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Food patterns measured by principal component analysis and obesity in the Nepalese adult
  1. Archana Shrestha1,
  2. Rajendra Prasad Koju2,3,
  3. Shirley A A Beresford1,
  4. Kwun Chuen Gary Chan4,
  5. Biraj Man Karmacharya1,3,5,6,
  6. Annette L Fitzpatrick1,3,7
  1. 1Department of Epidemiology, University of Washington, Seattle, Washington, USA
  2. 2Department of Cardiology, Dhulikhel Hospital—Kathmandu University Hospital, Dhulikhel, Nepal
  3. 3Department of Global Health, University of Washington, Seattle, Washington, USA
  4. 4Department of Biostatistics, University of Washington, Seattle, Washington, USA
  5. 5Department of Community Medicine, Dhulikhel Hospital – Kathmandu University Hospital, Dhulikhel, Nepal
  6. 6Department of Community Programs, Dhulikhel Hospital – Kathmandu University Hospital, Dhulikhel, Nepal
  7. 7Departments of Family Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to Dr Archana Shrestha, 105 Summer Street Apt 304, Malden, MA 02148, USA; deararchana{at}


Objective About one-fourth of Nepalese adults are overweight or obese but no studies have examined their risk factors, especially pertaining to diet. The present study aimed to identify dietary patterns in a suburban Nepalese community and assess their associations with overweight and obesity prevalence.

Methods This cross-sectional study used data from 1073 adults (18 years or older) participating in the baseline survey of the Dhulikhel Heart Study. We derived major dietary patterns from a principal component analysis of reported intake from a Food Frequency Questionnaire. Overweight was defined as Body Mass Index (BMI) of 25 kg/m2 or higher and obesity was defined as BMI of 30 kg/m2 or higher. Statistical analysis was conducted using generalised estimating equations with multivariate logistic regression (with household as cluster) adjusting for age, sex, ethnicity, religion, marital status, income, education, alcohol consumption, smoking, physical activity and systolic blood pressure.

Results Four dietary patterns were derived: mixed, fast food, refined grain–meat–alcohol and solid fats–dairy. The refined grain–rice–alcohol pattern was significantly associated with overweight (adjusted OR 1.19, 95% CI 1.03 to 1.39; p=0.02) after adjusting for demographic and traditional cardiovascular risk factors. In adults of 40 years or older, the fast food pattern was associated with obesity controlling for demographic and traditional risk factors (adjusted OR 1.69, 95% CI 1.19 to 2.39; p value=0.003).

Conclusions Our results suggest that refined grains–meat–alcohol intake is associated with higher prevalence of overweight, and fast food intake is associated with higher prevalence of obesity in older adults (40 years or above) in suburban Nepalese adults.

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    BMJ Publishing Group Ltd, British Cardiovascular Society and Asia Pacific Heart Association