Dietary Diversity, Dietary Patterns, and Cardiometabolic Health in University Students: A Cross-Sectional Study.

Approximately one-third of participants exhibited markers of early cardiometabolic risk despite their young age and low prevalence of diagnosed disease.

• Study population consisted of 349 undergraduate students aged 18-26 years enrolled in health sciences programs in Ecuador
• Markers of early cardiometabolic risk included excess body weight and central adiposity
• Participants had low prevalence of pre-existing diagnosed conditions
• The study highlights normal weight obesity—characterized by excess adiposity despite normal BMI—as a source of early metabolic vulnerability

Higher dietary diversity was independently associated with a higher prevalence of excess body weight.

• Adjusted prevalence ratio per one-unit increase in Individual Dietary Diversity Score (IDDS): 1.17 (95% CI: 1.06–1.30)
• Association was identified using multivariable Poisson regression
• Models were adjusted for age, sex, academic program, physical activity level, and pre-existing conditions
• Dietary diversity was quantified using the Food and Agriculture Organization's Individual Dietary Diversity Score

Higher dietary diversity was independently associated with greater relative muscle mass.

• Adjusted β = 0.13 (95% CI: 0.05–0.22) per one-unit increase in IDDS
• Relative muscle mass was assessed by bioelectrical impedance analysis
• Association was identified using multivariable linear regression adjusted for age, sex, academic program, physical activity level, and pre-existing conditions
• No association was observed between dietary diversity and handgrip strength

Dietary diversity showed no significant association with handgrip strength.

• Handgrip strength was one of three primary outcomes alongside excess body weight and relative muscle mass
• Multivariable linear regression models were fitted and adjusted for age, sex, academic program, physical activity level, and pre-existing conditions
• The lack of association contrasts with the positive association found between dietary diversity and relative muscle mass

Empirically derived dietary patterns showed no significant associations with adiposity, muscular strength, or relative muscle mass after adjustment.

• Dietary patterns were identified through principal component analysis followed by k-means clustering
• No significant associations were found with any of the three cardiometabolic or functional outcomes after multivariable adjustment
• The authors attribute the limited discriminatory capacity of dietary patterns to dietary homogeneity within the cohort
• Dietary intake was assessed using a validated food frequency questionnaire

Dietary diversity alone does not necessarily reflect diet quality in contemporary food environments.

• The same dietary diversity metric was associated with both increased adiposity and greater lean mass simultaneously
• Authors conclude that diversity metrics must be interpreted alongside indicators of food quality, energy density, and body composition
• Findings are particularly relevant in Latin American populations, where the relationship between dietary diversity and cardiometabolic outcomes has been described as inconsistent
• The study underscores the importance of evaluating early cardiometabolic risk beyond BMI-based classifications