Journal of Nutrition Education and Behavior
Research briefAssociations between Eating Competence and Cardiovascular Disease Biomarkers
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.
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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.