# Dietary Risk Factors, Food Group Diversity, and Food Pattern Influences Assessed Using the Food Frequency Questionnaire on Cardiovascular Disease Risk and Other Noncommunicable Disease Profiles in Urban India

## TL;DR

This study in urban India finds that dietary patterns, including low salad and nut intake, are linked to higher risks of cardiovascular disease, diabetes, and hypertension.

## Contribution

The study quantifies the impact of food group diversity and eating patterns on noncommunicable disease risk in an urban Indian population.

## Key findings

- Less frequent salad and nut intake increased cardiovascular disease risk after adjusting for behavioral factors.
- Higher tea consumption was associated with increased diabetes risk.
- Higher dietary diversity was linked to lower cardiovascular disease risk scores.

## Abstract

Introduction: Evidence from the Global Burden of Disease 2023 study and the National Family Health Survey 5 of India suggests that diet is an important predictor of metabolic and cardiovascular diseases (CVDs). India, especially in the urban areas, is experiencing a rapid dietary transition marked by high consumption of refined carbohydrates and processed foods, which is contributing to the increasing burden of CVDs and related risk factors.

Objectives: This study aimed to quantify food group consumption patterns, average nutrient intake, and dietary diversity by the Food Frequency Questionnaire and explore their association with 10-year CVD risk by the World Health Organization International Society of Hypertension risk chart and other noncommunicable diseases like type II diabetes (by Indian Council of Medical Research and Research Society for the Study of Diabetes in India criteria) and hypertension (by Joint National Committee 8) in an urban adult population in Central India.

Methodology: Data were analyzed using IBM Statistical Package for the Social Sciences version 27 (IBM Corp., 2020, Armonk, NY). The association between food group frequency and CVD risk, diabetes, and hypertension was tested using the chi-square test. Significant variables were included in ordinal logistic regression for CVD scores and binary logistic regression for diabetes and hypertension. Correlations of CVD risk with average intake and dietary diversity were evaluated using Pearson’s test and linear regression as appropriate.

Results: A total of 400 participants were included in the study. The number of participants who consumed cereals daily was 400 (100%), other vegetables daily was 294 (73.5%), and green leafy vegetables weekly was 278 (69.5%), while intake of salad, fruits, nuts, milk, milk products, and nonvegetarian items was generally low or infrequent. Less frequent intake of salad (adjusted odds ratio (AOR) = 2.057, p = 0.001) and nuts/raisins (AOR = 1.868, p = 0.006) increased CVD risk, even after adjusting for behavioral factors like tobacco and alcohol. Twice-daily or more frequent tea was associated with diabetes (crude odds ratio (Crude OR) = 1.628, p = 0.023), which remained significant after adjusting for sociodemographic and behavioral variables. Less than weekly salad (Crude OR = 1.582, p = 0.029) and less than monthly milk product intake (Crude OR = 1.766, p = 0.005) were associated with hypertension. Increased quantity of salad was negatively correlated, and tea was positively correlated with CVD risk scores, with a p value of <0.05. Participants with higher dietary diversity had lower CVD risk scores (Adjusted R2 = 0.008, p = 0.037).

Conclusions: Daily consumption of salad/nuts/raisins is good for cardiovascular health. Rather than single foods, overall eating patterns and balanced diets play a greater role in chronic conditions.