Sex differences in (poly)phenol intake patterns and cardiovascular risk in Spanish adult population at high risk of cardiovascular disease: Cross-sectional findings

Background: Men and women tend to follow different dietary patterns, but this is often disregarded when relating diet to health outcomes. Objective: Our aim was to analyze (poly)phenol intake patterns and their association with cardiovascular risk (CVR) according to sex. Methods: 6633 participants were included in this cross-sectional study. The intake of 26 (poly)phenol classes/subclasses was included in the factor analysis obtaining for the total sample, men and women. Linear regression models were performed with the estimation of absolute CVR (Framingham equation) as the dependent variable, and each (poly)phenol pattern categorized into quintiles as the independent variable. Results: For the total sample, (poly)phenol pattern three (olives and olive oil) was positively associated with CVR (β_Q5vs.Q1 = 2.71%, 95% CI = 1.45, 3.96), presenting a higher risk of diabetes prevalence, smoking more and consuming more salt. In men, pattern three (olives and olive oil) was also positively associated with CVR (β_Q5vs.Q1 = 3.17%, 95% CI = 1.58, 5.64), exhibiting higher prevalence of diabetes and higher sodium intake. Also in men, pattern four (coffee) was positively associated (β_Q5vs.Q1 = 1.99 %, 95% CI = 0.26, 3.73) presenting a higher diabetes and current smokers prevalence and higher sugar intake. In women, greater adherence to pattern four (coffee) was associated with higher CVR (β_Q5vs.Q1 = 2.19%, 95% CI = 1.05, 3.34). Conclusions: We found sex differences in (poly)phenol intake patterns and in their associations with CVR. These differences may be explained by the fact that subjects at higher risk at baseline may be motivated to improve their dietary habit (reverse causality). Clinical Trial Registry number: The trial was registered at the International Standard Randomized Controlled Trial (ISRCTN89898870).