Association of cooking patterns with inflammatory and cardio-metabolic risk biomarkers

nu ien s A icle Associa ion o Cooking Pa e ns wi h In lamma o y and Ca dio-Me abolic Risk Bioma ke s Belén Mo eno-F anco 1,2 , Mon se a Rod íguez-Ayala 3, Ca olina Dona -Va gas 3,4,5, Helena Sando al-Insaus i 3,6, Jimena Rey-Ga cía3,7 , Es he Lopez-Ga cia 3,4, JoséR. Banegas 3, Fe nando Rod íguez-A alejo 3,4 and Pila Gualla -Cas illón3,4,*   Ci a ion: Mo eno-F anco, B.; Rod íguez-Ayala, M.; Dona -Va gas, C.; Sando al-Insaus i, H.; Rey-Ga cía, J.; Lopez-Ga cia, E.; Banegas, J.R.; Rod íguez-A alejo, F.; Gualla - Cas illón, P. Associa ion o Cooking Pa e ns wi h In lamma o y and Ca dio-Me abolic Risk Bioma ke s. Nu ien s 2021,13, 633. h ps:// doi.o g/10.3390/nu13020633 Academic Edi o : Ma a Guasch-Fe é Recei ed: 29 Decembe 2020 Accep ed: 13 Feb ua y 2021 Published: 16 Feb ua y 2021 Publishe ’s No e: MDPI s ays neu al wi h ega d o ju isdic ional claims in published maps and ins i u ional a il- ia ions. Copy igh : © 2021 by he au ho s. Licensee MDPI, Basel, Swi ze land. This a icle is an open access a icle dis ibu ed unde he e ms and condi ions o he C ea i e Commons A ibu ion (CC BY) license (h ps:// c ea i ecommons.o g/licenses/by/ 4.0/). 1Depa men o Mic obiology, Pedia ics, Radiology and Public Heal h, Uni e sidad de Za agoza, 50009 Za agoza, Spain; mbmo eno@uniza .es 2Ins i u o de In es igación Sani a ia A agón, Hospi al Uni e si a io Miguel Se e , 50009 Za agoza, Spain 3Depa men o P e en i e Medicine and Public Heal h, School o Medicine, Uni e sidad Au ónoma de Mad id-IdiPAZ and CIBERESP (CIBER o Epidemiology and Public Heal h), 28029 Mad id, Spain; [email p o ec ed] (M.R.-A.); ca [email p o ec ed] (C.D.-V.); [email p o ec ed] (H.S.-I.); jimena. eyga [email p o ec ed] (J.R.-G.); es he [email p o ec ed] (E.L.-G.); [email p o ec ed] (J.R.B.); [email p o ec ed] (F.R.-A.) 4IMDEA-Food Ins i u e, CEI UAM+CSIC, 28049 Mad id, Spain 5Uni o Nu i ional Epidemiology, Ins i u e o En i onmen al Medicine, Ka olinska Ins i u e , 17177 S ockholm, Sweden 6Depa men o Nu i ion, Ha a d T.H. Chan School o Public Heal h, Bos on, MA 02115, USA 7In e nal Medicine Depa men , Ramón y Cajal Uni e si y Hospi al, 28034 Mad id, Spain *Co espondence: mpila [email p o ec ed] Abs ac : Die has been clea ly associa ed wi h ca dio ascula disease, bu ew s udies ocus on he in luence o cooking and ood p ese a ion me hods on heal h. The aim o his s udy was o desc ibe cooking and ood p ese a ion pa e ns, as well as o examine hei associa ion wi h in lamma o y and ca dio-me abolic bioma ke s in he Spanish adul popula ion. A c oss-sec ional s udy o 10,010 indi iduals, ep esen a i e o he Spanish popula ion, aged 18 yea s o o e was pe o med using da a om he ENRICA s udy. Food consump ion da a we e collec ed h ough a ace- o- ace die a y his o y. Cooking and ood p ese a ion pa e ns we e iden i ied by ac o analysis wi h a imax o a ion. Linea eg ession models adjus ed o main con ounde s we e buil . Fou cooking and ood p ese a ion pa e ns we e iden i ied. The Spanish adi ional pa e n (posi i ely co ela ed wi h boiling and sau éing, b ining, and ligh ying) ends o be ca dio-me abolically bene icial (wi h a educ ion in C- eac i e p o ein ( − 7.69%)), excep o high densi y lipop o ein choles e ol (HDL-c), insulin le els, and an h opome ics. The heal h-conscious pa e n (nega i ely co ela ed wi h ba e ing, ying, and s ewing) ends o imp o e enal unc ion (wi h a educ ion in u ine albumin ( − 9.60%) and he u ine albumin/c ea inine a io ( − 4.82%)). The you h-s yle pa e n (posi i ely co ela ed wi h so d inks and dis illed alcoholic d inks and nega i ely wi h aw ood consump ion) ends o be associa ed wi h good ca dio-me abolic heal h excep , o lowe HDL-c ( − 6.12%), highe insulin (+6.35%), and highe u ine albumin (+27.8%) le els. The social business pa e n (posi i ely co ela ed wi h he consump ion o e men ed alcoholic d inks, ood cu ed wi h sal o smoke, and cu ed cheese) ends o be de imen al o he lipid p o ile (excep HDL-c), enal unc ion (u ine albumin +8.04%), dias olic blood p essu e (+2.48%), and an h opome ics. Cooking and ood p ese a ion pa e ns showed a ela ionship wi h in lamma o y and ca dio-me abolic heal h bioma ke s. The Spanish adi ional pa e n and he heal h-conscious pa e n we e associa ed wi h bene icial e ec s on heal h and should be p omo ed. The you h-s yle pa e n calls a en ion o some conce ns, and he social business pa e n was he mos de imen al one. These indings suppo he in luence o cooking and p ese a ion pa e ns on heal h. Keywo ds: ca dio ascula isk ac o s; in lamma o y ma ke s; die a y pa e ns; cooking me hods; ood p ese a ion Nu ien s 2021,13, 633. h ps://doi.o g/10.3390/nu13020633 h ps://www.mdpi.com/jou nal/nu ien s Nu ien s 2021,13, 633 2 o 14 1. In oduc ion Unheal hy ea ing is associa ed wi h majo causes o dea h, such as ca dio ascula disease (CVD) and some ypes o cance [ 1 ]. Food consump ion guidelines o ch onic disease p e en ion base hei ecommenda ions on da a exclusi ely ocused on nu ien s, oods, ood g oups, and, mo e ecen ly, die a y pa e ns; howe e , hey ha dly ake in o accoun he in luence o cooking and ood p ese a ion me hods on heal h. Cooking and ood p ese a ion me hods modi y he o ganolep ic condi ions o ood, making i mo e pala able, while in luencing he bioa ailabili y o nu ien s, i amins, and mine als. A he same ime, some cooking and ood p ese a ion me hods, (as in ying) inc ease a and ene gy con en , as well as he possible p esence o oxic elemen s ha may esul , o example, om he cooking and ehea ing o ood [2]. F ying is he cooking me hod mos widely s udied. When a ood is ied, wa e is eplaced by a , and he composi ion o he ood is modi ied. The e is also an inc ease in ans- a y acids as a esul o deep ying [ 3 ]. The i s ele an a icle on he heal h e ec s o ying was a c oss-sec ional analysis o 30,000 middle-aged adul s. An inc ease in o e all obesi y and cen al obesi y was obse ed among hose wi h a high in ake o ied ood [ 4 ]. Howe e , in longi udinal analyses, ied ood consump ion was no associa ed wi h co ona y hea disease, s oke, o all-cause mo ali y [ 5 , 6 ]. Mo eo e , in a p ospec i e coho , a high consump ion o ied ood was also linked wi h weigh gain, cen al obesi y, and hype ension [ 7 – 9 ]. O he longi udinal analyses [ 10 , 11 ] ha e shown an associa ion o ied ood consump ion wi h diabe es, CVD, and hea ailu e [ 12 ]. Thus, based on his e idence, he cu en ecommenda ion is o consume ied ood in mode a ion, while emphasizing an o e all heal hy die [13]. O he cooking me hods ha e ba ely been s udied. Boiling and o he cooking me hods ha use he applica ion o hea lead o deg ada ion o i amins, as well as an inc ease in he glycemic index, leading o as e abso p ion o suga [ 14 ], as well as he o ma ion o oxic subs ances such as ac ylamide when hea ing oods ich in s a ch [ 15 ] o he e ocyclic amines when applying hea o mea p oduc s [ 16 ]. Fu he mo e, he inc ease in sal in ake esul ing om p ese a ion me hods such as b ining, sal cu ing, o canning [ 17 ] a e clea examples o how indus ial p ocessing has an impac on heal h. In addi ion, a esul o his indus ial p ocessing is an inc ease in oxida i e s ess and in lamma ion [ 18 ]. On he con a y, die s composed exclusi ely o aw ood ha e shown an associa ion wi h nega i e heal h ou comes [ 19 , 20 ]. Resea ch on o he o ms o cooking is e y limi ed and mainly ocuses on speci ic oods [21–25]. The s udy o die a y pa e ns p o ides a global app oach conce ning he associa ion be ween ood consump ion and ch onic diseases. The e o e, i seems easonable o include he in luence o cooking and ood p ese a ion me hods when assessing die as a whole. The aim o his s udy is o iden i y cooking and ood p ese a ion pa e ns in he Spanish adul popula ion and o examine hei associa ion wi h in lamma o y and ca dio-me abolic bioma ke s. Cooking me hods, beyond he consump ion o ied oods, a e li le analyzed and ha e ne e been s udied as a pa e n. 2. Ma e ials and Me hods 2.1. S udy Design, Se ing, and Pa icipan s Da a we e aken om he ENRICA s udy, whose me hods ha e been desc ibed else- whe e [ 26 ]. In b ie , his coho was se up in 2008–2010 wi h 12,948 indi iduals aged ≥ 18 yea s, ep esen a i e o he Spanish popula ion. The ENRICA s udy was app o ed by he Clinical Resea ch E hics Commi ee o La Paz Uni e si y Hospi al (e hics app o al code HULP-PI-1793). S udy pa icipan s ga e in o med w i en consen . 2.2. Die a y Assessmen Food consump ion da a we e collec ed wi h a alida ed ace- o- ace compu e ized die his o y [ 27 ] ob ained by ained in e iewe s. The die a y his o y allowed o he collec ion o s anda dized da a on 860 oods. Each ood was assigned a cooking o p ese a ion Nu ien s 2021,13, 633 3 o 14 me hod, including mixed o ms o cooking ( o example, ege ables ha a e i s boiled and hen sau éed) (Table A1). The so wa e includes 127 se s o digi ized pho og aphs o help quan i y he size o ood po ions. Habi ual ood consump ion akes in o accoun a ypical week in he p eceding yea , and e e y ood consumed a leas once e e y 15 days was conside ed. The in ake o mac onu ien s, mic onu ien s, and mine als om he oods was es ima ed using Spanish composi ion ables [28]. Twen y- ou possible cooking and ood p ese a ion me hods we e assessed: i een cooking me hods ( aw (no cooked), dai y p oduc s (including milk, yogu s, and esh uncu ed cheese), boiling, oas ing, pan- ying, ying, oas ing, sau éing, s ewing, boiling and hen sau éing, ligh ying (so i o), ba e ing (b ead c umbed), s eaming, ba becuing, and mic owa ing), i e p ese ing me hods (cu ing cheese, cu ing wi h sal o smoke, canning in oil, canning no in oil, and b ining), and ou g oups o be e ages (so d inks, e men ed alcoholic d inks, co ee o ea, and dis illed alcoholic d inks). 2.3. An h opome ic, Clinical, and Biochemical Cha ac e is ics Heigh was measu ed wice wi h po able ex endable s adiome e s (model Ka We 44 444Seca), weigh wi h an elec onic scale (p ecision 100 g), and wais and hip ci cum e ences wi h a lexible inelas ic bel - ype ape, ollowing s anda dized p o ocols [ 29 ]. The weigh o pa icipan s was aken in he mo ning, a e 12 h o as ing, and in ligh clo hes. The body mass index (BMI) was calcula ed as weigh in kilog ams di ided by heigh in me e s- squa ed. Blood p essu e was measu ed using s anda d p ocedu es [ 30 ] and alida ed au oma ic de ices (Om on M6) wi h app op ia e cu s o h ee sizes. Bioma ke s o in lamma ion and ca dio-me abolic isk we e de e mined in 12 h as ing blood samples. High-sensi i i y C- eac i e p o ein (Hs-CRP) was measu ed by la ex- enhanced nephelome y and ib inogen by he coagula ion me hod. To al choles e ol was measu ed by enzyma ic me hods using choles e ol es e ase and choles e ol oxidase; high densi y lipop o ein choles e ol (HDL-c) by he di ec me hod by elimina ion/ca alase, and iglyce ides by he glyce ol phospha e oxidase me hod. Low densi y lipop o ein choles- e ol (LDL-c) le els we e calcula ed wi h he F iedewald equa ion [ 31 ]. Fas ing glucose was measu ed by he glucose oxidase me hod and insulin by immuno adiome ic assay. Homeos a ic model assessmen o insulin esis ance (HOMA-IR) was calcula ed by mul i- plying as ing se um insulin ( µ IU/mL) by as ing se um glucose (mg/dL) and di iding by 405 [ 32 ]. U ic acid was measu ed by he u icase-pe oxidase echnique, c ea inine by he Ja éalkaline pic a e kine ic eac ion, and albumin in u ine by polye hylene glycol (PEG)-enhanced immuno u bidime y. All he labo a o y de e mina ions we e pe o med cen ally a he Cen e o Biological Diagnosis o he Clinic Hospi al in Ba celona acco ding o s anda d p ocedu es and using app op ia e quali y con ols. 2.4. O he Va iables Pa icipan s epo ed hei sex, age, educa ional le el (p ima y, seconda y, and uni- e si y), and smoking s a us (cu en , o me , o ne e smoke ). Physical ac i i y a leisu e ime was assessed wi h he EPIC (Eu opean P ospec i e In es iga ion in o Cance and Nu i ion) Spain coho ques ionnai e [ 33 ] and exp essed in me abolic equi alen s (METs)-hou s/week [ 34 ]. The numbe o hou s pe week spen wa ching TV was also epo ed. The in e iewe collec ed he ollowing sel - epo ed diseases diagnosed by a physician: pneumonia, as hma o ch onic b onchi is, hea in a c ion, s oke o hea ailu e, os eoa h i is/a h i is, hip ac u e, cholecys oli hiasis, in es inal polyps, s omach o duodenal ulce , ci hosis, u ina y ac in ec ion, ca a ac , dep ession equi ing d ug ea men , Pa kinson’s disease, demen ia, Alzheime ’s disease, and pe iodon al disease. Nu ien s 2021,13, 633 4 o 14 2.5. S a is ical Analysis The s udy sample comp ised 12,948 indi iduals. O hese, hose wi h a lack o da a on die , bioma ke s o in lamma ion and ca dio-me abolic isk, o o he a iables we e excluded. Thus, he inal analy ical sample included 10,010 indi iduals. An explo a o y ac o analysis wi h a imax o a ion was ca ied ou o iden i y cooking and ood p ese a ion pa e ns. The ac o s we e o a ed by he a imax unc ion. An o hogonal o a ion was made o assimila e each a iable wi h an axis, educing he complexi y o he pa e ns and acili a ing hei in e p e a ion [ 35 ]. Posi i e loading ac o s indica ed ha he indi idual cooking o p ese a ion me hod was di ec ly associa ed wi h he ac o s, while nega i e loading ac o s indica ed an in e se associa ion wi h he ac o s. Fac o ial loadings abo e 0.3 we e conside ed o be majo con ibu o s o he ac o s [ 36 ]. Cooking pa e ns we e named acco ding o he cooking and ood p ese a ion me hods ha con ibu ed he mos . The associa ions be ween each cooking and p ese a ion pa e n wi h in lamma o y and ca dio-me abolic isk bioma ke s we e e alua ed by mul i a ia e linea eg ession. Each pa icipan ecei ed a sco e o each pa e n ha indica ed he deg ee o ad- he ence o ha pa icipan o ha speci ic pa e n. So, cooking and p ese a ion pa e ns we e modeled in sex-speci ic qua iles, and he lowes qua ile was used as e e ence. In lamma o y and ca dio-me abolic bioma ke s ha did no ollow a no mal dis ibu- ion we e log- ans o med p io o s a is ical analysis. Fo each qua ile, he adjus ed ma ginals o he bioma ke s we e calcula ed. The geome ic mean ( ± SD) was ob ained by in e se ans o ma ion. As a summa y o aid in e p e a ion, he ela i e di e ences be ween ex eme qua iles we e calcula ed and p esen ed in a summa y able (( alue in he i s qua ile- alue in he las qua ile)/ alue in he i s qua iles). The linea end was calcula ed conside ing qua iles as a con inuous a iable. The linea eg ession models we e adjus ed o sex, age, educa ional le el (p ima y, seconda y, o uni e si y), smoking s a us (cu en , o me , o ne e smoke ), physical ac i i y (MET-h/week), ime spen wa ching TV (h/week), ene gy in ake (kcal/day), and mo bidi y ( o ha e a leas one o he conside ed como bidi ies). Only ela i e changes among ex eme qua iles g ea e han 1% we e conside ed o he desc ip ion o he ends. All analyses we e pe o med wi h STATA ( e sion 15.0; S a aCo p). S a is ical es s we e 2- ailed wi h a signi icance le el o 5%. 3. Resul s The explo a o y ac o ial analysis iden i ied ou cooking and ood p ese a ion pa e ns. The i s pa e n was posi i ely associa ed wi h sau éing and boiling, b ining, ligh ying (so i o), oas ing, boiling, canning in oil, and ying and nega i ely associa ed wi h pan- ying, and his was named he Spanish adi ional pa e n. The second ac o was posi i ely associa ed wi h oas ing, b ining, s eaming, and canning in oil and nega i ely associa ed wi h ba e ing, ying, and s ewing, and his was named he heal h-conscious pa e n. The hi d ac o was posi i ely associa ed wi h so d inks and dis illed alcoholic d inks and nega i ely associa ed wi h he consump ion o aw ood, co ee, and ea, and his was named he you h-s yle pa e n. The ou h ac o was posi i ely associa ed wi h e men ed alcoholic d inks, cu ing (sal ed o smoked), cu ing cheese, and dis illed alcoholic d inks and nega i ely associa ed wi h he in ake o dai y p oduc s, and his was named he social business pa e n (Table 1). These ou pa e ns accoun ed o 22% o he a iance o o al cooking and ood p ese a ion me hods. Pa icipan s wi h a g ea e adhe ence o he Spanish adi ional pa e n we e less physically ac i e, wa ched less TV, and epo ed a g ea e in ake o ene gy han hose wi h a lowe adhe ence o his pa e n. Pa icipan s wi h a g ea e adhe ence o he heal h- conscious pa e n we e mo e educa ed, less equen ly smoked, we e mo e physically ac i e, wa ched less TV, and epo ed a lowe ene gy in ake. Pa icipan s wi h a g ea e adhe ence o he you h-s yle pa e n we e younge , mo e educa ed, and mo e equen smoke s and pe o med mo e physical ac i i y, wa ched less TV, epo ed a highe ene gy Nu ien s 2021,13, 633 5 o 14 in ake, and had ewe como bidi ies. Finally, pa icipan s wi h a g ea e adhe ence o he social business pa e n we e mo e educa ed, mo e equen ly smoked, pe o med less physical ac i i y, spen less ime wa ching TV, had a highe ene gy in ake, and had ewe como bidi ies compa ed o hose wi h a lowe adhe ence o his pa e n (Table 2). Table 1. Va imax- o a ed ac o -loading ma ix ob ained using ac o analysis. Cooking and Food P ese a ion Me hods G ams Mean (SD) Spanish T adi ional Pa e n Heal h-Conscious Pa e n You h-S yle Pa e n Social Business Pa e n Cooking me hods Raw (no cooked) 356.5 (215.9) −0.574 Dai y p oduc s 276.9 (170.8) −0.436 Boiling 271.4 (138.8) 0.398 Roas ing 197.0 (109.8) 0.426 Pan- ying 66.8 (65.1) −0.326 F ying 58.2 (55.3) 0.370 −0.451 Toas ing 34.7 (44.0) 0.407 Sau éing 33.5 (38.2) S ewing 25.1 (37.8) −0.440 Boiling and hen sau éing 23.3 (26.9) 0.558 Ligh ying (so i o) 18.7 (21.9) 0.443 Ba e ing (b ead c umbed) 9.1 (21.6) −0.458 S eaming 2.2 (10.5) 0.368 Ba becuing 1.5 (10.5) Mic owa ing 0.8 (7.1) P ese ing me hods Cu ing cheeses 21.7 (33.1) 0.478 Cu ing (wi h sal o smoke) 17.8 (30.9) 0.487 Canning in oil 6.7 (11.2) 0.377 0.304 Canning (no in oil) 5.2 (15.8) B ining 4.4 (10.3) 0.449 0.383 Be e ages So d inks 133.4 (252.1) 0.648 Fe men ed alcoholic d inks 127.9 (243.2) 0.583 Co ee o ea 113.3 (127.1) −0.400 Dis illed alcoholic d inks 4.6 (18.5) 0.464 0.336 Loading ac o s o <0.30 a e no shown. Rega ding he associa ion be ween he di e en iden i ied pa e ns and he measu ed bioma ke s, pa icipan s wi h a highe adhe ence o he Spanish adi ional pa e n had lowe le els o Hs-CRP ( − 7.69%), ib inogen ( − 1.79%), o al choles e ol ( − 1.39%), LDL- c ( − 1.44%), glucose ( − 1.09%), and u ine albumin/c ea inine a io ( − 1.87%). On he con a y, hey ended o p esen a de imen al p o ile o HDL-c ( − 2.28%), insulin (+1.58%), and an h opome ic measu emen s (BMI +0.97%; wais ci cum e ence +1.75%; wais - o- hip a io +1.13%) (Table 3). The heal h-conscious pa e n was associa ed wi h lowe le els o u ine albumin ( − 9.60%) and a low u ine albumin/c ea inine a io ( − 4.82%) (Table 4). The you h-s yle pa e n was associa ed wi h lowe le els o Hs-CRP ( − 7.69%), ib inogen ( − 5.62%), o al choles e ol ( − 9.09%), LDL-c ( − 11.7%), iglyce ides ( − 5.03%), glucose ( − 6.72%), u ic acid ( − 4.42%), u ine albumin/c ea inine a io ( − 6.36%), sys olic and dias olic blood p essu e ( − 5.82% and − 4.37% espec i ely), BMI ( − 4.26%), wais ci cum e ence ( − 5.19%), and wais - o-hip a io ( − 4.49%). In con as , i showed lowe le els o HDL-c ( − 6.12%), insulin (+6.35%), and u ine albumin (+27.8%) (Table 5). The social business pa e n was associa ed wi h lowe le els o ib inogen ( − 3.56%), insulin (5.81%), and HOMA-IR ( − 5.71%). On he con a y, i p esen ed highe le els o o al choles e ol, LDL-c (+3.94%), HDL-c (+3.51%), iglyce ides (+3.68%), u ic acid (+4.42%), u ine albumin (+8.04), dias olic blood p essu e (+2.48%), and an h opome ics (BMI +1.44%; wais ci cum e ence +1.06%; wais - o-hip a io +1.13%) (Tables 6and A2). Nu ien s 2021,13, 633 6 o 14 Table 2. Cha ac e is ics o he s udy pa icipan s by qua iles o adhe ence o he cooking and ood p ese a ion pa e ns. The ENRICA s udy 2008–2010. Spanish T adi ional Pa e n Heal h-Conscious Pa e n You h-S yle Pa e n Social Business Pa e n Q1 Q4 p-Value T end Q1 Q4 p-Value T end Q1 Q4 p-Value T end Q1 Q4 p-Value T end n= 2.315 n= 2.522 n= 2.516 n= 2.381 n= 2.464 n= 2.463 n= 2.452 n= 2.501 Men, n, % 1188 (51.3) 1258 (49.9) 0.787 1273 (50.6) 1195 (50.2) 0.938 1257 (51.0) 1236 (50.2) 0.956 1217 (49.6) 1246 (49.8) 0.711 Age, y 47.9 (0.42) 47.1 (0.48) 0.389 47.2 (0.49) 46.0 (0.52) 0.188 55.2 (0.41) 36.0 (0.42) <0.001 47.8 (0.51) 46.6 (0.52) 0.016 Educa ion, n, % 0.114 <0.001 <0.001 <0.001 P ima y 693 (29.9) 840 (33.3) 837 (33.3) 687 (28.9) 855 (34.7) 562 (22.8) 820 (33.4) 664 (26.5) Seconda y 940 (40.6) 1022 (40.5) 1076 (42.7) 952 (40.0) 837 (34.0) 1340 (54.4) 976 (39.8) 1074 (42.9) Uni e si y 682 (29.5) 660 (26.2) 603 (24.0) 742 (31.1) 772 (31.3) 561 (22.8) 656 (26.8) 763 (30.5) Smoking s a us, n, % 0.396 <0.001 <0.001 <0.001 Cu en smoke 653 (28.2) 660 (26.2) 769 (30.5) 612 (25.7) 499 (20.2) 898 (36.5) 524 (21.4) 850 (34.0) Fo me smoke 598 (25.8) 617 (24.5) 583 (23.2) 665 (27.9) 810 (32.9) 412 (16.7) 507 (20.7) 710 (28.4) Ne e smoke 1064 (46.0) 1245 (49.3) 1164 (46.3) 1104 (46.4) 1155 (46.9) 1152 (46.8) 1421 (57.9) 941 (37.6) Physical ac i i y, MET-h/week 29.6 (21.5) 27.8 (23.0) <0.001 26.3 (21.6) 31.0 (22.6) <0.001 28.1 (20.1) 31.1 (24.8) <0.001 28.8 (22.4) 28.2 (22.3) <0.001 Time wa ching TV, h/week 14.0 (9.6) 13.7 (10.9) <0.001 13.9 (10.5) 13.5 (10.0) <0.001 14.2 (10.0) 13.2 (9.8) <0.001 14.3 (10.3) 13.2 (9.9) <0.001 Ene gy in ake, kcal/day 1874.7 (549.3) 2600.1 (619.6) <0.001 2372.2 (674.7) 2265.1 (602.3) <0.001 2076.5 (573.7) 2457.0 (650.6) <0.001 2023.7 (592.5) 2450.0 (624.0) <0.001 Mo bidi y, n, % 943 (40.7) 1051 (41.7) 0.473 1070 (42.5) 920 (38.6) 0.138 1185 (48.1) 799 (32.4) <0.001 1108 (45.2) 921 (36.8) <0.001 MET: me abolic equi alen s. Nu ien s 2021,13, 633 7 o 14 Table 3. Plasma and u ine concen a ions o in lamma o y and ca dio-me abolic bioma ke s, blood p essu e, and an h opo- me ics acco ding o he qua iles o he Spanish adi ional pa e n. Spanish T adi ional Pa e n 1 Q1 Q2 Q3 Q4 p-Value o T end Bioma ke s High-sensi i i y C- eac i e p o ein (Hs-CRP) (mg/L) 20.13 (1.42) 0.13 (1.41) 0.13 (1.44) 0.12 (1.46) <0.001 Fib inogen (g/L) 23.34 (1.09) 3.31 (1.09) 3.30 (1.09) 3.28 (1.09) <0.001 To al choles e ol (mg/dL) 2193.72 (1.07) 192.49 (1.07) 191.70 (1.07) 191.02 (1.07) <0.001 LDL-choles e ol (mg/dL) 2117.90 (1.08) 117.08 (1.08) 116.53 (1.09) 116.20 (1.09) <0.001 HDL-choles e ol (mg/dL) 252.08 (1.12) 51.76 (1.13) 51.39 (1.13) 50.89 (1.14) <0.001 T iglyce ides (mg/dL) 295.70 (1.17) 94.70 (1.17) 94.81 (1.19) 95.06 (1.19) 0.425 Glucose (mg/dL) 292.14 (1.07) 91.49 (1.07) 91.31 (1.07) 91.13 (1.08) <0.001 Insulin (µIU/mL) 27.46 (1.12) 7.45 (1.12) 7.51 (1.13) 7.58 (1.14) <0.001 Homeos a ic model assessmen o insulin esis ance (HOMA-IR) 21.70 (1.18) 1.68 (1.18) 1.70 (1.19) 1.71 (1.20) 0.319 U ic acid (mg/dL) 25.08 (1.17) 5.08 (1.18) 5.09 (1.19) 5.12 (1.20) 0.242 U ine albumin (mg/dL) 26.29 (1.21) 6.31 (1.21) 6.32 (1.22) 6.37 (1.23) 0.130 U ine albumin/c ea inine a io (mg/g c ea inine) 25.34 (1.22) 5.26 (1.21) 5.26 (1.22) 5.24 (1.23) 0.034 Blood p essu e Sys olic blood p essu e (mmHg) 129.52 (9.16) 128.59 (9.03) 128.25 (9.82) 128.24 (9.97) 0.002 Dias olic blood p essu e (mmHg) 75.63 (3.11) 75.50 (3.09) 75.50 (3.32) 75.69 (3.38) 0.693 An h opome ics Body mass index (kg/m2)26.64 (1.95) 26.57 (1.91) 26.68 (2.09) 26.90 (2.15) 0.001 Wais ci cum e ence (cm) 89.91 (8.20) 89.96 (8.17) 90.52 (8.93) 91.52 (9.12) <0.001 Wais - o-hip a io 0.87 (0.06) 0.87 (0.06) 0.88 (0.07) 0.88 (0.07) 0.009 1 Values a e adjus ed o sex, age, educa ional le el (p ima y, seconda y, o uni e si y), smoking s a us (cu en , o me , o ne e smoke ), physical ac i i y (MET-h/week), ime spen wa ching TV (h/week), ene gy in ake (kcal/day), and mo bidi y (yes, no). 2 Geome ic means. LDL: Low densi y lipop o ein; HDL: high densi y lipop o ein. Table 4. Plasma and u ine concen a ions o in lamma o y and ca dio-me abolic bioma ke s, blood p essu e, and an h opo- me ics acco ding o he qua iles o he heal h-conscious pa e n 1. Heal h-Conscious Pa e n 1 Q1 Q2 Q3 Q4 p-Value o T end Bioma ke s Hs-CRP (mg/L) 20.13 (1.45) 0.13 (1.43) 0.13 (1.42) 0.13 (1.42) 0.132 Fib inogen (g/L) 23.29 (1.10) 3.32 (1.09) 3.32 (1.09) 3.31 (1.09) 0.048 To al choles e ol (mg/dL) 2192.06 (1.07) 192.63 (1.07) 192.84 (1.07) 191.22 (1.07) 0.184 LDL-choles e ol (mg/dL) 2117.00 (1.09) 117.29 (1.09) 117.28 (1.08) 116.00 (1.08) 0.018 HDL-choles e ol (mg/dL) 251.27 (1.14) 51.50 (1.13) 51.86 (1.12) 51.43 (1.13) 0.279 T iglyce ides (mg/dL) 294.99 (1.19) 95.35 (1.18) 94.82 (1.18) 95.05 (1.18) 0.860 Glucose (mg/dL) 291.20 (1.08) 91.72 (1.07) 91.76 (1.07) 91.34 (1.07) 0.532 Insulin (U/mL) 27.49 (1.13) 7.49 (1.13) 7.47 (1.12) 7.54 (0.13) 0.263 HOMA-IR 21.69 (1.20) 1.70 (1.19) 1.70 (1.18) 1.70 (1.18) 0.344 U ic acid (mg/dL) 25.08 (1.19) 5.10 (1.18) 5.09 (1.18) 5.11 (1.18) 0.626 U ine albumin (mg/dL) 26.72 (1.24) 6.40 (1.22) 6.11 (1.20) 6.07 (1.21) <0.001 U ine albumin/c ea inine a io (mg/g c ea inine) 25.36 (1.23) 5.34 (1.22) 5.26 (1.21) 5.13 (1.21) <0.001 Blood p essu e Sys olic blood p essu e (mmHg) 129.00 (10.02) 129.02 (9.59) 128.60 (9.30) 127.87 (9.03) 0.001 Dias olic blood p essu e (mmHg) 75.94 (3.40) 75.69 (3.26) 75.45 (3.13) 75.22 (3.08) <0.001 An h opome ics Body mass index (kg/m2)26.73 (2.14) 26.68 (2.06) 26.63 (1.97) 26.75 (1.96) 0.969 Wais ci cum e ence (cm) 90.47 (9.15) 90.43 (8.73) 90.35 (8.41) 90.70 (8.31) 0.581 Wais - o-hip a io 0.88 (0.07) 0.88 (0.07) 0.88 (0.06) 0.88 (0.06) 0.823 1 Values a e adjus ed o sex, age, educa ional le el (p ima y, seconda y, o uni e si y), smoking s a us (cu en , o me , o ne e smoke ), physical ac i i y (MET-h/week), ime spen wa ching TV (h/week), ene gy in ake (kcal/day), and mo bidi y (yes, no). 2 Geome ic means. LDL: Low densi y lipop o ein; HDL: high densi y lipop o ein; Hs-CRP: High-sensi i i y C- eac i e p o ein; HOMA-IR: Homeos a ic model assessmen o insulin esis ance. Nu ien s 2021,13, 633 8 o 14 Table 5. Plasma and u ine concen a ions o in lamma o y and ca dio-me abolic bioma ke s, blood p essu e, and an h opo- me ics acco ding o he qua iles o he you h-s yle pa e n 1. You h-S yle Pa e n 1 Q1 Q2 Q3 Q4 p-Value o T end Bioma ke s Hs-CRP (mg/L) 20.13 (1.43) 0.13 (1.45) 0.13 (1.47) 0.12 (1.42) 0.003 Fib inogen (g/L) 23.38 (1.08) 3.35 (1.09) 3.32 (1.09) 3.19 (1.09) <0.001 To al choles e ol (mg/dL) 2200.39 (1.05) 195.46 (1.06) 191.24 (1.06) 182.16 (1.06) <0.001 LDL-choles e ol (mg/dL) 2123.49 (1.07) 119.48 (1.07) 116.09 (1.08) 109.02 (1.07) <0.001 HDL-choles e ol (mg/dL) 253.07 (1.13) 52.16 (1.13) 51.07 (1.13) 49.82 (1.12) <0.001 T iglyce ides (mg/dL) 296.68 (1.19) 95.73 (1.18) 96.06 (1.19) 91.81 (1.17) <0.001 Glucose (mg/dL) 294.17 (1.07) 92.63 (1.07) 91.49 (1.07) 87.84 (1.06) <0.001 Insulin (µIU/mL) 27.22 (1.13) 7.41 (1.13) 7.67 (1.14) 7.71 (1.13) <0.001 HOMA-IR 21.68 (1.19) 1.70 (1.19) 1.73 (1.20) 1.67 (1.18) 0.903 U ic acid (mg/dL) 25.20 (1.19) 5.13 (1.18) 5.10 (1.19) 4.97 (1.18) <0.001 U ine albumin (mg/dL) 25.42 (1.19) 5.96 (1.19) 6.59 (1.20) 7.51 (1.18) <0.001 U ine albumin/c ea inine a io (mg/g c ea inine) 25.35 (1.21) 5.34 (1.22) 5.39 (1.24) 5.01 (1.22) <0.001 Blood p essu e Sys olic blood p essu e (mmHg) 131.78 (9.09) 129.93 (9.08) 128.70 (9.52) 124.11 (8.66) <0.001 Dias olic blood p essu e (mmHg) 77.08 (3.02) 76.11 (2.95) 75.42 (3.13) 73.71 (2.92) <0.001 An h opome ics Body mass index (kg/m2)27.18 (1.99) 26.86 (2.00) 26.73 (2.08) 26.02 (1.88) <0.001 Wais ci cum e ence (cm) 92.48 (8.59) 91.17 (8.39) 90.62 (8.77) 87.68 (8.14) <0.001 Wais - o-hip a io 0.89 (0.07) 0.88 (0.06) 0.88 (0.07) 0.85 (0.06) <0.001 1 Values a e adjus ed o sex, age, educa ional le el (p ima y, seconda y, o uni e si y), smoking s a us (cu en , o me , o ne e smoke ), physical ac i i y (MET-h/week), ime spen wa ching TV (h/week), ene gy in ake (kcal/day), and mo bidi y (yes, no). 2 Geome ic means. LDL: Low densi y lipop o ein; HDL: high densi y lipop o ein; Hs-CRP: High-sensi i i y C- eac i e p o ein; HOMA-IR: Homeos a ic model assessmen o insulin esis ance. Table 6. Plasma and u ine concen a ions o in lamma o y and ca dio-me abolic bioma ke s, blood p essu e, and an h opo- me ics acco ding o he qua iles o he social business pa e n 1. Social Business Pa e n 1 Q1 Q2 Q3 Q4 p-Value o T end Bioma ke s Hs-CRP (mg/L) 20.13 (1.48) 0.13 (1.45) 0.13 (1.40) 0.13 (1.38) 0.337 Fib inogen (g/L) 23.37 (1.10) 3.34 (1.09) 3.28 (1.09) 3.25 (1.08) <0.001 To al choles e ol (mg/dL) 2188.31 (1.08) 191.10 (1.07) 193.31 (1.06) 196.03 (1.06) <0.001 LDL-choles e ol (mg/dL) 2114.51 (1.09) 116.29 (1.09) 117.59 (1.08) 119.21 (1.08) <0.001 HDL-choles e ol (mg/dL) 250.65 (1.13) 51.19 (1.13) 51.78 (1.13) 52.43 (1.13) <0.001 T iglyce ides (mg/dL) 293.20 (1.19) 94.74 (1.18) 95.49 (1.18) 96.77 (1.18) <0.001 Glucose (mg/dL) 291.59 (1.08) 91.73 (1.08) 91.40 (1.07) 91.31 (1.07) 0.128 Insulin (µIU/mL) 27.74 (1.12) 7.59 (1.12) 7.40 (1.12) 7.29 (1.12) <0.001 HOMA-IR 21.75 (1.19) 1.72 (1.19) 1.67 (1.18) 1.65 (1.18) <0.001 U ic acid (mg/dL) 24.97 (1.18) 5.07 (1.19) 5.15 (1.18) 5.20 (1.19) <0.001 U ine albumin (mg/dL) 26.06 (1.22) 6.22 (1.22) 6.41 (1.21) 6.59 (1.21) <0.001 U ine albumin/C ea inine a io (mg/g c ea inine) 25.27 (1.25) 5.29 (1.23) 5.24 (1.21) 5.28 (1.19) 0.994 Blood p essu e Sys olic blood p essu e (mmHg) 128.89 (10.01) 128.94 (9.74) 128.46 (9.26) 128.26 (9.01) 0.038 Dias olic blood p essu e (mmHg) 74.62 (3.31) 75.30 (3.26) 75.84 (3.14) 76.52 (3.13) <0.001 An h opome ics Body mass index (kg/m2)26.51 (2.13) 26.67 (2.08) 26.71 (1.99) 26.90 (1.93) <0.001 Wais ci cum e ence (cm) 90.00 (8.78) 90.45 (8.73) 90.52 (8.55) 90.97 (8.52) 0.004 Wais - o-hip a io 0.87 (0.07) 0.88 (0.07) 0.88 (0.07) 0.88 (0.07) 0.037 1 Values a e adjus ed o sex, age, educa ional le el (p ima y, seconda y, o uni e si y), smoking s a us (cu en , o me , o ne e smoke ), physical ac i i y (MET-h/week), ime spen wa ching TV (h/week), ene gy in ake (kcal/day), and mo bidi y (yes, no). 2 Geome ic means. LDL: Low densi y lipop o ein; HDL: high densi y lipop o ein; Hs-CRP: High-sensi i i y C- eac i e p o ein; HOMA-IR: Homeos a ic model assessmen o insulin esis ance. Nu ien s 2021,13, 633 9 o 14 4. Discussion Fou di e en cooking and ood p ese a ion pa e ns we e iden i ied. The de i ed pa e ns did no sha e almos any cooking o p ese a ion me hod and we e linked o di e en ypes o social beha io s. The Spanish adi ional pa e n ended o be bene icial, excep o HDL-c, insulin, and an h opome ics. The heal h-conscious pa e n showed be e enal unc ion. The you h-s yle pa e n ended o be associa ed wi h bene icial ca dio-me abolic heal h excep o a dec ease in HDL-c and an inc ease in insulin and u ine albumin le els. Finally, he social business pa e n ended o associa e un a o ably wi h he lipid p o ile (excep HDL-c), u ic acid, u ine albumin, dias olic blood p essu e, and an h opome ics; on he con a y, i also ended o co ela e wi h lowe ib inogen le els. The cooking me hods o he Spanish adi ional pa e n co espond wi h he adi ional Spanish and Medi e anean cuisine, which ypically includes sau éing and boiling, b ining, ligh ying (so i o), and ying. In line wi h ou esul s, nume ous s udies ha e shown ha adhe ence o a Medi e anean die a y pa e n, cha ac e ized by a high consump ion o esh and no p ocessed oods mos ly o plan o igin, has been associa ed wi h heal h bene i s, including clea an i-in lamma o y and hea -heal hy p ope ies [ 37 ]. This Spanish adi ional pa e n was also associa ed wi h a de imen al an h opome ic p o ile as well as high insulin esis ance ha could be explained by he high p e alence o obesi y and me abolic synd ome in Spain [ 29 ]. Ano he possible explana ion o hese associa ions may be due o a highe ene gy in ake associa ed wi h an elabo a e and pala able die made a home, including high-densi y ood om ying and he consump ion o ood canned in oil, no accompanied by su icien physical ac i i y. In addi ion, he e is some e idence ha a g ea e in ake o oli e oil (as in he Medi e anean die ) is associa ed wi h obesi y [ 7 ]. Addi ionally, hose wi h a highe adhe ence o his pa e n p esen ed a dec ease in HDL-c ha could be pa ially explained by lowe physical ac i i y and low alcohol consump ion, e en when he models we e adjus ed o hese ac o s. I is wo h no ing ha b ined oods, such as ege ables [ 38 ], a e ich in ni a es and ni i es, which a e ela ed o ca dio ascula bene i s [ 39 ]. In addi ion, die a y phenolic compounds p esen in so i o enhance glucose me abolism [ 40 ]. When conside ed as a whole, his pa e n was heal hy (excep o an h opome ics). The heal h-conscious pa e n included simple ood elabo a ion le els ( oas ing o s eaming wi h no added oil), a oiding cooking me hods such as ba e ing, ying, o s ewing. This pa e n ended o imp o e enal unc ion (low u ine albumin and albu- min/c ea inine a io). This could be explained by he ac ha less elabo a ed ood ( oas ed, b ined, s eamed, ood canned in oil) leads o be e p ese a ion o an ioxidan and min- e al compounds (i.e. hose p esen in ege able ibe ) ha a e associa ed wi h ascula bene i s [ 41 ]. Mo eo e , his pa e n was in e sely ela ed o ene gy in ake, being he only pa e n wi h his cha ac e is ic. A mo e ac i e li es yle and o he heal hy habi s among hese pa icipan s, such as no smoking, could also pa ially explain he bene icial e ec s o his pa e n. The you h-s yle pa e n wi h highe adhe ence among younge pa icipan s (mean age 55 and 36 yea s old in Q1 and Q4, espec i ely) was s ongly associa ed wi h he consump ion o so d inks and dis illed alcoholic be e ages and nega i ely associa ed wi h he consump ion o aw ood, co ee, and ea. I was also ela ed o a high p e alence o cu en smoke s and high ene gy in ake. Despi e he abo e, in he highes qua ile o adhe ence, pa icipan s ended o ha e a clea inc ease in an i-in lamma o y bioma ke s, a hypolipidemic and hypo ensi e p o ile, as well as heal hie an h opome ics. Howe e , his pa e n p esen s some elemen s o conce n: lowe HDL-c and highe insulin le els. The la e is in acco dance wi h a highe consump ion o so d inks [ 42 ], and i could be explained by he e ec o swee ene s on glucagon-like-pep ide 1 (GLP-1), ha inc eases insulin sec e ion [ 42 – 44 ]. Rega ding HDL-c le els, a s udy o 7343 pa icipan s om he Uni ed S a es had simila esul s [ 45 ]. I should be no ed ha , al hough eg ession model adjus men included se e al con ounding ac o s (such as age, sex, ene gy consump ion, physical ac i i y, and mo bidi y), di e ences in age among qua iles a e impo an , and