Are dietary patterns useful for understanding the role of diet in chronic disease?

Top Cited Papers
Open Access
Publisher Website
Google Scholar
Abstract
The application of epidemiologic methods to nutrition is fraught with complications because of the highly interrelated nature of dietary exposures. For this reason, it is often difficult to separate out the specific effects of nutrients or foods despite the common practice of examining the role of single nutrients or foods in relation to disease risk. For example, diets high in fiber tend to be high in vitamin C, folate, various carotenoids, magnesium, and potassium. So when we see associations between fiber and disease risk, can we be certain that the relation is not a consequence of folate or carotenoid intake? The use of foods or food groups might help to capture some of the complexity of diet that is often lost in nutrient-based analyses, but similar problems exist with foods. For example, whole-grain consumption is inversely associated with meat and positively associated with vegetable, fruit, and fish consumption. When we see that whole-grain intake is associated with lower disease risk, can we be certain that the association is not due to differences in red meat or fruit and vegetable consumption? Even if we choose to adjust for intakes of other nutrients or foods, our ability to accomplish the adjustment can be limited when these intakes are highly correlated.