Cross-comparison of diet quality indices for predicting chronic disease risk: findings from the Observation of Cardiovascular Risk Factors in Luxembourg (ORISCAV-LUX) study

Association between dietary inflammatory index and risk of chronic kidney disease and low glomerular filtration rate; a systematic review and meta-analysis of observational studies

OBJECTIVE

Earlier studies on the association between the dietary inflammatory index (DII) and the risk of chronic kidney disease (CKD) and low estimated glomerular filtration rate (low-eGFR) have provided uncertain findings. Therefore, this study aimed to summarize the existing literature on the association between DII and CKD and low-eGFR.

METHODS

In April 2024, PubMed, Scopus, and Web of Science were searched for observational studies, along with manual inclusion of Google Scholar and Embase. The review was submitted to PROSPERO (CRD42024536756) and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Studies which reported risk for CKD or low-eGFR were included.

RESULTS

The random-effects model was used for statistical analysis and pooled effect sizes were reported as odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). A total of 13 studies, all with a cross-sectional design, were identified eligible for inclusion in the meta-analysis. The results revealed that higher DII scores were associated with significantly higher odds of CKD (OR: 1.36, 95% CI: 1.20-1.56, p < 0.001) and low-eGFR (OR: 1.58, 95% CI: 1.26-2.00, p = 0.001).

CONCLUSION

This study found a significant positive association between the DII and the odds of CKD and low-eGFR, suggesting a higher likelihood of CKD in individuals who adhere to a pro-inflammatory diet. Large-scale prospective cohort studies are required to confirm these findings, particularly by assessing different indicators of kidney function.

Food-based indexes and their association with dietary inflammation

Chronic inflammation is associated with an increased risk of noncommunicable diseases, prompting an intensified interest in the diet-disease relationship for modulating inflammation. Diet quality indexes are widely used to quantify dietary patterns. However, the optimal tool for assessing dietary quality in relation to chronic inflammation remains unclear. The objective of this study was to synthesize the literature on food-based diet quality indexes and their association with chronic inflammation. A systematic scoping review of scientific databases was conducted from inception to March 2024. Studies describing the development and validation of original dietary inflammatory indexes or assessed associations between established indexes and inflammatory biomarkers were included. Studies that predominantly focused on nutrient-based indexes were excluded. Forty-three food-based indexes, evaluated across 65 studies, were categorized into 4 distinct groups based on dietary patterns (n = 18), dietary guidelines (n = 14), dietary inflammatory potential (n = 6), and therapeutic diets (n = 5). Established indexes based on the Mediterranean diet and dietary guidelines were the most extensively utilized, demonstrating inverse associations with several inflammatory biomarkers across diverse populations. The Anti-Inflammatory Diet Index, Dietary Inflammation Score, and Empirical Dietary Inflammatory Index were identified as robust, empirically derived indexes to assess diet quality based on their inflammatory potential. The dietary composition of the evaluated indexes ranged from 4 to 28 dietary components, with fruits, vegetables, whole grains, and legumes consistently classified as favorable, whereas red/processed meats and added sugars were unfavorable. This scoping review identified several promising food-based indexes for assessing inflammation-related diet quality. Methodological variations and inconsistencies in algorithms underscore the need for further validation across diverse populations. Future research should consider the scoring methods, dietary composition, and validated inflammatory biomarkers when selecting indexes to evaluate diet-inflammation associations. Understanding the characteristics that underpin these indexes informs their application in nutrition research and clinical practice.

Associations between diet quality indices and psoriasis severity: results from the Asking People with Psoriasis about Lifestyle and Eating (APPLE) cross-sectional study

Psoriasis is a chronic immune-inflammatory skin disease. Cross-sectional research examining diet quality indices in psoriasis has focused on the Mediterranean diet and is confined to Mediterranean populations, thereby lacking generalisability to other populations. We explored associations between diet quality indices and the likelihood of reporting a higher psoriasis severity. This was an online cross-sectional study recruiting adult volunteers with psoriasis (n 257). A 147-item FFQ evaluated adherence to the Mediterranean diet score, the Dietary Approaches to Stop Hypertension score and the Plant-based Diet Index (PDI), including its original (oPDI), healthy (hPDI) and unhealthy (uPDI) subtypes. Psoriasis severity was determined with the self-assessed Simplified Psoriasis Index. When adjusted for age, sex, smoking, alcohol overconsumption, energy intake and psychological morbidity, multinomial logistic regression analyses revealed an increased likelihood of reporting a higher psoriasis severity in participants with a very low adherence to Dietary Approaches to Stop Hypertension (OR = 3·75; 95 % CI 1·313, 10·700; P = 0·01) and hPDI (OR = 4·04; 95 % CI 1·251, 13·064; P = 0·02) patterns. A reduced likelihood of reporting a higher psoriasis severity was shown in participants with low adherence to the uPDI (OR = 0·25; 95 % CI 0·085, 0·716; P = 0·01). With further adjustment for BMI, a very low adherence to the oPDI was significantly associated with an increased likelihood of reporting a higher psoriasis severity (OR = 3·46; 95 % CI 1·029, 11·656; P = 0·05). Dietary interventions and assessment should be introduced in the care pathway for psoriasis management.

From Olive Oil Lovers to Mediterranean Diet Lifestyle Followers: Consumption Pattern Segmentation in the Portuguese Context

The Mediterranean Diet (MedDiet) is considered an Intangible Cultural Heritage by UNESCO; it is also the world's most evidence-based eating pattern for promoting health and longevity. This study aims to investigate consumer segmentation based on consumption patterns and identify barriers to adherence to MedDiet. Data were collected in 2020 by telephonic survey based on PREDIMED, using a quota sampling technique by socio-demographic variables, such as gender, age, and regional representation of the Portuguese population. The final sample was composed of a total of 1000 respondents. The main results show that regardless of the awareness of the MedDiet (62%), Portugal witnessed a loss of the traditional MedDiet, with the exception of the stand-out statistic that 95% of respondents still use of olive oil as the main culinary fat. Five segments were identified: (1) MedDiet lifestyle followers (11%), (2) olive oil lovers (20%), (3) low-sugar diet foods seekers (11%), (4) healthy and balanced diet seekers (28%), and (5) low-fat diet foods seekers (30%). The main barriers to adhering to the MedDiet include lack of knowledge about the MedDiet, education level, financial comfort, and specific food preference, which by segment are: (1) being passionate about soda drinks, (2) an excess of sweets, (3) low level of pasta consumption, and a (5) lack of fruit, vegetables, and legumes. Segment (4) holds a leading position in MedDiet adherence. The main obstacle to consuming fish is its high price, taste, and challenges in cooking it. When it comes to bread and oleaginous nuts, the belief that these foods are "fattening" reduces consumption. Results help to tailor education strategy and increase adherence to the Mediterranean lifestyle.

The association between dietary quality index- international and metabolic risk factors in RaNCD cohort study

BACKGROUND

Non-communicable diseases (NCDs) are the leading cause of death around the world. The Dietary Quality Index-International (DQI-I) is one of the indicators that shows changes in diet and its association with NCDs. The aim of this study is to measure the association between the DQI-I and major metabolic risk factors.

METHODS

This study is a cross-sectional study based on data collected in the first phase of the prospective cohort study on Ravansar non-communicable diseases (RaNCD). To perform clinical and biochemical tests such as lipid profile, blood glucose and liver enzymes, blood samples were collected using standard vacutainer blood collection techniques. Information from the food frequency questionnaire containing 118 food items was used to score each person's DQI-I. Binary logistic regression was used to determine the association between the DQI-I tertile and the metabolic risk factors. Linear regression was also used for the association between subgroups of DQI-I score and the metabolic risk factors.

RESULTS

The total number of subjects in this study was 7,115, with a mean age of 47.14 ± 8.29 years. Dietary quality was generally poor, with 37.03% in the lowest tertile. Men had better dietary quality than women. Anthropometric measures, blood pressure, triglycerides and blood glucose were lower in the lowest tertile of dietary quality. A one-unit increase in the total DQI-I resulted in a 0.19 decrease in total cholesterol. Higher dietary quality was associated with a 22% increased risk of high triglycerides, a 19% increased risk of low high-density density lipoprotein, a 5% decreased risk of elevated low-density lipoprotein, a 42% increased risk of high blood pressure, and a 99% increased risk of high fasting blood glucose. Higher dietary quality was also associated with a 33% increased risk of overweight/obesity.

CONCLUSION

The study found that participants had poor dietary quality, with some favorable metabolic outcomes in the lowest tertile, but concerning associations in the highest tertile, including increased risk for high triglycerides, blood pressure, and obesity. The complex associations suggest that balanced, multifaceted interventions are needed.

Comparison of diet quality indices for predicting metabolic syndrome in Iran: cross-sectional findings from the persian cohort study

BACKGROUND

The metabolic syndrome (MetS) comprises metabolic irregularities, including hypertension and central obesity, which are influenced by genetic, metabolic, environmental, and dietary factors. As diet and lifestyle are risk factors for MetS, it is important to know which diet quality index better predicts MetS. The aim of this study is to compare the ability of different diet quality indices in predicting MetS and to identify the most effective one.

METHODS

This cross-sectional study involved 5,206 participants aged 35 to 70 engaged in the Prospective Epidemiological Research Study in Iran (PERSIAN) cohort. Assessment of one year's food intake via a validated 134-item semi-quantitative food frequency questionnaire (FFQ) facilitated the calculation of adherence to five diet quality indices: Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), Dietary Inflammatory Index (DII), and Diet Quality Indices (DQI). While bivariate Pearson correlation and binary logistic regression aided in identifying the strongest correlation and predictor for MetS among the indices.

RESULTS

This study showed a significant association between adhering to the DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, and the odds of developing MetS (OR: 0.94, (95% CI: 0.93-0.95), OR: 0.85, (95% CI: 0.81-0.89), OR: 0.84, (95% CI: 0.80-0.89), OR: 1.22, (95%CI: 1.11-1.34), OR: 0.95, (95%CI 0.94-0.96) respectively). Therefore, with each unit increase in DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, the odds of MetS was reduced by 5.4%, 14.5%, 15.6%, 22%, 5%, respectively. All the indices were correlated with the intake of most of the micronutrients, with the strongest correlations being observed in the DII. DASH diet score aligned with the most favourable MetS biomarker risk, while DII score primarily associated with MetS and could be considered as a predictor for MetS.

CONCLUSION

The present study's findings reveal that between all these five diet quality indices, the DASH diet score correlates strongly with a favourable biomarker risk profile, while the DII score is predominantly linked to MetS.

Associations of movement behaviours and dietary intake with arterial stiffness: results from the ORISCAV-LUX 2 cross-sectional study

OBJECTIVE

Adopting a physically active lifestyle and maintaining a diet rich in antioxidants can reduce the risk of vascular diseases. Arterial stiffness is an early marker for cardiovascular diseases, indicating vascular damage. This study investigates the relationship between physical activity (PA), sedentary behaviour (SB), dietary antioxidant, trace elements intake and vascular health in men and women, with a focus on pulse wave velocity (PWV), the gold standard for assessing arterial stiffness.

DESIGN

This is a nationwide population-based cross-sectional study (Observation of Cardiovascular Risk Factors in Luxembourg 2 (ORISCAV-LUX 2)).

SETTING

The study was conducted in Luxembourg, between November 2016 and January 2018.

PARTICIPANTS

In total, 988 participants from the ORISCAV-LUX 2 study, who were Luxembourg residents, aged 25-79 years, underwent the required physical examination, agreed to wear an accelerometer for 1 week and presented no personal history of myocardial infarction or stroke, were included in the analysis.

PRIMARY OUTCOME MEASURE

PWV was assessed with the validated Complior instrument. Elastic-net models were used to investigate the associations of dietary intake (antioxidant and trace elements) and movement behaviours (PA and SB) with PWV in men and women.

RESULTS

The findings reveal diverse associations between PA, SB, dietary intake and PWV, with distinct patterns observed in men and women. In women, a longer median moderate-to-vigorous PA bout length (mean coefficient (β)=-0.039), a higher long-range temporal correlation (higher scaling exponent alpha) at larger time scales (>120 min; β=-1.247) and an increased intake of vitamin C (β=-1.987) and selenium (β=-0.008) were associated with lower PWV. In men, a shorter median SB bout length (β=0.019) and a lower proportion of SB time accumulated in bouts longer than 60 min (β=1.321) were associated with lower PWV. Moreover, a higher daily intake of polyphenols (β=-0.113) and selenium (β=-0.004) was associated with lower PWV in men.

CONCLUSION

This study underscores the multifaceted nature of the associations between movement behaviours and dietary intake with PWV, as well as sex differences. These findings highlight the significance of considering both movement behaviours and dietary antioxidant intake in cardiovascular health assessments.

Adherence to the Mediterranean Diet, Sodium and Potassium Intake in People at a High Risk of Dementia

Adequate sodium and potassium intake, along with adherence to the Mediterranean diet (MedDiet), are key factors for preventing hypertension and cerebrovascular diseases. However, data on the consumption of these nutrients within the MedDiet are scarce. This cross-sectional study aims to assess the association between MedDiet adherence and sodium/potassium intake in the MIND-Matosinhos randomized controlled trial, targeting Portuguese adults at a high risk of dementia. Good adherence to the MedDiet was defined using the Portuguese Mediterranean Diet Adherence Screener questionnaire (≥10 points), and both sodium/potassium intakes were estimated from 24-hour urine collections. The association between MedDiet adherence and these nutrients' intake (dichotomized by the median) was quantified by calculating odds ratios (OR) and respective 95% confidence intervals (95% CI) using a logistic regression. A total of 169 individuals (60.9% female; median age: 70 years; range: 36-85 years) were included. Good adherence to the MedDiet was observed among 18.3% of the sample. After adjusting for sex, age, education and using antihypertensive drugs, good MedDiet adherence was associated with higher sodium (OR = 3.11; 95% CI: 1.27-7.65) and potassium intake (OR = 9.74; 95% CI: 3.14-30.26). Increased adherence to the MedDiet may contribute to a higher potassium intake but seems to have limited effects on the adequacy of sodium levels.

Living with obesity in Ireland: determinants, policy and future perspectives

Globally, the prevalence of those living with obesity (≥30 kg/m2) is rising, with this trend expected to continue if firm and decisive policy interventions are not introduced. Across Europe, despite many consecutive policies aiming to reverse rising trends in weight status over recent decades, no country is currently on track to halt and reverse current trends in the coming years. This is evident in Ireland too, whereby the reporting of nationally representative weight status data show that targets have not been achieved since reporting began. The aim of this review is to critically appraise recent evidence relating to the key determinants of obesity including weight status, diet quality and physical activity with an emphasis on socioeconomic inequalities. And to consider these in the context of respective policy measures and propose future-focused recommendations. Furthermore, as with the complex nature of obesity, multifaceted approaches that shift the focus from the individual and place responsibility at a societal level will be reviewed.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Serum Urate Concentrations: A Longitudinal Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND

Increased serum urate (SU) and hyperuricemia (HU) are associated with chronic noncommunicable diseases and mortality. SU concentrations are affected by several factors, including diet, and are expected to rise with age. We investigated whether the Dietary Approaches to Stop Hypertension (DASH) diet alter this trend.

OBJECTIVE

The objective was to assess whether adherence to the DASH diet predicts a longitudinal change in SU concentrations and risk of HU in 8 y of follow-up.

METHODS

Longitudinal analyses using baseline (2008-2010, aged 35-74 y), second (2012-2014), and third (2016-2018) visits data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The inclusion criteria were having complete food frequency questionnaire (FFQ) and urinary sodium measurement, in addition to having SU measurement at the 1st visit and at least 1 of the 2 follow-up visits. For the HU incidence analyses, participants had also to be free from HU at baseline. The final samples included 12575 individuals for the SU change analyses and 10549 for the HU incidence analyses. Adherence to DASH diet was assessed as continuous value. HU was defined as SU>6.8 mg/dL and/or urate-lowering therapy use. Mixed-effect linear and Poisson regressions (incidence rate ratio [IRR] and 95% confidence interval [CI]) were used in the analyses, adjusted for confounders.

RESULTS

The mean age was 51.4 (8.7) y, and 55.4% were females. SU means (standard deviation) were 5.4 (1.4) at 1st visit, 5.2 (1.4) at 2nd visit, and 5.1(1.3) mg/dL at 3rd visit. The HU incidence rate was 8.87 per 1000 person-y. Each additional point in adherence to the DASH diet accelerated SU decline (P< 0.01) and lowered the incidence of HU by 4.3% (IRR: 0.957; 95% CI: 0.938,0.977) in adjusted model.

CONCLUSION

The present study findings reinforce the importance of encouraging the DASH diet as a healthy dietary pattern to control and reduce the SU concentrations and risk of HU.

Diet quality indices and their relationship with dyslipidemia in adults: A cross-sectional study

INTRODUCTION

Food habits may influence a range of modifiable risk factors of cardiovascular diseases (CVDs) including dyslipidemia. This study was conducted to find whether healthy eating index (HEI) and dietary quality index-international (DQI-I) were associated with the risk of dyslipidemia among the Iranian adults in Shiraz.

METHOD

In this study, 236 participants with the age of 20-50 years were recruited from Shiraz medical centers through random cluster sampling. The HEI-2015 and DQI-I scores were computed using dietary intakes based on a 168-item food frequency questionnaire (FFQ). Logistic regression was utilized to estimate the relation between HEI-2015 and DQI-I score and lipid profile.

RESULTS

Individuals in the greatest adherence to the HEI-2015 was associated with reduced odds ratio (OR) of total cholesterol (TC) and low-density lipoprotein (LDL) in the crude model (OR: 0.46 and OR: 0.30). This association was significant after adjustment for potential confounders (OR: 0.40 and OR: 0.31). Also, we observed significant association between DQI-I with TC and LDL in crude model (OR: 0.42 and OR: 0.45). In the adjusted model, participants in the last tertile of DQI-I were 55%, 58% and 57% less likely to have abnormal TC (OR: 0.45), LDL (OR: 0.42) and high-density lipoprotein (HDL) (OR: 0.43), compared those in the first tertile.

CONCLUSION

In conclusion, higher adherence to DQI-I score was related to lower LDL and total cholesterol and higher HDL levels. Furthermore, in participants with higher adherence of HEI-2015 score, LDL and total cholesterol level were lower.

Dietary quality index and the risk of breast cancer: a case-control study

BACKGROUND

Diet quality is a significant determinant in the etiology of breast cancer (BrCa), but further studies are required to explore this relationship. Therefore, we tried to assess if diet quality, assessed using the Diet Quality Index-International (DQI-I), was related to BrCa among the Iranian population.

METHODS

In the present case-control research, 134 women with a recent diagnosis of BrCa and 267 without BrCa were selected as case and control groups. Individual food intake data from a food frequency questionnaire was used to compute DQI-I. Also, the multivariable logistic regression models were utilized to evaluate the association between DQI-I and BrCa odds .

RESULTS

We found a significant association between the last tertile of DQI-I and BrCa odds in the fully adjusted model (odds ratio (OR) = 0.30; 95% confidence interval (CI): 0.15-0.56). The subgroup analysis based on menopausal status also showed a significant decrease in BrCa odds in pre-and post-menopausal women (pre-menopausal: OR = 0.27; 95% CI: 0.10-0.70 - post-menopausal status: OR = 0.35; 95% CI: 0.13-0.92).

CONCLUSIONS

Our findings indicated that a higher DQI-I score was related to a lower chance of BrCa. According to our research, a healthy diet pattern is crucial for BrCa prevention.

The association between adherence to diet quality index and cardiometabolic risk factors in overweight and obese women: a cross-sectional study

Background

Obesity and overweight status increase the risk of cardiovascular disease. Diet quality can also predict the risk of cardiovascular diseases in obese and overweight patients. Therefore, in this study, we sought to examine the relationship between diet quality index (DQI) and cardiometabolic risk factors in obese and overweight women.

Method

A cross-sectional study was conducted on 197 Iranian women with a Body Mass Index (BMI) > 25, 18-48 years, and recruited from 20 Tehran Health Centers. Nutrition intake and DQI were assessed using a 147-item semi-quantitative food frequency questionnaire (FFQ). Additionally, anthropometric measurements, body composition, biochemical evaluations, and cardiometabolic risk factors were evaluated.

Results

There was an association between DQI and waist-to-hip ratio (WHR), atherogenic index of plasma (AIP), and CHOLINDEX in obese women, after adjusting for potential confounders. Whereas, there were no significant associations of the tertiles of DQI compared with the first tertile in other cardiometabolic risk factors, before and after adjustment.

Conclusion

This study provides evidence that dietary intake and DQI are associated with cardiometabolic risk factors and that dietary modification may be a predictor for reducing WHR, AIP, and CHOLINDEX. However, more research is needed to develop a DQI that reflects changes in cardiometabolic risk factors by considering women's eating habits and patterns.

The association between diet quality index-international and inflammatory markers in Iranian overweight and obese women

Objectives

The present study was conducted to evaluate whether there is a link between the diet quality index (DQI) and markers of systemic inflammation in Iranian overweight and obese women.

Methods

This cross-sectional study included 200 Iranian overweight and obese women aged 18-48 years. The DQI-international (DQI-I) comprises four main components: variety, adequacy, moderation, and overall balance. Blood samples were collected in a fasted state to measure inflammatory markers.

Results

After adjusting for age, body mass index (BMI), physical activity, total energy intake, economic status, education, supplement intake, age of starting obesity, and history of body mass loss, a marginally significant negative association was observed between the homeostasis model assessment of insulin resistance (HOMA-IR) and the DQI-I (β: -0.015, 95% CI: -0.03, 0.000; p = 0.061). The results after adjustment showed that DQI-I has a negative association with high-sensitivity C-reactive protein (hs-CRP) concentrations (β: -0.031, 95% CI: -0.104, -0.031; p = 0.023). Furthermore, negative associations were observed between the adequacy component and levels of HOMA-IR (β: -0.025, 95% CI: -0.100, 0.047, p = 0.050) and hs-CRP (β: -0.615, 95% CI: -1.191, -0.020; p = 0.045). In addition, negative associations were found between transforming growth factor-β (TGF-β) and balance score (β: -6.270, 95% CI: -39.211, -3.661, p = 0.020), as well as HOMA-IR (β: -0.080, 95% CI: -0.202, -0.000, p = 0.041) and chemoattractant protein-1 (MCP-1) (β: -0.562, 95% CI: -11.414, -0.282, p = 0.021), with the various component. A marginally significant negative association between galectin 3 (Gal-3) and moderation score (β: -0.451, 95% CI: -1.171, 0.060, p = 0.060) was found. In addition, a marginally significant inverse association was also established between hs-CRP and variety score (β: -0.311, 95% CI: -0.970, 0.001, p = 0.052). The Receiver Operating characteristic (ROC) curve analysis demonstrated that DQI-I might better predict HOMA-IR with a cut point of 3.13 (AUC = 0.698, 0.511-0.699, p = 0.050).

Conclusion

These findings showed that a higher adherence to diet quality and its components could probably be related to lowering the inflammatory markers considerably in overweight and obese women.

Association of diet quality indices with serum and metabolic biomarkers in participants of the ORISCAV-LUX-2 study

PURPOSE

Diet quality is a critical modifiable factor related to health, including the risk of cardiometabolic complications. Rather than assessing the intake of individual food items, it is more meaningful to examine overall dietary patterns. This study investigated the adherence to common dietary indices and their association with serum/metabolic parameters of disease risk.

METHODS

Dietary intakes of the general adult population (n = 1404, 25-79 years) were assessed by a validated food-frequency questionnaire (174 items). The French ANSES-Ciqual food composition database was used to compute nutrient intakes. Seven indicators were calculated to investigate participants' diet quality: the Alternative Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension Score (DASH-S), Mediterranean Diet Score (MDS), Diet Quality Index-International (DQI-I), Dietary Inflammatory Index (DII), Dietary Antioxidant Index (DAI), and Naturally Nutrient-Rich Score (NNRS). Various serum/metabolic parameters were used in the validity and association analyses, including markers of inflammation, blood glucose, and blood lipid status.

RESULTS

Following linear regression models adjusted for confounders, the DASH-S was significantly associated with most metabolic parameters (14, e.g., inversely with blood pressure, triglycerides, urinary sodium, uric acid, and positively with serum vitamin D), followed by the DQI-I (13, e.g., total cholesterol, apo-A/B, uric acid, and blood pressure) and the AHEI (11, e.g., apo-A, uric acid, serum vitamin D, diastolic blood pressure and vascular age).

CONCLUSION

Food-group-based indices, including DASH-S, DQI-I, and AHEI, were good predictors for serum/metabolic parameters, while nutrient-based indices, such as the DAI or NNRS, were less related to biological markers and, thus, less suitable to reflect diet quality in a general population.

Holistic Framework to Contextualize Dietary Quality Assessment: A Critical Review

Numerous dietary quality indices exist to help quantify overall dietary intake and behaviors associated with positive health outcomes. Most indices focus solely on biomedical factors and nutrient or food intake, and exclude the influence of important social and environmental factors associated with dietary intake. Using the Diet Quality Index- International as one sample index to illustrate our proposed holistic conceptual framework, this critical review seeks to elucidate potential adaptations to dietary quality assessment by considering-in parallel-biomedical, environmental, and social factors. Considering these factors would add context to dietary quality assessment, influencing post-assessment recommendations for use across various populations and circumstances. Additionally, individual and population-level evidence-based practices could be informed by contextual social and environmental factors that influence dietary quality to provide more relevant, reasonable, and beneficial nutritional recommendations.

Association of diet quality with glycemia, insulinemia, and insulin resistance in families at high risk for type 2 diabetes mellitus in Europe: Feel4 Diabetes Study

OBJECTIVE

The aim of the present study was to investigate the association of diet quality with fasting glycemia, insulinemia, and insulin resistance in a cross-sectional sample of adults from families at high risk for type 2 diabetes mellitus (T2DM) from six European countries, taking into account their socioeconomic status (SES).

METHODS

Baseline data from non-diabetic adults from the Feel4 Diabetes study were used and diet was assessed by the Healthy Diet Score (HDS). Insulin resistance (IR) was determined by homeostasis model assessment of IR (HOMA-IR). Sociodemographic and lifestyle characteristics were assessed through standardized questionnaires. Multiple linear regressions were adjusted for many confounders, in the total sample and by SES category.

RESULTS

In 1980 adults, the third tertile of diet quality was inversely associated with insulin levels (-1.48; 95% confidence interval [CI], -2.34 to 0.62), and HOMA-IR (-0.33; 95% CI, -0.57 to 0.09), yet with no statistically significant results for glucose levels. In the SES subgroup analysis, in the high SES group, both second and third diet score tertiles were inversely associated with insulin levels (-1.81; 95% CI, -2.66 to 0.95) and HOMA-IR values (-0.45; 95% CI -0.69 to 0.21), independent of age, sex, smoking and body mass index. No such associations were observed for glucose levels in the high SES group and for all indices in the low SES group.

CONCLUSION

In adults from families at high risk for T2DM, higher diet quality was negatively associated with fasting insulin levels and IR, only in the high SES group and not in the low SES group. Future larger studies may be able to explore further this association, as well as the potential factors that mitigate its strength in the low SES groups.

Diet quality indices and their associations with all-cause mortality, CVD and type 2 diabetes mellitus: an umbrella review

Numerous observational studies have investigated associations between diet indices and health outcomes. Our aim was to systematically synthesise data that was previously summarised separately for each diet index in one umbrella review of all diet indices with sufficient evidence gained in systematic reviews and to assess the quality and strength of evidence for selected health outcomes. The MEDLINE, EMBASE and Scopus databases were systematically searched following the PRISMA guidelines through October 2021 for systematic reviews of observational studies investigating associations between adherence to diet indices and selected health outcomes (all-cause mortality, CVD incidence or mortality, type 2 diabetes mellitus incidence or mortality). Methodological quality and quality of evidence were assessed using the AMSTAR 2 and NutriGrade tools. The inclusion criteria were met by seven systematic reviews, entirely based on prospective cohort studies and reviewing five different diet indices - alternate healthy eating index (AHEI), dietary approaches to stop hypertension (DASH), dietary inflammatory index (DII), healthy eating index (HEI) and Mediterranean diet (MedDiet). All seven included systematic reviews showed that greater adherence to these diet indices reduces the risks of all-cause mortality, CVD incidence and mortality and type 2 diabetes mellitus incidence. Moderate meta-evidence was presented for AHEI and DASH for all outcomes, also for DII for all-cause mortality, CVD mortality and incidence, MedDiet for all-cause mortality and for HEI for CVD incidence and mortality. Our umbrella review provides further evidence for AHEI, DASH, DII and HEI diet indices to be used as predictors of selected health outcomes.

The Dietary Inflammatory Index is positively associated with cardiometabolic risk parameters in atherosclerosis patients

Inflammation is implicated in the development and progression of a variety of cardiovascular diseases. We hypothesized that the Dietary Inflammatory Index (DII) is associated with anthropometric indices and metabolic parameters in Iranian atherosclerosis patients. The present cross-sectional study was conducted on 320 Iranian atherosclerosis patients. The DII was estimated using a valid and reliable 168-item food frequency questionnaire. Odds ratios and 95% confidence intervals were evaluated for anthropometric indices and metabolic parameters according to the DII score. Linear regression was used to estimate the relationship between DII scores with atherosclerosis-related dependent variables. According to the continuous score of DII, there was no significant association between DII and odds of obesity, total cholesterol/high-density lipoprotein cholesterol ratio, and aspartate aminotransferase/alanine aminotransferase ratio in all 3 models (P ≥ .05). In linear regression analysis, we found a significant association between DII score and fasting blood sugar, lipid profile (except for high-density lipoprotein cholesterol), liver enzymes (except for alkaline phosphatase), and serum sodium in adjusted models (P < .05). In this study, patients with atherosclerosis consuming a pro-inflammatory diet was positively associated with fasting blood sugar, lipid, and liver enzymes measures. Future studies with prospective and interventional designs are required to clarify the association between this dietary index and cardiovascular disease risk factors among patients with atherosclerosis.

Dietary inflammatory index significantly affects lipids profile among adults: An updated systematic review and meta-analysis

Background: The available data on the relationship between dietary inflammatory index (DII®) and serum lipids are controversial. This systematic review and meta-analysis aimed to investigate the relationship between DII® and serum lipids, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) in general populations. Methods: PubMed, Web of Science, SCOPUS, and Cochrane electronic databases were systematically searched from inception to December 2019. Case-control, cohort or cross-sectional studies that evaluated the relationship between DII® and serum lipids were included. The random-effects model was applied to evaluate the pooled weighted mean difference (WMD) and 95% confidence intervals (CI). Results: In total, twenty-four cross-sectional and one case-control studies with a total sample size of 129,759 were included in the meta-analysis. The pooled results showed that the highest category of DII® was associated with 5.16 mg/dl increase in TC (Pooled WMD: 5.16; 95% CI: 0.58-9.73, p = 0.02) and 3.99 mg/dl increase in LDL-C (Pooled WMD: 3.99; 95% CI: 1.16-6.81, p = 0.006). However, no significant association between DII® scores, HDL-C and TG was found. In subgroup analysis, the geographical region, gender, and dietary assessment methods were potent sources of heterogeneity. Conclusion: This study showed that a higher level of DII® was associated with higher levels of TC and LDL-C in apparently healthy populations. Since the included studies had observational designs, therefore, no conclusion of causality was possible. More studies with interventional designs are required to elucidate the causality of the observed association between DII® and the risk of abnormal lipid profile.

Diet Quality Indices in Relation to Cardiovascular Risk Factors in T2DM Patients: A Systematic Review

BACKGROUND

Dietary quality indices are practical as an instrument to investigate the extent of adhering to a special diet to prevent cardiovascular disease (CVD) in type 2 diabetes mellitus (T2DM). Considering the lack of any systematic review with regards to this issue, our aim was to examine observational studies to test the relationship between dietary quality indices and CVD risk factors in T2DM.

METHODS

Systematic search was performed in Web of knowledge, PubMed, Cochrane, Science direct, Google Scholar and Scopus databases from January 1990 to July 2020. The studies exploring the relationship between dietary quality indices (diet quality score (DQS), dietary diversity score (DDS), healthy diet indicator (HDI), healthy eating index (HEI), diet quality index (DQI), Mediterranean diet score (MDS)) and lipid profile, anthropometric indices, glucose profile as well as blood pressure were eligible to be included in this review. Overall, mean changes, odd ratio (RR), correlation coefficients, and beta coefficient of outcomes were extracted, with the quality assessment of studies performed applying The Newcastle-Ottawa scale.

RESULTS

From among 1627 papers, 10 articles were included: Eight cross-sectional and two prospective (cohort) studies. The association between HEI as well as MDS and CVD risk factors was more evident in the included studies. Fasting blood sugar, hemoglobin A1c, body mass index, and waist circumference revealed the greatest inverse significant relationship with dietary quality indices in adults with T2DM.

CONCLUSION

Overall, the findings of this study suggest that the level of CVD risk factors in T2DM decreases significantly with increase in the score of dietary quality indices. Further studies in future are required to confirm these findings.

Associations between the Nutrient Profiling System Underlying the Nutri-Score Nutrition Label and Biomarkers of Chronic Low-Grade Inflammation: A Cross-Sectional Analysis of a Middle- to Older-Aged Population

Low-grade systemic inflammation is associated with a range of conditions. Diet may modulate inflammation and public health strategies are needed to guide consumers’ dietary choices and help prevent diet-related disease. The Food Standards Agency nutrient profiling system (FSAm-NPS) constitutes the basis of the five-colour front-of-pack Nutri-Score labelling system. No study to date has examined FSAm-NPS dietary index associations with biomarkers of inflammation. Therefore, our objective was to test relationships between the FSAm-NPS and a range of inflammatory biomarkers in a cross-sectional sample of 2006 men and women aged 46–73 years. Individual participant FSAm-NPS scores were derived from food frequency questionnaires. Pro-inflammatory cytokine, adipocytokine, acute-phase response protein, coagulation factor and white blood cell count concentrations were determined. Correlation and linear regression analyses were used to examine FSAm-NPS relationships with biomarker levels. In crude and adjusted analyses, higher FSAm-NPS scores, reflecting poorer nutritional quality, were consistently and positively associated with biomarkers. In fully adjusted models, significant associations with concentrations of complement component 3, c-reactive protein, interleukin 6, tumour necrosis factor alpha, resistin, white blood cell count, neutrophils, eosinophils and the neutrophil-to-lymphocyte ratio persisted. These results suggest that dietary quality, determined by Nutri-Score rating, is associated with inflammatory biomarkers related to health.

Association between Dietary Fat Intake and Hyperuricemia in Men with Chronic Kidney Disease

Despite a close relationship between chronic kidney disease (CKD) and uric acid level, few studies have examined the relationship between uric acid level and fat intake by kidney function status. Therefore, we investigated the association between dietary fat intake and hyperuricemia with and without decreased kidney function in males living in Shika Town, Ishikawa Prefecture, Japan. This study included 361 males with a mean age of 60.7 years. Dietary fat and fatty acid intakes were evaluated using the brief-type self-administered diet history questionnaire. Reduced kidney function was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, while hyperuricemia was defined as a serum uric acid level >7.0 mg/dL. A two-way analysis of covariance showed that saturated fatty acid (p = 0.026), monounsaturated fatty acid (p = 0.014), and polyunsaturated fatty acid (p = 0.022) were significantly lower in the high uric acid group than in the normal uric acid group. In multiple logistic analysis stratified by renal function, lipid intake was negatively associated with hyperuricemia in the low eGFR group. These findings suggest that higher dietary lipid/fatty acid intake may be effective in the prevention and treatment of hyperuricemia in men with CKD.

Lifestyle and Dietary Habits Affect Plasma Levels of Specific Cytokines in Healthy Subjects

Low-grade chronic inflammation (LGCI) is a common feature of non-communicable diseases. Cytokines play a crucial role in LGCI. This study aimed to assess how LGCI risk factors [e.g., age, body mass index (BMI), smoke, physical activity, and diet] may impact on specific cytokine levels in a healthy population. In total, 150 healthy volunteers were recruited and subjected to questionnaires about the last 7-day lifestyle, including smoking habit, physical activity, and food frequency. A panel of circulating cytokines, chemokines, and growth factors was analyzed by multiplex ELISA. BMI showed the heaviest impact on the correlation between LGCI-related risk factors and cytokines and was significantly associated with CRP levels. Aging was characterized by an increase in IL-1b, eotaxin, MCP-1, and MIP-1α. Smoking was related to higher levels of IL-1b and CCL5/RANTES, while physical activity was related to MIP-1α. Within the different eating habits, CRP levels were modulated by eggs, red meat, shelled fruits, and greens consumption; however, these associations were not confirmed in a multivariate model after adjusting for BMI. Nevertheless, red meat consumption was associated with an inflammatory pattern, characterized by an increase in IL-6 and IL-8. IL-8 levels were also increased with the frequent intake of sweets, while a higher intake of shelled fruits correlated with lower levels of IL-6. Moreover, IL-6 and IL-8 formed a cluster that also included IL-1b and TNF-α. In conclusion, age, BMI, smoke, physical activity, and dietary habits are associated with specific cytokines that may represent potential markers for LGCI.

Dietary Inflammatory Index in relation to Type 2 Diabetes: A Meta-Analysis

BACKGROUND AND AIMS

Epidemiologic studies show a strong association between chronic inflammation and type 2 diabetes (T2D). Diet may also affect the risk of T2D by modulating inflammation. This meta-analysis aimed to assess the relation of dietary inflammatory index (DII) and risk of T2D.

METHODS

PubMed and Scopus were systematically searched from their inception to September 2020 to identify relevant studies. Relative risks, hazard ratios, or odds ratios (OR), with their corresponding 95% confidence intervals (95% CI), were calculated and pooled using a random-effects model.

RESULTS

A total of 48 different studies, with a total sample size of 1,687,424 participants, were eligible to be included in this meta-analysis. In the overall analysis, no significant association was observed between DII and risk of T2D (OR = 1.03, 95% CI: 0.91 to 1.15), with significant evidence for heterogeneity (I 2  = 96.5%, P < 0.001); however, higher DII was identified as being significantly related to increased risk of T2D in high quality studies (OR = 1.58, 95% CI: 1.15 to 2.17). In the stratified analysis by the dietary assessment tool, background disease, and sex of participants, DII showed no significant association with T2D.

CONCLUSIONS

Higher DII might be associated with an increased risk of T2D. Additional well-designed studies are required to confirm this finding.

Does the use of mobile applications or mobile health technology improve diet quality in adults? A protocol for a systematic literature review

Background: Mobile technology has grown at an exceptional rate and is now a huge part of our daily living. This use of mobile technology has opened up new possibilities in treating health, with almost half of the current applications linked to the mHealth sector. In particular, dietary measurement, applications have become very accessible and very popular. As dietary issues have become more prevalent, more mobile and mHealth applications offer various solutions. This systematic review aims to address if the use of such mobile applications or mobile health technology can improve diet quality in adults that interact with them. Methods: A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. The Cumulative Index to Nursing and Allied Health Literature (Cinahl), The American Psychological Association’s (APA Psycinfo), and PubMed will be searched from January 2010 to November 2021. Primary outcomes will include identifying if adults who use mobile applications and health technology improve their diet quality compared to adults who do not use this technology. Study selection will follow the Preferred Reporting Items for Systematic Reviews and MetaAnalyses (PRISMA) guidelines. The methodological appraisal of the studies will be assessed independently by two different reviewers (AS and JR) using the Cochrane Risk-of-Bias Tool for RCTs and the Risk-of Bias In Non-Randomised Studies Tool for NRCTs. Ethics and dissemination: Ethical approval is not essential for this systematic review. Only data from studies that are publically available from previously published studies will be used. The findings of this systematic review will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. PROSPERO registration: CRD42021240224 (01/03/2021).

Dietary score associations with markers of chronic low-grade inflammation: a cross-sectional comparative analysis of a middle- to older-aged population

PURPOSE

To assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Mediterranean Diet (MD), Dietary Inflammatory Index (DII^®) and Energy-adjusted DII (E-DII™) scores and pro-inflammatory cytokines, adipocytokines, acute-phase response proteins, coagulation factors and white blood cells.

METHODS

This was a cross-sectional study of 1862 men and women aged 46-73 years, randomly selected from a large primary care centre in Ireland. DASH, MD, DII and E-DII scores were derived from validated food frequency questionnaires. Correlation and multivariate-adjusted linear regression analyses with correction for multiple testing were performed to examine dietary score relationships with biomarker concentrations.

RESULTS

In fully adjusted models, higher diet quality or a less pro-inflammatory diet was associated with lower concentrations of c-reactive protein, neutrophils (all dietary scores), complement component 3 [C3], interleukin 6 [IL-6], tumour necrosis factor-alpha [TNF-α], white blood cell count [WBC], the neutrophil-to-lymphocyte ratio [NLR] (DASH, DII and E-DII), monocytes (DASH and DII) and resistin (DII and E-DII). After accounting for multiple testing, relationships with C3 (DASH: β = - 2.079, p = .011 and DII: β = 2.521, p = .036), IL-6 (DASH: β = - 0.063, p = .011), TNF-α (DASH: β = - 0.027, p = .034), WBC (DASH: β = - 0.028, p = .001 and DII: β = 0.029, p = .02), neutrophils (DASH: β = - 0.041, p = .001; DII: β = 0.043, p = .007; E-DII: β = 0.029, p = .009) and the NLR (DASH: β = - 0.035, p = .011) persisted.

CONCLUSIONS

Better diet quality, determined by the DASH score, may be more closely associated with inflammatory biomarkers related to health in middle- to older-aged adults than the MD, DII and E-DII scores.

Association of Diet Quality and Food Insecurity with Metabolic Syndrome in Obese Adults

Background:

The link between diet quality, food insecurity (FI), and metabolic syndrome (MetS) remains unclear in obese adults. The aim of this study was to examine the association of diet quality and FI with MetS in obese Iranian adults.

Methods:

This cross-sectional study was conducted on 300 obese adults. Dietary intake was assessed using a validated 168-item food frequency questionnaire. Diet quality and FI were measured using the Diet Quality Index-International (DQI-I) and an adapted USDA2000 household food security status questionnaire, respectively. MetS was defined according to the International Diabetes Federation diagnostic criteria. Association was determined using logistic regression analysis adjusting for potential confounders.

Results:

MetS subjects had lower DQI-I score than subjects without MetS (67.5 ± 8.7 vs 71.5 ± 7.4, P = 0.05). The prevalence of food insecurity was 48.6% (95% confidence interval (CI): 41.2, 56.1) in MetS subjects and 39.4% (95% CI: 29.4, 49.9) in subjects without MetS. After adjustment, participants in the fourth quartile of DQI-I score had 70% lower odds of MetS (Adjusted odds ratio [AOR], 0.3; 95% CI: 0.1–0.7), 70% lower odds of hypertriglyceridemia (AOR, 0.3; 95% CI: 0.2–0.7) and 60% lower risk of reduced high-density lipoprotein [HDL] (AOR, 0.4; 95% CI: 0.2–0.9) compared with the first quartile. Obese food insecure adults had 60% higher odds of high blood pressure (AOR, 1.6; 95% CI: 1.0–2.6) and 70% higher odds of hypertriglyceridemia (AOR, 1.7; 95% CI: 1.0–2.8) compared with food-secure obese adults. There was no statistically significant interaction observed between DQI-I and food insecurity on MetS.

Conclusions:

Lower DQI-I score and food insecurity were associated with an increased risk of MetS and some features such as hypertriglyceridemia, reduced HDL, and high blood pressure in obese Iranian adults.

Lifestyle Factors Influencing Dietary Patterns of University Professors

The objectives of this study are to identify eating patterns of university professors and to assess the relationships among sociodemographic factors in relation to lifestyle and physical activity. It is a cross-sectional, descriptive-correlational, and observational study with a representative sample of 127 educators, which covers almost the total population of university professors belonging to one of the campuses of the University of Granada (Spain). Two eating patterns were identified a posteriori through explanatory factor analysis: a Western pattern characterised by the consumption of dairy products, eggs, meat, sausages, refined oils, and butter, sugar, processed baked goods, and sugar-containing beverages and alcoholic drinks, and a Mediterranean pattern based on olive oil, fish, fruits, nuts, vegetables, pulses, cereals, and honey, which explain the 20.102 and 17.411 of variance, respectively. Significant differences are observed between the two genders with respect to anthropometric characteristics (weight and size, p < 0.001 in both cases) and to nutritional status (p = 0.011). Origin (p = 0.022) and level of physical activity (p = 0.010) were significantly related to adherence to a Western diet pattern. In the case of the Mediterranean diet pattern, significant differences are observed according to the professors' type of bachelor's degree (p = 0.37). This study provides evidence on factors having an impact on adherence to eating patterns of professors of the University of Granada, and it suggests that programmes addressed to such groups should be developed to promote health.

Comparing dietary score associations with lipoprotein particle subclass profiles: A cross-sectional analysis of a middle-to older-aged population

BACKGROUND AND OBJECTIVES

Lipoprotein particle concentrations and size are associated with increased risk for atherosclerosis and premature cardiovascular disease. Studies also suggest that certain dietary behaviours may be cardioprotective. Limited comparative data regarding any dietary score/index-lipoprotein particle subclass associations exist. Thus, our objective was to assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Health Eating Index-2015 (HEI-2015), Mediterranean Diet (MD) and Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and plasma lipids and lipoprotein profiles to test the hypothesis that healthier diet (better quality and more anti-inflammatory) would be associated with a more favourable lipoprotein profile.

MATERIALS AND METHODS

This was a cross-sectional study of 1862 men and women aged 46-73 years, randomly selected from a large primary care centre in Ireland. DASH, HEI-2015, MD and E-DII scores were derived from food frequency questionnaires. Lipoprotein subclass particle concentrations and size were determined using nuclear magnetic resonance spectroscopy. Correlation and multivariate-adjusted linear regression analyses with correction for multiple testing were performed to examine dietary score relationships with lipoprotein particle subclasses.

RESULTS

In fully adjusted models, higher diet quality or a more anti-inflammatory diet was associated with less large and medium very low-density lipoprotein (VLDL) (DASH and HEI-2015), intermediate-density lipoprotein (IDL) (DASH, MD and E-DII) and small high-density lipoprotein (HDL) (DASH, HEI-2015 and E-DII) particles. After accounting for multiple testing, relationships with large VLDL (DASH: β = -0.102, p = .037), IDL (DASH: β = -0.089, p = .037) and small HDL (DASH: β = -0.551, p = .014 and E-DII: β = 0.483, p = .019) concentrations persisted.

CONCLUSIONS

These findings provide evidence that better diet quality, determined by the DASH score, may be more closely associated with a more favourable lipoprotein particle subclass profile in middle-to older-aged adults than the HEI-2015, MD and E-DII scores. A less pro-atherogenic lipoprotein status may be a potential mechanism underlying the cardioprotective effects of higher dietary quality.

Association of Healthy Eating Index and the Alternative Healthy Eating Index with the cell blood count indices

OBJECTIVES

There is an association between diet quality and markers of inflammation. We aimed to investigate the relationship between diet quality with cell blood count (CBC) and inflammatory indices such as red cell distribution width (RDW) and white blood cell count (WBC).

STUDY DESIGN

A total of 367 male subjects aged 20-69 yrs, who were employees of Shahid Hasheminejad Gas Processing Company (SGPC) completed the study.

METHODS

All participants completed a questionnaire that contained questions about demography. Standard protocols were used for measuring anthropometric indices in all subjects. Blood samples were collected after a 12 hrs fast from all participants. Biochemical parameters were determined in all participants using an auto-analyzer (Eppendorf, Germany). Systolic and diastolic blood pressure were measured using a standard mercury sphygmomanometer. CBC was measured using the Sysmex auto analyser system (KX-21 N). The HEI/AHEI scores extracted from a validated food frequency questionnaire (FFQ) to evaluate the diet quality. Data analyses were performed using SPSS 16 (SPSS Inc., IL, and USA).

RESULTS

A total of 674 men (aged 43.68±9.09 yrs) completed the study. The CBC indices were not significantly different between the HEI/AHEI classifications among the Iranian men (p-value >0.05 for all variables). Moreover, there was no association between HEI/ AHEI with the CBC indices in our population (p-value >0.05 for all variables).

CONCLUSIONS

In summary, there was no association between the diet quality with the cell blood count parameters among Iranian men.

Dietary patterns and associations with biomarkers of inflammation in adults: a systematic review of observational studies

Background

Evidence indicates that low-grade inflammation is involved in manychronic diseases of ageing. Modifiable lifestyle factors including dietcan affect low-grade inflammation. Dietary patterns allow assessment of the complex interactions of food nutrients and health and may be associated with inflammatory status.

This systematic review aimed to summarises current evidence from observational studies for associations between dietary patterns and inflammatory biomarkers in the general adult population. This review followed the PRISMA guidelines.

Methods

We conducted a systematic search in Embase, CINAHL Complete, Global Health and MEDLINE complete databases. Search terms included terms for diet (“dietary patterns”, “diet scores”) and inflammation (“inflammation“, “c-reactive protein“, “interleukin“).

Results

The search produced 7161 records. Duplicates were removed leaving 3164 for screening. There were 69 studies included (60 cross-sectional, 9 longitudinal). Papers included studies that were: 1) observational studies; 2) conducted in community-dwelling adults over 18 years of age; 3) assessed dietary patterns; 4) measured specified biomarkers of inflammation and 5) published in English. Dietary patterns were assessed using diet scores (n = 45), data-driven approaches (n = 22), both a data-driven approach and diet score (n = 2). The most frequently assessed biomarkers were CRP (n = 64) and/or IL-6 (n = 22). Cross-sectionally the majority of analyses reported an association between higher diet scores (mostly Mediterranean and anti-inflammatory diet scores) and lower inflammatory markers with 82 significant associations from 133 analyses. Only 22 of 145 cross-sectional analyses using data-driven approaches reported an association between a dietary patterns and lower inflammatory markers; the majority reported no association. Evidence of an association between dietary patterns and inflammatory markers longitudinally is limited, with the majority reporting no association.

Conclusions

Adherence to healthy, Mediterranean and anti-inflammatory dietary scores, appear to be associated with lower inflammatory status cross-sectionally. Future research could focus on longitudinal studies using a potential outcomes approach in the data analysis.

Trial registration

PROSPERO Registration Number CRD42019114501.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00674-9.

The Relationship Between the Healthy Diet Index, Chronic Diseases, Obesity and Lifestyle Risk Factors Among Adults in Kaunas City, Lithuania

A healthy and balanced diet is an important factor contributing to overall health and wellness. The aim of this study was to develop a Healthy Diet Index (HDI) score and assess its association with various chronic diseases and lifestyle risk factors. A cross-sectional survey included 1,111 adults aged 18 years and older. Information on dietary habits was collected using a questionnaire. Additional demographic, socioeconomic and lifestyle risk factors data were also collected. Sixteen food groups were used to develop the HDI score for the residents of Kaunas city, Lithuania based on the national recommendations, World Health Organization (WHO) and other guidance on a healthy diet. We used logistic regression models to assess the association of the HDI score with chronic diseases, obesity and lifestyle risk factors. We found that both males and females were lacking the optimal consumption of the base components of a healthy diet-fruits and vegetables, starchy carbohydrates, and proteins. We also observed significant associations between the HDI score and several outcomes such as hypertension, arrhythmia, physical activity, and obesity. The suggested HDI score could serve as a valuable tool in assessing and improving dietary habits beneficial for promoting health and preventing many diseases.

Dietary Quality Determined by the Healthy Eating Index-2015 and Biomarkers of Chronic Low-Grade Inflammation: A Cross-Sectional Analysis in Middle-to-Older Aged Adults

Low-grade systemic inflammation is associated with a range of chronic diseases. Diet may modulate inflammation and represents a promising therapeutic target to reduce metabolic dysfunction. To date, no study has examined Healthy Eating Index-2015 (HEI-2015) diet score associations with biomarkers of inflammation. Thus, our objective was to assess relationships between the HEI-2015 score and a range of inflammatory biomarkers in a cross-sectional sample of 1989 men and women aged 46-73 years, to test the hypothesis that better dietary quality would be associated with more favourable circulating levels of inflammatory biomarkers. Pro-inflammatory cytokines, adipocytokines, acute-phase response proteins, coagulation factors and white blood cell counts were determined. Correlation and linear regression analyses were used to test HEI-2015 diet score relationships with biomarker concentrations. Higher dietary quality as determined by the HEI-2015 was associated with lower c-reactive protein (CRP) and interleukin 6 concentrations, white blood cell (WBC) counts and its constituents, adjusting for sex and age. Associations with CRP concentrations and WBC counts persisted in the fully adjusted models. No associations with complement component 3, tumour necrosis factor alpha, adiponectin, leptin, resistin or plasminogen activator inhibitor-1 levels were identified. Our data suggest that dietary quality, determined by the HEI-2015 score, in middle-to-older aged adults is associated with inflammatory biomarkers related to cardiometabolic health.

A comparison of diet quality indices in a nationally representative cross-sectional study of Iranian households

BACKGROUND

Iranian diet quality has been evaluated using indices that have not been created based on Iranian dietary guidelines. This study aimed to examine the applicability of two diet quality indices by examining their associations with nutrient adequacy, nutrient intakes and sociodemographics.

METHODS

Dietary data were collected using three 24-h dietary recalls from Iranian households. Nutrient adequacy was assessed using World Health Organization/Food and Agriculture Organization 2002 (WHO/FAO) cut points. Household diet quality was calculated using the Healthy Eating Index (HEI) and Diet Quality Index-International (DQI-I). Sociodemographics of the household members were assessed. Regression analyses were used to examine associations between diet quality and nutrient adequacy, and between sociodemographics and diet quality.

RESULTS

A total of 6935 households were included in the analysis. Higher household diet quality was associated with adequate intake of calcium (HEI: OR 1.11, 95% CI: 1.10, 1.13; DQI-I: OR 1.14, 95% CI: 1.13, 1.16), vitamin C (HEI: OR 1.19, 95% CI: 1.17, 1.20; DQI-I: OR 1.12, 95% CI: 1.11, 1.12) and protein (HEI: OR 1.01, 95% CI: 1.00, 1.02; DQI-I: OR 1.09, 95% CI: 1.08, 1.09). Higher household diet quality was associated with household heads who were older (> 56 years old) (HEI: β 2.06, 95% CI: 1.63, 2.50; DQI-I β 2.90, 95% CI: 2.34, 3.45), higher educated (college/university completed) (HEI: β 4.54, 95% CI: 4.02, 5.06; DQI-I: β 2.11, 95% CI: 1.45, 2.77) and living in urban areas (HEI: β 2.85, 95% CI: 2.54, 3.16; DQI-I: β 0.72, 95% CI: 0.32, 1.12).

CONCLUSIONS

Based on associations with nutrient adequacy and sociodemographics, the applicability of two diet quality indices for assessing the diet quality of Iranian households was demonstrated. Results also indicated DQI-I may be more applicable than HEI for evaluating Iranian nutrient adequacy. Findings have implications for the design and assessment of diet quality in Iranian populations. Future research should examine the link between these diet quality indices and health outcomes.

Mediterranean diet and the risk of chronic kidney disease: A systematic review and meta-analysis

OBJECTIVE

Mediterranean diet has been shown to be associated with lower risk of cardiovascular disease. However, its association with chronic kidney disease (CKD) remains inconclusive as the results were not consistent among population-based studies. This study aims to assess the association between Mediterranean diet adherence and CKD prevention.

METHODS

We performed a systematic review and meta-analysis of studies describing the risk for CKD in community-dwelling subjects ≥18 years of age. Mediterranean diet adherence was assessed by standardized food frequency questionnaires. The search was conducted through MEDLINE, EMBASE and Cochrane Library.

RESULTS

Of 168 citations, a total of nine (n = 19 151) and four studies (n = 8467) were included in the systematic review and meta-analysis, respectively. Only studies adopting Mediterranean Diet Scale (MDS) were included in the analysis. The mean score was 3.8 ± 0.3 points. With the mean follow-up duration of 20.6 ± 7.0 years, the pooled odds ratio (OR) for CKD was 0.901 (95% confidence interval [CI] 0.868-0.935) for each 1-point increment of MDS. The incidence of CKD was 0.026 events per person-year (95% CI 0.008-0.045). Moreover, male sex was associated with the incidence of CKD in an adjusted meta-regression analysis. In contrast, there was no significant association between age, black race, smoking, diabetes, hypertension estimated glomerular filtration rate and total daily energy intake vs CKD incidence.

CONCLUSION

Adherence to Mediterranean diet by a 1-point increment of MDS was associated with 10% lower risk of CKD. However, there were insufficient data on patients with pre-existing CKD or dialysis.

High variability of food and nutrient intake exists across the Mediterranean Dietary Pattern-A systematic review

A Mediterranean style dietary pattern (MDP) is considered beneficial for health. The MD Score (MDS) definition has evolved, resulting in considerable variability in the foods and nutrients associated with MDS adherence. We systematically investigated food and nutrient composition of the MD between studies, countries, and methods of classifying the MDS. We searched Embase for MD systematic reviews and selected observational studies reporting intakes of foods, macronutrients, or micronutrients by categories of MDS adherence. The percentage differences in food and nutrient intakes between categories of high and low adherence to the MDS were calculated for each study. A total of 369 full-text primary papers were reviewed from the included systematic reviews and 74 papers selected (66 adults, 8 children). We found considerable differences in MDS definitions and scoring criteria. Between-study variation in food intake between high- and low-adherence MDS adherence categories ranged from a mean of -23% for meat, to 119% for fruit, and 278% for fish. Greater variability was evident in non-Mediterranean than Mediterranean regions. We conclude that few studies report food and nutrient intakes across the range of the MDP in adults and even fewer in children. The considerable variability in the foods and nutrients reported makes comparison of results from studies and translation into dietary guidelines difficult. We recommend that future publications of MD studies include full details of the range of food and nutrient intakes across the distribution of MD adherence in order to facilitate translation into health policy and practice.

Relationship between diet quality and sarcopenia in elderly Koreans: 2008-2011 Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES

Given the increasing proportion of the Korean population that is aged 65 years and older, the present study analyzed the relationship between diet quality and sarcopenia in elderly persons by using data from the 2008-2011 Korea National Health and Nutrition Examination Survey (KNHANES).

SUBJECTS/METHODS

Data for 3,373 persons aged 65 years and over (men: 1,455, 43.1%) were selected from the 2008-2011 KNHANES. Sarcopenia assessments are based on a formula that divides a subject's appendicular skeletal muscle mass (ASM) by their weight (wt) and multiplies that result by 100 ([ASM/wt] × 100). Sarcopenia is present if the subject's result was less than one standard deviation (SD) below the sex-specific mean for a young reference group. For evaluation of diet quality, data obtained via the 24-hour recall method were used to calculate the Diet Quality Index for Koreans (DQI-K). A general linear model was applied in order to analyze general information and nutritional intake according to sarcopenia status. For analysis of the relationship between diet quality and sarcopenia, a binominal logistic regression analysis was undertaken.

RESULTS

The sarcopenia prevalence rate among the study subjects aged 65 years and over was 37.6%. The DQI-K of those without sarcopenia was 3.33 ± 0.04 points, while that of those with sarcopenia was 3.45 ± 0.04 points (P < 0.05). The relationship between diet quality and sarcopenia revealed that subjects aged 75 and older had a poor diet quality, and their odds ratio (OR) of sarcopenia presence was significantly higher (OR: 1.807, 95% confidence interval: 1.003-3.254, P < 0.05).

CONCLUSIONS

This study revealed that poor diet quality was related to sarcopenia presence in Koreans aged 75 and older. In order to improve the diet quality of the elderly (aged 75 and older), it is necessary to develop dietary improvement guidelines.

Dietary inflammatory index potentially increases blood pressure and markers of glucose homeostasis among adults: findings from an updated systematic review and meta-analysis

OBJECTIVE

In the current meta-analysis, we aimed to systematically review and summarize eligible studies for the association between dietary inflammatory index (DII) and blood pressure, hypertension (HTN) and glucose homeostasis biomarkers.

DESIGN/SETTING

In a systematic search of PubMed, Scopus and Google Scholar electronic databases up to February 2019, relevant studies were included in the literature review. Observational studies evaluating the association between DII and HTN, hyperglycaemia, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), insulin, homeostatic model assessment of insulin resistance (HOMA-IR) and glycated Hb (HbA1c) were included.

PARTICIPANTS

Not applicable.

RESULTS

Total numbers of studies were as follows: OR for DII and HTN (n 12), OR for DII and hyperglycaemia (n 9), HTN prevalence (n 9), mean (sd) of SBP and DII (n 12), mean (sd) of DBP and DII (n 10), mean (sd) of FBS and DII (n 13), mean (sd) of HbA1c and DII (n 3), mean (sd) of insulin and DII (n 6), mean (sd) of HOMA-IR and DII (n 7). Higher DII scores were associated with higher odds of HTN (OR = 1·13; 95 % CI 1·01, 1·27; P < 0·001), SBP (weighted mean difference (WMD) = 1·230; 95 % CI 0·283, 2·177; P = 0·011), FBS (WMD = 1·083; 95 % CI 0·099, 2·068; P = 0·031), insulin (WMD = 0·829; 95 % CI 0·172, 1·486; P = 0·013), HbA1c (WMD = 0·615; 95 % CI 0·268, 0·961; P = 0·001) and HOMA-IR (WMD = 0·192; 95 % CI 0·023, 0·361; P = 0·026) values compared with lowest DII categories.

CONCLUSIONS

Lower inflammatory content of diets for prevention of cardiovascular risk factors is recommended.

Improving diet quality over nine-years is associated with less weight gain in mid-age Australian women: A cohort study

BACKGROUND AND AIMS

Most studies measure baseline diet quality exclusively and hence the impact of longitudinal changes in dietary intake in relation to weight change is not considered. Therefore, this study aimed to examine whether change in diet quality over nine-years was associated with weight change over the same period in mid-age Australian women.

METHODS AND RESULTS

Healthy mid-age (45-49 years) women from the Australian Longitudinal study on Women's Health (ALSWH) were eligible a valid total energy intake (TEI) was reported at baseline (n = 2381), determined using Goldberg cut-offs. Diet quality was measured by the Australian Recommended Food Score (ARFS) using data derived from a validated food frequency questionnaire. Multiple linear regressions were used to evaluate relationships between change in diet quality and weight in mid-age women (n = 1999). Women in the highest tertile of ARFS change improved diet quality [mean ± SD] [7 ± 4 points], while those in the lowest [-9 ±5 points] and middle [-1±2 points] tertiles had worse diet quality at follow-up. Overall, mean weight gain was 2.3 ± 7.2 kg over nine years. Those in the highest tertile of ARFS change gained significantly less weight, compared to the lowest tertile; β = -1.2 kg [95% CI: -2.31, -0.11; p = 0.03] after adjustment for changes in confounders and baseline weight, baseline ARFS, and total energy intake.

CONCLUSIONS

Improving diet quality could be an important strategy for promoting modest weight loss and potentially contribute to preventing weight gain in mid-age women, which is important for metabolic health.

Association of dietary inflammatory potential with cardiometabolic risk factors and diseases: a systematic review and dose-response meta-analysis of observational studies

CONTEXT

The association of dietary inflammatory index (DII®), as an index of inflammatory quality of diet, with cardiometabolic diseases (CMDs) and risk factors (CMRFs) has been inconsistent in previous studies.

OBJECTIVE

The current systematic review and dose-response meta-analysis was performed to investigate the association of the DII score with CMDs and CMRFs.

DATA SOURCES

All published observational studies (cohort, case-control and cross-sectional) using PubMed/Medline, Scopus, ISI Web of Science, and Google Scholar databases were retrieved from inception through November 2019.

DATA EXTRACTION

Two reviewers independently extracted the data from included studies.

DATA ANALYSIS

Pooled hazard ratio (HR) or odds ratio (OR) were calculated by using a random-effects model.

RESULTS

Ten prospective cohort studies (total n = 291,968) with 31,069 CMDs-specific mortality, six prospective cohort studies (total n = 43,340) with 1311 CMDs-specific morbidity, two case-control studies with 2140 cases and 6246 controls and one cross-sectional study (total n = 15,613) with 1734 CMDs-specific morbidity were identified for CMDs. Meta-analyses of published observational studies demonstrated that the highest DII score category versus the lowest DII score category was associated with 29% increased risk of CMDs mortality (HR = 1.29; 95% confidence interval (CI) 1.18, 1.41). Moreover, there was a significant association between the DII score and risk of CMDs in cohort studies (HR = 1.35; 95% CI 1.13, 1.61) and non-cohort study (HR = 1.36; 95% CI 1.18, 1.57). We found a significant association between the DII score and metabolic syndrome (MetS) (OR: 1.13; 95% CI 1.03, 1.25), hyperglycemia and hypertension. None-linear dose response meta-analysis showed that there was a significant association between the DII score and risk of CMDs mortality (P_nonlinearity < 0.001). Moreover, evidence of none-linear association between the DII score and risk of CMDs was not observed (p-value = 0.1).

CONCLUSIONS

Adherence to pro-inflammatory diet was associated with increased risk of CMDs, mortality and MetS.

Perspective: The Application of A Priori Diet Quality Scores to Cardiovascular Disease Risk-A Critical Evaluation of Current Scoring Systems

Healthy dietary habits are the cornerstone of cardiovascular disease (CVD) prevention. Numerous researchers have developed diet quality indices to help evaluate and compare diet quality across and within various populations. The availability of these new indices raises questions regarding the best selection relevant to a given population. In this perspective, we critically evaluate a priori-defined dietary indices commonly applied in epidemiological studies of CVD risk and mortality. A systematic literature search identified 59 observational studies that applied a priori-defined diet quality indices to CVD risk factors and/or CVD incidence and/or CVD mortality. Among 31 different indices, these scores were categorized as follows: 1) those based on country-specific dietary patterns, 2) those adapted from distinct dietary guidelines, and 3) novel scores specific to key diet-related factors associated with CVD risk. The strengths and limitations of these indices are described according to index components, calculation methods, and the application of these indices to different population groups. Also, the importance of identifying methodological challenges faced by researchers when applying an index are considered, such as selection and weighting of food groups within a score, since food groups are not necessarily equivalent in their associations with CVD. The lack of absolute cutoff values, emphasis on increasing healthy food without limiting unhealthy food intake, and absence of validation of scores with biomarkers or other objective diet assessment methods further complicate decisions regarding the best indices to use. Future research should address these limitations, consider cross-cultural and other differences between population groups, and identify translational challenges inherent in attempting to apply a relevant diet quality index for use in CVD prevention at a population level.

Association of adherence to the dietary approach to stop hypertension diet and diet quality indices among women in Tehran: A cross- sectional study

Background: Examining dietary approach to stop hypertension (DASH) diet based on other dietary quality indices can be helpful to clarify positive aspects of this healthy dietary pattern. We aimed to examine the association between the DASH diet score and some diet quality indices among Iranian women.

Methods: In this cross-sectional study, 304 women aged 20 to 50 years old were recruited. Dietary diversity score (DDS), dietary energy density (DED), adherence to DASH diet, AlternativeHealthy Eating Index (AHEI) and mean adequacy ratio (MAR) were examined as suggested by previous articles. Dietary quality indices, anthropometric indices, and dietary intake were categorized based on DASH tertiles. A semi-quantitative food frequency questionnaire with 168items was used for dietary assessment.

Results: There were no significant differences in the demographic characteristics of participants across DASH tertiles (P>0.05). Participants who adhered more to the DASH diet had lower DEDthan those with lower adherence (0.99±0.35 vs 1.26±0.30; P=0.01). Significant differences were observed in the index of DDS across tertiles (P=0.01), however no differences in nutrient adequacy ratio (NAR) and MAR (0.93) index across the DASH categories were found.Additionally, DDS to DED in the top tertile of the DASH diet was greater than the bottom one(6.7±2.9 vs 4.4±1.9; P=0.001).

Conclusion: The present study indicated that greater adherence to the DASH diet is inversely associated with DED and AHEI. As well as, there was a positive association between the DASHdiet and DDS/DED ratio. However, more studies are needed to confirm the results of this study

Diet quality indices and cardiovascular diseases risk factors among diabetic women

BACKGROUND

Diabetes is a common chronic disease with many complications and is associated with the development of cardiovascular diseases (CVD). The present study aimed to investigate the association of diet quality indices and CVD risk factors among diabetic women. This cross-sectional study was conducted in 230 Tehrani women with type 2 diabetes. A validated and reliable food frequency questionnaire was completed to assess the dietary intake. Diet quality indices were considered with respect to adherence to the Healthy Eating Index-2010 (HEI-2010) and Diet Quality Index-International (DQI-I). Anthropometric measurements, blood pressure and biochemical tests were assessed. CVD risk factors were evaluated according to the adult treatment panel III.

RESULTS

Patients who were in the top tertile of the DQI consumed less fat, saturated fatty acids and sodium, as well as more protein, fiber, iron and calcium (P < 0.05). Participants who were in the top tertile of diet quality indices consumed less processed and organ meat and more fruits, and vegetables. Patients in the highest tertile of HEI had lower fasting blood sugar levels (148.92 ± 6.05 mg dL^-1 versus 171.30 ± 5.79 mg dL^-1 , P = 0.021). There was no significant association between DQI-I, HEI and other CVD risk factors.

CONCLUSION

There was no association between diet quality indices and CVD risk factors among diabetic patients. © 2019 Society of Chemical Industry.

Comparison of five international indices of adherence to the Mediterranean diet among healthy adults: similarities and differences

BACKGROUND/OBJECTIVES

To compare five indices of adherence to the Mediterranean Diet (MD) among adults living in the Mediterranean region.

SUBJECTS/METHODS

A total of 100 healthy Lebanese adults aged between 18 and 65 years. Face-to-face interviews to collect sociodemographic and medical information, to take anthropometric measurements, and to fill a validated, culturally adapted, food frequency questionnaire (FFQ). The score for each item was calculated following the recommendations for each corresponding index. The five MD indices were Mediterranean Diet Scale (MDScale), Mediterranean Food Pattern (MFP), MD Score (MDS), Short Mediterranean Diet Questionnaire (SMDQ), and the MedDiet score.

RESULTS

Significant correlations were detected between items with P-values < 0.001. Minimal agreement was seen between MDScale and MedDiet score and maximal agreement between MDS and MedDiet score. Univariate and multivariate analyses showed that MDS and MedDiet scores had significant correlations with fiber and olive oil intake, main components of the MD. MDScale showed a significant correlation with waist-to-hip ratio and with total energy intake but none of the five indices was correlated to body mass index (BMI).

CONCLUSIONS

The indices that showed the highest correlation with variables related to the MD are the MDScale and the MedDiet score; therefore, they can be used to assess our future study populations. Based on the current results, more than half of the study population was non-adherent to the MD and adherence to this diet did not appear to protect against being overweight (BMI ≥ 30).

Adherence to DASH-Style Dietary Pattern Impacts on Adiponectin and Clustered Metabolic Risk in Older Women

While dietary patterns are related to the age-related progression of chronic diseases, to what extent different dietary patterns influence inflammatory and metabolic risk factors in older adults remains to be elucidated. Additionally, potential moderating effects by physical activity (PA) become important to clarify. Here, we hypothesize that dietary patterns are linked to inflammatory and metabolic biomarkers and that these links are independent of PA. The present study aims to explore links between two dietary constructs and biomarkers of systemic inflammation and metabolic health in older women, while considering time spent in moderate-to-vigorous PA (MVPA). A cross-sectional analysis of a sample of 112 community-dwelling older women (65–70 years old) was performed. Dietary constructs based on the Dietary Approach to Stop Hypertension (DASH) and the dietary inflammatory index (DII) were determined from food records. MVPA was objectively assessed using accelerometry. Metabolic outcomes (waist circumference, systolic/diastolic blood pressures and levels of glucose, triglycerides and high-density lipoprotein (HDL)-cholesterol) and inflammatory biomarkers (C-reactive protein (CRP), fibrinogen and adiponectin) were determined using standardized procedures and a clustered metabolic risk score was derived. Adherence to DASH-style diet was significantly (p < 0.05) associated with a lower clustered metabolic risk, where women in the highest adherence group had a significantly (p < 0.05) lower waist circumference and blood glucose level compared to those in the lowest group. Further, a significantly higher (p < 0.05) adiponectin level was observed in the high DASH adherence group compared to those with low adherence. Notably, adjustment by waist circumference did not alter links with either adiponectin or blood glucose level. Importantly, all observed links remained significant after further adjustment for time in MVPA. Finally, no significant associations were observed when the dietary pattern was defined by the DII. The findings of this study demonstrate that DASH-style diets promote a systemic anti-inflammatory environment, while also mitigating clustered metabolic risk in older women. A key finding is that favourable impacts of the DASH-style diet are independent of time spent in moderate-to-vigorous PA, which further strengthens healthy eating behaviours as a key target for clinical and public health interventions designed to prevent age-related metabolic abnormalities.

Beneficial Effect of Dietary Fiber on Hyperuricemia in Rats and Humans: A Review

Hyperuricemia is recognized as a lifestyle-related disease and the prevalence is increasing in many parts of the world. Excessive intake of purines increases serum uric acid concentration and is thought to be one factor causative of hyperuricemia. Therefore, it is thought that prevention of hyperuricemia by dietary control may be very important. This is an article of our basic research regarding the role of dietary fiber in the suppression of hyperuricemia induced by dietary purines in rats; in addition, clinical research suggesting the possibility that dietary fiber intake has a beneficial effect on the prevention or suppression of hyperuricemia in humans is discussed. Our own studies reveal that the test dietary fiber significantly suppresses the elevation of serum uric acid concentration induced by dietary RNA (12.3-46.2%), adenosine-5'-monophosphate (9.5-23.2%), adenosine (10.7-20.4%), or adenine (16.3-38.9%) and suppresses experimental hyperuricemia in rats. The mechanism is presumed to be mediated by suppression of the digestion and/or absorption of dietary purines by dietary fiber. In clinical studies, intake of dietary fiber decreases serum uric acid concentrations. Reports of recent epidemiological studies indicate that higher levels of hyperuricemia increase the prevalence of its comorbidities (e.g., chronic kidney disease, obesity, hypertension, diabetes, and cardiovascular disease) and dietary fiber intake is associated with significantly lower risk for hyperuricemia and its comorbidities. We wish to emphasize the importance of recognizing the validity of increased dietary fiber intake as a preventive or suppressive method for hyperuricemia and its comorbidities.

How Does Diet Change with A Diagnosis of Diabetes? Protocol of the 3D Longitudinal Study

Diet quality influences glycemic control in people with type 2 diabetes (T2D), impacting their risk of complications. While there are many cross-sectional studies of diet and diabetes, there is little understanding of the extent to which people with T2D change their diet after diagnosis and of the factors that impact those changes. This paper describes the rationale for and design of the 3D longitudinal Study which aims to: (i) describe diet quality changes in the 12 months following T2D diagnosis, (ii) identify the demographic, physical and psychosocial predictors of sustained improvements in diet quality and glycemic control, and (iii) identify associations between glycemic control and diet quality in the 12 months following diagnosis. This cohort study will recruit adults registered with the Australian National Diabetes Services Scheme who have been recently diagnosed with T2D. Participants will be involved in five purposefully developed telephone surveys, conducted at 3 monthly intervals over a 12-month period. Diet quality will be determined using a 24-h dietary recall at each data collection point and the data will be scored using the Dietary Approaches to Stop Hypertension (DASH) diet-quality tool. This study is the first dedicated to observing how people newly diagnosed with T2D change their diet quality over time and the predictors of sustained improvements in diet and glycemic control.

Eating habits in the population of the Aeolian Islands: an observational study

OBJECTIVE

We conducted a study to describe food profile, health status and stroke risk factors in the population of the Aeolian Islands.

DESIGN

Self-administrated questionnaires regarding eating habits, health status and stroke risk factors were obtained from a sample of the general Aeolian population. We analysed the difference from common healthy eating habits indicated by the Italian Institute of Nutrition.

SETTING

Current evidence finds the Mediterranean diet is a protective factor for cardio- and cerebrovascular diseases. The Aeolian Islands are an interesting study setting because of their peculiarity in the epidemiology of cerebrovascular and neurodegenerative diseases.

PARTICIPANTS

Individuals (n 586; age range 15-93 years; mean 52 (sd 18) years) living in the Aeolian Islands.

RESULTS

We found low fish consumption in 13·3% and vitamin intake deficiency in 5·8% of participants. A marked excess of saturated fats was observed in 71·0% of participants. Sodium excess was reported almost in half of participants (49·0%). Eating habits were characterized by high consumption of fruits and vegetables, consistent use of olive oil and scanty use of cured meat. Health status as evaluated by the General Health Questionnaire was characterized by 'normal distress' level in the majority of participants.

CONCLUSIONS

Study findings show the eating habits and health status of the Aeolian people in an interesting setting of low incidence of cerebrovascular disease. This nutrition regimen has been proved to be protective against cerebrovascular disease. Nutrition is likely to contribute to the low incidence of stroke in this population.

Ideal cardiovascular health associated with fatty liver: Results from a multi-ethnic survey

BACKGROUND AND AIMS

Little is known about the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The ideal cardiovascular health (CVH) score proposed by the American Heart Association (AHA) can be used to predict mortality and morbidity. We investigated the association of the CVH score with liver enzymes and the risk of non-alcoholic fatty liver disease (NAFLD) among US adults.

METHODS

By using the National Health and Nutrition Examination Survey database (cross-sectional), the CVH score was calculated as meeting ideal levels of the following components: 4 behaviors (smoking, body mass index, physical activity and diet adherence) and 3 factors (total cholesterol, blood pressure and fasting glucose).

RESULTS

Individuals with a higher CVH score ("better CVH") had a more favorable profile of liver biomarkers. Adjusted (for age, gender, race, poverty to income ratio, education, marital status and alcohol intake) linear regression indicated significant and negative associations between liver biomarkers and CVH score: (β = -0.069, p < 0.001) for alanine aminotransferase, (β = -0.095, p < 0.001), aspartate aminotransferase, (β = -0.067, p < 0.001), alkaline phosphatase and (β = -0.125, p < 0.001) and fatty liver index. In the logistic regression, with the same confounders, individuals with a higher CVH score had 12% less likelihood of NAFLD compared with those with a lower score. Furthermore, each CVH metric separately was inversely linked to the risk of NAFLD.

CONCLUSIONS

For the first time among US adults, our findings shed light on the role CVH on liver biomarkers.