Diet Quality Index as a predictor of short-term mortality in the American Cancer Society Cancer Prevention Study II Nutrition Cohort

Diet Quality and Mortality among Chinese Adults: Findings from the China Health and Nutrition Survey

The association between diet quality and all-cause mortality in Chinese population is unclear. We aimed to study the associations of three a priori diet quality indices-including the Diet Quality Index-International (DQI-I), Chinese Healthy Eating Index (CHEI), and energy-adjusted Dietary Inflammatory Index (E-DII)-and their included components with all-cause mortality. We used baseline data from the 2004, 2006, 2009, and 2011 waves of the China Health and Nutrition Survey (CHNS). We used a multivariable-adjusted Cox model to examine the associations between DQI-I, CHEI, and E-DII with all-cause mortality. During a mean of 7 years of follow-up, a total of 461 deaths occurred among 12,914 participants. For DQI-I, there were significant inverse associations with mortality for the variety score (HRQ4 vs. Q1 = 0.69, 95%CI = 0.52-0.92) and overall balance score (HR>0 vs. 0 = 0.81, 95%CI = 0.66-0.91). The adequacy score of CHEI was associated with 40% less risk of all-cause mortality (HRQ4 vs. Q1 = 0.60, 95%CI = 0.43-0.84). E-DII was not associated with mortality. An estimated 20.1%, 13.9%, and 31.3% of total mortality would be averted if the DQI-I variety score, DQI-I overall balance score, and CHEI adequacy score improved from the bottom to the top quartile, respectively. Improving diet quality, especially improving diet variety and adequacy, and having a more balanced diet may reduce all-cause mortality in Chinese adults.

International diet quality index and revised diet quality index relationship with non-alcoholic fatty liver disease: a case-control study

BACKGROUND/OBJECTIVES

Recent studies show the potential role of dietary quality and quantity in predicting the risk of chronic diseases, such as liver disease, therefore, in the present study, we aimed to assess the association of diet quality index International (DQI-I) and diet quality index revised (DQI-R) and their main components with the odds of non-alcoholic fatty liver disease (NAFLD) in adult populations.

METHODS

The current case-control study was conducted on 225 patients with NAFLD and 450 controls. Dietary intake was assessed using a validated 168-item food frequency questionnaire, and DQI-I and DQI-R were calculated in participants. Multi-variable logistic regression was used to examine the association of DQI-I and DQI-R and their components with the odds of NAFLD.

RESULTS

The mean (SD) age and BMI of participants (53% men) were 38.1 (8.8) years and 26.8 (4.3) kg/m2, respectively. In the final model, each one SD increment in the DQI-I score was associated with decreased odds of NAFLD (OR = 0.63; 95%CI = 0.40-0.98) (P = 0.040). Also, of DQI-I components, high adequacy score was related to lower odds of NAFLD (OR = 0.16; 95%CI = 0.06-0.40) (P < 0.001). Also, our findings showed that participants in the highest tertile of DQI-R score had lower odds of NAFLD compared to the lowest tertile of DQI-R (OR = 0.24; 95%CI = 0.10-0.53) (P < 0.001). Furthermore, of DQI-R components, high moderation score are linked to a lower risk of NAFLD (OR = 0.17;95%CI = 0.07-0.43) (P < 0.001).

CONCLUSION

Our findings suggested that greater adherence to diet with a higher score of DQI-I and DQI-R may be associated with lower odds of NAFLD.

Diet Quality Index for older adults (DQI-65): development and use in predicting adherence to dietary recommendations and health markers in the UK National Diet and Nutrition Survey

Diet quality indexes (DQI) are useful tools for assessing diet quality in relation to health and guiding delivery of personalised nutritional advice; however, existing DQI are limited in their applicability to older adults (aged ≥ 65 years). Therefore, this research aimed to develop a novel evidence-based DQI specific to older adults (DQI-65). Three DQI-65 variations were developed to assess the impacts of different component quantitation methods and inclusion of physical activity. These were Nutrient and Food-based DQI-65 (NFDQI-65), NFDQI-65 with Physical Activity (NFDQI-65+PA) and Food-based DQI-65 with Physical Activity (FDQI-65+PA). To assess their individual efficacy, the NFDQI-65, NFDQI-65+PA and FDQI-65+PA were explored alongside the validated Healthy Eating Index-2015 (HEI-2015) and Alternative Healthy Eating Index-2010 (AHEI-2010) using data from the cross-sectional UK National Diet and Nutrition Survey (NDNS) rolling programme. Scores for DQI-65 variations, the HEI-2015 and AHEI-2010 were calculated for adults ≥ 65 years from years 2-6 of the NDNS (n 871). Associations with nutrient intake, nutrient status and health markers were analysed using linear and logistic regression. Higher DQI-65 and HEI-2015 scores were associated with increased odds of meeting almost all our previously proposed age-specific nutritional recommendations, and with important health markers of importance for older adults, including lower BMI, lower medication use and lower C-reactive protein (P < 0·01). Few associations were observed for the AHEI-2010. This analysis suggests value of all three DQI-65 as measures of dietary quality in UK older adults. However, methodological limitations mean further investigations are required to assess validity and reliability of the DQI-65.

Development of a diet pattern assessment tool for coronary heart disease risk reduction

Objective

Existing diet indices have gaps including neglect of the patterns of intake known to affect the final metabolic impact and use of measurement units prone to reporting error, and have applicability that is limited to specific populations. This study sought to develop a tool for diet-pattern assessment (Prudent Approach to Cardiovascular Epidemic, for Indians – Diet Quality Index (iPACE-DQI)) to reduce diet-related coronary-heart-disease (CHD) risk.

Study design

The iPACE-DQI was developed on a 0–100 points scale (higher numeric value healthier). A proof-of-concept analysis was done to examine its construct validity and relation with risk-markers.

Methods

Development of iPACE-DQI was partly guided by ‘prudent diet’ principles, with assessment focus on quality, quantity, and the pattern of intake. In the second part of the study, construct validity was evaluated by association of iPACE-DQI score with nutrients. Further, relationship of the score with risk-markers high-sensitivity C-reactive protein(hs-CRP), body-mass-index(BMI) and body-fat-percent was examined at single-point-in-time (baseline), and predictive ability of score change on hs-CRP change was evaluated in a proof-of-concept 12-weeks pre-post intervention, among free-living Indians (25–44years,n = 55) in an urban setting.

Results

The iPACE-DQI consists of eight main components. Associations of iPACE-DQI score with mean daily intake of key nutrients were robust and in expected direction [total-dietary-fiber (r = 0.5, p < 0.001), crude-fiber (r = 0.6, p < 0.001), protein (r = 0.5, p < 0.001), total-fat (r = −0.4, p = 0.002), vitamin-C (r = 0.5, p < 0.001), total-carbohydrate (r = 0.3, p = 0.017)]. Trends of hs-CRP, BMI and body-fat-percent across increasing diet-pattern score showed highest degree of abnormality in lowest tertile (≤35). Logistic regression model indicated higher likelihood for hs-CRP reduction (OR: 1.6, 95% CI 0.5–4.9) among those with ≥20% increase in iPACE-DQI score as compared with <20% increase or no-increase over 12-weeks

Conclusion

The iPACE-DQI is a 100-point scale that assesses diet-pattern with respect to CHD-risk. The proposed tool could be useful for researchers/health practitioners to track diet-pattern change and concomitant CHD-risk reduction.

Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review

Importance

The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)?

Objective

To ascertain the association between dietary patterns consumed and ACM.

Evidence Review

Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements.

Findings

A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings.

Conclusions and Relevance

In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.

Adaptation and validity assessment of a diet quality index for patients with type 2 diabetes

PURPOSE

As diet quality indices (DQI) are likely to be influenced by disease background, adapting the existing indices for each disease is crucial. No study has been adapted a DQI for patients with type 2 diabetes. We aimed to adapt healthy eating index and assess its validity for Iranian patients with type 2 diabetes mellitus (T2DM).

METHODS

In this cross-sectional study, the analysis was conducted on 489 adults with T2DM. We adapted HEI and assessed its validity using construct validity. Construct validity was assessed using a 168-item semi-quantitative food-frequency questionnaire (FFQ). General linear model was used to assess associations between adapted HEI scores and demographic characteristics, anthropometric indices, physical activity and food and nutrient intakes.

RESULTS

Adapted HEI were examined on 489 subjects (163 men and 326 women). Findings showed that in older subjects the mean adapted HEI score was greater than the younger ones. However, it was significant only in women (p = 0.01). Women with higher education level obtained the greater score (p < 0.001). The greatest mean score of the adapted HEI score in men was related to non-smokers. The mean score in both genders were raised following the increase in physical activity level (p < 0.05). Moreover, a reduction in the mean score of adapted HEI was observed in men with higher BMI compared to those with the lower one (p = 0.001).

CONCLUSION

Adapted HEI could successfully discriminate diet quality in patients with T2DM. Older and high-educated women were adhered greatly to high quality diets. The adapted DQI linked with greater physical activity level and non-smokers diabetic men with lower BMI.

Association between Healthy Eating Index-2015 and Breast Cancer Risk: A Case-Control Study

OBJECTIVE

Diet quality is known to influence cancer risk. The Healthy Eating Index (HEI) is one of the most frequently used measures of diet quality. However, the association between HEI-2015 and breast cancer risk is not known. The present study was undertaken to evaluate the association between HEI-2015 and breast cancer risk.

METHODS

A case-control study comprising 134 breast cancer patients and 265 cancer-free controls were conducted. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), from which the HEI-2015 score was calculated. Logistic regression was used to derive the odds ratios (ORs) for measuring the association between HEI-2015 scores and breast cancer risk.

RESULTS

Subjects in the top quartile of HEI-2015 had a 46% lower chance of breast cancer compared with subjects in the bottom quartile (OR 0.54; 95% CI 0.30, 0.98). After adjustment for potential confounders such as age, age at menarche, oral contraceptive drug use, menopausal status, marital status, body mass index, smoking and education level, the association between HEI-2015 score and a lower risk of breast cancer was enhanced (OR 0.32; 95% CI 0.16, 0.65).

CONCLUSION

We successfully demonstrated that a higher HEI-2015 score was associated with a reduced breast cancer risk.

How Dietary Patterns are Related to Inflammaging and Mortality in Community-Dwelling Older Chinese Adults in Hong Kong - A Prospective Analysis

INTRODUCTION

Studies examining dietary patterns and inflammageing in relation to mortality are limited.

OBJECTIVE

We examined the influence of various dietary patterns on all-cause and cardiovascular disease (CVD) mortality, taking into account demographics, lifestyle factors, and serum inflammatory markers.

METHODS

We conducted multivariate Cox regression analyses using data from a cohort of community-dwelling older Chinese adults (1,406 men, 1,396 women) in Hong Kong. Baseline interviewer administered questionnaires covered dietary intake estimation and dietary pattern generation from the food frequency questionnaire, demographic and lifestyle factors, cognitive function and depressive symptoms. Serum high-sensitivity C-reactive protein (hsCRP) and 25-hydroxyvitamin D (25OHD) were measured. All-cause and CVD mortality data at 14-year follow up were retrieved from an official database.

RESULTS

In men, higher hsCRP level was associated with lower Diet Quality Index-International (DQI-I) score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet (MIND) score, Okinawan diet score, "vegetables-fruits" pattern score and "snacks-drinks-milk" pattern score. Higher serum 25OHD level was associated with higher Mediterranean Diet Score (MDS) but lower "snacks-drinks-milk" pattern score. None of the dietary pattern scores was associated with all-cause or CVD mortality after adjusting for all covariates. In women, hsCRP level and serum 25OHD level were not associated with any dietary patterns. Higher DQI-I score (HR=0.77 (95% CIs: 0.59, 0.99) highest vs. lowest tertile, p-trend=0.038) and Okinawan diet score (HR=0.78 (95% CIs: 0.61, 1.00) highest vs lowest tertile, p-trend=0.046) was associated with a lower risk of all-cause mortality, whereas higher MIND score (HR=0.63 (95% CI: 0.36, 1.09) highest vs. lowest tertile, p-trend=0.045) was associated with a reduced risk of CVD morality in the multivariate adjusted model.

CONCLUSION

Higher DQI-I score and Okinawan diet score were associated with a lower risk of all-cause mortality, and higher adherence to the MIND diet was related to a reduced risk of CVD mortality in community-dwelling Chinese older women.

Review of a priori dietary quality indices in relation to their construction criteria

A multitude of indices measure the healthiness of dietary patterns. Because validation results with respect to health outcomes do not sufficiently facilitate the choice of a specific dietary quality index, the decision of which index to use for a particular research objective should be based on other criteria. This review aims to provide guidance on which criteria to focus upon when choosing a dietary index for a specific research question. A review of 57 existing specifications of dietary quality indices was conducted, taking explicitly into account relevant construction criteria explicated in the Organisation for Economic Co-operation and Development handbook on constructing composite indicators. Index construction choices regarding the following criteria were extracted: theoretical framework, indicator selection, normalization and valuation functions, and aggregation methods. Preferable features of dietary indices are discussed, and a summarizing toolbox is provided to help identify indices with the most appropriate construction features for the respective study aim and target region and with regard to the available database. Directions for future efforts in the specification of new diet quality indices are given.

Relationship Between Serum Tumor-related Markers and Dietary Intakes in Korean Healthy Adults

The purpose of this study was to investigate the relationship between serum tumor markers and dietary intakes in healthy adults to address a nutrition guide for cancer prevention. We analyzed tumor-related markers, carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP), prostate-specific antigen (PSA), and cancer antigen 125 (CA125) in serum and daily food and nutrient intakes using a 24-hour recall method in 23 healthy men and 32 healthy women. The average age was 50.7 years for men and 48.9 years for women. There were no significant differences in biochemical tumor markers and food intake between the men and women except energy intake. A significantly positive correlation was found between serum AFP, a biochemical marker of liver cancer, and serum glutamic oxaloacetic transaminase (GOT) and/or glutamic pyruvate transaminase (GPT) in both men and women. CEA had a significant and negative correlation with energy intake for men and food intake in women. PSA, a biomarker of prostate cancer, was significantly and positively correlated with the intake of animal iron and cholesterol in men. CA125, a biomarker of gynecologic cancers, was significantly and positively correlated with meat intake in women. As this study revealed the significant relationship between biochemical tumor markers and dietary factors, further studies are needed to elucidate the underlying mechanism of this relationship.

An association between diet quality index for Koreans (DQI-K) and total mortality in Health Examinees Gem (HEXA-G) study

BACKGROUND/OBJECTIVES

Diet quality scores or indices, based on dietary guidelines, are used to summarize dietary intake into a single numeric variable. The aim of this study was to examine the association between the modified diet quality index for Koreans (DQI-K) and mortality among Health Examinees-Gem (HEXA-G) study participants.

SUBJECTS/METHODS

The DQI-K was modified from the original diet quality index. A total of 134,547 participants (45,207 men and 89,340 women) from the HEXA-G study (2004 and 2013) were included. The DQI-K is based on eight components: 1) daily protein intake, 2) percent of energy from fat, 3) percent of energy from saturated fat, 4) daily cholesterol intake, 5) daily whole-grain intake, 6) daily fruit intake, 7) daily vegetable intake, and 8) daily sodium intake. The association between all-cause mortality and the DQI-K was examined using Cox proportional hazard regression models. Hazard ratios and confidence intervals were estimated after adjusting for age, gender, income, smoking status, alcohol drinking, body mass index, and total energy intake.

RESULTS

The total DQI-K score was calculated by summing the scores of the eight components (range 0–9). In the multivariable adjusted models, with good diet quality (score 0–4) as a reference, poor diet quality (score 5–9) was associated with an increased risk of all-cause mortality (hazard ratios = 1.23, 95% confidence intervals = 1.06–1.43). Moreover, a one-unit increase in DQI-K score resulted in a 6% higher mortality risk.

CONCLUSIONS

A poor diet quality DQI-K score was associated with an increased risk of mortality. The DQI-K in the present study may be used to assess the diet quality of Korean adults.

Nutrient profiling and adherence to components of the UK national dietary guidelines association with metabolic risk factors for CVD and diabetes: Airwave Health Monitoring Study

CVD is the leading cause of death worldwide. Diet is a key modifiable component in the development of CVD. No official UK diet quality index exists for use in UK nutritional epidemiological studies. The aims of this study are to: (i) develop a diet quality index based on components of UK dietary reference values (DRV) and (ii) determine the association between the index, the existing UK nutrient profile (NP) model and a comprehensive range of cardiometabolic risk markers among a British adult population. A cross-sectional analysis was conducted using data from the Airwave Health Monitoring Study (n 5848). Dietary intake was measured by 7-d food diary and metabolic risk using waist circumference, BMI, blood lipid profile, glycated Hb (HbA1c) and blood pressure measurements. Diet quality was assessed using the novel DRV index and NP model. Associations between diet and cardiometabolic risk were analysed via multivariate linear models and logistic regression. A two-point increase in NP score was associated with total cholesterol (β -0·33 mmol/l, P<0·0001) and HbA1c (β -0·01 %, P<0·0001). A two-point increase in DRV score was associated with waist circumference (β -0·56 cm, P<0·0001), BMI (β -0·15 kg/m2, P<0·0001), total cholesterol (β -0·06 mmol/l, P<0·0001) and HbA1c (β -0·02 %, P=0·002). A one-point increase in DRV score was associated with type 2 diabetes (T2D) (OR 0·94, P=0·01) and obesity (OR 0·95, P<0·0001). The DRV index is associated with overall diet quality and risk factors for CVD and T2D, supporting its application in nutritional epidemiological studies investigating CVD risk in a UK population.

Diet quality and bullying among a cross-national sample of youth

Bullying perpetration and victimization have been linked to a number of high-risk health behaviors, including involvement in sedentary activities and sleep deprivation. Even so, the link between diet quality and bullying is generally overlooked. The present study examines the associations between diet quality, bully perpetration, and bully victimization in a cross-national sample of adolescents. Data come from the Health Behaviors of School Children (HBSC) survey, 2005/2006 (N=142,828-143,425). Youths from 41 countries/regions in North America and Europe reported features of their social context, various health behaviors, and their involvement in bullying. Approximately 11% of youth in the sample bully other youths at least 2-3 times a month, whereas 13% of youth are bullied by other youths at least 2-3 times a month. Logistic regression analyses revealed that youths with low quality diets incurred a 123% increase in the odds of attaining bully status, relative to youths with high quality diets. No such association was detected between diet quality and victim status. Results also suggest that the association between low diet quality and bully perpetration is significantly more pronounced in very developed nations (relative to developed nations). Dietary behaviors may be an important point of intervention in the effort to minimize the prevalence of bullying among youths, particularly in very developed nations. Scholars should seek to build upon the current study by exploring the mechanisms (e.g., low self-control) that might explain the association between diet quality and bullying.

Diet Quality and Cancer Outcomes in Adults: A Systematic Review of Epidemiological Studies

Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk and mortality. The aims of this systematic review are to (1) describe diet quality scores used in cohort or cross-sectional research examining cancer outcomes; and (2) describe associations between diet quality scores and cancer risk and mortality. The protocol was registered in Prospero, and a systematic search using six electronic databases was conducted through to December 2014. Records were assessed for inclusion by two independent reviewers, and quality was evaluated using a validated tool. Sixty-four studies met inclusion criteria from which 55 different diet quality scores were identified. Of the 35 studies investigating diet quality and cancer risk, 60% (n = 21) found a positive relationship. Results suggest no relationship between diet quality scores and overall cancer risk. Inverse associations were found for diet quality scores and risk of postmenopausal breast, colorectal, head, and neck cancer. No consistent relationships between diet quality scores and cancer mortality were found. Diet quality appears to be related to site-specific adult cancer risk. The relationship with cancer mortality is less conclusive, suggesting additional factors impact overall cancer survival. Development of a cancer-specific diet quality score for application in prospective epidemiology and in public health is warranted.

Quality of diet and mortality among Japanese men and women: Japan Public Health Center based prospective study

OBJECTIVE

To examine the association between adherence to the Japanese Food Guide Spinning Top and total and cause specific mortality.

DESIGN

Large scale population based prospective cohort study in Japan with follow-up for a median of 15 years.

SETTING

11 public health centre areas across Japan.

PARTICIPANTS

36,624 men and 42,970 women aged 45-75 who had no history of cancer, stroke, ischaemic heart disease, or chronic liver disease.

MAIN OUTCOME MEASURES

Deaths and causes of death identified with the residential registry and death certificates.

RESULTS

Higher scores on the food guide (better adherence) were associated with lower total mortality; the multivariable adjusted hazard ratios (95% confidence interval) of total mortality for the lowest through highest scores were 1.00, 0.92 (0.87 to 0.97), 0.88 (0.83 to 0.93), and 0.85 (0.79 to 0.91) (P<0.001 for trend) and the multivariable adjusted hazard ratio associated with a 10 point increase in food guide scores was 0.93 (0.91 to 0.95; P<0.001 for trend). This score was inversely associated with mortality from cardiovascular disease (hazard ratio associated with a 10 point increase 0.93, 0.89 to 0.98; P=0.005 for trend) and particularly from cerebrovascular disease (0.89, 0.82 to 0.95; P=0.002 for trend). There was some evidence, though not significant, of an inverse association for cancer mortality (0.96, 0.93 to 1.00; P=0.053 for trend).

CONCLUSION

Closer adherence to Japanese dietary guidelines was associated with a lower risk of total mortality and mortality from cardiovascular disease, particularly from cerebrovascular disease, in Japanese adults.

Adherence to World Cancer Research Fund/American Institute for Cancer Research recommendations and pancreatic cancer risk

BACKGROUND

Pancreatic cancer is a leading cause of cancer death. A role of dietary factors in pancreatic carcinogenesis has been suggested. The World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) published 8 recommendations for cancer prevention. We evaluated the effect of adherence to the WCRF/AICR recommendations on pancreatic cancer risk.

METHODS

We operationalized 7 of the 8 WCRF/AICR recommendations to generate a WCRF/AICR score. We examined the association of WCRF/AICR score with pancreatic cancer in data from an Italian case-control study of 326 incident cases and 652 controls.

RESULTS

Adherence to WCRF/AICR recommendations was associated with a significantly decreased risk of pancreatic cancer. Using a WCRF/AICR score <3.5 as a reference, the adjusted odds ratio (OR) for a score 3.5-<4 was 0.80 (95% CI 0.49, 1.28), for a score 4-<5 0.54 (95% CI 0.35, 0.82), and for score 5 or more 0.41 (95% CI 0.24, 0.68; p-value for trend 0.0002). The OR for a continuous increment of one unit of the WCRF/AICR score was 0.72 (95% CI 0.60, 0.87).

CONCLUSION

Adherence to the WCRF/AICR recommendations may reduce pancreatic cancer risk.

The use of predefined diet quality scores in the context of CVD risk during urbanization in the South African Prospective Urban and Rural Epidemiological (PURE) study

OBJECTIVE

Urbanization is generally associated with increased CVD risk and accompanying dietary changes. Little is known regarding the association between increased CVD risk and dietary changes using approaches such as diet quality. The relevance of predefined diet quality scores (DQS) in non-Western developing countries has not yet been established.

DESIGN

The association between dietary intakes and CVD risk factors was investigated using two DQS, adapted to the black South African diet. Dietary intake data were collected using a quantitative FFQ. CVD risk was determined by analysing known CVD risk factors.

SETTING

Urban and rural areas in North West Province, South Africa.

SUBJECTS

Apparently healthy volunteers from the South African Prospective Urban and Rural Epidemiological (PURE) study population (n 1710).

RESULTS

CVD risk factors were significantly increased in the urban participants, especially women. Urban men and women had significantly higher intakes of both macro- and micronutrients with macronutrient intakes well within the recommended CVD guidelines. While micronutrient intakes were generally higher in the urban groups than in the rural groups, intakes of selected micronutrients were low in both groups. Both DQS indicated improved diet quality in the urban groups and good agreement was shown between the scores, although they seemed to measure different aspects of diet quality.

CONCLUSIONS

The apparent paradox between improved diet quality and increased CVD risk in the urban groups can be explained when interpreting the cut-offs used in the scores against the absolute intakes of individual nutrients. Predefined DQS as well as current guidelines for CVD prevention should be interpreted with caution in non-Western developing countries.

Dietary indices, cardiovascular risk factors and mortality in middle-aged adults: findings from the Aerobics Center Longitudinal Study

PURPOSE

We examined the association between three predefined dietary indices and both cardiovascular disease (CVD) risk factors and long-term mortality in adult Aerobics Center Longitudinal Study's participants.

METHODS

Between 1987 and 1999, 12,449 (77% male) participants aged 20-84 years completed a clinical examination, which included dietary assessment by 3-day diet records. Three dietary indices were calculated: the Ideal Diet Index, the Diet Quality Index, and the Mediterranean Diet Score. CVD risk factors measurements included body mass index, total cholesterol, fasting glucose, blood pressure, and cardiorespiratory fitness. We calculated hazard ratios from Cox regression analyses, adjusting for potential confounders including physical fitness.

RESULTS

Higher Ideal Diet Index, Diet Quality Index, and Mediterranean Diet Score scores were consistently associated with lower body mass index, cholesterol and glucose levels, and diastolic blood pressure, and higher cardiorespiratory fitness (all P < .05). However, after adjusting for age, sex, energy intake, and baseline examination year, the indices were not significantly related to all-cause, CVD, or cancer mortality. No association was observed in fully adjusted models, which controlled for fitness.

CONCLUSIONS

Although these dietary indices based on 3-day diet records are strongly associated cross-sectionally to CVD risk profile of middle-aged men and women, they do not add to ability to predict long-term mortality in follow-up.

Evaluation of diet quality indicators in adults

Several indices evaluate the quality of diet. The indices are based on nutrient requirements and dietary guidelines for the prevention of chronic diseases (to reduce the risk of chronic diseases). The Healthy Eating Index, Healthy Diet Indicator, and Diet Quality Index consist of components, which represent different aspects of a healthy diet. The indicators of diet quality are based on dietary intake data from 24-hour dietary recalls.  The aim of the research was to evaluate the nutrition of adults according to the selected criteria of three diet quality indicators: Healthy Eating Index, Healthy Diet Indicator, Diet Quality Index. 234 nutrition daily records were evaluated (from 78 probands per 3 days). Nutritional intake and blood biochemical parameters were defined in 56 females and 22 men (72% and 28% respectively) aged from 24 to 62 years. The nutritional software Alimenta 4.3e (Food Research Institute, Bratislava, Slovakia, 2004) was used to calculate the nutrient intake. The evaluation of nutrition intake was focused on four parameters/recommendations of the Healthy Eating Index (to reduce total fat intake to 30% or less of energy, to reduce saturated fatty acid intake to less than 10% of energy, to reduce cholesterol intake to less than 300 mg daily, to limit total daily intake of sodium to 2400 mg or less), on five parameters/recommendations of the Healthy Diet Indicator (saturated fatty acids 0-10% of energy intake, polyunsaturated fatty acids 3-7% of energy intake, protein 10-15% of energy intake, dietary fiber 27-40 g, cholesterol 0-300 mg), on five parameters/recommendations of the Diet Quality Index (to reduce total fat intake to 30% or less of energy,to reduce saturated fatty acid intake to less than 10% of energy, to reduce cholesterol intake to less than 300 mg daily, to limit total daily intake of sodium to 2400 mg or less, to maintain adequate calcium intake – approximately Recommended Dietary Allowance levels, i.e. ³RDA). Blood samples from peripheral blood were taken after all-night starvation and then analyzed by using Reflotron (Roche Diagnostics GmbH, Mannheim, Germany). The data from nutritional intake and biochemical parameters were analyzed using t-test and chi-quadrat-test. The normal cholesterolaemia occured in 47% (thr first group Without risk), and 53% of the examined participants (the second group Risk) were classified with risky cholesterol values (5 mmol.l-1 and more). Among the subjects with hypercholesterolaemia they had 27% higher values of triglycerides (1.9 mmol.l-1 and more), while in the rest of set there were only 14% characterized with hypertriacylglycerolaemia. The probands with the negative high cholesterol level in blood had significantly higher triacylglycerolaemia (P<0.001) and the age of (P<0.05). In case of Healthy Eating Index the most participants met the criterion only for one recommendation (41%), and fifth of volunteers fulfilled two recommendation altogether. Taking into account all parameters the probands met cholesterol in diet (56%) best, less saturated fat (35%), total fat (24%), and at least sodium intake (9%). Within Healthy Diet Indicator there were recorded fulfillments: for cholesterol in 56%, for saturated fatty acids in 35%, for protein in 32%, for fiber in 22%, and for polyunsaturated fatty acids in 17%. From five criteria there was met only one recommendation of 36% of subjects, 17% achieved two fulfillments, and other 17% three ones. Evaluation of Diet Quality Index recorded that the following order of recommendation fulfillment was obtained: cholesterol (56 %) > calcium (44 %) > saturated fat (35 %) > total fat (24 %) > natrium (9 %). Only one fulfillment reached 37 %, two recommendations met 27 %, and three 14 %. From all three considered indicators the recommendation for cholesterol intake was met most (by 56% probands), worst for total fat (24%), fiber (22%), polyunsaturated fat (17%), and  natrium (9%). In conclusion, this study demonstrated higher saturated fat, polyunsaturated fatty acids, fiber, and significantly higher calcium intake (P<0.05) in the examined participants with normal cholesterolaemia in comparison with  the group of  risk cholesterol.

Diet quality concept

The term diet quality has recently gained considerable attention in nutritional research. Despite widespread use, it is often poorly defined and remains difficult to measure. Confusion surrounds the term, as there is no consensus on how to define quality of the diet or to pin down a framework for producing a standard indicator. The composite and cut-off selection of most diet quality indices depend on investigator choices in line with research objectives. In addition to the frequently used dietary compliance-based approach, innovative approaches have emerged to construct diet quality indices based on antioxidant and anti-inflammatory profiles of diet. Different viewpoints and overlapping interests may yield different interpretations. Most of the unresolved issues are related directly or indirectly to the multidimensional and open-textured nature of the concept. This review aims to elucidate several debated key points to understand the reasons behind this confusion and address the complexity of how to define and quantify this concept. A standardized and well-defined framework of diet quality is of great importance for both consumers and scientists from different disciplines.

Monitoring and benchmarking population diet quality globally: a step-wise approach

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.

3,3'-Diindolylmethane suppresses the growth of gastric cancer cells via activation of the Hippo signaling pathway

Recent studies have revealed that 3,3-diindolylmethane (DIM) has antitumor effects in both in vivo and in vitro tumor models. However, the biological function of DIM in human gastric cancer cells is unknown. Genetic and biological studies have confirmed the importance of the novel Hippo tumor-suppressor pathway in regulating cell proliferation, apoptosis, organ size and tumorigenesis in mammals. Thus, the purpose of this study was to investigate the cytotoxic effects of DIM in human gastric cancer cells and to elucidate whether DIM induces cell death by activating the Hippo signaling pathway. Two human gastric cancer cell lines (SNU-1 and SNU-484) were used to investigate the DIM response. DIM significantly inhibited the proliferation of human gastric cancer cells in a dose-dependent manner. The percentage of G1 phase cells increased 24 h following DIM treatment. DIM reduced CDK2, CDK4, CDK6 and cyclin D1 protein levels, while increasing p53 protein levels. DIM induced the levels of cleaved poly(ADP-ribose) polymerase, cleaved-caspase-9, and diminished pro-caspase-3 protein production. In addition, DIM increased pLATS1, Mob1, pMob1, pYAP and Ras association domain family 1 (RASSF1) protein levels and reduced Yap protein production levels. DIM stimulated the binding of RASSF1 with the Mst1/2-LATS1-Mob1 complex, promoting an active Hippo signaling pathway and favoring YAP phosphorylation (pYAP) that inactivates cell proliferation. Furthermore, DIM inhibited the growth of human gastric tumors in a xenograft mouse model. These results indicate that DIM suppresses the growth of gastric cancer cells by activating the Hippo signaling pathway.

Adherence to WCRF/AICR cancer prevention recommendations and risk of postmenopausal breast cancer

BACKGROUND

In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) released eight recommendations related to body fatness, physical activity, and diet aimed at preventing the most common cancers worldwide. However, limited information exists on the association between meeting these recommendations and risks of specific cancers, including breast cancer.

METHODS

We operationalized six recommendations (related to body fatness, physical activity, foods that promote weight gain, plant foods, red and processed meats, and alcohol) and examined their association with invasive breast cancer incidence over 6.7 years of follow-up in the Vitamins and Lifestyle (VITAL) study cohort. Participants included 30,797 postmenopausal women, ages 50-76 years at baseline in 2000-2002 with no history of breast cancer. Breast cancers (n = 899) were tracked through the Western Washington Surveillance, Epidemiology, and End Results database.

RESULTS

Breast cancer risk was reduced by 60% in women who met at least five recommendations compared with those who met none [HR: 0.40; 95% confidence interval (CI): 0.25-0.65; Ptrend < 0.001]. Further analyses that sequentially removed individual recommendations least associated with reduced risk suggested that this reduction is due to meeting recommendations related to body fatness, plant foods, and alcohol (HR for meeting vs. not meeting these three recommendations: 0.38; 95% CI: 0.25-0.58; Ptrend < 0.001).

CONCLUSIONS

Meeting the WCRF/AICR cancer prevention recommendations, specifically those related to alcohol, body fatness, and plant foods, is associated with reduced postmenopausal breast cancer incidence.

IMPACT

Increased adherence to the WCRF/AICR cancer prevention recommendations could substantially reduce postmenopausal breast cancer risk in U.S. women.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research guidelines and risk of death in Europe: results from the European Prospective Investigation into Nutrition and Cancer cohort study1,4

BACKGROUND

In 2007, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) issued recommendations on diet, physical activity, and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence.

OBJECTIVE

We investigated whether concordance with WCRF/AICR recommendations is related to risk of death.

DESIGN

The current study included 378,864 participants from 9 European countries enrolled in the European Prospective Investigation into Cancer and Nutrition study. At recruitment (1992-1998), dietary, anthropometric, and lifestyle information was collected. A WCRF/AICR score, which incorporated 6 of the WCRF/AICR recommendations for men [regarding body fatness, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, and alcoholic drinks (score range: 0-6)] and 7 WCRF/AICR recommendations for women [plus breastfeeding (score range: 0-7)], was constructed. Higher scores indicated greater concordance with WCRF/AICR recommendations. Associations between the WCRF/AICR score and risks of total and cause-specific death were estimated by using Cox regression analysis.

RESULTS

After a median follow-up time of 12.8 y, 23,828 deaths were identified. Participants within the highest category of the WCRF/AICR score (5-6 points in men; 6-7 points in women) had a 34% lower hazard of death (95% CI: 0.59, 0.75) compared with participants within the lowest category of the WCRF/AICR score (0-2 points in men; 0-3 points in women). Significant inverse associations were observed in all countries. The WCRF/AICR score was also significantly associated with a lower hazard of dying from cancer, circulatory disease, and respiratory disease.

CONCLUSION

Results of this study suggest that following WCRF/AICR recommendations could significantly increase longevity.

Is quality of diet associated with the microvasculature? An analysis of diet quality and retinal vascular calibre in older adults

It is unknown whether diet quality is associated with microvascular structure. The present study aimed to investigate the relationship between diet quality, reflecting adherence to dietary guidelines, with retinal microvascular calibre in older adults. The dietary data of 2720 Blue Mountains Eye Study participants, aged 50+ years, were collected using a semi-quantitative FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Fundus photographs were taken and retinal vascular calibre measured using computer-assisted techniques and summarised. After adjusting for age, sex, BMI, mean arterial blood pressure, smoking, serum glucose, leucocyte count and history of diagnosed stroke or CHD, persons with higher TDS had healthier retinal vessels cross-sectionally, with wider retinal arteriolar calibre (by approximately 3 μm, comparing the highest with the lowest quartile of TDS, Ptrend= 0·0001) and narrower retinal venular calibre (by approximately 2·5 μm; Ptrend= 0·02). In younger subjects aged ≤ 65 years, increasing TDS (lowest to the highest quartile) was associated with healthier retinal vessels: approximately 4·4 μm wider retinal arteriolar (Ptrend< 0·0001) and approximately 2·3 μm narrower venular calibre (Ptrend= 0·03). After multivariable adjustment, however, baseline TDS were not associated with retinal arteriolar (Ptrend= 0·89) or venular calibre (Ptrend= 0·25), 5 years later. Also, baseline TDS were not associated with the 5-year change in retinal arteriolar (β = 0·14; P= 0·29) or venular calibre (β = − 0·26; P= 0·07). Greater compliance with published dietary guidelines (higher diet quality) was cross-sectionally associated with wider retinal arterioles and narrower venules, indicating better retinal microvascular health.

Diet quality is inversely related to cardiovascular risk factors in adults

The goal of the study was to determine if there was an association between diet quality and cardiovascular risk factors (CVRF) in adults. NHANES 2001-2008 data were used to compare diet quality, as determined by using 2005 Healthy Eating Index (HEI-2005) scores, and CVRF in adults aged ≥19 y (n = 18,988; 51% men, 50% white, 21% African American, 25% Hispanic American, 4% other). HEI-2005 scores were calculated by using one 24-h dietary recall collected from the participants. Weight and adiposity, blood pressure, and CVRF were measured. Regression analyses were conducted to assess the linear relationship of CVRF and HEI-2005 scores by using appropriate covariates accounting for sample weights and the complex sample design of NHANES. OR were calculated for HEI quartiles and CVRF. BMI (P < 0.0001), waist circumference (WC) (P < 0.0001), diastolic blood pressure (P = 0.0002), C-reactive protein (P = 0.0016), total cholesterol (P = 0.0006), LDL cholesterol (P = 0.0039), and metabolic syndrome (P = 0.0035) were inversely associated with HEI-2005. HDL cholesterol significantly (P = 0.0048) increased across HEI-2005 quartiles. Compared with the lowest HEI-2005 quartile, individuals with the highest diet quality (HEI-2005 quartile 4) were less likely to be overweight or obese (34%) or have elevated WC (35%), elevated blood pressure (26%), metabolic syndrome (35%), and decreased HDL-cholesterol concentrations (21%). Data suggest that diet quality is inversely associated with several CVRF.

Is concordance with World Cancer Research Fund/American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study

BACKGROUND

In 2007 the World Cancer Research Fund (WCRF) and the American Institute of Cancer Research (AICR) issued 8 recommendations (plus 2 special recommendations) on diet, physical activity, and weight management for cancer prevention on the basis of the most comprehensive collection of available evidence.

OBJECTIVE

We aimed to investigate whether concordance with the WCRF/AICR recommendations was related to cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study.

DESIGN

The present study included 386,355 EPIC participants from 9 European countries. At recruitment, dietary, anthropometric, and lifestyle information was collected. A score was constructed based on the WCRF/AICR recommendations on weight management, physical activity, foods and drinks that promote weight gain, plant foods, animal foods, alcoholic drinks, and breastfeeding for women; the score range was 0-6 for men and 0-7 for women. Higher scores indicated greater concordance with WCRF/AICR recommendations. The association between the score and cancer risk was estimated by using multivariable Cox regression models.

RESULTS

Concordance with the score was significantly associated with decreased risk of cancer. A 1-point increment in the score was associated with a risk reduction of 5% (95% CI: 3%, 7%) for total cancer, 12% (95% CI: 9%, 16%) for colorectal cancer, and 16% (95% CI: 9%, 22%) for stomach cancer. Significant associations were also observed for cancers of the breast, endometrium, lung, kidney, upper aerodigestive tract, liver, and esophagus but not for prostate, ovarian, pancreatic, and bladder cancers.

CONCLUSION

Adherence to the WCRF/AICR recommendations for cancer prevention may lower the risk of developing most types of cancer.

Scoring models of a diet quality index and the predictive capability of mortality in a population-based cohort of Swedish men and women

Objective

To examine how different scoring models for a diet quality index influence associations with mortality outcomes.

Design

A study within the Malmö Diet and Cancer cohort. Food and nutrient intakes were estimated using a diet history method. The index included six components: SFA, PUFA, fish and shellfish, fibre, fruit and vegetables, and sucrose. Component scores were assigned using predefined (based on dietary recommendations) and population-based cut-offs (based on median or quintile intakes). Multivariate Cox regression was used to model associations between index scores (low, medium, high) and all-cause and cause-specific mortality by sex.

Setting

Malmö, the third largest city in Sweden.

Subjects

Men (n 6940) and women (n 10 186) aged 44–73 years. During a mean follow-up of 14·2 years, 2450 deaths occurred, 1221 from cancer and 709 from CVD.

Results

The predictive capability of the index for mortality outcomes varied with type of scoring model and by sex. Stronger associations were seen among men using predefined cut-offs. In contrast, the quintile-based scoring model showed greater predictability for mortality outcomes among women. The scoring model using median-based cut-offs showed low predictability for mortality among both men and women.

Conclusions

The scoring model used for dietary indices may have a significant impact on observed associations with disease outcomes. The rationale for selection of scoring model should be included in studies investigating the association between dietary indices and disease. Adherence to the current dietary recommendations was in the present study associated with decreased risk of all-cause and cause-specific mortality, particularly among men.

Adherence to dietary guidelines and 15-year risk of all-cause mortality

Past investigation of diet in relation to disease or mortality has tended to focus on individual nutrients. However, there has been a recent shift to now focus on overall patterns of food intake. The present study aims to investigate the relationship between diet quality reflecting adherence to dietary guidelines and mortality in a sample of older Australians, and to report on the relationship between core food groups and diet quality. This was a population-based cohort study of persons aged 49 years or older at baseline, living in two postcode areas west of Sydney, Australia. Baseline dietary data were collected during 1992-4, from 2897 people using a 145-item Willett-derived FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine diet quality scores. The Australian National Death Index provided 15-year mortality data using multiple data linkage steps. Hazard risk (HR) ratios and 95 % CI for mortality were assessed for diet quality. Subjects in quintile 5 (highest) of the Total Diet Score had a 21 % reduced risk of all-cause mortality (HR 0·79, 95 % CI 0·63, 0·98, P(trend)=0·04) compared with those in quintile 1 (lowest) after multivariate adjustment. The present study provides longitudinal support for a reduced risk of all-cause mortality in an older population who have greater compliance with published dietary guidelines.

The Nordic Nutrition Recommendations and prostate cancer risk in the Cancer of the Prostate in Sweden (CAPS) study

OBJECTIVE

The Nordic Nutrition Recommendations (NNR) aim at preventing diet-associated diseases such as cancer in the Nordic countries. We evaluated adherence to the NNR in relation to prostate cancer (PC) in Swedish men, including potential interaction with a genetic risk score and with lifestyle factors.

DESIGN

Population-based case-control study (Cancer of the Prostate in Sweden (CAPS), 2001-2002). Using data from a semi-quantitative FFQ, we created an NNR adherence score and estimated relative risks of PC by unconditional logistic regression. Individual score components were modelled separately and potential modifying effects were assessed on the multiplicative scale.

SETTING

Four regions in the central and northern parts of Sweden.

SUBJECTS

Incident PC patients (n 1386) and population controls (n 940), frequency-matched on age and region.

RESULTS

No overall association with PC was found, possibly due to the generally high adherence to the NNR score and its narrow distribution in the study population. Among individual NNR score components, high compared with low intakes of polyunsaturated fat were associated with an increased relative risk of localized PC. No formal interaction with genetic or lifestyle factors was observed, although in stratified analysis a positive association between the NNR and PC was suggested among men with a high genetic risk score but not among men with a medium or low genetic risk score.

CONCLUSIONS

Our findings do not support an association between NNR adherence and PC. The suggestive interaction with the genetic risk score deserves further investigations in other study populations.

3,3'-Diindolylmethane exhibits antileukemic activity in vitro and in vivo through a Akt-dependent process

3,3′-diindolylmethane (DIM), one of the active products derived from Brassica plants, is a promising antitumor agent. The present study indicated that DIM significantly induced apoptosis in U937 human leukemia cells in dose- and time-dependent manners. These events were also noted in other human leukemia cells (Jurkat and HL-60) and primary human leukemia cells (AML) but not in normal bone marrow mononuclear cells. We also found that DIM-induced lethality is associated with caspases activation, myeloid cell leukemia-1 (Mcl-1) down-regulation, p21^cip1/waf1 up-regulation, and Akt inactivation accompanied by c-jun NH2-terminal kinase (JNK) activation. Enforced activation of Akt by a constitutively active Akt construct prevented DIM-mediated caspase activation, Mcl-1 down-regulation, JNK activation, and apoptosis. Conversely, DIM lethality was potentiated by the PI3K inhibitor LY294002. Interruption of the JNK pathway by pharmacologic or genetic approaches attenuated DIM-induced caspases activation, Mcl-1 down-regulation, and apoptosis. Lastly, DIM inhibits tumor growth of mouse U937 xenograft, which was related to induction of apoptosis and inactivation of Akt, as well as activation of JNK. Collectively, these findings suggest that DIM induces apoptosis in human leukemia cell lines and primary human leukemia cells, and exhibits antileukemic activity in vivo through Akt inactivation and JNK activation.

Diet quality is associated with all-cause mortality in adults aged 65 years and older

Diet quality indices assess compliance with dietary guidelines and represent a measure of healthy dietary patterns. Few studies have compared different approaches to assessing diet quality in the same cohort. Our analysis was based on 972 participants of the British Diet and Nutrition Survey of people aged 65 y and older in 1994/1995 and who were followed-up for mortality status until 2008. Dietary intake was measured via a 4-d weighed food record. Three measures of diet quality were used: the Healthy Diet Score (HDS), the Recommended Food Score (RFS), and the Mediterranean Diet Score (MDS). HR for all-cause mortality were obtained using Cox regression adjusted for age, sex, energy intake, social class, region, smoking, physical activity, and BMI. After adjustment for confounders, the MDS was significantly associated with mortality [highest vs. lowest quartile; HR = 0.78 (95% CI = 0.62-0.98)]. Similarly, the RFS was also associated with mortality [HR = 0.67 (95 % CI = 0.52-0.86)]; however, there were no significant associations for the HDS [HR = 0.99 (95% CI = 0.79-1.24)]. The HDS was not a predictor of mortality is this population, whereas the RFS and the MDS were both associated with all-cause mortality. Simple measures of diet quality using food-based indicators can be useful predictors of longevity.

Reduced risks of neural tube defects and orofacial clefts with higher diet quality

OBJECTIVE

To examine whether better maternal diet quality was associated with reduced risk for selected birth defects.

DESIGN

A multicenter, population-based case-control study, the National Birth Defects Prevention Study.

SETTING

Ten participating centers in the United States.

PARTICIPANTS

Eligible subjects' estimated due dates were from October 1997 through December 2005. Telephone interviews were conducted with 72% of case and 67% of control mothers. Analyses included 936 cases with neural tube defects (NTDs), 2475 with orofacial clefts, and 6147 nonmalformed controls.

MAIN EXPOSURES

Food-frequency data were used to calculate the Mediterranean Diet Score (MDS) and Diet Quality Index (DQI), modeled after existing indices.

MAIN OUTCOME MEASURE

Adjusted odds ratios (ORs).

RESULTS

After covariate adjustment, increasing diet quality based on either index was associated with reduced risks for the birth defects studied. The strongest association was between anencephaly and DQI; the OR for highest vs lowest quartile was 0.49 (95% CI, 0.31-0.75). The ORs for cleft lip with or without cleft palate and cleft palate and DQI were also notable (0.66 [95% CI, 0.54-0.81] and 0.74 [95%CI, 0.56-0.96], respectively).

CONCLUSIONS

Healthier maternal dietary patterns, as measured by diet quality scores, were associated with reduced risks of NTDs and clefts. These results suggest that dietary approaches could lead to further reduction in risks of major birth defects and complement existing efforts to fortify foods and encourage periconceptional multivitamin use.

Does the Mediterranean diet predict longevity in the elderly? A Swedish perspective

Dietary pattern analysis represents a useful improvement in the investigation of diet and health relationships. Particularly, the Mediterranean diet pattern has been associated with reduced mortality risk in several studies involving both younger and elderly population groups. In this research, relationships between dietary macronutrient composition, as well as the Mediterranean diet, and total mortality were assessed in 1,037 seventy-year-old subjects (540 females) information. Diet macronutrient composition was not associated with mortality, while a refined version of the modified Mediterranean diet index showed a significant inverse association (HR=0.93, 95% CI: 0.89; 0.98). As expected, inactive subjects, smokers and those with a higher waist circumference had a higher mortality, while a reduced risk characterized married and more educated people. Sensitivity analyses (which confirmed our results) consisted of: exclusion of one food group at a time in the Mediterranean diet index, exclusion of early deaths, censoring at fixed follow-up time, adjusting for activities of daily living and main cardiovascular risk factors including weight/waist circumference changes at follow up. In conclusion, we can reasonably state that a higher adherence to a Mediterranean diet pattern, especially by consuming wholegrain cereals, foods rich in polyunsaturated fatty acids, and a limited amount of alcohol, predicts increased longevity in the elderly.

Coronary heart disease prevention: nutrients, foods, and dietary patterns

Diet is a key modifiable risk factor in the prevention and risk reduction of coronary heart disease (CHD). Results from the Seven Countries Study in the early 1970s spurred an interest in the role of single nutrients such as total fat in CHD risk. With accumulating evidence, we have moved away from a focus on total fat to the importance of considering the quality of fat. Recent meta-analyses of intervention studies confirm the beneficial effects of replacing saturated fat with polyunsaturated fatty acids on CHD risk. Scientific evidence for a detrimental role of trans fat intake from industrial sources on CHD risk has led to important policy changes including listing trans fatty acid content on the "Nutrition Facts" panel and banning the use of trans fatty acids in food service establishments in some cities. The effects of such policy changes on changes in CHD incidence are yet to be evaluated. There has been a surging interest in the protective effects of vitamin D in primary prevention. Yet, its associations with secondary events have been mixed and intervention studies are needed to clarify its role in CHD prevention. Epidemiological and clinical trial evidence surrounding the benefit of B vitamins and antioxidants such as carotenoids, vitamin E, and vitamin C, have been contradictory. While pharmacological supplementation of these vitamins in populations with existing CHD has been ineffective and, in some cases, even detrimental, data repeatedly show that consumption of a healthy dietary pattern has considerable cardioprotective effects for primary prevention. Results from these studies and the general ineffectiveness of nutrient-based interventions have shifted interest to the role of foods in CHD risk reduction. The strongest and most consistent protective associations are seen with fruit and vegetables, fish, and whole grains. Epidemiological and clinical trial data also show risk reduction with moderate alcohol consumption. In the past decade, there has been a paradigm shift in nutritional epidemiology to examine associations between dietary patterns and health. Several epidemiological studies show that people following the Mediterranean style diet or the Dietary Approaches to Stop Hypertension (DASH) diet have lower risk of CHD and lower likelihood of developing hypertension. Studies using empirical or data driven dietary patterns have frequently identified two patterns - "Healthy or Prudent" and "Western". In general, the "Healthy", compared to the "Western" pattern has been associated with more favorable biological profiles, slower progression of atherosclerosis, and reduced incidence. Evidence on changes in dietary patterns and changes in CHD risk is still emerging. With the emergence of the concept of personalized nutrition, studies are increasingly considering the role of genetic factors in the modulation of the association between nutrients and CHD. More studies of genetic variation and dietary patterns in relation to CHD are needed.

Higher adherence to French dietary guidelines and chronic diseases in the prospective SU.VI.MAX cohort

BACKGROUND/OBJECTIVES

Nutritional recommendations are widely disseminated, but assessment of their predictive value for risk of chronic diseases and mortality is essential for ensuring their validity. We evaluated, in a large population-based study, the association between the French Programme National Nutrition Santé (PNNS) Guideline Score (GS) (maximum score of 15 points), an a priori-based score, and the incidences of cancer, cardiovascular disease (CVD) and overall mortality.

SUBJECTS/METHODS

Subjects included in this analysis (n=5823) were participants in the Supplémentation en Vitamines et Minéraux AntioXydants study, with available data for estimating the PNNS-GS. Hazards ratios (HRs) and 95% confidence intervals (95% CIs) for outcomes (cancer, CVD and death) were estimated across quartiles of PNNS-GS using Cox proportional hazards models.

RESULTS

A total of 734 major events were recorded during an average 11.6-year follow-up (maximum 13 years): 423 cancers, 193 ischemic diseases and 118 deaths. In the fully adjusted model, a significant reduction in CVD risk between the first and fourth PNNS-GS quartiles (HR=0.65, 95% CI=0.41, 1.00, P for trend=0.04) was observed. No significant overall association with risk of cancer or death was detected.

CONCLUSIONS

These observations support the role of nutritional guidelines in prevention of CVD.

Diet quality is independently associated with weight status in children aged 9-10 years

Although energy imbalance is key to the development of childhood obesity, the association between different dietary components, reflected in diet quality scores, and children's weight status has not been extensively studied. The current study determined if diet quality, characterized according to 3 predefined scores, was associated with weight status in a population-based sample of 9- to 10-y-old British children, independently of factors previously associated with weight status. In a cross-sectional study of 1700 children (56% girls), data from 4-d food diaries were used to calculate 3 diet quality scores modified to be reflective of children's diets: the Diet Quality Index (DQI), Healthy Diet Indicator (HDI), and Mediterranean Diet Score (MDS). Physical activity was measured with 7-d accelerometery, and height, weight, waist, and bio-impedance were objectively measured and used to calculate weight status variables. After multiple adjustments, including physical activity and overall energy density, higher DQI and HDI scores were significantly associated with improved weight status. Comparing extreme quintiles of the scores revealed the DQI and HDI were associated with lower waist circumference (-3.0%, P = 0.005 and -2.5%, P = 0.033, respectively), and lower body fat (-5.1%, P = 0.023 and -4.9%, P = 0.026, respectively). The DQI was also associated with lower weight (-5.9%; P = 0.002) and BMI (-4.2%; P = 0.004). No significant associations were observed with the MDS. These findings suggest that diet quality is independently associated with children's weight status. Future work should consider if diet quality scores could be key components of interventions designed to reduce obesity in children.

Development of a diet quality index assessing adherence to the Swedish nutrition recommendations and dietary guidelines in the Malmö Diet and Cancer cohort

Objective

To develop a diet quality index (DQI) that assesses adherence to the Swedish nutrition recommendations (SNR) and the Swedish dietary guidelines (SDG).

Design

A cross-sectional study within the Malmö Diet and Cancer (MDC) cohort. A diet history method collected dietary data, a structured questionnaire lifestyle and socio-economic information, and anthropometric data were collected by direct measurements. The index (DQI-SNR) included six components: SFA, PUFA, fish and shellfish, dietary fibre, fruit and vegetables, and sucrose.

Setting

Malmö, Sweden.

Subjects

Men (n 4525) and women (n 8491) of the MDC cohort enrolled from September 1994 to October 1996.

Results

For participants with high DQI-SNR scores, nutrient and food intakes were close to recommendations. However, most of the study population exceeded the recommended intake for SFA (98 %) and few reached recommended intakes for dietary fibre (24 %), fruit and vegetables (32 %), vitamin D (18 %) and folate (2 %). A high DQI-SNR score was positively associated with age, physical activity, not smoking, past food habit change, education and socio-economic status. Individuals with high scores were more likely to have a diabetes diagnosis or experienced a cardiovascular event.

Conclusions

Results suggest that the DQI-SNR is a useful tool for assessing adherence to the SNR 2005 and the SDG in the MDC cohort. No index has previously been developed with the aim of evaluating adherence to the current dietary recommendations in Sweden. Further validation of the DQI-SNR, and evaluation of its utility, is needed.

Dietary patterns and survival of older adults

BACKGROUND

Recent research has linked overall dietary patterns to survival in older adults.

OBJECTIVES

The objective of this study was to determine the dietary patterns of a cohort of older adults, and to explore associations of these dietary patterns with survival over a 10-year period. A secondary goal was to evaluate participants' quality of life and nutritional status according to their dietary patterns.

DESIGN

The Health, Aging, and Body Composition Study is a prospective cohort study of 3,075 older adults. In this study, all-cause mortality was assessed from baseline through Year 10. Food intake was estimated with a modified Block food frequency questionnaire, and dietary patterns of 2,582 participants with complete data were derived by cluster analysis.

RESULTS

Six dietary pattern clusters were identified, including a Healthy Foods cluster, characterized by higher intake of low-fat dairy products, fruit, whole grains, poultry, fish, and vegetables. Both the High-Fat Dairy Products and Sweets and Desserts clusters had a 1.4-fold higher risk of mortality than the Healthy Foods cluster after adjusting for potential confounders. The Healthy Foods cluster also had significantly more years of healthy life and more favorable levels of selected nutritional biomarkers than the other clusters.

CONCLUSIONS

A dietary pattern consistent with current guidelines to consume relatively high amounts of vegetables, fruit, whole grains, poultry, fish, and low-fat dairy products may be associated with superior nutritional status, quality of life and survival in older adults.

A novel mechanism of indole-3-carbinol effects on breast carcinogenesis involves induction of Cdc25A degradation

The natural compound indole-3-carbinol (I3C; found in vegetables of the genus Brassica) is a promising cancer prevention or therapy agent. The cell division cycle 25A (Cdc25A) phosphatase is overexpressed in a variety of human cancers and other diseases. In the present study, I3C induced degradation of Cdc25A, arrest of the G(1) cell cycle, and inhibition of the growth of breast cancer cells. We also showed that the Ser124 site of Cdc25A, which is related to cyclin-dependent kinase 2, is required for I3C-induced degradation of Cdc25A in breast cancer cells, and that interruption of the ATM-Chk2 pathway suppressed I3C-induced destruction of Cdc25A. Our in vivo studies of different mutated forms of Cdc25A found that the mutation Cdc25A(S124A) (Ser124 to Ala124), which confers resistance to I3C-induced degradation of Cdc25A, attenuated I3C inhibition of breast tumorigenesis in a mouse xenograft model. The present in vitro and in vivo studies together show that I3C-induced activation of the ATM-Chk2 pathway and degradation of Cdc25A represent a novel molecular mechanism of I3C in arresting the G(1) cell cycle and inhibiting the growth of breast cancer cells. The finding that I3C induces Cdc25A degradation underscores the potential use of this agent for preventing and treating cancers and other human diseases with Cdc25A overexpression.

Dietary patterns: biomarkers and chronic disease riskThis paper is one of a selection of papers published in the CSCN–CSNS 2009 Conference, entitled Are dietary patterns the best way to make nutrition recommendations for chronic disease prevention?

With increasing appreciation of the complexity of diets consumed by free-living individuals, there is interest in the assessment of the overall diet or dietary patterns in which multiple related dietary characteristics are considered as a single exposure. The 2 most frequently used methods to derive dietary patterns use (i) scores or indexes based on prevailing hypotheses about the role of dietary factors in disease prevention; and (ii) factors and clusters from exploration of available dietary data. A third method, a hybrid of the hypothesis-driven and data-driven methods, attempts to predict food combinations related to nutrients or biomarkers with hypothesized associations with particular health outcomes. Dietary patterns derived from the first 2 approaches have been examined in relation to nutritional and disease biomarkers and various health outcomes, and generally show the desirable dietary pattern to be consistent with prevalent beliefs about what constitutes a healthful diet. Results from observational studies suggest that the healthful dietary patterns were associated with significant but modest risk reduction (15%–30%) for all-cause mortality and coronary heart disease. Findings for various cancers have been inconsistent. The available randomized controlled intervention trials with a long-term follow-up to examine dietary patterns in relation to health outcome have generally produced null findings. Novel findings with the potential to change existing beliefs about diet and health relationships are yet to emerge from the dietary patterns research. The field requires innovation in methods to derive dietary patterns, validation of prevalent methods, and assessment of the effect of dietary measurement error on dietary patterns.