Adherent Group Research Articles

A PRELIMINARY ANALYSIS ON HOME EXERCISE PROGRAM ADHERENCE IN MIDDLE-AGED ADULTS USING THE EXERCISE ADHERENCE RATING SCALE (EARS) – A RETROSPECTIVE STUDY.

Background: Adherence to Home Exercise Program (HEP) is crucial for achieving an effective rehabilitation outcome, particularly among middle-aged adults (40-60 years) who have to face many challenges maintaining regular physical activities. Understanding the current adherence levels can inform strategies to enhance participation in HEP regimens. Objective: The study aims to find the level of adherence in middle-aged adults to HEP using the Exercise Adherence Rating Scale (EARS) through a patient report. Methods: The study was conducted with middle-aged adults who follow HEP for musculoskeletal conditions. Participants were asked to fill the EARS; to know the level of adherence they have towards home exercise program. Data were collected from patients who approached OPD following a musculoskeletal condition. Descriptive statistics are done with the data collected to analyze the adherence of subjects towards exercise. Result: From the EARS questionnaire it was analyzed that from a total of 94 subjects present in this study, 76 subjects showed a non-adherent value, and 18 subjects showed adherent value. The average mean value and standard deviation value of the non-adherent group is 11.8 ± 0.607 and 2.701, while for the adherent group it is 19.16 ± 0.385 and 0.833 respectively. Conclusion: From this study it is known that middle-aged adults are non-adherent to home exercise programs because of which the improvement in the rehabilitation program is not fulfilled.

Mediterranean Diet and Olive Oil Redox Interactions on Lactate Dehydrogenase Mediated by Gut Oscillibacter in Patients with Long-COVID-19 Syndrome

Chronic viral inflammation is associated with oxidative stress and changes in gut microbiota. The Mediterranean diet (MD), with recognized anti-inflammatory and antioxidant properties, modulates gut microorganisms, specifically on the interaction between extra virgin olive oil, a key component of the MD with well-documented antioxidant effects. This study investigated the influence of adherence to MD and antioxidant-rich foods (extra virgin olive oil) on biochemical, inflammatory, and microbiota profiles in patients with chronic inflammation defined as a prolonged inflammatory response due to immune dysregulation following the acute phase of the viral infection. Participants were classified into low (n = 54) and high (n = 134) MD adherence groups (cut-off of 7 points based on previous studies utilizing the same threshold in the assessment of MD adherence). Gut microbiota was sequenced using the 16S technique, and the adherence to MD was assessed using a validated questionnaire for a Spanish population. High adherence to the MD was linked to significant improvements in inflammatory and oxidative stress markers, including reductions in LDL-cholesterol, glucose, and lactate dehydrogenase (LDH) levels, an indicative of redox balance, as well as a significant higher consumption of antioxidant foods. Moreover, gut microbiota analysis revealed distinct compositional shifts and a lower abundance of the Oscillibacter genus in the high adherence group. Notably, a significant interaction was observed between MD adherence and extra virgin olive oil consumption, with Oscillibacter abundance influencing LDH levels, suggesting that the MD antioxidant properties may modulate inflammation through gut microbiota-mediated mechanisms. These findings provide new evidence that adherence to the Mediterranean diet can reduce inflammatory markers in patients with long-COVID-19, a population that has not been extensively studied, while also highlighting the potential role of the bacterial genus Oscillibacter in modulating this effect.

Adherence to antihypertensive medications in Omani patients: a comparison of drug biochemical analysis and the Morisky Medication Adherence Scale.

Medication nonadherence is a major risk factor for suboptimal or failed hypertension pharmacologic therapy. To determine the nonadherence rate to antihypertensive medications using high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) and the self-reported Morisky Medication Adherence Scale (MMAS). This study used a prospective cross-sectional cohort design. Patients with hypertension aged ≥18 years and prescribed at least one antihypertensive medication were recruited from an outpatient hypertensive clinic at a tertiary healthcare institution in Oman. Adherence was assessed using LC-MS/MS urine analysis and the MMAS. In total, 162 patients completed the MMAS questionnaire and provided urine samples for LC-MS/MS analysis. The overall mean age of the cohort was 55 ± 13 years, and 57% of the patients were men. The mean systolic and diastolic blood pressures were 146 ± 18 mmHg and 79 ± 10 mmHg, respectively. Using the MMAS method, 65% of the patients reported nonadherence. However, LC-MS/MS analysis revealed that only 27% of the patients were nonadherent. The adherent group by LC-MS/MS had significantly lower systolic (P = 0.026) and diastolic blood pressures (P < 0.001) than the nonadherent group, whereas no differences were observed using the MMAS method. There was weak or no agreement between the MMAS and LC-MS/MS results (P = 0.142). Almost one-fourth of our patients with hypertension were nonadherent to their medications. There was a weak concordance between the MMAS and LC-MS/MS methods in detecting medication nonadherence. Further research into noninvasive convenient adherence scales or methods and their correlations with LC-MS/MS analysis is warranted.

Diet changes and colorectal cancer risk in the UK Biobank.

Modifying dietary behaviors into healthier habits may attenuate the risk of colorectal cancer (CRC) risk. This study aimed to investigate the association between dietary changes and the risk of CRC. Following dietary recommendations for red and processed meat, fruit and vegetables, and alcohol consumption, we classified 50,640 participants into poor and good adherence groups in the UK Biobank. Changes in dietary habits were defined as stable poor, poor to good, good to poor, and stable to good adherence. A Cox proportional hazard model was used to examine the association between dietary changes and CRC risk. Women were more likely to follow dietary recommendations than men. After a median of 3.3 years from the latest follow-up, 8,328 (16.4%) participants followed an improved dietary habit and 5,808 (11.5%) participants had a worsened diet. Compared to men who stably consumed fruit and vegetables <5 servings/day, those who increased their consumption to ≥5 servings/day were related to CRC risk reduction (hazard ratio: 0.24, [0.09-0.63]). However, the beneficial associations of increased fruit and vegetable consumption were not statistically significant in women (hazard ratio: 0.41, [0.11-1.56]). Our findings support the evidence that increasing fruit and vegetable intake could serve as a beneficial strategy to mitigate CRC risk in men. Participants from the UK Biobank significantly changes their adherence to dietary recommendations during the follow-up. Increasing fruit and vegetable consumption was inversely associated with CRC risk among men.

Treatment of obstructive sleep apnea with CPAP improves daytime sleepiness and fatigue in cancer patients.

Fatigue and sleep disorders are prevalent in cancer patients. Obstructive sleep apnea (OSA) commonly causes excessive daytime sleepiness (EDS) and fatigue. We hypothesize that treating cancer patients with OSA using positive airway pressure (PAP) will improve EDS and fatigue. A retrospective chart review of sleep clinic visits of cancer patients with newly diagnosed OSA was performed. Epworth Sleepiness Scale (ESS) and fatigue reported at baseline and within 6 months of starting PAP therapy were compared between PAP-adherent and PAP-non-adherent patients. 65 cancer patients with OSA and ESS >10 were recommended PAP therapy, including 45 patients with fatigue. 29 patients pursued PAP therapy with 79% (n = 23) adherent at follow-up. The median baseline apnea hypopnea index (AHI) for OSA was 24.0 (interquartile range [IQR] 14.3, 32.3) and 23.8 (IQR 10.1, 42.8) events/hour among PAP-adherent and PAP-non-adherent patients, respectively (p = 0.90). Median baseline ESS was 14.0 (IQR 12.0, 17.0) among adherent and 17.0 (IQR 11.0, 17.3) among non-adherent patients (p = 0.73). The median ESS at follow-up of the adherent and non-adherent groups was 8.0 (IQR 6.0, 10.0) and 11.0 (IQR 8.0, 15.8), respectively (p = 0.08). Median ESS change was -5.0 (IQR -7.0, -4.0) in PAP adherent patients and -2.5 (IQR -5.25, -1.50) in PAP-non-adherent patients (p = 0.07). When the groups are examined separately, the median change in the PAP-adherent group was highly significant (p = 0.001), while the ESS median change in the PAP-non-adherent group was considerably less (p = 0.04). 17out of the 21 PAP-adherent patients reporting fatigue at baseline indicated improvement at follow-up. PAP therapy for OSA in cancer patients improves EDS and fatigue. Larger studies are necessary to evaluate the efficacy of PAP in improving fatigue in this population.

The role of early orthotic intervention in the management of post-traumatic elbow contractures: Study protocol for phase II double-blinded randomised controlled trial.

Restoration of full elbow extension following trauma is difficult and influenced by the injury profile, surgeon preference, patient and environmental factors. The literature suggests that orthotic interventions are effective in improving contractures when movement plateaus despite normal therapeutic interventions. It is not known if extension orthotic intervention is more superior to standard treatment regardless of when it is commenced. The literature lacks patient-reported considerations to contracture management using elbow orthoses. This protocol describes a Phase II double blinded randomised controlled feasibility trial (RCT) and mixed methods study, aimed to examine outcome with extension in an orthotic intervention group (OG) versus control (CG). All participants will undergo six weekly therapy sessions, which include a standardised therapeutic program. OG participants will be provided with an additional extension orthosis and the outcome is assessed according to the change in elbow extension motion after 6 weeks of intervention. Data will be collected via questionnaires, logbooks, feedback forms, and semi-structured interviews at baseline and final assessments for descriptive statistical analysis. Under the guidance of a statistician, all quantitative data will be evaluated using the appropriate parametric or non-parametric analyses to evaluate for systematic differences between groups. Preliminary extension gains are used to determine the final sample size required to achieve adequate power for a full-scaled RCT. Interview data on OG participants will be qualitatively analysed using the "five-factorial dimensions of adherence" framework to identify key differences in the influencers between adherent or non-adherent groups. ANZCTR ACTRN12619001402134p.

Mediterranean diet score linked to cognitive functioning in women: evidence from the Czech Republic

Abstract Background Evidence suggests that adherence to the Mediterranean diet (MED) may be beneficial in preventing cognitive decline, although findings are inconsistent. We aimed to explore this association in the Czech population of older adults. Methods A total of 6,028 males and females from the Czech arm of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study were included in the analysis. Dietary data were collected using a food frequency questionnaire, and MED was calculated based on nine food groups. The MED score ranged from 0 to 16 points and was categorized into three groups: 0-7, 8-10, and 11-16 points. Cognitive function was measured using four tests assessing verbal memory and learning, verbal fluency, and attention, mental speed and concentration, from which single z-scores were computed. The composite score of cognitive function was computed as the mean of z-scores. The cross-sectional associations between MED and composite score of cognitive function were analyzed using multivariate linear regression. Results Females with a dietary score of 8-10 points (Beta=0.05, 95% CI: -0.002; 0.097), and those with a score of 11-16 points (Beta=0.08, 95% CI: 0.016; 0.140) had a higher composite cognitive score than women in lowest adherence group. Looking at specific domains, women in the highest adherence group had significantly better immediate verbal memory (Beta=0.12, 95% CI: 0.031; 0.205) and delayed recall (Beta=0.12, 95% CI: 0.027; 0.212), respectively, than those in the lowest adherence group. There were no associations in males. Conclusions Higher adherence to the MED was associated with better cognitive functioning in verbal memory and composite cognitive score in Czech females. The results suggest that the Mediterranean diet may help to improve cognitive functioning in older women. #NGEU Key messages • Findings suggest that Mediterranean diet may be beneficial in cognitive functioning in older women. • Higher adherence to the Mediterranean diet is connected to better cognitive function particularly in verbal memory domain.

Adherence to Mediterranean diet and cardiometabolic risk among mountain communities in European Alps

Abstract Background The Mediterranean diet has emerged as a model promoting a better health status, particularly for cardiovascular diseases prevention. Adherence to the Mediterranean diet (AMD) may vary depending on geographical location and sociocultural factors. Mountains and rural communities may experience lower adherence, also depending on food provision-related services availability. Our cross-sectional study aims to investigate the association between AMD and cardiometabolic risk in a cohort of mountain dwellers. As a secondary aim, we will test if services availability may influence health status via AMD. Methods In spring/summer 2023, healthy volunteers from 5 small villages in Italian Alps were enrolled. Dietary habits were investigated by Medi-Lite standardized questionnaire. The waist-to-height ratio (WHtR) was calculated by dividing the waist circumference by height, then used as an anthropometric index for central adiposity and related cardiometabolic risk. Services availability was assessed by network analysis implemented in QGIS. A multilevel logistic regression model, with center as random intercept and adjusted for age, sex, BMI, education and physical activity was used to test the association between AMD and cardiometabolic risk. Ethical approval was provided by University of Turin. Results To date, 142 subjects (59.2% females, 49.9±14.0 y.o.) have been enrolled. Preliminary analyses showed that, as compared to the least adherent group, subjects reporting the highest AMD level (3rd tertile of Medi-Lite scoring) were strongly protected from cardiometabolic risk (OR: 0.07, 95% C.I.: 0.01, 0.67; p = 0.021). A similar trend was observed for the 2nd tertile. Conclusions Our preliminary findings suggest the beneficial role of the Mediterranean diet also in remotely located populations. We plan to investigate how service availability may impact AMD and, indirectly, cardiometabolic health to reinforce the importance of equity in services distribution for Public Health Key messages • Independently of age, sex, BMI, education and physical activity, adherence to the Mediterranean diet can promote cardiometabolic health among rural and mountain communities. • Mediterranean eating pattern can positively influence central adiposity and should be promoted to ensure more effective prevention strategies in mountain dwellers.

Medication adherence and antithrombotic therapy outcomes: insights from a post-hoc analysis of the AFIRE trial

Abstract Background The AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial established noninferiority in efficacy and superiority in safety endpoints of rivaroxaban monotherapy over rivaroxaban plus antiplatelet therapy (combination therapy) in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). However, the impact of medication adherence to rivaroxaban on AFIRE study outcomes remains unclear. Purpose This post-hoc analysis aimed to explore the influence of medication adherence on AFIRE trial results. Methods Among 2,120 patients, participants were classified into adherent and non-adherent groups based on self-reported measures, which were further verified through on-site visits to the facilities. Adherent patients were defined as those who reported consistently taking their medication as prescribed. The primary efficacy endpoint comprised stroke, systemic embolism, myocardial infarction, unstable angina requiring revascularization, or all-cause death, including cerebral events. Analysis also examined differences in the primary efficacy endpoint between adherent and non-adherent patients. Results Of the 2,120 patients, 2,012 (94.9%) were adherent to rivaroxaban, while 108 (5.1%) were non-adherent. Among adherent patients, rivaroxaban monotherapy showed significantly better efficacy outcomes compared to combination therapy (hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.54–0.98; p=0.04, Figure 1A). However, primary efficacy outcomes did not significantly differ among non-adherent patients (HR 0.64, 95% CI 0.23–1.81, p=0.40, Figure 1B). Adherent patients exhibited improved outcomes relative to non-adherent patients, though this difference was not statistically significant (HR 1.68; 95% CI 0.99–2.85; p=0.05, Figure 2A). In clinically high-risk patients with a history of angina pectoris, those who demonstrated adherence to medication (n=1281) exhibited significantly better efficacy outcomes compared to non-adherent patients (n=68) (HR 1.97; 95% CI 1.09–3.56; p=0.03, Figure 2B). Conclusions Rivaroxaban monotherapy versus combination therapy showed favorable efficacy outcomes in patients with good adherence, consistent with the overall AFIRE trial. However, these benefits were not observed in non-adherent patients. Adherence to rivaroxaban is crucial for achieving its maximum therapeutic effect as monotherapy.Figure1Figure2

Higher Adherence to the Mediterranean Diet Is Associated with a Lower Risk of Steatotic, Alcohol-Related, and Metabolic Dysfunction-Associated Steatotic Liver Disease: A Retrospective Analysis

Background and Aims: Metabolic liver disease is associated with obesity, insulin resistance, cardiovascular disease, and metabolic disorders. A Mediterranean diet (MD), known for its anti-inflammatory and antioxidant properties, is effective in managing various chronic diseases, including liver diseases. This study aimed to explore the influence of adherence to the MD on the risk of chronic metabolic diseases, including steatotic liver disease (SLD), metabolic dysfunction-associated steatotic liver disease (MASLD), and alcohol-related liver diseases (ALDs). Methods: This retrospective cohort study analyzed 5395 individuals from a single center between 2020 and 2022, grouped by adherence to the MD using the Korean Mediterranean Diet Adherence Score (K-MEDAS). MASLD score, ALD, and cardiovascular risk factors were also assessed. Statistical analyses were performed using 1:1 exact matching and multiple regression to compare the less adherent (K-MEDAS 0–7) and highly adherent (K-MEDAS 8–13) groups. Results: Adjusting for confounding variables, high adherence to the MD was significantly associated with lower rates of SLD (odds ratio [OR] 0.818, 95% confidence interval [CI] 0.700–0.957, p = 0.012), MASLD (OR 0.839, 95% CI 0.714–0.986, p = 0.033), and ALD (OR 0.677, 95% CI 0.671–0.683, p &lt; 0.001). Post-propensity score matching analysis revealed that the highly adherent group exhibited significantly lower triglyceride levels, triglyceride and glucose index, atherogenic Index of Plasma, and Framingham risk scores than the less adherent group. Conclusions: Good adherence to the MD considerably reduces the risk of SLD, MASLD, and ALD, underscoring its protective effects and potential to prevent metabolic liver diseases and their complications.

Psychometric evaluation of the Adelphi Adherence Questionnaire (ADAQ©) in adults with osteoarthritis

BackgroundMedication non-adherence is a common issue in chronic illness. The World Health Organization has recognized a need for a valid and reliable method of measuring adherence to understand and mitigate non-adherence. This study aimed to psychometrically evaluate the English version of the Adelphi Adherence Questionnaire (ADAQ©), a questionnaire designed to assess patient-reported medication adherence across multiple therapy areas, in patients with Osteoarthritis (OA).MethodologyData from the Adelphi OA Disease Specific Programme™, a survey of physicians and their consulting adult patients with OA conducted in the United States, November 2020 to March 2021, was used to assess the psychometric properties of the ADAQ. Patients completed the ADAQ, Adherence to Refills and Medication Scale (ARMS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and EQ-5D-3L. The measurement model of the 13-item ADAQ was assessed and refined using latent variable modelling (Multiple Indicator Multiple Cause, confirmatory and exploratory factor analyses, item response theory, Mokken scaling, and bifactor analyses). Correlational analyses (Spearman’s rank and polyserial as appropriate) with ARMS, WOMAC, and EQ-5D-3L scores assessed construct validity. Anchor- and distribution-based analyses were performed to estimate between-group clinically important differences (CID).ResultsOverall, 723 patients were included in this analysis (54.5% female, 69.0% aged ≥ 60). Latent variable modelling indicated a unidimensional reflective model was appropriate, with a bifactor model confirming an 11-item essentially unidimensional score. Items 12 and 13 were excluded from scoring as they measured a different concept. The ADAQ had high internal reliability with omega hierarchical and Cronbach’s alpha coefficients of 0.89 and 0.97, respectively. Convergent validity was supported by moderate correlations with items of the ARMS, and physician-reported adherence and compliance. Mean differences in ADAQ score between high and low adherence groups yielded CID estimates between 0.49 and 1.05 points, with a correlation-weighted average of 0.81 points.ConclusionThis scoring model showed strong construct validity and internal consistency reliability when assessing medication adherence in OA. Future work should focus on confirming validity across a range of disease areas.

Changes in Antipsychotic Medication Adherence Among Medicaid Beneficiaries with Schizophrenia During COVID-19.

To identify patterns of medication adherence during the pandemic and factors associated with these patterns among Medicaid-enrolled individuals with schizophrenia who had highly adherent medication use prior to the COVID-19 pandemic. We used Medicaid claims from Philadelphia to identify individuals with schizophrenia ≥ 18years of age, their demographic characteristics, and health service use. We used group trajectory models to identify adherence trends, and ANOVA to examine associations between adherence groups and demographic characteristics and service use. The sample included 1,622 individuals. A 4-group trajectory model best fit our data. Seventy percent of individuals averaged about 92% adherence throughout the study period; 10% experienced a pronounced decline when the pandemic started (pandemic non-adherers); 11% experienced a sharp decline mid-pandemic (late non-adherers); and 9% experienced a sharp decline at the beginning of the pandemic and returned to higher adherence after a year (disrupted adherers). Adherers were least likely to be diagnosed with a substance use disorder, and had more telehealth visits, mental health outpatient visits, and fewer emergency department visits on average. Late non-adherers were more likely than adherers to have substance use disorders and physical health conditions. Pandemic non-adherers had more co-occurring psychiatric disorders than adherers and had the lowest use of case management. Three in ten previously adherent individuals with schizophrenia became less adherent to antipsychotic medications, either at the onset or later in the pandemic. Our findings point to telehealth and case management as critical strategies for treatment engagement, especially during public health crises, and well as the need to address co-occurring conditions.

Predicting buprenorphine adherence among patients with opioid use disorder in primary care settings

BackgroundMedications for opioid use disorder (MOUD), including buprenorphine, are effective treatments for opioid use disorder (OUD) and reduce risk for overdose and death. Buprenorphine can be prescribed in outpatient primary care settings to treat OUD; however, prior research suggests adherence to buprenorphine in these settings can be low. The purpose of this study was to identify the rates of and factors associated with buprenorphine adherence among patients with OUD in the first six months after a new start of buprenorphine.MethodsData were extracted from the electronic health record (EHR) from a large integrated health system in the upper Midwest. Patients with OUD (N = 345; Mean age = 37.6 years, SD 13.2; 61.7% male; 78% White) with a new start of buprenorphine between March 2019 and July 2021 were included in the analysis. Buprenorphine adherence in the first six months was defined using medication orders; the proportion of days covered (PDC) with a standard cut-point of 80% was used to classify patients as adherent or non-adherent. Demographic (e.g., age, sex, race and ethnicity, geographic location), service (e.g., encounters, buprenorphine formulations and dosage) and clinical (e.g., diagnoses, urine toxicology screens) characteristics were examined as factors that could be related to adherence. Analyses included logistic regression with adherence group as a binary outcome.ResultsLess than half of patients were classified as adherent to buprenorphine (44%). Adjusting for other factors, male sex (OR = 0.34, 95% CI = 0.20, 0.57, p < .001) and having an unexpected positive for opioids on urine toxicology (OR = 0.42, 95% CI = 0.21, 0.83, p < .014) were associated with lower likelihood of adherence to buprenorphine, whereas being a former smoker (compared to a current smoker; OR = 1.82, 95% CI = 1.02, 3.27, p = .014) was associated with greater likelihood of being adherent to buprenorphine.ConclusionsThese results suggest that buprenorphine adherence in primary care settings may be low, yet male sex and smoking status are associated with adherence rates. Future research is needed to identify the mechanisms through which these factors are associated with adherence.

Discrepancy between Subjective and Objective Measurements for the Evaluation of Medication Adherence-A Cross-Sectional Study in Patients with Cardiovascular Diseases.

Medication adherence is important for the appropriate drug-based treatment in patients with chronic diseases, especially those with cardiovascular diseases (CVDs). The purpose of the present study was to evaluate medication adherence among patients with CVDs using subjective and objective measurements. We enrolled outpatients who visited Fukuoka University Chikushi Hospital from June to December 2022. As a subjective measurement, we used a self-reported questionnaire developed by Ueno et al., which consists of 12 questionnaire items grouped into the following four domains: medication compliance (subjective compliance), collaboration with health care providers (collaboration), willingness to access and use information about medication (willingness), and acceptance to take medication and how taking medication fits a patient's lifestyle (acceptance). The pill counting method was used as an objective measurement to calculate the medication adherence rate; Poor Adherence was defined as a medication adherence rate of <100%. Ninety-four patients were analyzed. No statistically significant differences were observed between the patients in the Good and Poor Adherence groups classified by pill counting, an objective indicator; in the subjective evaluation index Ueno scale scores of subjective compliance, collaboration, willingness, and acceptance domains; and in the total score. A multivariate analysis revealed that obesity (odds ratio, 3.527; 95% confidence interval, 1.387-9.423; p = 0.008) was an independent factor associated with Poor Adherence. In conclusion, we found a discrepancy between subjective and objective measurements for the evaluation of medication adherence. Furthermore, obesity was an independent factor associated with poor medication adherence assessed by the pill counting method; thus, patients with CVD and obesity require a careful follow-up.

Effect of Mediterranean Diet Composition on Metabolic Syndrome Marker Parameters Based on NCEP-ATP III Criteria

Metabolic syndrome refers to a cluster of metabolic abnormalities in the body, including central obesity, elevated blood pressure, high glucose, and triglyceride levels, as well as low HDL levels. The Mediterranean diet, known for its specific composition, is believed to mitigate metabolic syndrome. This study aims to assess the impact of adhering to the Mediterranean diet on individuals with metabolic syndrome. It employs an observational analytic approach, utilizing a prospective cohort of 30 participants who followed the Mediterranean diet regimen as part of their treatment at a clinic in Bandung City. Systematic Random Sampling was used to select participants, and blood pressure was measured at the beginning (T1) and end (T2) of the study. Data on dietary intake were collected using the Relative Mediterranean Diet (rMED) scale via a Food Frequency Questionnaire (FFQ). Statistical analyses, including ANOVA and Tukey’s post-hoc test, were conducted to compare dietary compositions across adherence groups and to assess the impact of the Mediterranean diet on metabolic syndrome components. The findings revealed that participants, with an average age of 57.94 years and 69.44% female, experienced significant improvements in certain metabolic syndrome components, such as waist circumference (fruit and nut intake), triglycerides (vegetable intake), HDL (meat intake), and blood glucose (dairy product intake). However, no significant effects were observed for legumes, seeds, fish, and olive oil components on MetS. Keywords: components, Mediterranean diet, MetS, NCEP-ATP III

The Effect of the Mediterranean Diet Components on Blood Pressure, Mean Arterial Pressure, and Pulse Pressure in Hypertensive Patients

According to the 2018 Basic Health Research Data (RISKESDAS), the prevalence of hypertension in West Java was 39.6%, while in Cimahi City it was 41.83%. The composition of the Mediterranean diet contains a high proportion of MUFA and PUFA which act as anti-inflammatory, antioxidant, and cardioprotective with a potential to lower blood pressure. The aim of this study is to determine the impact of Mediterranean diet components on blood pressure in patients with hypertension. The study uses observational analytic methods as the design and also employs a prospective cohort sample of 36 patients with hypertension for three months, using a systematic random sampling technique. The research subjects were checked for blood pressure in the first month (T1) and the last month of the study (T2). The relative Mediterranean Diet (rMED) was used as a source of data on component intakes by administering the Food Frequency Questionnaire (FFQ) 12 times within three months. The differences in Mediterranean diet composition and blood pressure in all Mediterranean diet adherence groups were examined using the ANOVA test and Tuckey’s post-hoc test, as well as to test comparisons of proportions between rMED adherence groups. The impact of each component of the Mediterranean Diet on blood pressure was evaluated using a linear regression analysis test. The results showed that the average age of hypertensive patients who underwent the Mediterranean diet was 57.94 years and 69.44% were female. The components of fruit and nuts, vegetables, and fish have a significant effect on systolic blood pressure. Fish components have a significant effect on diastolic blood pressure. The components of vegetables and fish have a significant effect on the mean arterial pressure (MAP). Fruit and nut components have a significant effect on pulse pressure. The limitations of this study are the short research time, the absence of salt consumption restrictions on the Mediterranean diet, and the presence of smoking and physical activity as confounding activities. Keywords: blood pressure, composition, Mediterranean diet, mean arterial pressure, pulse pressure

Effect of the Composition of the Mediterranean Diet on Body Mass Index, Waist Circumference, Fat Level, and Visceral Fat in Patients with Obesity

Excessive and unhealthy fat storage is known as obesity. Both monounsaturated and polyunsaturated fatty acids are highly encouraged in the Mediterranean diet. Obese patients at a Bandung clinic were studied to examine how the Mediterranean diet affects their BMI, waist size, fat percentage, and visceral fat. Analytical observational methods utilizing prospective cohort observations were employed. A systematic random sample technique was used to carry out the sampling. Participants were 34 overweight individuals who had twelve monthly food pattern assessments and two monthly examinations for body mass index (BMI), waist size, fat percentage, and visceral fat. To compare proportions between the rMED adherence groups and to look for differences in the composition of the Mediterranean diet on BMI, waist circumference, fat content, and visceral fat, we used the ANOVA test and Tuckey’s post-hoc test. In addition, the eight tenets of the Mediterranean diet were assessed using linear regression. The average age of the obese patients who followed the Mediterranean diet was 57.54 years, and 79.41% of them were female. It was found that the components of vegetables, fruits, nuts, seafood, and dairy products had a substantial impact on the body mass index of the participants, while the components of vegetables, fruits, nuts, legumes, seeds, meat, fish, olive oil, and dairy products did not have a significant impact on the waist circumference, fat content, or visceral fat. Keywords: body mass index, fat content Mediterranean diet composition, obesity, visceral fat, waist circumference

Adherence to Mediterranean Diet and Biomarkers of Redox Balance and Inflammation in Old Patients Hospitalized in Internal Medicine.

We have previously described that low adherence to the Mediterranean diet (MD) in elderly patients admitted in internal medicine wards is linked to poorer clinical outcomes. This investigation was designed to explore whether adherence to the MD is related to circulating markers of redox balance and inflammation in this clinical scenario. A cross-sectional study was performed on 306 acute old patients hospitalized in internal medicine wards. Adherence to the MD was estimated by the Italian Mediterranean Index (IMI). The circulating markers of redox balance were assessed in serum and erythrocytes and correlated with inflammatory markers across different MD adherence groups. Compared to the patients with high adherence, those with low adherence to the MD exhibited severely impaired redox balance, as evidenced by a higher GSSG/GSH ratio and increased serum hydroxynonenal/malondialdehyde-protein adducts. No modifications were described in the expression of antioxidant enzymes in peripheral blood mononuclear cells. Patients with low adherence to the MD exhibited a higher neutrophil-to-lymphocyte ratio and markers of systemic inflammation, as well as raised levels of interleukin-6 and tumor necrosis factor, compared to those with high MD adherence. A strong association was observed between the circulating markers of redox balance and inflammation/immune response, with the highest regression coefficients found in the low adherence group. Old patients admitted to internal medicine wards with low adherence to the MD display unfavorable profiles of the circulating markers of redox balance and inflammation. It is conceivable that such effects on redox balance can be linked to the high polyphenol content of MD. This study supports the rationale for intervention trials that attest to the effectiveness of MD as a nutritional strategy for disease prevention.

A high adherence level to nutritional recommendations minimizes protein and minerals loss while maximizes visceral fat loss in bariatric surgery patients

BackgroundMetabolic bariatric surgeries are considered the finest and most appropriate treatment option for patients with severe obesity. Besides the surgical procedure, many factors appear to be associated with improved postoperative outcomes such as compliance to the postoperative diet and supplementation, regular physical activity, medical and nutritional follow-up, and modifications in dietary habits. The objectives of this study were to investigate the effect of adherence to post-operative recommendations on anthropometric measurements and body composition and assess the percentage of total weight loss (%TWL) and excess weight loss (%EWL) 3 months post-operative. Material and MethodsFifty-two participants who underwent a Roux-en-Y gastric bypass or sleeve gastrectomy were included. Participants have filled out a pre-operative questionnaire. Anthropometric measurements were obtained pre-operative and 3 months post-operative using a Body Impedance Analyzer (Inbody 270). The adherence to post-operative recommendations was assessed by the Bariatric Surgery Self-management Questionnaire 3 months post-operative and classified to three adherence levels. ResultsMost anthropometric measurements decreased 3 months post-operative in the three adherence groups (p≤0.05). No significant differences were observed between groups in anthropometric measurements and body composition, except for minerals and visceral fat levels. The mineral loss has decreased in both the high and intermediate adherence groups (-0.09 ± 0.22 kg, and -0.09 ± 0.18 kg, respectively). Also, the high adherence group showed less loss in protein amount post-operatively (p=0.06). Visceral fat level decreased in the high adherence group (p≤ 0.05). ConclusionAdherence to post-operative behavioral and nutritional recommendations was associated with less protein and mineral loss and enhanced visceral fat reduction post-operatively.

Between Public Guidelines for User Involvement and Ideals About Free Research: Using Collaborative Autoethnography to Explore Researcher Experiences From a User Involvement Process.

User participation is a prerequisite for receiving research funding in healthcare in Norway. Despite many positive benefits, studies report challenges from users' and researchers' perspectives. Limited knowledge exists concerning researchers' experiences in scenarios where the users are professionals within healthcare and research. The aim of this retrospective study was to explore and reflect on personal experiences as researchers from a process of planning and developing research questions for a PhD project, following the James Lind Alliance guidelines, which were a requirement for funding. We focused on how the process of collaboration with a specific group of users influenced the researchers' sense of selves. We used a qualitative design based on collaborative autoethnography, exploring personal experiences from a sociocultural point of view. Two of the three researchers in the team recollected their experiences from the user involvement process while applying the James Lind Alliance guidelines. We used different data sources to develop two autoethnographic narratives. The narratives were analysed using thematic analysis. The autoethnographic narratives demonstrate the complexity of user involvement from the researchers' perspectives. We identified four themes in the analysis: intrinsic and extrinsic motivation, competing paradigms, hierarchy and dual roles. The accounts illustrated the researchers' ambivalence within the process, indicating that they feared a loss of control over the direction of the research project. The narratives visualised a struggle to appear as credible researchers, illustrating how the involvement of a specific group of users and adherence to a specific guideline for user involvement influenced the researchers' experiences of their roles and identities in the collaboration. The results point to the relevance of the sociocultural backdrop; researchers might become frontline providers of policy implementation in research, balancing tensions between regulatory constraints, user involvement and researchers' professional identity and research ideals, when a specific, detailed procedure for user involvement is required. Two user panels comprising participants from clinical practice, education and research, along with a service user, collaborated in the planning and development of research questions for a PhD project. This autoethnographic study elaborates this process.