Dietary patterns, cardiometabolic risk factors, and the incidence of cardiovascular disease in severe obesity

Objective The longitudinal associations between a dietary pattern (DP) and cardiometabolic risk factors and cardiovascular disease (CVD) incidence were investigated in a cohort of adults with severe obesity. Methods The analysis included 2,037 individuals with severe obesity (>34 and >38 kg/m2 for men and women, respectively) from the Swedish Obese Subjects study repeatedly followed up for 10 years. Reduced rank regression was used to identify a DP characterized by dietary energy density, saturated fat intake, and fiber density. Mixed models examined relationships between repeated measures of DP z-scores and cardiometabolic risk factors. Cox proportional hazards models assessed relationships between DP scores and CVD incidence. Results An energy-dense, high-saturated-fat, and low-fiber DP was derived. A one-unit increase in the DP z-score between follow-ups was associated with an increase in weight [β (SE)] (1.71-±-0.10 kg), waist circumference (1.49-±-0.07 cm), BMI (0.60-±-0.34 kg/m2), serum cholesterol (0.06-±-0.01 mmol/l), and serum insulin (1.22-±-0.17 mmol/l; all P-