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Dietary patterns and lifestyle factors in the Norwegian EPIC cohort: The Norwegian Women and Cancer (NOWAC) study

Abstract

Objective:

To identify different dietary patterns in Norway using a combination of cluster and factor analysis.

Design:

Cross-sectional study.

Setting:

Nation-wide, population-based study.

Subjects:

The Norwegian EPIC cohort is a subcohort of the Norwegian Women and Cancer study (NOWAC), and consist 37.226 women aged 41–56 y who answered a food frequency questionnaire (FFQ) in 1998.

Interventions:

The associations among 50 food variables were first investigated by using principal component analysis. Five important factors were found. The five principal components were then used as input in the cluster analysis. Different socioeconomic and lifestyle variables were examined.

Results:

Six clusters of dietary patterns were found, and were labelled accordingly: ‘traditional fish eaters’, ‘healthy eaters’, ‘average, less fish, less healthy’, ‘Western’, ‘traditional bread eaters’, and ‘alcohol users’. The traditional fish eaters and the traditional bread eaters were both highly represented in the north and west of Norway and were more likely to be present among persons with lower income and lower education. The healthy and the alcohol drinkers were found mostly in the south and east and were more likely to have higher income. Persons in the alcohol group were more likely to be current smokers. The western group had the highest percentage of three or more persons in the household and the shortest time since last birth, indicating that families with children dominate this group.

Conclusion:

Our data indicate six different dietary patterns in Norway, each with different socio-demographic and lifestyle characteristics.

Sponsorship:

The Norwegian Cancer Society (E 04038/006).

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References

  • Amilien V, Bjørkum E, Bugge A, Dulsrud A, Døving R, Fagerli R, Jacobsen E, Kjærnes U, Lavik R, Stø E, Torjusen H & Vittersø G (2000): Om matkultur. National Institute for Consumer Research (SIFO). 19-2000 (report) (in Norwegian).

  • Blaker B, Aarsland M & Landsforeningen for kosthold og helse (1989): Mål og vekt for matvarer. Oslo: Landsforeningen for kosthold & helse (in Norwegian).

  • Brustad M, Braaten T & Lund E (2004): Predictors for cod-liver oil supplement use—the Norwegian Women and Cancer Study. Eur. J. Clin. Nutr. 58, 128–136.

    Article  CAS  Google Scholar 

  • Chen HL, Ward MH, Graubard BI, Heineman EF, Markin RM, Potischman NA, Russell RB, Weisenburger DD & Tucker KL (2002): Dietary patterns and adenocarcinoma of the esophagus and distal stomach. Am. J. Clin. Nutr. 75, 137–144.

    Article  CAS  Google Scholar 

  • Everitt BS, Leese M & Landau S (2001): Cluster Analysis, 4th Edition. London: Arnold.

    Google Scholar 

  • Ferrari P, Slimani N, Ciampi A, Trichopoulou A, Naska A, Lauria C, Veglia F, Bueno-de-Mesquita HB, Ocké MC, Brustad M, Braaten T, José Tormo M, Amiano P, Mattisson I, Johansson G, Welch A, Davey G, Overvad K, Tjønneland A, Clavel-Chapelon F, Thiebaut A, Linseisen J, Boeing H, Hemon B & Riboli E (2002): Evaluation of under- and overreporting of energy intake in 24-hour diet recalls in the European Prospective Investigation into Cancer and Nutrition (EPIC). Public Health Nutr. 5, 1329–1345.

    Article  CAS  Google Scholar 

  • Fraser GE, Welch A, Luben R, Bingham SA & Day NE (2000): The effect of age, sex, and education on food consumption of a middle-aged English cohort—EPIC in East Anglia. Prevent. Med. 30, 26–34.

    Article  CAS  Google Scholar 

  • Fung T, Hu FB, Fuchs C, Giovannucci E, Hunter DJ, Stampfer MJ, Colditz GA & Willett WC (2003): Major dietary patterns and the risk of colorectal cancer in women. Arch. Intern. Med. 163, 309–314.

    Article  Google Scholar 

  • Fung TT, Willett WC, Stampfer MJ, Manson JE & Hu FB (2001): Dietary patterns and the risk of coronary heart disease in women. Arch. Intern. Med. 161, 1857–1862.

    Article  CAS  Google Scholar 

  • Greenwood DC, Cade JE, Draper A, Barrett JH, Calvert C & Greenhalgh A (2000): Seven unique food consumption patterns identified among women in the UK Women's Cohort Study. Eur. J. Clin. Nutr. 54, 314–320.

    Article  CAS  Google Scholar 

  • Hair JF (1995): Multivariate Data Analysis with Readings, 4th Edition. New York: Prentice-Hall.

    Google Scholar 

  • Handa K & Kreiger N (2002): Diet patterns and the risk of renal cell carcinoma. Public Health Nutr. 5, 757–767.

    Article  Google Scholar 

  • Hjartåker A & Lund E (1998): Relationship between dietary habits, age, lifestyle, and socio-economic status among adult Norwegian women. The Norwegian Women and Cancer Study. Eur. J. Clin. Nutr. 52, 565–572.

    Article  Google Scholar 

  • Hoffmann K, Schulze M, Boeing H & Altenburg H (2000): Dietary patterns: report of an international workshop. Public Health Nutr. 5, 89–90.

    Google Scholar 

  • Hu FB, Bronner L, Willett WC, Stampfer MJ, Rexrode KM, Albert CM, Hunter D & Manson JE (2002): Fish and omega-3 fatty acid intake and risk of coronary heart disease in women. JAMA 287, 1815–1821.

    Article  CAS  Google Scholar 

  • Hu FB, Rimm E, Smith-Warner SA, Feskanich D, Stampfer MJ, Ascherio A, Sampson L & Willett WC (1999): Reproducibility and validity of dietary patterns assessed with a food-frequency questionnaire. Am. J. Clin. Nutr. 69, 243–249.

    Article  CAS  Google Scholar 

  • Jacobsen BK & Thelle DS (1987): The Tromso Heart Study: the relationship between food habits and the body mass index. J.Chronic.Dis. 40, 795–800.

    Article  CAS  Google Scholar 

  • Jacques PF & Tucker KL (2001): Are dietary patterns useful for understanding the role of diet in chronic disease? Am. J. Clin. Nutr. 73, 1–2.

    Article  CAS  Google Scholar 

  • Johansson L, Solvoll K, Bjorneboe GE & Drevon CA (1997): Dietary habits among Norwegian men and women. Scand. J. Nutr. 41, 63–70.

    Google Scholar 

  • Johansson L, Thelle DS, Solvoll K, Bjorneboe GE & Drevon CA (1999): Healthy dietary habits in relation to social determinants and lifestyle factors. Br. J. Nutr. 81, 211–220.

    Article  CAS  Google Scholar 

  • Kjærnes U, Ekström MP, Gronow J, Holm L, Mäkelä J, Jääskeläinen A, Fürst EL & Berg L (2001): Eating Patterns. A day in the Lives of Nordic People. National Institute for Consumer Research (SIFO), 7-2001 (report).

    Google Scholar 

  • Landbruksdepartementet & Informasjonsenheten (1997): Norsk mat- og ernæringspolitikk. Myndighetenes rolle. In Trygg mat til forbrukarane, stortingsmelding om matkvalitet og forbrukartryggleik chapter 5, ed. Informasjonsenheten. Oslo: Landbruksdepartementet, Informasjonseininga (in Norwegian).

  • Lund E, Kumle M, Braaten T, Hjartaker A, Bakken K, Eggen E & Gram TI (2003): External validity in a population-based national prospective study—the Norwegian Women and Cancer Study (NOWAC). Cancer Causes Control 14, 1001–1008.

    Article  Google Scholar 

  • Markaki I, Linos D & Linos A (2003): The influence of dietary patterns on the development of thyroid cancer. Eur J Cancer. 39, 1912–1919.

    Article  CAS  Google Scholar 

  • Millen BE, Quatromoni PA, Gagnon DR, Cupples LA, Franz MM & DAgostino RB (1996): Dietary patterns of men and women suggest targets for health promotion: The Framingham Nutrition Studies. Am J Health Promotion 11, 42–52.

    Article  CAS  Google Scholar 

  • Millen BE, Quatromoni PA, Nam BH, O'Horo CE, Polak JF & D'Agostino RB (2002): Dietary patterns and the odds of carotid atherosclerosis in women: The Framingham nutrition studies. Prevent. Med. 35, 540–547.

    Article  Google Scholar 

  • Milligan GW & Cooper MC (1985): An examination of procedures for determining the number of clusters in a data set. Psychometrika 50, 159–179.

    Article  Google Scholar 

  • Mishra G, Ball K, Arbuckle J & Crawford D (2002): Dietary patterns of Australian adults and their association with socioeconomic status: results from the 1995 National Nutrition Survey. Eur. J. Clin. Nutr. 56, 687–693.

    Article  CAS  Google Scholar 

  • Newby P, Muller D, Hallfrisch J, Qiao N, Andres R & Tucker KL (2003): Dietary patterns and changes in body mass index and waist circumference in adults. Am. J. Clin. Nutr. 77, 1417–1425.

    Article  CAS  Google Scholar 

  • Oomen CM, Feskens EJ, Rasanen L, Fidanza F, Nissinen AM, Menotti A, Kok FJ & Kromhout D (2000): Fish consumption and coronary heart disease mortality in Finland, Italy, and The Netherlands. Am. J. Epidemiol. 151, 999–1006.

    Article  CAS  Google Scholar 

  • Pryer JA, Nichols R, Elliott P, Thakrar B, Brunner E & Marmot M (2001): Dietary patterns among a national random sample of British adults. J. Epidemiol. Commun. Health 55, 29–37.

    Article  CAS  Google Scholar 

  • Pryer JA, Vrijheid M, Nichols R, Kiggins M & Elliott P (1997): Who are the ‘low energy reporters’ in the dietary and nutritional survey of British adults? Int. J. Epidemiol. 26, 146–154.

    Article  CAS  Google Scholar 

  • Quatromoni PA, Copenhafer DL, Demissie S, D'Agostino RB, O'Horo CE, Nam BH & Millen BE (2002): The internal validity of a dietary pattern analysis: The Framingham nutrition studies. J. Epidemiol. Commun. Health 56, 381–388.

    Article  CAS  Google Scholar 

  • Riboli E, Hunt KJ, Slimani N, Ferrari P, Norat T, Fahey M, Charrondiere UR, Hemon B, Casagrande C, Vignat J, Overvad K, Tjonneland A, Clavel-Chapelon F, Thiebaut A, Wahrendorf J, Boeing H, Trichopoulos D, Trichopoulou A, Vineis P, Palli D, Bueno-De-Mesquita HB, Peeters PH, Lund E, Engeset D, Gonzalez CA, Barricarte A, Berglund G, Hallmans G, Day NE, Key TJ, Kaaks R & Saracci R (2002): European Prospective Investigation into Cancer and Nutrition (EPIC): study populations and data collection. Public Health Nutr. 5, 1113–1124.

    Article  CAS  Google Scholar 

  • Rimestad AH, Statens næringsmiddeltilsyn, Statens råd for ernæring og fysisk aktivitet & Universitetet i Oslo & Institutt for ernæringsforskning (2001): Matvaretabellen, 2nd Edition. Oslo: Gyldendal undervisning.

    Google Scholar 

  • Sanchez-Villegas A, Delgado-Rodriguez M, Martinez-Gonzalez MA & Irala-Estevez J (2003): Gender, age, socio-demographic and lifestyle factors associated with major dietary patterns in the Spanish Project SUN (Seguimiento Universidad de Navarra). Eur. J. Clin. Nutr. 57, 285–292.

    Article  CAS  Google Scholar 

  • Schulze MB, Hoffmann K, Kroke A & Boeing H (2003): An approach to construct simplified measures of dietary patterns from exploratory factor analysis. Br. J. Nutr. 89, 409–418.

    Article  CAS  Google Scholar 

  • Slattery ML, Boucher KM, Caan BJ, Potter JD & Ma KN (1998): Eating patterns and risk of colon cancer. Am. J. Epidemiol. 148, 4–16.

    Article  CAS  Google Scholar 

  • Spencer EA, Appleby PN, Davey GK & Key TJ (2002): Validity of self-reported height and weight in 4808 EPIC-Oxford participants. Public Health Nutr. 5, 561–565.

    Article  Google Scholar 

  • Terry P, Hu FB, Hansen H & Wolk A (2001): Prospective study of major dietary patterns and colorectal cancer risk in women. Am. J. Epidemiol. 154, 1143–1149.

    Article  CAS  Google Scholar 

  • Tucker KL, Dallal GE & Rush D (1992): Dietary patterns of elderly Boston-area residents defined by cluster-analysis. J. Am. Dietetic Assoc. 92, 1487–1491.

    CAS  Google Scholar 

  • van Dam RM, Grievink L, Ocke MC & Feskens EJM (2003): Patterns of food consumption and risk factors for cardiovascular disease in the general Dutch population. Am. J. Clin. Nutr. 77, 1156–1163.

    Article  CAS  Google Scholar 

  • Wirfalt AKE & Jeffery RW (1997): Using cluster analysis to examine dietary patterns: Nutrient intakes, gender, and weight status differ across food pattern clusters. J. Am. Dietetic Assoc. 97, 272–279.

    Article  CAS  Google Scholar 

  • Wirfalt E, Hedblad B, Gullberg B, Mattisson I, Andren C, Rosander U, Janzon L & Berglund G (2001): 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. 154, 1150–1159.

    Article  CAS  Google Scholar 

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Correspondence to D Engeset.

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Guarantor: D Engeset.

Contributors: DE wrote the paper and contributed to the statistical analysis. EA performed the statistical analysis and contributed to the writing of the paper. AC contributed to the writing of the paper and to the statistical analysis. EL was the principal investigator.

Supplementary Information accompanies the Paper on Euroepan Journal of Clinical Nutrition Website (http://www.nature.com/ejcn).

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Engeset, D., Alsaker, E., Ciampi, A. et al. Dietary patterns and lifestyle factors in the Norwegian EPIC cohort: The Norwegian Women and Cancer (NOWAC) study. Eur J Clin Nutr 59, 675–684 (2005). https://doi.org/10.1038/sj.ejcn.1602129

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  • DOI: https://doi.org/10.1038/sj.ejcn.1602129

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