Food consumption patterns and Framingham cardiovascular risk score among shift workers: A Nova-based approach

Objective: To evaluate the association between dietary quantity and variety, by extent and purpose of processing, and Framingham cardiovascular disease (CVD) risk score among rotating shift workers.

Methods: The cross-sectional study included male shift workers. Dietary intake was assessed using a 24-h recall method conducted by trained interviewers. Food items were classified using two approaches: the first was based on the amount of food consumed in each food group. Fruits, vegetables, and legumes (FVL) intake, is classified as recommended at 400 g per day by WHO guidelines. Ultraprocessed foods (UPFs) were analyzed based on tertiles of daily caloric contribution. The second approach, the Nova dietary diversity score (DDS-Nova) assessed the variety of consumed items within each food group, assigning points for each unique item consumed, irrespective of quantity or frequency. The CVD-risk score was evaluated using the Framingham coronary heart disease risk score, categorizing participants as low risk (<5%) or intermediate to high risk (≥5%). Descriptive, univariate, and multivariate logistic regression were used, with adjustments made for age, skin color, schooling, duration of shift work, physical activity, body mass index and total caloric intake.

Results: The study involved 213 participants, with an average age of 38.67 years (±6.96), a minimum of 26 and a maximum of 60. The majority (62.4%) were between 30 and 40 years old; 49.3% identified themselves as brown; 56.8% had completed high school; and 79.3% were married. The Framingham CVD-risk score indicated that 56.2% were at low risk (<5%) and 43.7% at intermediate to high risk (≥5%). The average consumption of FVL was 272.32 g (±350.43), with 70.4% meeting the recommendation of ≥400 g/day. Participants consumed an average of 3.46 fresh food items, 3.74 minimally processed food items, 2.54 processed food items and 3.39 ultra-processed food items. In the multivariate model, consuming ≥400 g/day of FVL reduced the likelihood of cardiovascular risk ≥5% by 2.12 times (OR: 0.47; 95%CI: 0.23-0.98). Each additional item of fresh food reduced the risk by 49.2% (OR: 0.67; 95%CI: 1.01-1.66), while each additional item of ultra-processed food increased the risk by 30.0% (OR: 1.30; 95%CI: 0.52-0.87). There was no significant association between the calorie intake of ultra-processed foods and cardiovascular risk.

Conclusion: Both adequate consumption of FVL quantity and a greater variety of fresh-foods were associated with a lower chance of CVD-risk, while a higher variety of consumption of UPF items increased this chance.