Joint temporal dietary and physical activity patterns: associations with health status indicators and chronic diseases.

BACKGROUND 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 may be used to create patterns with relationships to health status indicators. OBJECTIVES The objectives were to create clusters of joint temporal dietary and PA patterns (JTDPAPs); determine their association with health status indicators including BMI, waist circumference (WC), fasting plasma glucose, hemoglobin A1c, triglycerides, high-density lipoprotein cholesterol, total cholesterol, blood pressure and disease status including obesity, T2DM, and MetS in United States adults. DESIGN A 24-hour dietary recall and random day of accelerometer data of 1836 participants from the cross-sectional NHANES 2003-2006 data were used to create JTDPAPs clusters by constrained dynamic time warping, coupled with kernel k-means clustering algorithm. Multivariate regression models determined associations between the 4 JTDPAP clusters and health and disease status indicators, controlling for potential confounders and adjusting for multiple comparisons. RESULT A JTDPAP cluster with proportionally equivalent energy consumed at two main eating occasions reaching up to 1600 and 2200 kcal from 11:00 to 13:00 and 17:00 to 20:00, and the highest PA counts among 4 clusters from 8:00 to 20:00, was associated with significantly lower body mass index (BMI) (P < 0.0001), WC (P = 0.0001), total cholesterol (P = 0.02) and odds of obesity (OR = 0.2, 95% CI: 0.1, 0.5) compared to a JTDPAP cluster with proportionally equivalent energy consumed reaching up to 1600 and 1800 kcal from 11:00 to 14:00 and 17:00 to 21:00, and high PA counts from 9:00 to 12:00. CONCLUSIONS The joint temporally patterned sequence of diet and PA can be used to cluster individuals with meaningful associations to BMI, WC, total cholesterol, and obesity. Temporal patterns hold promise for future development of lifestyle patterns that integrate additional temporal and contextual activities.