Table 3.
Sensitivity analysis. Association between concurrent changes in CQI and fat distribution (z-scores) during follow-up.
| A. Visceral fat z-score | Continuous | Tertiles of increment in CQI | ||||
|---|---|---|---|---|---|---|
| CQI (per 3-point increment) | T1 (low) |
T2 (medium) |
T3 (high) |
|||
| β (95% CI) | p-value | β (95% CI) | β (95% CI) | β (95% CI) | p for trend | |
| Overall | −0.067 (−0.088; −0.046) | <0.001 | reference | −0.057 (−0.104; −0.010) | −0.155 (−0.209; −0.100) | <0.001 |
| Nutritional factors | ||||||
| + changes in intake of carbohydrates (g/day) | −0.070 (−0.091; −0.048) | <0.001 | reference | −0.059 (−0.106; −0.012) | −0.160 (−0.214; −0.105) | <0.001 |
| + changes in intake of MUFA, PUFA, SFA, trans FA, and protein (g/day) | −0.058 (−0.080; −0.036) | <0.001 | reference | −0.044 (−0.091; 0.004) | −0.132 (−0.188; −0.076) | <0.001 |
| + changes in adherence to erMedDiet (17p score) | −0.038 (−0.062; −0.015) | 0.001 | reference | −0.018 (−0.067; 0.030) | −0.084 (−0.143; −0.024) | 0.012 |
| + changes in UPF consumption (% of total intake g/day) | −0.061 (−0.083; −0.040) | <0.001 | reference | −0.048 (−0.095; −0.001) | −0.142 (−0.197; −0.087) | <0.001 |
| Excluding total energy intake (kcal/day) | −0.065 (−0.086; −0.044) | <0.001 | reference | −0.053 (−0.099; −0.006) | −0.149 (−0.204; −0.095) | <0.001 |
| Health conditions | ||||||
| + number of MetS factors | −0.067 (−0.088; −0.046) | <0.001 | reference | −0.056 (−0.103; −0.010) | −0.154 (−0.209; −0.100) | <0.001 |
| + history of overweight | −0.067 (−0.088; −0.046) | <0.001 | reference | −0.057 (−0.104; −0.010) | −0.155 (−0.209; −0.100) | <0.001 |
| + changes in body weight (kg) | −0.030 (−0.049; −0.010) | 0.002 | reference | −0.013 (−0.056; 0.029) | −0.069 (−0.118; −0.020) | 0.013 |
| + changes in total fat mass (g) | −0.028 (−0.046; −0.010) | 0.003 | reference | −0.009 (−0.049; 0.031) | −0.060 (−0.107; −0.014) | 0.018 |
| Dealing with missing follow-up data using LOCF | −0.053 (−0.071; −0.035) | <0.001 | reference | −0.034 (−0.072; 0.004) | −0.119 (−0.163; −0.074) | <0.001 |
| B. Android-to-gynoid fat ratio z-score | Continuous | Tertiles of increment in CQI | ||||
|---|---|---|---|---|---|---|
| CQI (for 3-point increment) | T1 (low) |
T2 (medium) |
T3 (high) |
|||
| β (95% CI) | p-value | β (95% CI) | β (95% CI) | β (95% CI) | p for trend | |
| Overall | −0.038 (−0.059; −0.017) | <0.001 | reference | −0.041 (−0.087; 0.006) | −0.060 (−0.114; −0.005) | 0.047 |
| Nutritional factors | ||||||
| + changes in intake of carbohydrates (g/day) | −0.039 (−0.060; −0.018) | <0.001 | reference | −0.041 (−0.088; 0.005) | −0.061 (−0.115; −0.006) | 0.044 |
| + changes in intake of MUFA, PUFA, SFA, trans FA, and protein (g/day) | −0.030 (−0.052; −0.008) | 0.008 | reference | −0.029 (−0.076; 0.018) | −0.037 (−0.093; 0.018) | 0.257 |
| + changes in adherence to erMedDiet (17p score) | −0.019 (−0.042; 0.005) | 0.120 | reference | −0.012 (−0.060; 0.036) | −0.007 (−0.066; 0.052) | 0.981 |
| + changes in UPF consumption (% of total intake g/day) | −0.036 (−0.057; −0.014) | 0.001 | reference | −0.036 (−0.083; 0.011) | −0.053 (−0.108; 0.002) | 0.086 |
| Excluding total energy intake (kcal/day) | −0.037 (−0.058; −0.016) | 0.001 | reference | −0.039 (−0.085; 0.007) | −0.057 (−0.111; −0.003) | 0.056 |
| Health conditions | ||||||
| + number of MetS factors | −0.038 (−0.059; −0.017) | <0.001 | reference | −0.040 (−0.086; 0.007) | −0.058 (−0.113; −0.004) | 0.051 |
| + history of overweight | −0.036 (−0.060; −0.017) | <0.001 | reference | −0.041 (−0.088; 0.005) | −0.060 (−0.114; −0.006) | 0.044 |
| + changes in body weight (kg) | −0.029 (−0.050; −0.007) | 0.008 | reference | −0.029 (−0.075; 0.017) | −0.037 (−0.091; 0.017) | 0.239 |
| + changes in total fat mass (g) | −0.028 (−0.049; −0.007) | 0.008 | reference | −0.028 (−0.074; 0.017) | −0.036 (−0.089; 0.018) | 0.254 |
| Dealing with missing follow-up data using LOCF | −0.030 (−0.048; −0.013) | 0.001 | reference | −0.027 (−0.065; 0.010) | −0.044 (−0.088; 0.001) | 0.084 |
| C. Total fat mass z-score | Continuous | Tertiles of increment in CQI | ||||
|---|---|---|---|---|---|---|
| CQI (per 3-point increment) | T1 (low) |
T2 (medium) |
T3 (high) |
|||
| β (95% CI) | p-value | β (95% CI) | β (95% CI) | β (95% CI) | p for trend | |
| Overall | −0.064 (−0.080; −0.047) | <0.001 | reference | −0.077 (−0.113; −0.041) | −0.152 (−0.194; −0.110) | <0.001 |
| Nutritional factors | ||||||
| + changes in intake of carbohydrates (g/day) | −0.064 (−0.080; −0.047) | <0.001 | reference | −0.077 (−0.113; −0.041) | −0.152 (−0.194; −0.110) | <0.001 |
| + changes in intake of MUFA, PUFA, SFA, trans FA, and protein (g/day) | −0.055 (−0.072; −0.038) | <0.001 | reference | −0.065 (−0.101; 0.029) | −0.131 (−0.173; −0.088) | <0.001 |
| + changes in adherence to erMedDiet (17p score) | −0.034 (−0.052; −0.016) | <0.001 | reference | −0.039 (−0.076; −0.003) | −0.083 (−0.128; −0.038) | 0.001 |
| + changes in UPF consumption (% of total intake g/day) | −0.058 (−0.075; −0.041) | <0.001 | reference | −0.069 (−0.104; −0.033) | −0.140 (−0.182; −0.098) | <0.001 |
| Excluding total energy intake (kcal/day) | −0.062 (−0.078; −0.045) | <0.001 | reference | −0.073 (−0.109; −0.038) | −0.147 (−0.189; −0.105) | <0.001 |
| Health conditions | ||||||
| + number of MetS factors | −0.064 (−0.080; −0.047) | <0.001 | reference | −0.077 (−0.113; −0.042) | −0.153 (−0.195; −0.111) | <0.001 |
| + history of overweight | −0.064 (−0.080; −0.047) | <0.001 | reference | −0.077 (−0.113; −0.042) | −0.152 (−0.194; −0.111) | <0.001 |
| + changes in body weight (kg) | −0.015 (−0.028; −0.002) | 0.028 | reference | −0.021 (−0.050; 0.007) | −0.043 (−0.077; −0.009) | 0.020 |
| Dealing with missing follow-up data using LOCF | −0.052 (−0.065; −0.038) | <0.001 | reference | −0.061 (−0.090; −0.033) | −0.122 (−0.156; −0.088) | <0.001 |
Abbreviations: FA – fatty acids; CQI – carbohydrate quality index, erMedDiet – energy-restricted Mediterranean diet; LOCF – last observation carried forward; MetS – metabolic syndrome; MUFA – monounsaturated fatty acids, PUFA – polyunsaturated fatty acids, SFA – saturated fatty acids; UPF – ultra-processed foods.
Visceral fat (g), android-to-gynoid fat ratio, and total fat mass (% of DXA-derived total body mass (sum of total bone, fat and muscle mass)) were normalized into sex-specific z-scores for analysis.
Analyses were performed using linear mixed-effects models with random intercepts at recruiting center, cluster family and patient level, after adjusting in full model for baseline variables, such as age, sex, study arm, educational level, marital status, smoking habits, type 2 diabetes prevalence, height, as well as repeatedly measured physical activity, sedentary behavior, total energy and alcohol intake, and follow-up time.
In the continuous model, beta represents changes in adiposity indicators expressed as sex-specific z-scores, associated with 3-point increment in CQI. In the categorical model, beta represents changes in adiposity indicators expressed as sex-specific z-scores in each sex-specific tertile of CQI versus tertile 1 (reference category).