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Nutritional Epidemiology

Common and Country-Specific Dietary Patterns in Four European Cohort Studies¹

Helena F. Balder^*,,2, Mikko Virtanen^**, Henny A. M. Brants^*, Vittorio Krogh, L. Beth Dixon^,, Frans Tan^#, Satu Mannisto^**, Rino Bellocco, Pirjo Pietinen^**, Alicja Wolk, Franco Berrino, Piet A. Van den Brandt, Anne M. Hartman and R. Alexandra Goldbohm^*

^* Department of Nutritional Epidemiology, TNO Nutrition and Food Research, Zeist, The Netherlands; Department of Epidemiology, Maastricht University, Maastricht, The Netherlands; ^** Department of Nutrition, National Public Health Institute, Helsinki, Finland; Epidemiology Unit, National Cancer Institute, Milan, Italy; Department of Nutrition, Food Studies, and Public Health, New York University, New York, NY; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; ^# Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands; and Institute of Environmental Epidemiology, Karolinska Institutet, Stockholm, Sweden

²To whom correspondence should be addressed. E-mail: balder{at}voeding.tno.nl.

The association between diet and cancer, predominantly investigated univariately, has often been inconsistent, possibly because of the large number of candidate risk factors and their high intercorrelations. Analysis of dietary patterns is expected to give more insight than analysis of single nutrients or foods. This study aimed to develop and apply a common methodological approach to determine dietary patterns in four cohort studies originating in Finland, the Netherlands, Sweden and Italy. Food items on each of the food frequency questionnaires were aggregated into 51 food groups, defined on the basis of their position in the diet pattern and possible relevance to cancer etiology. Exploratory factor analysis was used to analyze dietary patterns. Using a standardized approach, 3–5 stable dietary patterns were identified, explaining 20–29% of total variance in consumption of the food groups. Two dietary patterns, which explained most of the variance, were consistent across the studies. The first pattern was characterized by high consumption of (salad) vegetables, the second by high consumption of pork, processed meat and potatoes. In addition, a few specifically national food patterns were identified. Sensitivity analyses showed that the identified patterns were robust for number of factors extracted, distribution of input variables and energy adjustment. Our findings suggest that some important eating patterns are shared by the four populations under study, whereas other eating patterns are population specific.

KEY WORDS: • dietary patterns • factor analysis • principal components analysis • cohort studies • cancer

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