<strong>DEVELOPMENT, COMPARISON, AND INTERPRETATION OF TEMPORAL LIFESTYLE BEHAVIOR PATTERNS </strong>
Creators: name: Lin, Luotao
Publisher: name: Purdue University Graduate School
Year: 2023
Subjects: classificationCode: 420208
subject: Nutritional epidemiology

description: Diet and physical activity (PA) are independent risk factors for obesity and chronic diseases including type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). The temporal sequence of these exposures could be used to create patterns with potential links to health status indicators. The objectives were (1) to create clusters of joint temporal dietary and PA patterns (TDPAPs) and to determine their association with health status indicators including body mass index (BMI), waist circumference (WC), fasting plasma glucose, glycated hemoglobin, triglycerides, high density lipoprotein cholesterol, total cholesterol, blood pressure, and disease status including obesity, T2DM, and MetS; (2) compare the number and strength of association between clusters of daily temporal dietary patterns (TDPs), temporal PA patterns (TPAPs), and TDPAPs and health status indicators above; (3) determine the association between TDPs on weekday and weekend days and health indicators (diet quality, waist circumference, BMI, and obesity) and their overlap of membership; (4) assess concurrent validity of energy and time cut-offs describing the data-driven TDPs by determining their relationships to BMI and WC. A 24-h dietary recall and random day of accelerometer data of U.S. adults aged 20-65 years from the cross-sectional National Health and Nutrition Examination Survey 2003-2018 data were used to create data-driven TDPAP, TDP, TPAP clusters by constrained or modified dynamic time warping, coupled with a kernel k-means clustering algorithm. Multivariate regression models determined associations between the temporal pattern clusters and health status indicators, controlling for potential confounders and adjusting for multiple comparisons. The number of significant differences among clusters and adjusted R2/the Akaike information criterion compared the strength of associations between clusters of patterns and continuous/categorical health status indicators. The percentages of overlap in cluster membership between temporal patterns were also calculated. A TDPAP/TDP cluster with proportionally equivalent energy consumed at evenly spaced eating occasions, or a TDPAP/TPAP cluster with the highest PA counts among 4 clusters, was associated with significantly better health indicators including lower BMI, WC, and odds of obesity than other temporal lifestyle pattern clusters. TDPAPs and TDPs had stronger and more numerous associations with health indicators compared with TPAPs. Both a weekday and weekend day TDP of proportionally equivalent energy consumed throughout the day were significantly associated with better health indicators compared with the other TDP clusters but the TDPs of most adults were not consistent on weekdays and weekend days. The data-driven TDP was validated using descriptive cut-off generated TDP and holds promise for obesity interventions and translation to dietary guidance. Temporal lifestyle patterns are significantly associated with health indicators, providing evidence that incorporating time with lifestyle style behaviors comprehensively may provide insight into health. Further evaluation of temporal patterns linked to health holds potential for application to interventions to prevent chronic disease.