By Benoit Arsenault, PhD, Assistant professor, Department of Medicine, Faculty of Medicine, Université Laval.
The results of several recent studies have suggested that beyond its nutrient content (low-fat, low-carbs, low-salt, etc.), assessing the quality of the diet, which enables the identification of eating patterns, may provide valuable information on one’s risk of developing chronic diseases such as cardiovascular disease (CVD). However, one of the caveats of this approach is that such dietary patterns are somewhat difficult to define and are population specific. In Western societies, a few dietary patterns have been described, but two of them really stand out: the Mediterranean dietary pattern and the Western dietary pattern. People following a Mediterranean-style diet usually consume more fruits and vegetables, whole grains, olive oil, low-fat dairy products, lean meat and fish and not much processed food while people following a Western-type diet usually consume more refined cereal products, fried foods, red and processed meats as well as sweets and desserts.
In the past few years, randomized controlled trials and large-scale epidemiological studies have clearly highlighted the cardiovascular benefits of following a Mediterranean-style diet over a Western-type diet. It is, however, somewhat naïve to narrow down the number of dietary patterns to only two and a study published in the Journal of the American College of Cardiology identified a new, contemporary dietary pattern: the social-business eating pattern.
This social-business eating pattern was identified in a Spanish cohort called PESA (Progression of Early Subclinical Atherosclerosis) by seeking dietary “clusters” using a factor analysis. This cohort included 4,082 men and women free of CVD aged between 40 and 54. All of the study participants were employees of the Santander Bank in Madrid. Habitual food intake was assessed in all study participants using a computerized questionnaire that took about one hour to fill in and was supervised by a dietitian. Subclinical atherosclerosis (the presence of plaques in carotid arteries and elsewhere) was also assessed in all study participants using computed tomography and vascular ultrasound. The factor analysis identified three clusters corresponding to the Mediterranean dietary pattern, the Western dietary pattern and the social-business eating pattern, the latter included participants who reported the highest consumption of red meat, shellfish, processed foods, appetizers and snacks, as well as the highest consumption of alcoholic and sugar-sweetened beverages. This group also included the participants who reported eating out most often because of job requirements or due to a busier agenda.
Results of this investigation suggest that compared to participants of the Mediterranean or Western diet group, participants included in the social-business eating pattern group had a more deteriorated cardiometabolic risk profile such as a higher body mass index, higher cholesterol and triglyceride levels, higher blood pressure as well as a higher prevalence of type 2 diabetes. Overall, more than 60% of the participants of the PESA cohort had atherosclerotic plaques. However, compared to participants of the Mediterranean diet group, those included in the social-business eating pattern had 30-40% higher odds of having atherosclerotic plaques.
Interestingly, diet was not the only component differentiating participants of the social-business eating pattern from the others. Participants included in the social-business eating pattern were more likely to be male, to have a higher income level (there were more executives), and to smoke. Additionally, they also reported engaging in more physical activities. Therefore, although identified as an eating pattern, this new paradigm could also be viewed as a social-business lifestyle. Although this study had an observational design and should be interpreted with caution, as causality cannot be inferred, this study could have clinical implications. Indeed, as health professionals are now advised to focus more on the eating behaviours than on the nutrient content of the diet to improve cardiovascular health, it might also be time to consider taking this concept to another level and consider all lifestyle components globally to optimize the prevention of CVD in the active adult population. It will also be interesting to see if this dietary pattern can be observed in other populations.