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A Proposed Epidemiological Approach to Investigate Mechanisms between Diet and Vascular Function

Insights into associations between diet and Cardiovascular Disease (CVD) are constantly evolving due to methodological developments and identification of novel pathophysiological pathways. Nutritional epidemiology research often aims to examine the association between single nutrients/foods and CVD. More recently, dietary patterns (DPs) which incorporate cumulative and interactive effects of foods/nutrients, are studied in association with cardio metabolic disease risk. Hypothesis-driven approaches to DP analysis are based on adherence to predefined diets (e.g. Mediterranean diet score) therefore, they may not reflect overall diet. While exploratory DP approaches (e.g. principal components analysis) can represent real-world dietary behaviours, they may not fully explain the disease-relevant variation in dietary intake. Reduced rank regression (RRR) takes advantage of both prior knowledge and data-driven aspects by incorporating hypothesised intermediates on the diet-disease pathway when identifying DPs. T...