What is the relationship between adherence to dietary guidelines and recommendations or specific dietary patterns (assessed using methods other than index or score, cluster or factor, or reduced rank regression analyses) and body weight status?
The goal of this systematic review
project is to identify patterns of food and beverage intake that promote health and prevent disease. Historically, most dietary guidance has been based on research conducted on individual food components or nutrients. Dietary patterns
are defined as the quantities, proportions, variety or combination of different foods, drinks and nutrients (when available) in diets, and the frequency with which they are habitually consumed. Different methods of analyses are used to assess dietary patterns including index or score, cluster or factor, and reduced rank regression, in addition to other methods, to exam the relationship between adherence to dietary guidelines or recommendations or specific dietary patterns of a population and outcomes of public health concern. The objective of this systematic review was to assess the relationship between patterns of food and beverage intake identified using methods other than index or score, factor or cluster, or reduced rank analyses, and body weight.
There is moderate evidence that adherence to a dietary pattern
that emphasizes vegetables, fruits and whole grains
is associated with modest benefits in preventing weight gain or promoting weight loss in adults
. (DGAC Grade: II-Moderate
Literature searches were conducted using PubMed, Embase, Navigator (BIOSIS, CAB Abstracts and Food Science and Technology Abstracts) and Cochrane databases to identify studies that evaluated the association between dietary patterns defined using methods other than index factor or cluster analysis and body weight status. Studies that met the following criteria were included in the review:
- Conducted in subjects aged two years to 18 years
- Randomized controlled trials, non-randomized controlled trials, or quasi-experimental studies
- Subjects from countries with high or very high human development (based on the 2011 Human Development Index)
- Subjects who were healthy or at elevated chronic disease risk
- Published in English in a peer-reviewed journal
- Unlimited date range.
The results of each included study were summarized in evidence worksheets (including a study quality rating) and an evidence table. A group of subject matter experts were involved in a qualitative synthesis of the body of evidence, development of a conclusion statement and assessment of the strength of the evidence (grade) using pre-established criteria including evaluation of the quality, quantity, consistency, magnitude of effect and generalizability of available evidence.
- The Women’s Health Initiative (WHI), Mediterranean, Vegetarian and “Healthy” dietary patterns were associated with beneficial body weight outcomes. These dietary patterns consistently emphasized fruits, vegetables and whole grains. Fewer studies considered, but consistently observed, benefits with reduced meat intake. Some studies also considered total fat intake; these studies did not support that targeting a low total fat intake is required for weight loss or stability.
- Studies included in this review were short to moderate in duration, and individuals with greater adherence to the plant-based dietary pattern experienced better body weight outcomes
- Additional research is needed to quantify the amounts of food groups that are beneficial to consume, but in general, movement to a dietary pattern with more plant foods and less meat is favorable related to body weight status.
The ability to draw strong conclusions was limited due to the following issues:
- Five of the seven studies included in this review assessed dietary intake using food frequency questionnaires (FFQ). Additionally, one study assessed dietary patterns by using a simple series of questions. These dietary assessment methodologies have measurement error and also prevent sufficient quantification of dietary intake.
- The studies did not consistently consider or report calorie intake or energy expenditure, which are important to consider when examining body weight status.