Neo-Traditional and Industrialized Dietary Patterns Coexist and Are Differentially Associated with Cardiometabolic Health among Adults in Puerto Rico.

BACKGROUND: An increasingly industrialized food system has marginalized local, traditional food cultures in Puerto Rico (PR). Recent efforts to decolonize diets have promoted local food intake; however, how resulting dietary patterns may influence cardiometabolic disease remains unknown. OBJECTIVES: This study aimed to 1) identify dietary patterns in PR and 2) determine their associations with metabolic syndrome (MetS) and its components. METHODS: Data were obtained from participants (30-75 y) in PROSPECT (PR Observational Study of Psychosocial, Environmental, and Chronic Disease Trends; n = 989). Dietary patterns were derived using partial least squares analysis with food frequency questionnaire data, using nutrients associated with local food purchasing (dietary fiber, magnesium, saturated fat) as response variables. MetS was classified using harmonized criteria from clinical and laboratory measures and medication use. Fully adjusted generalized linear models tested associations between tertiles of dietary patterns and MetS. RESULTS: Approximately half (52%) of the participants were classified with MetS. Four dietary patterns were revealed: conventional (legumes, coffee, and dairy), industrialized starch and meat-centric (red/processed meats, pasta, and starchy roots), industrialized sugar-centric (rice, sugary beverages, and refined grains), and neo-traditional (local plants and seafood). Individuals in the highest (compared with lowest) tertile of the industrialized starch and meat-centric dietary pattern had higher mean waist circumference (102 compared with 99 cm) (P = 0.01), fasting glucose (106 compared with 98 mg/dL) (P = 0.019), and systolic blood pressure (123 compared with 119 mmHg) (P = 0.022). Individuals in the highest (compared with lowest) tertile of the neo-traditional diet were 0.69 (0.49, 0.97) times less likely to have MetS (P = 0.035) and had 4.1 cm lower mean waist circumference (P = 0.002). CONCLUSIONS: Promoting a neo-traditional diet and curbing industrialized starch and meat-centric diets may improve cardiometabolic health in PR. Results can guide local food promotion as a healthful, decolonizing approach in island settings.