Abstract P369: Higher Diet quality is Prospectively Associated with Markers of Endothelial Dysfunction: The Coronary Artery Risk Development in Young Adults Study
Authors: Sijtsma Femke P , Meyer Katie A , Nettleton Jennifer A , Steffen Lyn M , Van Horn Linda , Shikany James M , Holvoet Paul , Gross Myron D , Kromhout Daan , Jacobs David R 
Published: July 2021

Introduction
We examined the prospective association between diet quality and circulating soluble intercellular adhesion molecule 1 (sICAM-1) and p-selectin, higher values of both of which indicate endothelial dysfunction, a stage in the development of atherosclerosis. We hypothesized that higher diet quality relates inversely with these biomarkers of endothelial dysfunction.

Methods
We studied 2,569 black and white men and women in the Coronary Artery Risk Development in Young Adults (CARDIA) study, aged 18-30 at year 0 (1985-86). Diet was assessed at years 0 and 7; sICAM-1 and p-selectin were assayed at year 15. Principal component analysis yielded a diet pattern score rich in refined grain, butter and red meat (meat diet), higher scores reflecting poorer diet quality, and one rich in plant foods (fruit and vegetable (FV) diet), higher scores reflecting better diet quality. Linear regression models predicted sICAM-1 and p-selectin from the diet pattern scores, adjusting for sex, race, study center, age, total energy, smoking status, educational attainment and physical activity and in a separate model additionally adjusted for BMI (all regressors average of year 0 and 7).

Results
Concentrations of sICAM-1 and p-selectin (year 15 mean and standard deviation (SD)) were 153.4±44.1 ng/mL and 36.7±11.3 ng/mL, respectively. Both diet pattern scores were associated with sICAM-1 (
table
), most strongly the meat diet. The mean sICAM-1 was 17.3 ng/mL lower in the lowest than the highest meat diet quintile, amounting to an effect size of 39% of an SD for sICAM-1 (17.3/44.1 ng/mL). P-selectin was positively associated with the meat diet
,
but was not significantly associated with the FV diet. Associations were little affected by adjustment for BMI.

Conclusion
The association of higher diet quality with biomarkers of endothelial dysfunction should be considered as a possible pathway through which diet may affect the development of cardiovascular disease.

Estimated mean biomarkers of endothelial dysfunction, sICAM-1 and P-selectin by quintile of 3 diet pattern scores. The CARDIA Study, 1985-86 to 2005-06

Quintile of Dietary Pattern Consumption

1
2
3
4
5
p-trend

sICAM-1 (153.4±44.1 ng/mL)

Meat diet
N
536
576
577
504
376

Model 1
b (se)
0
3.5 (2.5)
10.2 (2.9)
17.5 (3.6)
17.3 (5.3)
0.001

Model 2
b (se)
0
3.0 (2.5)
8.4 (2.8)
15.4 (3.5)
16.5 (5.2)
0.0023

FV diet
N
427
506
530
565
541

Model 1
b (se)
0
−1.8 (2.7)
−3.1 (2.9)
−5.8 (3.0)
−8.4 (3.3)
0.011

Model 2
b (se)
0
−1.5 (2.7)
−3.0 (2.8)
−5.6 (2.9)
−8.2 (3.3)
0.0066

P-selectin (36.7±11.3 ng/mL)

Meat diet
N
538
584
581
515
388

Model 1
b (se)
0
0.6 (0.7)
1.8 (0.8)
3.1 (0.9)
5.6 (1.4)
0.0018

Model 2
b (se)
0
0.5 (0.7)
1.6 (0.8)
2.9 (0.9)
5.6 (1.4)
0.0026

FV diet
N
433
516
535
567
555

Model 1
b (se)
0
0.5 (0.7)
0.5 (0.8)
−0.1 (0.8)
−0.7 (0.9)
0.144

Model 2
b (se)
0
0.5 (0.7)
0.5 (0.8)
0.0 (0.8)
−0.6 (0.9)
0.1321

Each row represents a separate regression model. Model 1 adjusted for race, sex, center, age, education, energy intake and physical activity, model 2 additionally adjusted for BMI. Each cell provides for a given quintile of the particular diet pattern score the number at risk (N) or the regression coefficient and standard error (b (se)) comparing mean sICAM-1 or p-selectin to its value in the lowest diet pattern score quintile.