What can dietary patterns tell us about the Caribbean nutrition transition?

Background: The nutrition transition is a worldwide phenomenon characterized by profound shifts in diet and activity patterns and by major demographic, socioeconomic and health status changes. Despite the urgency regarding increasing rates of obesity and chronic diseases in the Caribbean, very few studies characterize the nutrition transition in this area, in particular changes in dietary patterns. The aim of our study was to characterize dietary patterns typical of the French West Indies and their association with health status, food supply practices and demographic and socioeconomic characteristics. Materials and methods: This cross-sectional analysis included 1,144 subjects (≥16y) from a multistage sampling survey conducted in 2013-2014 on a representative sample of the Guadeloupean and Martinican population. To identify typical dietary patterns, principal component analysis (PCA) was performed using 25 food groups, followed by a clustering procedure in order to classify participants in independent clusters. Then, their associations with health status (body mass index, metabolic syndrome), diet quality index-international (DQI-I), food supply practices (self-production or donation and supply locations for fresh food groups) and sociodemographic and socioeconomic characteristics were studied using multivariable models. Results: Four dietary patterns were identified, representing 25%, 24%, 31% and 20% of the sample, respectively: (1) a "healthy" cluster characterised by a high DQI-I, composed of high educated individuals; (2) a "traditional" cluster with a high DQI-I and high consumption of traditional French West Indies dishes, formed mostly by women and older persons, with a high obesity prevalence (26%); (3) a "western" cluster with the lowest DQI-I, high intakes of sweetened beverages, snacks and fast foods, composed mainly of young participants, buying their fruits, vegetables and tubers only or mainly in supermarkets; and (4) a "transitional" cluster with the highest consumption of bread, processed meat, sauces, butter and alcoholic beverages and high intake of sweetened beverages but conversely high intakes of tubers, legumes, fish and low intakes of biscuits, cakes and pastries. This last cluster was composed mainly of middle age men, self-employed or manual workers, and 35% had metabolic syndrome. Discussion: The diversified dietary patterns identified in the French West Indies seem to reflect different steps of dietary change as described by Popkin et al. (2006), suggesting an ongoing Caribbean nutrition transition. Indeed, these dietary patterns co-exist with a generational contrast, providing useful information for public health actions regarding population groups at higher nutritional risk.