Research brief
Associations between Eating Competence and Cardiovascular Disease Biomarkers

https://doi.org/10.1016/j.jneb.2007.05.004Get rights and content

Abstract

Objective

Explore the relationship between eating competence (EC) and biomarkers of risk for cardiovascular disease (CVD).

Design

Secondary analysis of data collected for a larger, 2-way crossover clinical trial.

Setting

Outpatient clinical research center.

Participants

Forty-eight hypercholesterolemic (LDL cholesterol ≥ 110 mg/dL) men (n = 19) and women (n = 29) 21 to 70 years of age.

Main Outcome Measures

Participant descriptives, cardiovascular disease biomarker levels, and eating competence (EC) determined by the ecSatter Inventory (ecSI).

Analysis

T tests for differences in eating competence between males and females, analysis of variance for differences in risk between those categorized as EC or not. Associations between EC and baseline biochemical measures, as well as participant characteristics and dietary intake, were assessed by Pearson correlation analyses. Logistic regression estimated relative risk of CVD risk factors from ecSI scores.

Results

Several significant associations were found between EC total and CVD risk factors. Eating competence was positively correlated with HDL-cholesterol, and inversely associated with systolic and diastolic blood pressure. High EC participants had significantly lower ratios of total cholesterol: HDL-cholesterol and triglycerides: HDL-cholesterol. Participants who were not eating competent were 5 times more likely to have LDL-cholesterol levels ≥130 mg/dL and 7 times more likely to have triglyceride levels ≥150 mg/dL.

Conclusions and Implications

Eating competence appears to be a cognitive, affective construct with physiological manifestations, making nutrition education to increase eating competence a medical nutrition therapy.

Introduction

Biomarkers of selected hormones, lipids, amino acids and peptides can predict risk for cardiovascular disease (CVD).1, 2 Expense, invasiveness, and limitations in predictive ability of these biomarkers, plus evidence for psychobiological factors in health and CVD support examination for cognitive markers of CVD risk.3, 4, 5 Significant evidence exits for heritability of personality traits in addition to CVD risk factors.6 Studies with twins7 and Amish adults8 show significant heritability of eating behaviors, specifically cognitive restraint and uncontrolled and emotional eating, as measured by original9 and revised versions10 of the Three Factor Eating Questionnaire (TFEQ). Eating behaviors impact dietary intake, and although studies of TFEQ outcomes and CVD biomarkers have not been reported, a Dietary Quality Score was inversely related to blood levels of total cholesterol, triglyceride, low-density lipoprotein-cholesterol, homocysteine, and the absolute risk of ischemic heart disease, adjusted for sex, age, smoking habits, and physical activity level.11

Eating competence as defined by Satter (ecSatter) is a robust construct addressing eating, affective, and cognitive behaviors. Competent eaters “are positive, comfortable and flexible with eating and are matter-of-fact and reliable about getting enough to eat of enjoyable and nourishing food.”12 Eating competence is not an isolated attribute but mirrors and integrates the complexities associated with eating behaviors. A measure of eating competence, the ecSatter Inventory (ecSI) has been tested for reliability13 and validated with the TFEQ and other validated measures of dietary, culinary, and cognitive behaviors.14 Specifically, high ecSI scores were significantly associated with less dietary restraint and disinhibition, lower indication of disordered eating, greater food acceptance, and more physical activity. The ecSI is easy to administer and score, and its TFEQ linkage and demonstrated comparability with other behavioral measures argue for its use in identifying CVD biomarker and behavioral relationships. This cross-sectional, exploratory analysis examines eating competence, as measured by ecSI, in moderately hypercholesterolemic individuals and its relationship to the following biomarkers for risk of CVD: serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), C-reactive protein (CRP), systolic blood pressure (SBP), diastolic blood pressure (DBP), interleukin-1 (IL-1), interleukin-6 (IL-6), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1).

Section snippets

Participants

Baseline data collected as part of a crossover dietary intervention study were examined. Participants were 48 men and women (n = 19 and n = 29, respectively) 21 to 70 years of age. Recruitment methods were similar to those used in previous work.15 Inclusion criteria included serum LDL-C levels greater than or equal to 110 mg/dL, serum total cholesterol between 190 mg/dL and 300 mg/dL, and nonsmokers in good health. Exclusion criteria included presence of a medical condition or chronic disease,

Characteristics of Participants

Participants were mostly female (60%). Levels of HDL-C were significantly higher in females (56.9 ± 11.9 vs. 45.6 ± 9.3 mg/dL). Blood glucose levels (93.1 ± 6.8 vs. 97.0 ± 5.4 mg/dL), resting DBP (64.0 ± 8.8 vs. 70.4 ± 10.4 mm Hg), and DBP during the speech task (76.4 ± 9.1 vs. 84.8 ± 10.0 mm Hg) were significantly lower in females when compared to males (P ≤ .05). Table 1 contains a complete list of participant characteristics, including mean ecSI scores. Gender differences in ecSI scores are

Discussion

This study examined whether eating competence, as measured by the ecSI, was associated with biomarkers for cardiovascular risk in a group of healthy adults with elevated cholesterol. It was shown that participants with higher ecSI scores (≥ 32) had significantly better coronary risk profiles than subjects who scored lower on this measure. Specifically, high EC participants had significantly lower BP overall when collapsing across measurements at rest and during exposure to standardized

Implications for Research and Practice

Given the significant associations between eating competence and reduced risk for CVD, nutrition education interventions that aim to increase EC31 may be beneficial for reduction of risk of cardiovascular disease and related disorders. Further research about EC and corollary factors associated with CVD risk, such as socioeconomic status or dietary behavior, may help to design a feasible eating behavior protocol with multifocal impacts on health.

Acknowledgments

We wish to recognize Dr. Penny Kris-Etherton as co-investigator for the dietary intervention, the staff of the Penn State Diet Assessment Center for managing the dietary recalls, and Dee Bagshaw for coordinating the study. The services of the General Clinical Research Center at The Pennsylvania State University (NIH #M01RR10732) are greatly appreciated.

References (31)

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The services of the General Clinical Research Center at Pennsylvania State University (NIH #M01RR10732) are greatly appreciated.

An author of this article (Lohse), is also the Guest Editor for this issue, and is on the JNEB staff as Associate Editor, Research, Reports and GEMs. Review of this article was handled, exclusively, by the Editor-in-Chief to minimize conflict of interest.

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