Objective To identify dietary patterns associated with subclinical atherosclerosis measured as coronary artery calcium (CAC). Design Cross-sectional analysis of data from the Brazilian Longitudinal Study of Adult Health. Dietary data were assessed using a food frequency questionnaire, and a principal component factor analysis was used to derive the dietary patterns. Scree plot, eigenvalues >1, and interpretability were considered to retain the factors. CAC was measured using a computed

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... y scanner and an electrocardiography-gated prospective calcium score examination, and was categorized into three groups based on the CAC score: 0, 1–100, and >100 Agatston units. Multinomial regression models were conducted for dietary patterns and CAC severity categories. Setting Brazil, São Paulo, 2008–2010. Subjects Active and retired civil servants who lived in São Paulo and underwent a CAC exam were included (N = 4,025). Results Around 10% of participants (294 men, 97 women) had a detectable CAC (>0), 6.5% (182 men, 73 women) had a CAC of 1–100, and 3.5% (110 men, 23 women) had a CAC > 100. Three dietary patterns were identified: convenience food, which was positively associated with atherosclerotic calcification; plant-based and dairy food, which showed no association with CAC; and the traditional Brazilian food pattern (rice, legumes, and meats), which was inversely associated with atherosclerotic calcification. Conclusions Our results showed that a dietary pattern consisting of traditional Brazilian foods could be important to reducing the risk of atherosclerotic calcification, and prevent future cardiovascular events, whereas a convenience dietary pattern was positively associated with this outcome.