Alternate Mediterranean Diet Score Research Articles

Association of Dietary Quality With Risk of Incident Systemic Lupus Erythematosus in the Nurses' Health Study and Nurses' Health Study II.

Knowledge remains scarce regarding diet and systemic lupus erythematosus (SLE) risk. Our objective was to investigate 4 dietary quality scores and SLE risk overall and by anti-double-stranded DNA (anti-dsDNA) positive versus negative subtypes. We studied 79,568 women in the Nurses' Health Study (1984-2014) and 93,554 in the Nurses' Health Study II (1991-2013). Using validated food frequency questionnaires, we calculated 4 dietary scores: the 2010 Alternative Healthy Eating Index (AHEI-2010), the Alternative Mediterranean Diet Score (aMed), the Dietary Approach to Stop Hypertension (DASH), and the Empirical Dietary Inflammatory Pattern (EDIP). Incident SLE was confirmed by medical record review. Time-varying Cox regression models estimated pooled hazard ratios (HRs) and 95% confidence intervals (95% CIs) of SLE risk, overall and by anti-dsDNA, for cumulative average dietary quality score tertiles and individual AHEI-2010 components. We identified 194 incident SLE cases. SLE risk was similar in women with the highest (versus lowest) dietary scores (AHEI-2010 HR 0.78 [95% CI 0.54-1.14], aMed HR 0.82 [95% CI 0.56-1.18], DASH HR 1.16 [95% CI 0.81-1.66], EDIP HR 0.83 [95% CI 0.57-1.21]). No association was demonstrated for anti-dsDNA+ or anti-dsDNA- SLE risk. Women in the highest (versus lowest) AHEI-2010 tertile of nut/legume intake had a decreased SLE risk (HR 0.59 [95% CI 0.40-0.87]). No association was demonstrated for other AHEI-2010 components and SLE risk. We observed no association between long-term adherence to the AHEI-2010, aMed, DASH, or EDIP scores with SLE risk, suggesting a large effect of dietary quality on SLE risk is unlikely. However, potential reduction in overall SLE risk with high nut/legume intake warrants further investigation.

Diet Quality and the Risk of Impaired Speech Reception Threshold in Noise: The UK Biobank cohort.

Previous studies have examined the association between several diet quality indexes and risk of hearing loss, based on self-reported information or on audiometry test, with inconsistent results. However, the impact of healthy diets on the capacity to listening in noise, a proxy of disability due to hearing loss, is unknown. This research assessed the prospective association between five diet quality indexes and the speech reception threshold in noise in the UK Biobank study. Prospective cohort with 105,592 participants aged ≥40 years. At baseline, adherence to the Mediterranean Diet Adherence Screener, the alternate Mediterranean Diet score, the Dietary Approaches to Stop Hypertension, the Alternate Healthy Eating Index-2010, and the healthful Plant-Based Diet Index were assessed. Functional auditory capacity was measured with a digit triplet test, and impairment was defined as a speech reception threshold in noise >-3.5 dB in any physical exam during the follow-up. Over a median follow-up of 3.2 (SD: 2.1) years, 1704 participants showed impaired speech reception threshold in noise. After adjusting for potential confounders, the hazard ratios (95% confidence interval) of impairment per 1-SD increase in the Mediterranean Diet Adherence Screener, alternate Mediterranean Diet score, Dietary Approaches to Stop Hypertension, Alternate Healthy Eating Index-2010 and healthful Plant-Based Diet Index scores were, respectively, 0.98 (0.94 to 1.03), 1.01 (0.96 to 1.06), 1.02 (0.97 to 1.07), 1.01 (0.96 to 1.06), and 1.00 (0.96 to 1.05). Results were similar when analyses were restricted to those >60 years, with British ethnicity, without chronic disease, without tinnitus or with optimal cognitive function. Adherence to a healthy diet did not show an association with the speech reception threshold in noise. More research is needed to identify the impact of individual foods or nutrients on this outcome.

Maternal diet patterns during early pregnancy in relation to neonatal outcomes

Research has established that maternal diet influences fetal growth and preterm birth, but most studies only evaluate single nutrients. Relations between dietary patterns and neonatal outcomes are understudied. We evaluated associations of neonatal outcomes with maternal diet patterns derived using 3 a priori diet scores [Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet score (aMed), and Dietary Approaches to Stop Hypertension (DASH)] as well as principal components analysis (PCA). We studied 1948 women from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singletons, a racially diverse multisite cohort of pregnant women in the USA (2009-2013). Diet in the past 3 mo was assessed using a self-administered FFQ at 8-13 weeks of gestation. Birthweight was abstracted from medical records and neonatal anthropometry measured postdelivery using standardized protocols. All 3 a priori scores were significantly associated with increased birthweight, and aMed was also associated with reduced odds of low birthweight [quartile 4 versus 1: ORadj=0.42; 95% CI: 0.18, 1.00 (P-trend=0.02)]. Greater aMed and DASH scores were significantly associated with increased length [aMed: quartile 4 versus 1: 0.54 cm; 95% CI: 0.10, 0.99 (P-trend=0.006); DASH: quartile 4 versus 1: 0.62 cm; 95% CI: 0.25, 0.99 (P-trend=0.006)] and upper arm length. Neither diet pattern derived from PCA was significantly associated with birthweight. Among mostly low-risk pregnant women, pre- and early pregnancy healthful diet quality indices, particularly the aMed score, were associated with larger neonatal size across the entire birthweight distribution. In the absence of generally accepted pregnancy-specific diet quality scores, these results provide evidence for an association between maternal diet patterns and neonatal outcomes.

Metabolic Biomarkers of Mediterranean Diet in Pregnant Women

Abstract Objectives Using an untargeted approach to identify plasma metabolomics signature of the Mediterranean diet, a healthful dietary pattern related to both maternal and fetal outcomes, in pregnancy. Methods This study included 193 pregnant women from the NICHD Fetal Growth Studies-Singletons (FGS) cohort who had habitual dietary intake in the past three months measured at 8–13 gestational weeks (GW) by the semi-quantified food frequency questionnaire. Fasting plasma metabolomics profiles at 15–26 GW were measured by the high-throughput liquid chromatography quadrupole time of-flight mass spectrometry (LC-QTOF MS/MS). Metabolites were re-scaled to a median of 1 for each batch and log transformed. Alternate Mediterranean Diet (aMED) score was calculated by eight food and nutrient components (i.e., fruits, vegetables, whole grains, nuts, fish, legumes, red and processed meats, and monounsaturated-to-saturated fat ratio), with a higher score indicating a better adherence. Prospective associations of aMED score in peri-conception and early pregnancy with individual metabolites at 15–26 GW were estimated using the linear regression adjusting for potential confounders and multiple testing. LASSO (Least Absolute Shrinkage and Selection Operator) regression with 10-fold cross-validation was performed to select metabolites that were jointly associated with high aMED score (defined as the top tertile). All statistical analyses were weighted to represent the entire FGS cohort. Results A total of 460 known metabolites were profiled and annotated. Six metabolites were selected as the biomarkers of high aMED score by the LASSO regression (i.e., with no-zero coefficients). Among them, glutamic acid and 3-hydroxybutyric acid were negatively whereas PC (40:7), CE (20:5), TG (49:1), and TG (58:4) were positively associated with aMED score. The six biomarkers were also confirmed by the linear regression with false discovery rates < 0.1. Conclusions Our study is the first one conducted in pregnant women using the untargeted metabolomics approach and we newly identified several biomarkers of Mediterranean diet in pregnant women. Results from this study warrant the replication by future studies. Funding Sources The work was supported by the intramural research program of the NICHD and the internal fund from UCLA.

Mediterranean Diet and Lifestyle Index Development for Older Adults

ObjectivesThe Mediterranean diet is associated with many health benefits, yet it is typically only the food pattern that is assessed without consideration for lifestyle attributes that accompany a Mediterranean way of life. The Mediterranean diet pyramid includes lifestyle activities at the base of the pyramid such as regular physical activity (PA), adequate rest, conviviality, biodiversity and seasonality, traditional local and eco-friendly products, and culinary activities. The purpose of this study was to design and pilot test a Mediterranean diet and lifestyle index for older adults in the U.S.MethodsThe Harvard Food Frequency Questionnaire was used to determine the alternative Mediterranean Diet Score (aMed). The short version of the Minnesota Leisure Time PA questionnaire and additional Mediterranean diet-related dietary habit and lifestyle questions were piloted in 75 older adults attending senior centers.ResultsParticipants were primarily women (80.6%) and Caucasian (68%) with an average age of 71.89+/−7.60 years. A 27-item index including the aMed food groups, dietary habits, PA, culinary activities, purchasing of local and seasonal foods, and adequate rest resulted in a reliable score (α = 0.75). Individual index factors correlated with the overall Mediterranean diet and lifestyle score.ConclusionsWhile this Mediterranean diet and lifestyle index resulted in good internal consistency; assessment of conviviality, especially for older adults in the time of Covid-19, need be re-evaluated as a lifestyle measure that can impact dietary intake and overall health.Funding SourcesEastern Michigan University Faculty Research Fellowship Award.

Abstract MP05: Night-to-night Variability In Sleep Duration Is Associated With Higher Energy Intake And Poorer Diet Quality In The Multi-Ethnic Study Of Atherosclerosis

Introduction: Variability in sleep patterns is an emerging risk factor for metabolic and cardiovascular diseases (CVD). Poor diet likely contributes to these relations, given the intricate link between sleep and diet, both of which are important determinants of cardiometabolic health. However, associations of irregular sleep with energy intake and consumption of a Mediterranean diet pattern, key markers of diet quantity and quality predictive of CVD risk, have not been evaluated. Hypothesis: Greater night-to-night variability in sleep duration will be associated with higher energy intake and poorer diet quality, defined as lower alternate Mediterranean (aMed) diet scores (range: 0-9). Methods: This was a cross-sectional analysis of 2,007 men and women (age: 68.6±9.2 y, 61% racial/ethnic minority) from the Multi-Ethnic Study of Atherosclerosis Sleep Ancillary Study. The standard deviation (SD) of sleep duration, derived from 1-wk of wrist actigraphy, was used as a measure of sleep duration variability. Diet, including daily energy intake, aMed score, and consumption of aMed components, was ascertained from a food frequency questionnaire. Multivariable linear regression models adjusted for age, race/ethnicity, sex, study site, marital status, and education, evaluated associations of sleep duration variability with diet. Sensitivity analyses, also adjusted for sociodemographic factors, were conducted to evaluate relations of weekday sleep duration SD, a potentially more representative measure of habitual sleep, with diet. Results: Mean sleep duration variability was 84±48 min. Greater sleep duration variability was associated with higher energy intake and lower aMed score; each 30-min increase in sleep duration SD related to 23±11 more kcal/d (P=0.04) and 0.06±0.02 lower aMed score (P=0.02). Higher sleep duration SD (per 30 min increase) was also associated with lower intakes of whole grains (β=-0.01±0.01, P<0.05), nuts/seeds (β=-0.01±0.01, P=0.02), and monounsaturated to saturated fat ratio (β=-0.02±0.01, P=0.02). Results of sensitivity analyses showed that each 30-min increase in weekday sleep duration SD was associated with 28±11 kcal higher energy intake (P=0.01) and 0.06±0.02 lower aMed score (P=0.02) as well as 0.02±0.01 and 0.01±0.01 fewer servings (per 1000 kcal) of whole grains and seeds/nuts, respectively (P<0.01). Conclusions: We provide novel initial evidence that irregular sleep duration, particularly during weekdays, may contribute to overconsumption and poor diet quality. Further investigation into a possible mechanistic role of diet in the association of sleep variability with cardiometabolic disease risk is warranted. Longitudinal or experimental data are needed to elucidate a potential complex interplay between sleep duration variability, diet, and other health and lifestyle factors, including physical activity, obesity, and depression.

Diet Quality and Risk of Lung Cancer in the Multiethnic Cohort Study.

Diet quality, assessed by the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED) score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII®), was examined in relation to risk of lung cancer in the Multiethnic Cohort Study. The analysis included 179,318 African Americans, Native Hawaiians, Japanese Americans, Latinos, and Whites aged 45–75 years, with 5350 incident lung cancer cases during an average follow-up of 17.5 ± 5.4 years. In multivariable Cox models comprehensively adjusted for cigarette smoking, the hazard ratios (95% confidence intervals) for the highest vs. lowest quality group based on quintiles were as follows: 0.85 (0.77–0.93) for HEI-2015; 0.84 (0.77–0.92) for AHEI-2010; 0.83 (0.76–0.91) for aMED; 0.83 (0.73–0.91) for DASH; and 0.90 (0.82–0.99) for DII. In histological cell type-specific analyses, the inverse association was stronger for squamous cell carcinoma than for adeno-, small cell, and large cell carcinomas for all indexes. There was no indication of differences in associations by sex, race/ethnicity, and smoking status. These findings support that high-quality diets are associated with lower risk of lung cancer, especially squamous cell carcinomas, in a multiethnic population.

Classifying Individuals Into a Dietary Pattern Based on Metabolomic Data.

The objectives are to develop a metabolomic-based model capable of classifying individuals into dietary patterns and to investigate the reproducibility of the model. K-means cluster analysis is employed to derive dietary patterns using metabolomic data. Differences across the dietary patterns are examined using nutrient biomarkers. The model is used to assign individuals to a dietary pattern in an independent cohort, A-DIET Confirm (n = 175) at four time points. The stability of participants to a dietary pattern is assessed. Four dietary patterns are derived: moderately unhealthy, convenience, moderately healthy, and prudent. The moderately unhealthy and convenience patterns has lower adherence to the alternative healthy eating index (AHEI) and the alternative mediterranean diet score (AMDS) compared to the moderately healthy and prudent patterns (AHEI = 24.5 and 22.9 vs 26.7 and 28.4, p <0.001). The dietary patterns are replicated in A-DIET Confirm, with good reproducibility across four time points. The stability of participants' dietary pattern membership ranged from 25.0% to 61.5%. The multivariate model classifies individuals into dietary patterns based on metabolomic data. In an independent cohort, the model classifies individuals into dietary patterns at multiple time points furthering the potential of such an approach for nutrition research.

Diet Quality Indexes, Arterial Stiffness and Endothelial Function in Healthy Young Adults

Cardiovascular disease (CVD) is the number one cause of death globally. High quality dietary patterns such as the DASH diet and the Mediterranean diet are shown to be effective at improving endothelial function and other vascular risk factors in older adults and those with comorbid conditions. To our knowledge, no study has examined the relation between overall diet quality and vascular function in healthy young adults, which could have implications for preventing CVD onset. We aimed to test the hypothesis that lower diet quality, assessed by diet index scores, would be associated with greater arterial stiffness and poorer endothelial function in healthy, non-hypertensive young adults. Seventeen men and 28 women ages 27.0±0.9 y with normal blood pressure (systolic BP: 112±2 mmHg; diastolic BP: 70±1 mmHg), non-obese body mass index (BMI) (23.4±0.4 kg/m2) and no diagnosed chronic disease completed this cross-sectional study. Two DASH diet scores, the alternative Mediterranean diet score (aMED), and the Healthy Eating Index-2015 (HEI-2015) were calculated from 3-day diet records analyzed with NDSR software. Augmentation index (AIx) and carotid-femoral pulse wave velocity (PWV) were measured using the SphygmoCor XCEL system. Brachial artery flow mediated dilation (FMD) was assessed using ultrasound. Separate multiple linear regression analyses with appropriate physiological variables included in the models (for AIx: height, heart rate, age, and sex; for PWV: mean arterial pressure, BMI, age, and sex; for FMD: age and sex) were used to assess the relation between the dietary indexes and vascular outcomes. Average Mellen DASH score was 2.6±0.2 (out of 9), Fung DASH score was 24.1±0.8 (out of 40), aMED score was 3.9±0.3 (out of 9), and HEI-2015 was 60.8±1.9 (out of 100). Average AIx was 6.4±1.7%, average PWV was 5.5±0.1 m/s, and average FMD was 7.9±2.7%. The Mellen DASH score, the aMED score, and the HEI-2015 were inversely associated with AIx, though the associations did not reach statistical significance (B=-1.416, 95% CI: -3.415, 0.583, p=0.16; B=-1.223, 95% CI: -2.833, 0.388, p=0.133; and B=-0.159, 95% CI: -0.386, 0.069, p=0.167, respectively). No other associations between diet index scores and AIx, PWV, or FMD approached statistical significance. Our results suggest that overall diet quality, as assessed using dietary indexes, is not associated with arterial stiffness or endothelial function in healthy young adults. Notably, however, there was room for improvement in our participants’ diet index scores. Intervention studies are warranted to determine how improving diet quality may affect these vascular outcomes in this population.

Adherence to the Mediterranean Diet and Determinants Among Pregnant Women: The NELA Cohort.

The Mediterranean diet represents one of the most studied dietary patterns; however, there is no single tool for measuring the grade of adherence and no single set of criteria for adapting these indices to pregnant women. We characterized the adherence to the Mediterranean diet (MDA) of pregnant women participating in the NELA (Nutrition in Early Life and Asthma) cohort and identified the sociodemographic determinants and lifestyle habits associated with a higher risk of a low MDA. Maternal diet during gestation was assessed by a validated Food Frequency Questionnaire (FFQ) (n = 665). We estimated the Relative Mediterranean Diet score (rMED), Alternative Mediterranean Diet score (aMED), and the Alternate Healthy Eating Index-2010 (AHEI-2010). Multivariate regression models were performed to identify the sociodemographic and lifestyle factors associated with each index. Mothers with a lower age and more previous deliveries had a greater probability of low MDA (p < 0.05). For the aMED index only, mothers with university education and/or who practiced sport activities for two or more hours per week had a lower probability of a low MDA (p < 0.01). The three indices classified the NELA cohort as having a medium level of adherence. These results may be improved by designing intervention strategies and dietary recommendations for both maternal and offspring health.

Established diet quality indices are not universally associated with body composition in young adult women.

To determine which established diet quality indices best predict weight-related outcomes in young women. In this cross-sectional analysis, we collected dietary information using the Harvard FFQ and measured body fat percentage (BF%) by dual-energy X-ray absorptiometry. We used FFQ data to derive five diet quality indices: Recommended Food Score (RFS), Healthy Eating Index 2015 (HEI-2015), Alternate Healthy Eating Index 2010 (AHEI-2010), alternate Mediterranean Diet Score (aMED) and Healthy Plant-Based Diet Index (HPDI). University of Massachusetts at Amherst. Two hundred sixty healthy women aged 18-30 years. The AHEI-2010 and HPDI were associated with BMI and BF%, such that a ten-point increase in either diet score was associated with a 1·2 percentage-point lower BF% and a 0·5 kg/m2 lower BMI (P < 0·05). Odds of excess body fat (i.e. BF% > 32 %) were 50 % lower for those in the highest v. lowest tertile of the AHEI-2010 (P = 0·04). Neither the RFS nor HEI-2015 was associated with BMI or BF%; the aMED was associated with BMI but not BF%. These results suggest that diet quality tends to be inversely associated with BMI and BF% in young women, but that this association is not observed for all diet quality indices. Diet indices may have limited utility in populations where the specific healthful foods and food groups emphasised by the index are not widely consumed. Future research should aim to replicate these findings in longitudinal studies that compare body composition changes over time across diet indices in young women.

818 Diet quality predicts hypertensive disorders of pregnancy in hawaii cohort

Data are mixed on whether diet quality in early gestation is associated with adverse pregnancy outcomes. This study aims to see if there is a correlation with diet quality and the development of hypertensive disorders of pregnancy (HDP) in Hawaii. In a longitudinal cohort study, diet quality was measured via a Food Frequency Questionnaire during each trimester in 56 healthy women. Three diet quality indices were assigned – The Healthy Eating Index (HEI), The Alternate Mediterranean Diet score (aMED), and the Dietary approaches to Stop Hypertension (DASH) score. Mean aggregate scores were compared among those who did and did not develop hypertensive disorders of pregnancy. Logistic Regression models were used or confounding demographic covariates (age, parity, BMI, ethnicity). Generalized Estimating equations were also used to see if a longitudinal change in diet quality was associated with HDP. There was a high incidence of HDP in this cohort, with 12 participants (21%) developing the condition. There was no change of diet quality scores over time from 1st to 3rd trimester. Aggregate mean diet quality scores were higher in the unaffected group versus those who developed HDP. Logistic regression models showed that all three scores were significantly associated with development of HDP, with the DASH diet score having the greatest effect, and the best fit modeling. Age and nulliparity were also independently associated with this disorder. Every point higher of DASH diet score portended a 3% less chance of developing HDP. The components of the DASH Score that contributed the most difference between the two groups were consumption of whole grains, dairy, and legumes or nuts. Diet quality can help predict risk of HDP and may be a modifiable risk factor to target. The DASH diet score may be most predictive of this condition. Further studies in a larger cohort may further identify the mechanism by which nutritional components contribute to this risk.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Mediterranean Diet and Healthy Eating in Subjects with Prediabetes from the Mollerussa Prospective Observational Cohort Study

We aimed to assess differences in dietary patterns (i.e., Mediterranean diet and healthy eating indexes) between participants with prediabetes and those with normal glucose tolerance. Secondarily, we analyzed factors related to prediabetes and dietary patterns. This was a cross-sectional study design. From a sample of 594 participants recruited in the Mollerussa study cohort, a total of 535 participants (216 with prediabetes and 319 with normal glucose tolerance) were included. The alternate Mediterranean Diet score (aMED) and the alternate Healthy Eating Index (aHEI) were calculated. Bivariable and multivariable analyses were performed. There was no difference in the mean aMED and aHEI scores between groups (3.2 (1.8) in the normoglycemic group and 3.4 (1.8) in the prediabetes group, p = 0.164 for the aMED and 38.6 (7.3) in the normoglycemic group and 38.7 (6.7) in the prediabetes group, p = 0.877 for the aHEI, respectively). Nevertheless, women had a higher mean of aMED and aHEI scores in the prediabetes group (3.7 (1.9), p = 0.001 and 40.5 (6.9), p < 0.001, respectively); moreover, they had a higher mean of aHEI in the group with normoglycemia (39.8 (6.6); p = 0.001). No differences were observed in daily food intake between both study groups; consistent with this finding, we did not find major differences in nutrient intake between groups. In the multivariable analyses, the aMED and aHEI were not associated with prediabetes (odds ratio (OR): 1.19, 95% confidence interval (CI): 0.75–1.87; p = 0.460 and OR: 1.32, 95% CI: 0.83–2.10; p = 0.246, respectively); however, age (OR: 1.04, 95% CI: 1.02–1.05; p < 0.001), dyslipidemia (OR: 2.02, 95% CI: 1.27–3.22; p = 0.003) and body mass index (BMI) (OR: 1.09, 95% CI: 1.05–1.14; p < 0.001) were positively associated with prediabetes. Physical activity was associated with a lower frequency of prediabetes (OR: 0.48, 95% CI: 0.31–0.72; p = 0.001). In conclusion, subjects with prediabetes did not show a different dietary pattern compared with a normal glucose tolerance group. However, further research is needed on this issue.

An An Exploratory Study Examining Mediterranean Diet Perceptions, Eating Practices, and Food Choice of Emerging Adults from Cyprus and the United States

Background. The Mediterranean Diet (MD) is a food pattern that offers numerous potential health benefits. Mediterranean countries, including Cyprus, are experiencing a decline in adherence to the traditional MD while other non-Mediterranean countries, such as the United States (U.S.), are providing recommendations to increase adherence to the MD.&#x0D; Objective. The aim of this research was to explore the foods, eating practices, and perception of the MD in emerging adults (18-25 years of age) from a Mediterranean (Cyprus) and non-Mediterranean (U.S.) country to better understand emerging adult adherence and behaviors related to a MD pattern.&#x0D; Design. An exploratory descriptive study was designed to include focus group interviews to understand perceptions and eating practices as well as dietary assessment using the Mediterranean Diet Score Survey and Harvard Food Frequency Questionnaire for calculation of the alternate Mediterranean Diet Score to determine MD adherence among emerging adults in Mediterranean and non-Mediterranean regions.&#x0D; Participants/Setting. Twenty-four emerging adults from Cyprus and the U.S. participated. &#x0D; Analysis. Descriptive approaches for analysis of qualitative and quantitative data were used. A qualitative content analysis was used for focus group interview data that included both inductive and deductive processes. Descriptive statistics were used to describe participant demographic and dietary characteristics. &#x0D; Results. Themes that emerged from the focus group interviews included perceptions of MD foods, health benefits of a MD, lifestyle cooking and eating practices, and influences on food choice in Cyprus and the U.S. While perception of MD foods and eating practices differed, MD adherence scores and participant identification of health benefits did not differ. Likewise, there were similar influences on food choice among emerging adults from both populations.&#x0D; Conclusion. These findings suggest that emerging adults may acknowledge health benefits of a MD but can benefit from emphasis on food preparation and other behaviors to promote MD food pattern adherence in both Mediterranean and non-Mediterranean countries.

Organic food consumption is associated with inflammatory biomarkers among older adults.

The association between organic food consumption and biomarkers of inflammation, C-reactive protein (CRP) and cystatin C (CysC) was explored in this cross-sectional analysis of older adults. Dietary data and organic food consumption was collected in 2013 from a FFQ. Alternative Mediterranean diet score (A-MedDiet) was calculated as a measure of healthy eating. Biomarkers CRP and CysC were collected in serum or plasma in 2016. We used linear regression models to assess the associations between organic food consumption and CRP and CysC. This cross-sectional analysis uses data from the nationally representative, longitudinal panel study of Americans over 50, the Health and Retirement Study. The mean age of the analytic sample (n 3815) was 64·3 (se 0·3) years with 54·4 % being female. Log CRP and log CysC were inversely associated with consuming organic food after adjusting for potential confounders (CRP: β = -0·096, 95 % CI 0·159, -0·033; CysC: β = -0·033, 95 % CI -0·051, -0·015). Log CRP maintained statistical significance (β = -0·080; 95 % CI -0·144, -0·016) after additional adjustments for the A-MedDiet, while log CysC lost statistical significance (β = -0·019; 95 % CI -0·039, 0·000). The association between organic food consumption and log CRP was driven primarily by milk, fruit, vegetables and cereals, while log CysC was primarily driven by milk, eggs and meat after adjustments for A-MedDiet. These findings support the hypothesis that organic food consumption is inversely associated with biomarkers of inflammation CRP and CysC, although residual confounding by healthy eating and socioeconomic status cannot be ruled out.

Association of Diet Quality With Survival Among People With Metastatic Colorectal Cancer in the Cancer and Leukemia B and Southwest Oncology Group 80405 Trial

Diet has been associated with survival in patients with stage I to III colorectal cancer, but data on patients with metastatic colorectal cancer are limited. To examine the association between diet quality and overall survival among individuals with metastatic colorectal cancer. This was a prospective cohort study of patients with metastatic colorectal cancer who were enrolled in the Cancer and Leukemia Group B (Alliance) and Southwest Oncology Group 80405 trial between October 27, 2005, and February 29, 2012, and followed up through January 2018. Participants completed a validated food frequency questionnaire within 4 weeks after initiation of first-line treatment for metastatic colorectal cancer. Diets were categorized according to the Alternative Healthy Eating Index (AHEI), Alternate Mediterranean Diet (AMED) score, Dietary Approaches to Stop Hypertension (DASH) score, and Western and prudent dietary patterns derived using principal component analysis. Participants were categorized into sex-specific quintiles. Multivariable hazard ratios (HRs) and 95% CIs for overall survival. In this cohort study of 1284 individuals with metastatic colorectal cancer, the median age was 59 (interquartile range [IQR]: 51-68) years, median body mass index was 27.2 (IQR, 24.1-31.4), 521 (41%) were female, and 1102 (86%) were White. There were 1100 deaths during a median follow-up of 73 months (IQR, 64-87 months). We observed an inverse association between the AMED score and risk of death (HR quintile 5 vs quintile 1, 0.83; 95% CI, 0.67-1.04; P = .04 for trend), but the point estimates were not statistically significant. None of the other diet scores or patterns were associated with overall survival. In this prospective analysis of patients with metastatic colorectal cancer, diet quality assessed at initiation of first-line treatment for metastatic disease was not associated with overall survival.

Adherence to the Mediterranean Diet and Overall Cancer Incidence: The Netherlands Cohort Study

BackgroundMediterranean diet adherence has been associated with reduced risks of various cancer types. However, prospective findings for overall cancer risk are inconclusive. ObjectiveThe aim of this study was to examine sex-specific relations of Mediterranean diet adherence with overall cancer risk. DesignThis analysis was conducted as part of the prospective Netherlands Cohort Study. Baseline data on diet and other cancer risk factors were collected using a self-administered questionnaire. Participants were followed up for cancer incidence for 20.3 years through record linkages with the Netherlands Cancer Registry and the Dutch Pathology Registry. The alternate Mediterranean diet score without alcohol was the principal measure of Mediterranean diet adherence. Participants/settingThe study population consisted of 120,852 inhabitants of the Netherlands, who were aged 55 to 69 years in September 1986. Main outcome measureThe primary outcome was overall cancer incidence. Statistical analyses performedCox regression analyses (case-cohort design) were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of Mediterranean diet adherence with incidence of cancer (subgroups). In total, 12,184 male and 7,071 female subjects with cancer had complete data on potential confounders and were eligible for inclusion in the Cox models. ResultsMiddle compared with low Mediterranean diet adherence (alternate Mediterranean diet score without alcohol) was significantly associated with a reduced overall cancer risk in women (HR [95% CI]: 0.85 [0.75-0.97]). Decreased HR estimates for the highest Mediterranean diet adherence category and per 2-point increase in score were also observed, but did not reach statistical significance in multivariable-adjusted analyses. In men, there was no evidence of an association for overall cancer risk (HRper 2-point increment [95% CI]: 1.02 [0.95-1.10]). Results for cancer subgroups, defined by relations with tobacco smoking, obesity, and alcohol consumption, were largely similar to the overall findings. Model fits diminished when alcohol was included in the Mediterranean diet score. ConclusionsMediterranean diet adherence was not associated with overall cancer risk in male participants of the prospective Netherlands Cohort Study. HR estimates in women pointed in the inverse direction, but lost statistical significance after full adjustment for confounding in most cases.

A Mediterranean Dietary Pattern Predicts Better Sleep Quality in US Women from the American Heart Association Go Red for Women Strategically Focused Research Network.

Consumption of a Mediterranean diet has been linked to better sleep health in older, European populations. However, whether this dietary pattern is predictive of sleep quality in US women, a group prone to poor sleep, is unknown. This prospective cohort study of 432 US women (20–76 y; 60% racial/ethnic minority) evaluated whether compliance with a Mediterranean diet at baseline predicted sleep quality at 1-y follow-up. Alternate Mediterranean (aMed) diet scores and habitual sleep quality were computed from the validated Block Brief Food Frequency Questionnaire and Pittsburgh Sleep Quality Index (PSQI), respectively. Linear regression models evaluated prospective associations of the aMed diet pattern and its components with measures of sleep quality, after adjustment for age, BMI, race/ethnicity, education, and health insurance status. Higher baseline aMed scores were associated with lower PSQI scores (β = −0.30 ± 0.10, p < 0.01), indicative of better sleep quality, higher sleep efficiency (β = 1.20 ± 0.35, p < 0.001), and fewer sleep disturbances (β = −0.30 ± 0.12, p = 0.01) at 1-y. Fruit and vegetable consumption also predicted lower PSQI scores, higher sleep efficiency and fewer sleep disturbances (all p < 0.05). Higher legume intake predicted better sleep efficiency (β = 1.36 ± 0.55, p = 0.01). These findings suggest that adherence to a Mediterranean diet pattern should be evaluated as a strategy to promote sleep quality in US women.

Diet Quality and Long-Term Absolute Risks for Incident Cardiovascular Disease and Mortality

BackgroundLong-term absolute risks for cardiovascular disease and mortality and cardiovascular disease-free survival according to diet quality at different adult ages are unclear. MethodsData from 6 prospective cohorts collected in 1985-2016 were analyzed (n = 29,497). Baseline diet quality was assessed by alternate Healthy Eating Index 2010 (aHEI-2010), alternate Mediterranean (aMED) diet score, and Dietary Approaches to Stop Hypertension (DASH) score. Absolute risks were estimated using modified Kaplan-Meier analysis and cardiovascular disease-free survival using Irwin's restricted mean. Analyses were stratified by sex and baseline age: young (20-39 years), middle-aged (40-59), and older (60-79). ResultsComparing participants in the lowest quintile with those in the highest quintile of aHEI-2010 score, the 40-year risks for incident cardiovascular disease were 14.3% (95% confidence interval [CI]: 10.0-18.6) compared to 5.9% (3.0-8.9) in young men, 8.8% (4.3-13.3) compared to 3.0% (1.6-4.4) in young women, 39.6% (36.1-43.2) compared to 30.8% (26.2-35.3) in middle-aged men, and 32.9% (28.0-37.8) compared to 19.5% (16.6-22.4) in middle-aged women. For older adults, the 30-year risks for incident cardiovascular disease were 54.7% (49.3-60.2) compared to 49.7% (44.5-55.0) in men and 48.3% (44.0-52.5) compared to 42.4% (38.2-46.7) in women. Similar inverse associations were identified for all-cause mortality. Compared with participants in the lowest quintile of aHEI-2010 score, those in the highest quintile had ~0.5-2.2 years of longer cardiovascular disease-free survival. Results based on DASH score, but not aMED score, were similar to results based on aHEI-2010 score. ConclusionsConsuming a higher quality diet was associated with lower long-term absolute risks for cardiovascular disease and mortality and longer cardiovascular disease-free survival, regardless of sex or age at dietary assessment.

Role of dietary patterns and acculturation in cancer risk and mortality among postmenopausal Hispanic women: results from the Women's Health Initiative (WHI).

To investigate the association between dietary patterns and total and obesity-related cancers risk. Additionally, to examine if acculturation modifies this relationship. Dietary intake of postmenopausal Hispanic women (N=5,482) enrolled in the Women's Health Initiative was estimated from a Food Frequency Questionnaire and used to calculate dietary pattern scores; Healthy Eating Index-2015 (HEI-2015), Mexican Diet (MexD) score, alternate Mediterranean Diet Score (aMED), and the energy adjusted-Dietary Inflammatory Index (E-DII™). Associations were evaluated using Cox proportional hazards regression models. 631 cancers and 396 obesity-related cancers were diagnosed over a mean-follow up of 12 years. Across dietary scores, there were no significant associations with cancer risk or mortality. Trend analysis suggest a potentially lower risk for total cancer related to the highest MexD score (HR 0.68, 95% CI 0.45-1.04, P-trend=0.03), and lower risk for obesity-related cancer mortality related to the highest score category for MexD (HR 0.65, 95% CI 0.37-1.16, P-trend=0.02), and aMED (HR 0.87, 95% CI 0.45-1.67, P-trend=0.04). Further analysis suggests less acculturated women with higher MexD scores had 56% lower risk for any cancer (HR 0.44, 95% CI 0.22-0.88, P-trend=0.03) and 83% lower risk for cancer mortality (HR 0.17, 95% CI 0.04-0.76, P-trend=0.01) compared to more acculturated Hispanic women. Dietary patterns were not associated with cancer risk and mortality in postmenopausal Hispanic women. Less-acculturated, Spanish-preferred speakers, who reported consuming a more traditional Mexican diet may experience a lower risk for cancer and cancer mortality.