Race and diet in the overweight: association with cardiovascular risk in a nationally representative sample

Objective Because dietary differences may account for much of the racial and ethnic disparities in cardiovascular risk status, we evaluate the effect of race on cardiovascular risk after adjustment for dietary factors. Methods Prevalence of healthy diets in overweight U.S. adults (body mass index ≥ 25 kg/m2, age ≥ 18 y) by race or ethnicity was determined by using 24-h dietary recalls from the National Health and Nutrition Examination Survey of 1999 to 2000. Dietary recalls included daily total calories, percentage of calories obtained from saturated fat, cholesterol, dietary fiber, and sodium and potassium intakes. Logistic regressions were used to evaluate the association between race/ethnicity, dietary factors, and cardiovascular risk markers (high levels of total cholesterol, C-reactive protein, systolic blood pressure, and diastolic blood pressure and low levels of high-density lipoprotein). Results The percentage of respondents who met healthy diet parameters ranged from 11.2 to 63.3. Non-Hispanic whites without diagnosed disease were less likely to have healthy diets than were African Americans or Hispanics, except with regard to cholesterol and fiber intake. After controlling for dietary factors, African American ethnicity was associated with a lower risk of hypercholesterolemia (odds ratio 0.587, 95% confidence interval 0.403 to 0.855), lower level of high-density lipoprotein (odds 0.440, 95% confidence interval 0.236 to 0.763), and a greater risk of high systolic blood pressure (odds ratio 2.383, 95% confidence interval 1.043 to 5.442) compared to whites. Conclusions Differences in adherence to healthy diet parameters by race/ethnicity exist. However, after adjustment for diet and other modifiable factors, African Americans have a decreased risk of hypercholesterolemia and low level of high-density lipoprotein but an increased risk of systolic hypertension. Further research into the genetic basis for these differences is suggested.