Food intake patterns and risk of coronary heart disease: a prospective cohort study examining the use of traditional scoring techniques

Objective: This study analyses the risk of coronary heart disease (CHD) associated with food intake patterns. Design: A cohort study with follow-up in 1996 for first admission to hospital for a CHD diagnosis or death caused by CHD (280 cases). Three food patterns were identified from a food frequency questionnaire: (1) a predefined healthy food index; (2) a prudent diet (reflecting frequent intakes of wholemeal cereals, fruit and vegetables); and (3) a Western food pattern (reflecting frequent intakes of meat products, butter and white bread) derived by factor analysis. Both factor scores had a mean of zero and a standard deviation of 1. Setting: Copenhagen County, Denmark. Subjects: A random sample of 7316 adults participated in health examinations conducted either in 1982 - 1984, 1987, or 1991-1992. Results: The healthy food index and the Western pattern were not associated with CHD. The prudent pattern was associated with a decreased risk of CHD (Hazard ratio (HR per score unit increase) - 0.85; 95% confidence intervals (CI), 0.75, 0.96), but the association vanished (HR - 1.06; 95% CI, 0.93, 1.21) after controlling for confounding. Body mass index (BMI) modified the effect of the prudent and the Western patterns on CHD risk, suggesting an inverse association between both patterns and CHD in persons with low BMI, while the risk of CHD seemed to be positively related to the prudent and the Western pattern in those with high BMIs. Conclusions: This study showed no association between dietary patterns and CHD risk, but suggests that BMI modifies the relation between diet and CHD risk.