115.
Osler M, Heitmann BL, Gerdes LU, Jorgensen LM, Schroll M: Dietary patterns and mortality in Danish men and women: a prospective observational study. Br J Nutr 2001, 85:219–225.
Kennedy ET, Ohls J, Carlson S, Fleming K: The Healthy Eating Index: design and applications. J Am Diet Assoc 1995, 95:1103–1108.
McCullough ML, Feskanich D, Rimm EB, et al.: Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men. Am J Clin Nutr 2000, 72:1223–1231.
McCullough ML, Feskanich D, Stampfer MJ, et al.: Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in women. Am J Clin Nutr 2000, 72:1214–1222.
Haines PS, Siega-Riz AM, Popkin BM: The Diet Quality Index revised: a measurement instrument for populations. J Am Diet Assoc 1999, 99:697–704.
Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC: Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000, 343:16–22.
Hu FB, Manson JE, Stampfer MJ, et al.: Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001, 345:790–797.
Sacks FM, Rosner B, Kass EH: Blood pressure in vegetarians. Am J Epidemiol 1974, 100:390–398.
Armstrong B, van Merwyk AJ, Coates H: Blood pressure in Seventh-day Adventist vegetarians. Am J Epidemiol 1977, 105:444–449.
Rouse IL, Beilin LJ, Armstrong BK, Vandongen R: Blood-pressure-lowering effect of a vegetarian diet: controlled trial in normotensive subjects. Lancet 1983, 1:5–10.
Miller WL, Crabtree BF, Evans DK: Exploratory study of the relationship between hypertension and diet diversity among Saba Islanders. Public Health Rep 1992, 107:426–432.
Margetts BM, Beilin LJ, Vandongen R, Armstrong BK: Vegetarian diet in mild hypertension: a randomised controlled trial. BMJ (Clin Res Ed) 1986, 293:1468–1471.
Appel LJ, Moore TJ, Obarzanek E, et al.: A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997, 336:1117–1124.
Sacks FM, Svetkey LP, Vollmer WM, et al.: Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. N Engl J Med 2001, 344:3–10.
Williams DE, Prevost AT, Whichelow MJ, et al.: A cross-sectional study of dietary patterns with glucose intolerance and other features of the metabolic syndrome. Br J Nutr 2000, 83:257–266.
Gittelsohn J, Wolever TM, Harris SB, et al.: Specific patterns of food consumption and preparation are associated with diabetes and obesity in a Native Canadian community. J Nutr 1998, 128:541–547.
van Dam RM, Rimm EB, Willett WC, Stampfer MJ, Hu FB: Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Ann Intern Med 2002, 136:201–209.
Pan XR, Li GW, Hu YH, et al.: Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997, 20:537–544.
Tuomilehto J, Lindstrom J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350.
Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.
Nicklas TA, Webber LS, Thompson B, Berenson GS: A multivariate model for assessing eating patterns and their relationship to cardiovascular risk factors: the Bogalusa Heart Study. Am J Clin Nutr 1989, 49:1320–1327.
Fung TT, Rimm EB, Spiegelman D, et al.: Association between dietary patterns and plasma biomarkers of obesity and cardiovascular disease risk. Am J Clin Nutr 2001, 73:61–67.
Hu FB, Rimm EB, Stampfer MJ, et al.: Prospective study of major dietary patterns and risk of coronary heart disease in men. Am J Clin Nutr 2000, 72:912–921.
Fung TT, Willett WC, Stampfer MJ, Manson JE, Hu FB: Dietary patterns and the risk of coronary heart disease in women. Arch Intern Med 2001, 161:1857–1862.
Menotti A, Kromhout D, Blackburn H, et al.: Food intake patterns and 25-year mortality from coronary heart disease: cross-cultural correlations in the Seven Countries Study. The Seven Countries Study Research Group. Eur J Epidemiol 1999, 15:507–515.
Singh RB, Rastogi SS, Verma R, et al.: Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ 1992, 304:1015–1019.
de Lorgeril M, Salen P, Martin JL, et al.: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.
Martinez ME, Marshall JR, Sechrest L: Invited commentary. Factor analysis and the search for objectivity. Am J Epidemiol 1998, 148:17–19.
McCann SE, Marshall JR, Brasure JR, Graham S, Freudenheim JL: Analysis of patterns of food intake in nutritional epidemiology: food classification in principal components analysis and the subsequent impact on estimates for endometrial cancer. Public Health Nutr 2001, 4:989–997.
Hu FB, Rimm E, Smith-Warner SA, et al.: Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am J Clin Nutr 1999, 69:243–249.
Cronbach LJ: Coefficient alpha and the internal structure of tests. Psychometrika 1951, 16:297–334.
Maskarinec G, Novotny R, Tasaki K: Dietary patterns are associated with body mass index in multiethnic women. J Nutr 2000, 130:3068–3072.
Schulze MB, Hoffmann K, Kroke A, Boeing H: Dietary patterns and their association with food and nutrient intake in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study. Br J Nutr 2001, 85:363–373.
Riboli E: The European Prospective Investigation into Cancer and Nutrition (EPIC): plans and progress. J Nutr 2001, 131:170S-175S.
Rights and permissions
About this article
Cite this article
Schulze, M.B., Hu, F.B. Dietary patterns and risk of hypertension, type 2 diabetes mellitus, and coronary heart disease. Curr Atheroscler Rep 4, 462–467 (2002). https://doi.org/10.1007/s11883-002-0051-1
- Dietary Pattern
- Trans Fatty Acid
- Glycemic Load
- European Prospective Investigation Into Cancer
- Pattern Score