This study aims to investigate spousal concordance in dietary behaviors, spousal concordance in metabolic components (MCs), and their association. A cross-sectional survey was conducted in Taiwan from November 2014 to May 2015. Matched-pair analysis, McNemar’s test, logistic regression analysis, and stratified analysis were performed. A total of 901 pairs of spouses (1802 participants) were analyzed. Husbands were less likely to report intakes of high-fiber food (ORMP (matched pairs odds ratio) = 0.30, p < 0.0001), fish (ORMP = 0.74, p = 0.0128), biscuits or cakes (ORMP = 0.60, p < 0.0001), and fast food (ORMP = 0.65, p = 0.01) compared with their wives. Husbands had significantly higher odds of being overweight (ORMP = 2.34, p < 0.0001); and of having hypertension (ORMP = 2.14, p < 0.0001), hypercholesterolemia (ORMP = 1.75, p = 0.0007), hyperlipidemia (ORMP = 2.96, p < 0.0001), and one or more metabolic components (composite MCs) (ORMP = 2.50, p < 0.0001) compared with their wives. After adjusting for age and education, the spousal concordance in high-fiber food intake was inversely associated with the spousal concordance in composite MCs (aOR = 0.62, 95% CI = 0.44−0.88, p = 0.0074), whereas the spousal concordance in processed food intake was positively associated with the concordance in composite MCs (aOR (adjusted odds ratio) = 1.56, 95% CI (Confidence Interval) = 1.03−2.36, p = 0.034). An intervention study for couples with intakes of different fiber foods and/or processed foods is critical for future study, in order to test what kinds of fiber foods/processed foods are associated with the development of the spousal concordance of metabolic components.
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