Adv Nutr. 2023 Dec 23:100165. doi: 10.1016/j.advnut.2023.100165. Online ahead of print.
Although a posteriori dietary patterns (DPs) naturally reflect actual dietary behavior in a population, their specificity limits generalizability. Among other issues, the absence of a standardized approach to analysis have further hindered discovery of genuinely reproducible DPs across studies from the same/similar populations. A systematic review on a posteriori DPs from principal component analysis or exploratory factor analysis (EFA) across study populations from Italy provides the basis to explore assessment and drivers of DP reproducibility in a case study of epidemiological interest. First to our knowledge, we carried out a qualitative (i.e., similarity plots built on text descriptions) and quantitative (i.e., congruence coefficients, CCs) assessment of DP reproducibility. The 52 selected papers were published in 2001-2022 and represented dietary habits in 1965-2022 from 70% of the Italian regions; children/adolescents, pregnancy/breastfeeding women, and elderly were considered in 15 papers. The included studies mainly derived EFA-based DPs on food groups from food-frequency questionnaires and were of “good quality” according to standard scales. Based on text descriptions, the 186 identified DPs were collapsed into 113 (69 food-based and 44 nutrient-based) apparently different DPs (39.3% reduction), later summarized along with the 3 Mixed-Salad/Vegetable-based Patterns, Pasta-and-Meat-oriented/Starchy Patterns, and Dairy Products and Sweets/Animal-based Patterns groups, by matching similar food-based and nutrient-based groups of collapsed DPs. Based on CCs (215 CCs, 68 DPs, 18 papers using the same input lists), all pairs of DPs showing the same/similar names were at least “fairly similar” and ∼81% were “equivalent”. The 30 “equivalent” DPs ended up into 6 genuinely different DPs (80% reduction) that targeted fruit and (raw) vegetables, pasta and meat combined, and cheese and deli meats. Such reduction reflects the same study design, list of input variables, and DP identification method followed across papers from the same groups. This review was registered at PROSPERO as CRD42022341037. STATEMENT OF SIGNIFICANCE (2 SENTENCES, TRUE NOVELTY): This is the first systematic review collecting evidence on Italian dietary patterns derived from principal component or exploratory factor analysis. The systematic review provides the basis for a qualitative and quantitative assessment of reproducibility of Italian dietary patterns, as based on text descriptions and congruence coefficients, respectively. We found that Italian dietary patterns based on fruit and (raw) vegetables, pasta and meat combined, and cheese and deli meats are reproducible across studies, although more rigorous statistical approaches may allow a better identification of reproducible dietary patterns and related causes. The established evidence base may inform dietary pattern identification in the Italian population and more generally future research on dietary pattern reproducibility across studies within the same country.