Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology

Differences in the association of diet quality with body fat distribution between men and women

European Journal of Clinical Nutrition volume 74, pages 1434–1441 (2020)Cite this article

Subjects

Abstract

Background/objective

As dietary intake and endocrine metabolism are vastly different by sex, we evaluated differences in the association of diet quality with body composition between men and women.

Subjects/methods

Close to 2000 participants from the Multiethnic Cohort completed calibrated quantitative food frequency questionnaires at cohort entry (1993–96) and clinic visit (2013–16), from which the Healthy Eating Index (HEI-2010) was computed. Adiposity measures were obtained through DXA and MRI at clinic visit. Multivariable-adjusted mean adiposity measures were estimated by tertiles of HEI-2010 scores using general linear regression. The associations of diet quality with high visceral fat (VAT) and nonalcoholic fatty liver disease (NAFLD) were examined by logistic regression. To assess sex differences, cross-product terms with the HEI-2010 were added to the models.

Results

Mean HEI-2010 scores were higher for women than men at cohort entry (67.4 vs. 64.0) and clinic visit (73.6 vs. 71.0). Past and current diet quality was inversely associated with adiposity measures in men and women. Although interaction terms were not significant, the magnitude of the slopes and differences in adjusted means across tertiles suggested a stronger association for women than men. When comparing individuals who maintained a high vs. poor quality diet over 20 years, women but not men showed significantly lower risks for high VAT, whereas high HEI-2010 scores predicted a lower risk of NAFLD in both sexes.

Conclusions

The inverse association of diet quality with adiposity was similar in both sexes, but diet quality appeared to have a stronger influence on VAT in women than men.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Lee H, Pak YK, Yeo E-J, Kim YS, Paik HY, Lee SK. It is time to integrate sex as a variable in preclinical and clinical studies. Off J Korean Soc Biochem Mol Biol. 2018;50:1–2.

    Google Scholar 

  2. Lee H, Kang M, Song WO, Shim JE, Paik HY. Gender analysis in the development and validation of FFQ: a systematic review. Br J Nutr. 2016;115:666–71.

    Article  CAS  Google Scholar 

  3. Smiciklas-Wright H, Mitchell DC, Mickle SJ, Cook AJ, Goldman JD. Foods commonly eaten in the United States. US Dep Agric NFS Rep. 2002;965:1–264.

    Google Scholar 

  4. Kelly MT, Rennie KL, Wallace JM, Robson PJ, Welch RW, Hannon-Fletcher MP, et al. Associations between the portion sizes of food groups consumed and measures of adiposity in the British National Diet and Nutrition Survey. Br J Nutr. 2009;101:1413–20.

    Article  CAS  Google Scholar 

  5. Kang M, Park SY, Boushey CJ, Wilkens LR, Monroe KR, Le Marchand L, et al. Portion sizes from 24-hour dietary recalls differed by sex among those who selected the same portion size category on a food frequency questionnaire. J Acad Nutr Diet. 2018;118:1711–8.

    Article  Google Scholar 

  6. Shiferaw B, Verrill L, Booth H, Zansky SM, Norton DM, Crim S, et al. Sex-based differences in food consumption: Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey, 2006-2007. Clin Infect Dis. 2012;54 Suppl 5:S453–7.

    Article  Google Scholar 

  7. Bates CJ, Prentice A, Finch S. Gender differences in food and nutrient intakes and status indices from the National Diet and Nutrition Survey of people aged 65 years and over. Eur J Clin Nutr. 1999;53:694–9.

    Article  CAS  Google Scholar 

  8. Guenther PM, Casavale KO, Reedy J, Kirkpatrick SI, Hiza HA, Kuczynski KJ, et al. Update of the healthy eating index: HEI-2010. J Acad Nutr Dietetics. 2013;113:569–80.

    Article  Google Scholar 

  9. U.S. Department of Health and Human Services, US Department of Agriculture. Dietary Guidelines for Americans 2010. Available from: https://health.gov/dietaryguidelines/2010/. (Accessed 1/21/2020).

  10. Kang M, Park S-Y, Shvetsov YB, Wilkens LR, Marchand LL, Boushey CJ, et al. Gender differences in sociodemographic and lifestyle factors associated with diet quality in a multiethnic population. Nutrition. 2019;66:147–52.

    Article  Google Scholar 

  11. The GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.

  12. Mohamed Asrih FRJ. Diets and nonalcoholic fatty liver disease: the good and the bad. Eur Soc Clin Nutr Metab. 2014;33:186–90.

    Google Scholar 

  13. Foster MT, Pagliassotti MJ. Metabolic alterations following visceral fat removal and expansion: Beyond anatomic location. Adipocyte. 2012;1:192–9.

    Article  CAS  Google Scholar 

  14. Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev. 2013;93:359–404.

    Article  CAS  Google Scholar 

  15. Maskarinec G, Lim U, Jacobs S, Monroe KR, Ernst T, Buchthal SD, et al. Diet quality in midadulthood predicts visceral adiposity and liver fatness in older ages: the Multiethnic Cohort Study. Obesity. 2017;25:1442–50.

    Article  Google Scholar 

  16. Kolonel LN, Henderson BE, Hankin JH, Nomura AMY, Wilkens LR, Pike MC, et al. A multiethnic cohort in Hawaii and Los Angeles: baseline characteristics. Am J Epidemiol. 2000;151:346–57.

    Article  CAS  Google Scholar 

  17. Lim U, Monroe KR, Buchthal S, Fan B, Cheng I, Kristal BS, et al. Propensity for intra-abdominal and hepatic adiposity varies among ethnic groups. Gastroenterology. 2019;156:966–75.

    Article  Google Scholar 

  18. Stram DO, Hankin JH, Wilkens LR, Henderson B, Kolonel LN. Calibration of the dietary questionnaire for a multiethnic cohort in Hawaii and Los Angeles. Am J Epidemiol. 2000;151:358–70.

    Article  CAS  Google Scholar 

  19. Murphy SP, Wilkens LR, Hankin JH, Foote JA, Monroe KR, Henderson BE, et al. Comparison of two instruments for quantifying intake of vitamin and mineral supplements: a brief questionnaire versus three 24-hour recalls. Am J Epidemiol. 2002;156:669–75.

    Article  Google Scholar 

  20. Harmon BE, Boushey CJ, Shvetsov YB, Ettienne R, Reedy J, Wilkens LR, et al. Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project. Am J Clin Nutr. 2015;101:587–97.

    Article  CAS  Google Scholar 

  21. Nazare JA, Smith JD, Borel AL, Haffner SM, Balkau B, Ross R, et al. Ethnic influences on the relations between abdominal subcutaneous and visceral adiposity, liver fat, and cardiometabolic risk profile: the International Study of Prediction of Intra-Abdominal Adiposity and its relationship with cardiometabolic risk/intra-abdominal adiposity. Am J Clin Nutr. 2012;96:714–26.

    Article  CAS  Google Scholar 

  22. Ellen W, Demerath SSS, Rogers Nikki, Lee Miryoung, Reed Derek, Choh AudreyC, et al. Anatomical patterning of visceral adipose tissue: race, sex, and age variation. Obesity. 2007;15:2984–93.

    Article  Google Scholar 

  23. Bertoli S, Leone A, Vignati L, Bedogni G, Martinez-Gonzalez MA, Bes-Rastrollo M, et al. Adherence to the Mediterranean diet is inversely associated with visceral abdominal tissue in Caucasian subjects. Clin Nutr. 2015;34:1266–72.

    Article  Google Scholar 

  24. Molenaar EA, Massaro JM, Jacques PF, Pou KM, Ellison RC, Hoffmann U, et al. Association of lifestyle factors with abdominal subcutaneous and visceral adiposity: the Framingham Heart Study. Diabetes Care. 2009;32:505–10.

    Article  Google Scholar 

  25. Chan R, Wong VW, Chu WC, Wong GL, Li LS, Leung J, et al. Diet-quality scores and prevalence of nonalcoholic fatty liver disease: a population study using proton-magnetic resonance spectroscopy. PLoS ONE 2015;10:e0139310.

    Article  Google Scholar 

  26. Fischer K, Moewes D, Koch M, Muller HP, Jacobs G, Kassubek J, et al. MRI-determined total volumes of visceral and subcutaneous abdominal and trunk adipose tissue are differentially and sex-dependently associated with patterns of estimated usual nutrient intake in a northern German population. Am J Clin Nutr. 2015;101:794–807.

    Article  CAS  Google Scholar 

  27. Ruttgers D, Fischer K, Koch M, Lieb W, Muller HP, Jacobs G, et al. Association of food consumption with total volumes of visceral and subcutaneous abdominal adipose tissue in a Northern German population. Br J Nutr. 2015;114:1929–40.

    Article  Google Scholar 

  28. Jacobs S, Harmon BE, Boushey CJ, Morimoto Y, Wilkens LR, Le ML, et al. A priori-defined diet quality indexes and risk of type 2 diabetes: the Multiethnic Cohort. Diabetologia. 2015;58:98–112.

    Article  CAS  Google Scholar 

  29. Aumueller N, Boushey CJ, Franke AA, Cooney RV, Monroe KR, Haiman CA, et al. Diet quality measured by four a priori-defined diet quality indices is associated with lipid-soluble micronutrients in the Multiethnic Cohort Study (MEC). Eur J Clin Nutr. 2019;73:703–13.

    Article  Google Scholar 

  30. Chai W, Maskarinec G, Franke AA, Monroe KR, Park SY, Kolonel LN, et al. Association of serum gamma-tocopherol levels with mortality: the Multiethnic Cohort Study. Eur J Clin Nutr. 2020;74:87–96.

  31. Jacobs S, Boushey CJ, Franke AA, Shvetsov YB, Monroe KR, Haiman CA, et al. A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort. Br J Nutr. 2017;118:312–20.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the Multiethnic Cohort Study participants who generously donated their time and effort and we acknowledge the excellence performance of the study staff. Funding was provided by the grants from the US National Institutes of Health (P01CA169530, U01CA164973, P30CA071789, #UL1TR000130).

Author information

Authors and Affiliations

  1. University of Hawaii Cancer Center, Honolulu, HI, USA

    Gertraud Maskarinec, Lisa A. Namatame, Minji Kang, Steven D. Buchthal, John A. Shepherd, Lynne R. Wilkens, Carol J. Boushey, Loïc Le Marchand & Unhee Lim

  2. University of Maryland, Baltimore, MD, USA

    Thomas Ernst

  3. University of Southern California, Los Angeles, CA, USA

    Kristine R. Monroe

Authors
  1. Gertraud Maskarinec
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lisa A. Namatame
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Minji Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven D. Buchthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas Ernst
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kristine R. Monroe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John A. Shepherd
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lynne R. Wilkens
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Carol J. Boushey
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Loïc Le Marchand
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Unhee Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LLM, UL, and LRW designed the overall research project; CJB developed nutritional support and the diet scores; SDB, TE, and JAS provided essential services in imaging and adiposity measures; LAN, MK, and GM analyzed the data and drafted the paper; LRW provided statistical advice; all authors contributed to data interpretation and critical revisions. GM had primary responsibility for the final content.

Corresponding author

Correspondence to Gertraud Maskarinec.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Maskarinec, G., Namatame, L.A., Kang, M. et al. Differences in the association of diet quality with body fat distribution between men and women. Eur J Clin Nutr 74, 1434–1441 (2020). https://doi.org/10.1038/s41430-020-0563-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-020-0563-1

Search

Advanced search

Quick links