A structural equation modeling approach for the association of a healthy eating index with metabolic syndrome and cardio-metabolic risk factors among obese individuals

• Published in: PloS one 2019-07, Vol.14 (7), p.e0219193-e0219193
• Main Authors: Khodarahmi, Mahdieh, Asghari-Jafarabadi, Mohammad, Abbasalizad Farhangi, Mahdieh
• Format: Article
• Language: English
• Subjects: Adult; Age; Anthropometry; Biology and Life Sciences; Blood pressure; Body fat; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Chronic diseases; Chronic illnesses; Cross-Sectional Studies; Demographic aspects; Demographics; Diet; Diet, Healthy - standards; Diet, Healthy - statistics & numerical data; Dietary intake; Feeding Behavior; Female; Females; Food and nutrition; Food habits; Health aspects; Health risks; High density lipoprotein; Homeostasis; Humans; Insulin; Insulin resistance; Latent Class Analysis; Male; Males; Mathematical models; Medical research; Medicine and Health Sciences; Mental depression; Mental disorders; Mental health; Metabolic diseases; Metabolic disorders; Metabolic syndrome; Metabolic Syndrome - epidemiology; Metabolic Syndrome - etiology; Metabolic Syndrome - prevention & control; Middle Aged; Modelling; Models, Biological; Nutrition Policy; Nutrition research; Nutritional requirements; Obesity; Obesity - complications; Obesity - diet therapy; Obesity - metabolism; Overweight persons; Parameter estimation; Patient Compliance - statistics & numerical data; Psychological aspects; Risk analysis; Risk assessment; Risk Assessment - methods; Risk Factors; Social class; Socioeconomic Factors; Socioeconomics; Structural equation modeling; Surveys and Questionnaires - statistics & numerical data; Systematic review; Triglycerides; Type 2 diabetes; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0219193

Numerous studies have evaluated the association between dietary factors and cardiovascular risk among patients with chronic disease. It is worthwhile to assess these associations in a combination model rather than in an isolated form. In the current study, we aimed to use structural equation modeling (SEM) to assess the association of adherence to a healthy eating index (HEI)-2015 with socio-demographic factors, psychological characteristics, metabolic syndrome (MetS) and other cardio-metabolic risk factors among obese individuals. This cross-sectional study was conducted among 188 healthy obese adults (96 males and 92 females) aged 20-50 years in Tabriz. A validated semi-quantitative food frequency questionnaire (FFQ) was used to record dietary intake and to estimate HEI-2015. Anthropometric parameters, blood pressure and biochemical measurements were evaluated according to standard protocols. Interrelationships among socio-demographic parameters and HEI with cardio-metabolic risk factors were analyzed using SEM. The results of SEM analysis revealed that HEI mediated the association between age and several cardio-metabolic risk factors including fat mass (FM), fat free mass (FFM), systolic blood pressure (SBP) and high-density lipoprotein (HDL) (p < 0.05). Moreover, adherence to Dietary Guidelines for Americans (DGA) appears to mediate association between gender and waist circumference (B = -9.78), SBP (B = -4.83), triglyceride (B = -13.01) and HDL (B = 4.31). HEI also mediated indirect negative effects of socioeconomic status on FM (B = -0.56), FFM (B = -0.25), SBP (B = -0.55) and diastolic blood pressure (DBP) (B = -0.3). Additionally, depression and age had indirect unfavorable effects on some insulin resistance indices such as homeostasis model assessment of insulin resistance (B = 0.07; p