Nevertheless, even in five articles which took alcohol drinking as a component, the factors loadings in western pattern were very low.
There were not much changes found in the risk estimates after we excluded outlier (Hajizadeh et al, 2010) in western pattern (OR=1.28, 95% CI: 0.82, 1.74, I=54.90%) and outlier (Navarro Silvera et al, 2011) in drinker/alcohol pattern (OR=2.02, 95% CI: 1.39, 2.84, I=0.10%).
Another possible explanation is that, in addition to processed meat, red meat, and fat, there was a big variation in the components contained in the western pattern.
In our study, women who had high Western pattern scores both in adolescence and in adulthood had the greatest risk of T2DM, suggesting that adhering to a Western dietary pattern during adolescence may affect risk of T2DM beyond that imparted by high Western pattern scores in adulthood, possibly by persistence of an unhealthy dietary pattern through the life course.
These differences may be related to the greater adherence to the Western pattern in younger women as reported by Garcia-Arenzana et al (2012).
In these studies, the Western pattern is generally defined as a high-fat diet with processed meat, snack products, fast food, refined cereals and sweets.
The Meat pattern, with a high consumption of red meat, processed/cured meat, and processed/cured red meat, is similar to the set of food items referred to as the Western pattern in many previous studies [ 33, 34].
Conversely, with increasing hours of watching television, a higher adherence to less healthy dietary patterns (e. g. 'snacky' or 'western'), similar to the association found among German girls with higher scores of the 'traditional and western' pattern in our study, was also previously observed [ 21, 24, 25, 40].
The "Western-type" diet identified in our cohort is very close to the original "Western" pattern defined in the American population, which has been shown to be associated with higher risk of inflammation.
In the present study, the Western pattern was found to be significantly associated with overweight in the Lebanese adolescent population.
After adjusting for age, BMI at age 18 years, total energy intake during high school, and physical activity and smoking during high school, participants in the highest quintile of Western pattern score had a 62% greater risk of T2DM than participants in the lowest quintile (relative risk [RR] 1.62; 95% CI 1.27 2.07; P trend <0.0001).
