Dietary patterns, fasting glucose, BMI, and waist circumference in US adolescents

Background: The increasing prevalence of impaired fasting glucose in adolescents has paralleled the obesity epidemic and shows no signs of reversal. Despite this, data in adolescents are sparse. Objective: To identify dietary patterns in U.S. adolescents and quantify the effect of these patterns on risk factors for the metabolic syndrome. This study tests the hypothesis that two major patterns (Western and American healthy) will result and the Western pattern will be associated with increased fasting glucose, BMI and waist circumference. Design: Using 24-hour dietary recalls from the National Health and Nutrition Examination Survey, dietary pattern scores for US adolescents (12-19 y old, n=1852) were derived by principal component analysis accounting for the complex survey design. Linear regression provided least square mean values by quintile of pattern score adjusting for confounders. Results: Two dietary patterns were identified: American Healthy characterized by high intakes of green leafy vegetables, fruit, oil, and dark yellow vegetables and Western characterized by potatoes, high energy drinks, processed meat, snacks, and refined grains. Waist circumference (cm) increased across quintiles of the Western pattern (78.0 lowest quintile; 81.5 highest quintile; p-for trend 0.07)) and decreased across the American Healthy pattern (79.7 lowest quintile; 81.8 highest quintile; p-for trend 0.04)). Similar trends were observed for BMI. Fasting glucose had no relationship with either pattern. Conclusions: Dietary patterns in a national sample of US adolescents are associated with BMI and waist circumference. Adherence to an American Healthy pattern may help decrease risk factors for the metabolic syndrome among US adolescents.