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Date of Award

9-2012

Document Type

Campus Access

Degree Name

Doctor of Philosophy (PhD)

Degree Program

Public Health

First Advisor

Nancy L. Cohen

Second Advisor

Elizabeth Bertone-Johnson

Third Advisor

Lorraine S. Cordeiro

Subject Categories

Nutrition

Abstract

According to the World Health Organization (WHO), Pakistan is facing a rapid rise in non-communicable diseases associated with lifestyle changes in urban cities. Nutrition and diet are key components of lifestyle modification factors that can help prevent and reduce the disease burden in Pakistan. Recently, dietary patterns became commonly used assessment method to examine the effects of an overall diet, representing a broader picture of food and nutrient consumption on health and disease outcome.

The first paper of this dissertation identifies key dietary patterns using factor analysis, examining their relationship to sociodemographic, anthropometric and lifestyle factors among 5,491 adults from the Control of Blood Pressure and Risk Attenuation (COBRA) study in Pakistan. Three dietary patterns were identified using a culturally-derived food frequency questionnaire and were labeled as: the "fat and sweet"; the "fruit and vegetable"; and the "seafood and yogurt" patterns. The fat and sweet pattern was inversely associated with male gender and abdominal obesity, and was positively associated with being single, unmarried and between 15-39 years old. The fruit and vegetable and seafood and yogurt patterns were positively associated with increased educational status, physical activity and non-tobacco use.

The second paper further examines the association between the identified dietary patterns and hypertension. Age, education, body mass index, marital status and sprinkling salt on cooked food were independently associated with hypertension in this population. Adjusted odds ratios for hypertension in the seafood and yogurt pattern scores were most protective, some protection was observed with the fruit and vegetable pattern and no significant association was seen for the fat and sweet pattern.

The third paper provides an additional dimension to the relationship of dietary patterns and health outcomes by evaluating the nutritional biomarkers relevant to cardiovascular disease among the COBRA cohort who were ≥ 40 years. In men, the fat and sweet pattern across the quartiles was positively associated with total lipids, triglycerides and negatively with blood glucose when adjusted for covariates. In women association was only seen for seafood and yogurt pattern.

These findings may hold some relevance in study of dietary patterns and health and disease outcome among Pakistanis.

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