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Nutritional risk and the metabolic syndrome in women: opportunities for preventive intervention from the Framingham Nutrition Study^1,2,3

¹ From the Department of Family Medicine (BEM and RWK) and the Graduate Medical Sciences Division (BEM and RWK), Boston University School of Medicine, Boston, MA; the Department of Mathematics, Boston University, Boston, MA (MJP, LZ, and RBD); the General Internal Medicine Division, Department of Medicine, Massachusetts Hospital and Harvard Medical School, Boston, MA (JBM); and the Lipid Metabolism Laboratory, US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University School of Medicine, Boston, MA (JMO)

Background: Diet is recognized as a key factor in the cause and management of the metabolic syndrome (MetS). However, policies to guide preventive clinical nutrition interventions of the condition are limited.

Objectives: We examined the relation between dietary quality and incident MetS in adult women and identified foci for preventive nutrition interventions.

Design: This was a prospective study of 300 healthy women (aged 30–69 y) in the Framingham Offspring-Spouse study who were free of MetS risk factors at baseline. The development of individual MetS traits and overall MetS status during 12 y of follow-up were compared in women by tertile of nutritional risk, based on intake of 19 nutrients. Multivariate logistic regression models considered age, smoking, physical activity, and menopausal status.

Results: Baseline age-adjusted mean nutrient intake and ischemic heart disease risk profiles differed by tertile of nutritional risk. Women with higher nutritional risk profiles consumed more dietary lipids (total, saturated, and monounsaturated fats) and alcohol and less fiber and micronutrients; they had higher cigarette use and waist circumferences. Compared with women with the lowest nutritional risk, those in the highest tertile had a 2- to 3-fold risk of the development of abdominal obesity and overall MetS during 12 y of follow-up [odds ratio: 2.3 (95% CI: 1.2, 4.3) and 3.0 (95% CI: 1.2, 7.6), respectively].

Conclusions: Higher composite nutritional risk predicts the development of abdominal obesity and MetS during long-term follow-up in healthy women, independent of lifestyle and ischemic heart disease risk factors. Preventive nutrition interventions for obesity and MetS risk reduction should focus on the overall nutritional quality of women's dietary profiles.

Key Words: Composite nutritional risk • dietary quality • ischemic heart disease risk • metabolic syndrome • abdominal obesity

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