Alternate Mediterranean Diet Score Research Articles

Dietary patterns and risk of incident chronic kidney disease: the Atherosclerosis Risk in Communities study

Adherence to healthy dietary patterns, measured by the Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), and alternate Mediterranean diet (aMed) scores, is associated with a reduced risk of cardiovascular disease. The association between these scores and chronic kidney disease (CKD) is undetermined. We aimed to estimate the association between the HEI, AHEI, and aMed scores and risk of incident CKD. We conducted a prospective analysis in 12,155 participants aged 45-64 y from the Atherosclerosis Risk in Communities (ARIC) Study. We calculated HEI-2015, AHEI-2010, and aMed scores for each participant and categorized them into quintiles of each dietary score. Incident CKD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 accompanied by ≥25% decline in estimated glomerular filtration rate, a kidney disease-related hospitalization or death, or end-stage renal disease. We used cause-specific hazard models to estimate risk of CKD from the quintile of the dietary score through to 31 December 2017. There were 3980 cases of incident CKD over a median follow-up of 24 y. Participants who had higher adherence to the HEI-2015, AHEI-2010, and aMed scores were more likely to be female, have higher educational attainment, higher income level, be nonsmokers, more physically active, and diabetic compared with participants who scored lower. All 3 dietary scores were associated with lower CKD risk (P-trend< 0.001). Participants who were in the highest quintile of HEI-2015 score had a 17% lower risk of CKD (HR: 0.83; 95% CI: 0.74, 0.92) compared with participants in the lowest quintile. Those in quintile 5 of AHEI-2010 and aMed scores, respectively, had a 20% and 13% lower risk of CKD compared with those in quintile 1. Higher adherence to healthy dietary patterns during middle age was associated with lower risk of CKD.

Adherence to the Mediterranean Diet and Risks of Prostate and Bladder Cancer in the Netherlands Cohort Study.

Prostate cancer and urinary bladder cancer are frequently occurring cancers with few risk factors identified. We examined the relation of Mediterranean diet (MD) adherence with risks of prostate and bladder cancer in the Netherlands Cohort Study (NLCS). Data were available for 58,279 men and 62,573 women, who completed a baseline questionnaire on diet and other cancer risk factors. Multiple MD scores, including the alternate Mediterranean diet score without alcohol (aMEDr), were calculated to assess MD adherence. After 20.3 years of follow-up, 3,868 prostate cancer cases (advanced: 1,256) and 1,884 bladder cancer cases could be included in multivariable Cox proportional hazards analyses. aMEDr was not associated with advanced prostate cancer risk [hazard ratio (HR)per 2-point increment (95% confidence interval, 95% CI) = 1.06 (0.96-1.17)]. In contrast, higher aMEDr values were associated with a significantly increased risk of nonadvanced prostate cancer (P trend = 0.04). For bladder cancer risk, no association was observed with aMEDr [HRper 2-point increment (95% CI) = 1.00 (0.92-1.09)]. Absolute scores based on the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) dietary recommendations were not associated with prostate or bladder cancer risk. MD adherence, measured by aMEDr or other MD scores, was not associated with decreased risks of advanced prostate cancer and bladder cancer in the NLCS. Higher levels of care-seeking behavior, screening attendance, and prostate cancer awareness in higher educated men with healthier lifestyles could potentially explain the positive associations observed for nonadvanced prostate cancer risk. MD adherence does not seem to reduce the risk of (advanced) prostate cancer or bladder cancer.

A Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults

The evidence associating diet and risk of multiple sclerosis (MS) is inconclusive. The aim of this study was to investigate associations between a Mediterranean diet and risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to MS. We used data from the 2003-2006 Ausimmune Study, an Australian multicenter, case-control study examining environmental risk factors for FCD, with participants matched on age, sex, and study region (282 cases, 558 controls; 18-59 y old; 78% female). The alternate Mediterranean diet score (aMED) was calculated based on data from a food-frequency questionnaire. We created a modified version of the aMED (aMED-Red) where ∼1 daily serving (65 g) of unprocessed red meat received 1 point. All other components remained the same as aMED. Conditional logistic regression (254 cases, 451 controls) was used to test associations between aMED and aMED-Red scores and categories and risk of FCD, adjusting for history of infectious mononucleosis, serum 25-hydroxyvitamin D concentrations, smoking, education, total energy intake, and dietary underreporting. There was no statistically significant association between aMED and risk of FCD [per 1-SD increase in aMED score: adjusted odds ratio (aOR): 0.89; 95% CI: 0.75, 1.06; P=0.181]. There was evidence of a nonlinear relation between aMED-Red and risk of FCD when a quadratic term was used (P=0.016). Compared with the lowest category of aMED-Red, higher categories were significantly associated with reduced risk of FCD, corresponding to a 37% (aOR: 0.63; 95% CI: 0.41, 0.98; P=0.039), 52% (aOR: 0.48; 95% CI: 0.28, 0.83; P=0.009), and 42% (aOR: 0.58; 95% CI: 0.35, 0.96; P=0.034) reduced risk of FCD in categories 2, 3, and 4, respectively. A Mediterranean diet, including unprocessed red meat, was associated with reduced risk of FCD in this Australian adult population. The addition of unprocessed red meat to a Mediterranean diet may be beneficial for those at high risk of MS.

Dietary patterns and nutrient intake of individuals with rheumatoid arthritis and osteoarthritis in the United States.

The aim of this study was to investigate the differences in adherence to the Mediterranean diet, assessed by the alternative Mediterranean Diet (aMED) score, and diet quality, assessed by Healthy Eating Index 2015 to 2020 (HEI-2015), between presence and type of arthritis (rheumatoid arthritis and osteoarthritis). Additionally, the study investigated the association between aMED scores and HEI-2015 scores and the presence of arthritis. Cross-sectional data from four cycles (2007-2014) of the National Health and Nutrition Examination Survey were used and weighted to produce a nationally representative sample. Arthritis information was extracted from the Medical Conditions file and recoded into relevant variables. Food group and nutrient data from the 24-h recall was transformed to provide aMED and HEI-2015 scores. Individuals with arthritis had significantly worse adherence to the Mediterranean diet and diet quality. aMED scores were 3.43 ± 0.04 for individuals with arthritis and 3.54 ± 0.03 for individuals without arthritis (P = 0.014). HEI-2015 scores were also lower in individuals with arthritis (51.41 ± 0.37) than in those without (53.50 ± 0.28; P < 0.001). There were no significant differences in aMED or HEI-2015 scores between individuals with rheumatoid arthritis and those with osteoarthritis. There were also no associations between aMED scores or HEI-2015 scores and the presence of arthritis. Individuals diagnosed with arthritis can take steps to improve their diet quality as a possible route to reduce arthritis symptoms and maintain a healthy body weight. Further research on dietary patterns and their potential to treat and manage arthritis is warranted.

Metabolomic markers of healthy dietary patterns in US postmenopausal women

Healthy diet patterns are associated with lower risk of cancer and other chronic diseases. Metabolomics has the potential to expand dietary biomarker development to include dietary patterns, which may provide a complement or alternative to self-reported diet. This study examined the correlation of serum untargeted metabolomic markers with 4 diet pattern scores-the alternate Mediterranean diet score (aMED), alternate Healthy Eating Index (AHEI)-2010, the Dietary Approaches to Stop Hypertension (DASH) diet, and the Healthy Eating Index (HEI)-2015-and used multivariate methods to identify discriminatory metabolites for each pattern. Among 1367 US postmenopausal women with serum metabolomic data in the Cancer Prevention Study-II Nutrition Cohort, we conducted partial correlation analysis, adjusted for demographic and lifestyle variables, to examine cross-sectional correlations between serum metabolomic markers and healthy diet pattern scores. In a randomly selected "training" set (50%), we conducted orthogonal partial least-squares discriminant analysis to identify metabolites that discriminated the top from bottom diet score quintiles. Combinations of metabolites with a variable importance in projection (VIP) score ≥2.5 were tested for predictability in the "testing" set based on the use of receiver operating characteristic curves. Out of 1186 metabolites, 32 unique metabolites were considered discriminatory based on a VIP score ≥2.5 in the training dataset with some overlap across scores (aMED=16; AHEI=17; DASH=13; HEI=12). Spearman partial correlation analyses, applying a cut-point (|r|≥0.15) and Bonferroni correction (P<1.05×10-5), identified similar key metabolites. The top 5 metabolites for each pattern mostly distinguished high compared with low scores; 4 of the 5 (fish-derived) metabolites were the same for aMED and AHEI, 2 of which were identified for HEI; 4 DASH metabolites were unique. Metabolomic methods that used a split-sample approach identified potential biomarkers for 4 healthy diet patterns. Similar metabolites across scores reflect fish consumption in healthy dietary patterns. These findings should be replicated in independent populations.

Abstract P221: Diet Quality and Incidence of Coronary Heart Disease and Coronary Revascularization Among US Women and Men With Hypertension

Background: Hypertension affects 45% of American adults and is a major risk factor for cardiovascular disease. Regrettably, about less than half of all affected individuals have their hypertension controlled. Healthy dietary patterns have been associated with a lower risk of cardiovascular disease in the general population. However, less is known about this association among individuals with hypertension. Aim: To study four diet quality scores, the alternate Mediterranean Diet (aMED) score; the alternate Healthy Eating Index 2010 (aHEI-2010); the Dietary Approaches to Stop Hypertension (DASH) score; and a Healthful Plant-based Diet Index (hPDI) and the incidence of coronary heart disease (CHD) and coronary revascularization (bypass, angioplasty or stent) among US women and men with hypertension. Methods: We included 22,270 women from the Nurses’ Health Study and 9,846 men from the Health Professionals Follow-up Study that had reported a professionally-diagnosed incident hypertension in 1988 or on subsequent biennial questionnaires. At inclusion, participants were free of other chronic diseases (CHD, coronary artery bypass/angioplasty/stent, angina, other heart disease, stroke, diabetes and cancer). Dietary data were collected every 4 years using a validated semi-quantitative food frequency questionnaire and covariate data were collected biennially. Using the cumulative average of dietary intake after hypertension diagnosis, we calculated hazard ratios (HR, 95% CI) comparing quintiles 5 to 1 of each diet quality score with multivariable Cox proportional hazards regression while adjusting for age, energy intake, alcohol (DASH and hPDI only), margarine (hPDI only), smoking, BMI, physical activity, family history of CHD, lipid-lowering medication, NSAIDs, postmenopausal hormone use (women) and hypertension medication. Results: We documented 922 incident CHD cases (299,520 person-years) and 1845 incident coronary revascularization cases (298,463 person-years) during follow-up. In pooled multivariable analyses, high adherence to all diet quality scores was inversely associated with risk of CHD (aMED: 0.73, 95% CI 0.59-0.91, p trend: &lt;0.01; aHEI-2010: 0.66, 95% CI 0.53-0.82, p trend: &lt;0.0001; DASH: 0.65, 95% CI 0.52-0.83, p trend: &lt;0.0001; hPDI: 0.78, 95% CI 0.61-0.99, p trend: 0.01) and coronary revascularization (aMED: 0.83, 95% CI 0.71-0.96, p trend: 0.02; aHEI-2010: 0.80, 95% CI 0.69-0.94, p trend: &lt;0.001; DASH: 0.88, 95% CI 0.75-1.03, p trend: 0.10; hPDI: 0.81, 95% CI 0.69-0.96, p trend: 0.07). Conclusions: This study suggests that individuals with hypertension may experience a lower risk of CHD and coronary revascularization with high adherence to healthy dietary patterns. Promoting healthy dietary habits among individuals with hypertension could be a cost-efficient and safe way to prevent the incidence of CHD and coronary revascularization.

Nutrition Risk is Associated with Leukocyte Telomere Length in Middle-Aged Men and Women with at Least One Risk Factor for Cardiovascular Disease.

Poor diet quality has been associated with several age-related chronic conditions, but its relationship to telomere length, a biological marker of cellular aging, is unclear. The purpose of this cross-sectional study was to determine whether overall diet quality was associated with relative leukocyte telomere length (rLTL) in a sample (n = 96) of nonsmoking middle-aged adults in Appalachia with at least one risk factor for cardiovascular disease. Diet quality was assessed using the Healthy Eating Index (HEI-2015), the alternate Mediterranean diet score (aMed), and the Dietary Screening Tool (DST). Peripheral rLTL was measured by quantitative real-time polymerase chain reaction. The associations between potentially confounding sociodemographic, lifestyle and health-related factors and the first and fourth rLTL quartile groups were examined using Chi-square or Fisher’s Exact tests or logistic regression. The relationships between diet quality index scores and rLTL as a continuous variable were analyzed using simple linear regression and multivariate linear models, analogous to linear covariance analyses. The rLTL ranged from 0.46 to 1.49 (mean ± SEM was 1.02 ± 0.18). Smoking history, income level, and cardiovascular health (Life’s Simple 7) were associated with the lowest and highest quartiles of rLTL and were used as covariates. In adjusted and unadjusted models, participants considered “at nutrition risk” by the DST were more likely to have shorter rLTL than those “not at risk or at potential risk” (p = 0.004). However, there was no evidence that adherence to the 2015–2020 Dietary Guidelines for Americans or to a Mediterranean diet was associated with rLTL in this sample. Intervention studies are needed to determine if improving the diet quality of those at nutrition risk results in reduced telomere attrition over time.

Mediterranean diet adherence and risk of esophageal and gastric cancer subtypes in the Netherlands Cohort Study

BackgroundMediterranean diet (MD) adherence has been associated with reduced risks of esophageal and gastric cancer (subtypes) in a limited number of studies. We prospectively investigated associations between MD adherence and risks of esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric non-cardia adenocarcinoma (GNCA) in a Dutch cohort.MethodsAnalyses were conducted using data from the 120852 participants of the Netherlands Cohort Study (NLCS), who were aged between 55 and 69 years at enrollment. Various MD scores, with and without alcohol, were calculated to estimate MD adherence. Using 20.3 years of follow-up, 133 ESCC, 200 EAC, 191 GCA, and 586 GNCA cases could be included in multivariable Cox regression analyses.ResultsOf the investigated scores, the alternate Mediterranean diet score without alcohol (aMEDr) performed best. aMEDr was inversely associated with risks of GCA and GNCA in men and women. However, statistical significance was only reached in men [ptrend: 0.019 (GCA), 0.016 (GNCA)]. Furthermore, higher aMEDr values were significantly associated with a reduced ESCC risk in men [HRper two−point increment (95% CI) = 0.57 (0.41–0.80), ptrend = 0.013], but not in women (pheterogeneity = 0.008). There was no evidence of an association between aMEDr and EAC risk. Educational level was a significant effect modifier for the association between aMEDr and GNCA risk (pheterogeneity = 0.0073).ConclusionsHigher MD adherence was associated with reduced risks of ESCC, GCA, and GNCA in the NLCS. However, the decreased ESCC risk might be limited to men.

Assessment of the knowledge and application of the Mediterranean diet among students of dietetics

&lt;b&gt;Purpose:&lt;/b&gt; To assess the knowledge of young adults (students of dietetics) of the health benefits of the Mediterranean diet (MedDiet) and the practical application of the principles of this diet. &lt;b&gt;Materials and methods:&lt;/b&gt; The study was performed on 97 women, students of dietetics. Research on general information about the respondents and knowledge about the MedDiet was carried out using a questionnaire with 29 questions. To assess the nutritional value of the diet, a 3-day nutritional diary and computer programme Diet 5.0 were used. Adherence to the MedDiet was appraised according to the 9-point scale of aMED (alternate Mediterranean Diet Score). &lt;b&gt;Results:&lt;/b&gt; The most students responded that they have high knowledge of the MedDiet, but do not use the MedDiet recommendations in their daily nutrition. Better adherence to MedDiet was significantly associated with the lower waist circumference of the women, higher intake of mono- and polyunsaturated fatty acids, omega3 fatty acids, fiber, vitamin C, folate, vitamin B1, vitamin E and magnesium, and the knowledge of participants of the diet and nutritional value of foods. &lt;b&gt;Conclusions:&lt;/b&gt; The adherence to the MedDiet is significantly associated with the participants' knowledge about the diet, the higher nutritional value of the daily diet and lower waist circumference

Diet quality and genetic association with body mass index: results from 3 observational studies

It is unknown whether dietary quality modifies genetic association with body mass index (BMI). This study examined whether dietary quality modifies genetic association with BMI. We calculated 3 diet quality scores including the Alternative Healthy Eating Index 2010 (AHEI-2010), the Alternative Mediterranean Diet score (AMED), and the Dietary Approach to Stop Hypertension (DASH) diet score. We examined the interactions of a genetic risk score (GRS) based on 97 BMI-associated variants with the 3 diet quality scores on BMI in 30,904 participants from 3 large cohorts. We found significant interactions between total GRS and all 3 diet scores on BMI assessed after 2-3 y, with an attenuated genetic effect observed in individuals with healthier diets (AHEI: P-interaction=0.003; AMED: P=0.001; DASH: P=0.004). For example, the difference in BMI (kg/m2) per 10-unit increment of the GRS was smaller among participants in the highest tertile of AHEI score compared with those in the lowest tertile (0.84; 95% CI: 0.72, 0.96 compared with 1.14; 95% CI: 0.99, 1.29). Results were consistent across the 3 cohorts with no significant heterogeneity. The interactions with diet scores on BMI appeared more significant for central nervous system GRSs (P<0.01 for 3 diet scores) than for non-central nervous system GRSs (P>0.05 for 3 diet scores). A higher diet quality attenuated genetic predisposition to obesity. These findings underscore the importance of maintaining a healthful diet for the prevention of obesity, particularly for those individuals with a strong genetic predisposition to obesity. This trial was registered with the Clinical Trial Registry as NCT03577639.

Dietary Patterns and Cognitive Function among Older Community-Dwelling Adults.

Diet may be an important modifiable risk factor for maintenance of cognitive health in later life. This study aimed at examining associations between common dietary indices and dietary patterns defined by factor analysis and cognitive function in older community-dwelling adults. Dietary information for 1499 participants from the Rancho Bernardo Study was collected in 1988–1992 and used to calculate the alternate Mediterranean diet score, Alternate Healthy Eating Index (AHEI)-2010 score and factor scores derived from factor analysis of nutrients. Global cognitive function, executive function, verbal fluency and episodic memory were assessed at approximate four-year intervals from 1988–2016. Linear mixed models were used to examine associations between dietary patterns and cognitive trajectories. Estimates for the highest vs. lowest tertile in models adjusting for age, sex, education, energy intake, lifestyle variables and retest effect showed greater adherence to the Mediterranean score was associated with better baseline global cognitive function (β (95% CI) = 0.33 (0.11, 0.55)). The AHEI-2010 score was not significantly associated with cognitive performance. Higher loading on a plant polyunsaturated fatty acid (PUFA)/vitamin E factor was associated with better baseline global cognitive function and executive function (β = 0.22 (0.02, 0.42) and β = −7.85 (−13.20, −2.47)). A sugar/low protein factor was associated with poorer baseline cognitive function across multiple domains. Dietary patterns were not associated with cognitive decline over time. Adherence to a healthy diet with foods high in PUFA and vitamin E and a low sugar to protein ratio, as typified by a Mediterranean diet, may be beneficial for cognitive health in late life.

Diet quality measured by four a priori-defined diet quality indices is associated with lipid-soluble micronutrients in the Multiethnic Cohort Study (MEC).

Background/ObjectivesThis study examined the long-term relation of lipid-soluble micronutrients with diet quality as assessed by four a priori-defined dietary patterns.Subjects/MethodsIn a prospective design, nutritional biomarkers (carotenoids, tocopherols, retinol, and coenzyme Q10) were measured using a validated HPLC based assay. General linear models were applied to obtain covariate-adjusted means of biomarkers for tertiles of 4 a priori diet quality indices: Healthy Eating Index (HEI) 2010, Alternative HEI (AHEI) 2010, Alternate Mediterranean Diet Score (aMED), and Dietary Approaches to Stop Hypertension (DASH). For a subcohort of 8 367 participants within the Multiethnic Cohort (MEC), diet was assessed by a validated quantitative food frequency questionnaire in 1993–96 and serum was collected in 2001–06.ResultsParticipants with the highest diet quality scores had significantly higher serum concentrations of all carotenoids, total tocopherols, and α-tocopherol, while γ-tocopherol was inversely associated with diet quality. Adjusted means for the lowest vs. highest tertile of HEI 2010 were 1.2 vs. 1.5 mg/L for total carotenoids, 11.4 vs. 12.3 mg/L for total tocopherols, and 1.9 vs. 1.6 mg/L for γ-tocopherol (ptrend<0.0001). The associations for the other dietary indices were similar; no indication for sex and ethnic differences was detected. Vegetable and fruit components were major predictors of most circulating micronutrients, but most other components were also associated.ConclusionsHigher diet quality scores measured by four a priori diet quality indices were significantly associated higher serum concentrations of carotenoids and α-tocopherol, while γ-tocopherol was inversely associated with diet quality.

Improved adherence to Mediterranean Diet in adults with type 1 diabetes mellitus

PurposeWe aimed to assess food intake and adherence to the Mediterranean Diet in patients with T1D compared with nondiabetic individuals.MethodsThis was an observational, multicenter study in 262 T1D subjects and 254 age- and sex-matched nondiabetic subjects. A validated food-frequency questionnaire was administered. The alternate Mediterranean Diet Score (aMED) and alternate Healthy Eating Index (aHEI) were assessed. The clinical variables were also collected. The analysis of data included comparisons between groups and multivariate models.ResultsCompared to the controls, the patients with T1D had a higher intake of dairy products (p < 0.001), processed meat (p = 0.001), fatty fish (p = 0.009), fruits and vegetables (p < 0.001), nuts (p = 0.011), legumes (p < 0.001), potatoes (p = 0.045), and bread (p = 0.045), and a lower intake of seafood (p = 0.011), sweets (p < 0.001), and alcohol drinks (p = 0.025). This intake pattern resulted in a higher consumption of complex carbohydrates (p = 0.049), fiber (p < 0.001), protein (p < 0.001), polyunsaturated fatty acids (PUFA) (p = 0.007), antioxidants (p < 0.001), vitamins (p < 0.001), and minerals (p < 0.001). The frequency of patients with T1D and low aMED score (23.2%) was lower than that of the controls (35.4%; p = 0.019). The overall multivariate analysis showed that, among other factors, being a T1D subject was associated with improved aMED and aHEI scores (p = 0.006 and p < 0.001). In patients with T1D, residing in a nonurban area was associated with improved aMED and aHEI scores (p = 0.001 and p < 0.001).ConclusionsAdult patients with T1D showed healthier dietary habits and a higher adherence to the Mediterranean Diet than nondiabetic subjects. Residing in a nonurban area is associated with an improved dietary pattern.

Comorbidity of Diabetes and Chronic Sleep Disturbances and Consumption of a Mediterranean-Style Diet

Objective: This study assessed whether comorbidity of diabetes and chronic sleep disturbances was associated with less healthy dietary consumption, defined as a Mediterranean-style Diet, compared to adults with only one or neither of the conditions. Research Design and Methods: Participants were selected from the Health and Retirement Study (HRS). Diabetes status and chronic sleep disturbances were assessed during the 2010 interview. Participants were categorized into one of four groups: no sleep disturbances or diabetes, sleep disturbances, diabetes, or sleep disturbances and diabetes. 7,423 participants completed a food frequency questionnaire by mail from which the alternative Mediterranean Diet (aMedDiet) score was assessed. Logistic regression was used to determine the odds of consuming an aMedDiet based on comorbidity of diabetes and chronic sleep disturbances. Models were stratified by gender. Results: After adjusting for age and caloric intake, men with diabetes were more likely to consume an aMedDiet in the highest quartile (OR 1.45; 95% CI 1.11-1.91) than men with neither chronic sleep disturbances nor diabetes. The magnitude of the association increased after adjustment for additional demographic and health variables (OR 1.70, 95% CI 1.25-2.29). Women with sleep disturbances were less likely to consume an aMedDiet than those without sleep disturbances. The reduction in the odds of consuming an aMedDiet was greatest among women with comorbidity of the two conditions (OR 0.53, 95% CI 0.37-0.77) yet was also significant among those with chronic sleep disturbances alone (OR sleep disturbances 0.71, 95% CI 0.56-0.90). The results in women were attenuated after multivariate adjustment. Conclusion: Chronic sleep disturbances reduce healthy dietary intake in adults with diabetes. Disclosure H. Guyer: None.

Adherence to Healthful Dietary Patterns Is Associated with Lower Risk of Hearing Loss in Women

Specific nutrients have been associated with hearing status, but associations between healthful dietary patterns and risk of hearing loss have not been prospectively evaluated. We sought to prospectively examine the relations between adherence to the Alternate Mediterranean diet (AMED), the Dietary Approaches to Stop Hypertension (DASH), and the Alternative Healthy Eating Index-2010 (AHEI-2010), and risk of hearing loss. We conducted a longitudinal cohort study (1991-2013) of 81,818 women in the Nurses' Health Study II, aged 27-44 y at baseline. We assessed diet every 4 y with the use of food frequency questionnaires and calculated AMED, DASH, and AHEI-2010 adherence scores. Baseline and updated information from validated biennial questionnaires was used in Cox proportional hazards regression models to examine independent associations between adherence scores and risk of self-reported moderate or worse hearing loss. During >1 million person-years of follow-up, 2306 cases of moderate or worse hearing loss were reported. Higher cumulative average AMED and DASH scores were significantly inversely associated with risk of hearing loss. For women with scores in the highest compared with the lowest quintile, the multivariable-adjusted relative risks (MVRRs) of hearing loss were 0.70 (95% CI: 0.60, 0.82) (P-trend <0.001) for AMED and 0.71 (95% CI: 0.61, 0.83) (P-trend <0.001) for DASH. Higher recent AHEI-2010 score was also associated with lower risk [MVRR=0.79 (95% CI: 0.69, 0.91); P-trend <0.001]. Among participants with additional hearing-related information (n=33,102), higher cumulative average adherence scores for all 3 dietary patterns were associated with lower risk; the MVRR was 0.63 (95% CI: 0.49, 0.81) for AMED, 0.64 (95% CI: 0.50, 0.83) for DASH, and 0.71 (95% CI: 0.56, 0.89) for AHEI-2010. Adherence to healthful dietary patterns is associated with lower risk of hearing loss in women. Consuming a healthy diet may be helpful in reducing the risk of acquired hearing loss.

Hypothesis and data-driven dietary patterns and colorectal Cancer survival: findings from Newfoundland and Labrador colorectal Cancer cohort

BackgroundDietary patterns are commonly used in epidemiological research, yet there have been few studies assessing if and how research results may vary across dietary patterns. This study aimed to estimate the risk of mortality/recurrence/metastasis using different dietary patterns and comparison amongst the patterns.MethodsDietary patterns were identified by Cluster Analysis (CA), Principal Component Analysis (PCA), Alternate Mediterranean Diet score (altMED), Recommended Food Score (RFS) and Dietary Inflammatory Index (DII) scores using a 169-item food frequency questionnaire.Five hundred thirty-two colorectal cancer patients diagnosed between 1999 and 2003 in Newfoundland were followed-up until 2010. Overall Mortality (OM) and combined Mortality, Recurrence or Metastasis (cMRM) were identified. Comparisons were made with adjusted Cox proportional Hazards Ratios (HRs), correlation coefficients and the distributions of individuals in defined clusters by quartiles of factor and index scores.ResultsOne hundred and seventy cases died from all causes and 29 had a cancer recurrence/metastasis during follow-up. Processed meats as classified by PCA (HR 1.82; 95% confidence interval (CI) 1.07–3.09), clusters characterized by meat and dairy products (HR 2.19; 95% CI 1.03–4.67) and total grains, sugar, soft drinks (HR 1.95; 95% CI 1.13–3.37) were associated with a higher risk of cMRM. Poor adherence to AltMED increased the risk of all-cause OM (HR 1.62; 95% CI 1.04–2.56). Prudent vegetable, high sugar pattern, RFS and DII had no significant association with both OM and cMRM.ConclusionEstimation of OM and cMRM varied across dietary patterns which is attributed to the differences in the foundation of each pattern.

Dietary patterns are positively associated with semen quality

To study association of semen quality with a priori whole dietary pattern indexes, which reflect real-world dietary practices and the numerous combinations by which foods are consumed: Healthy Eating Index (HEI), Dietary Approaches to Stop Hypertension (DASH), alternate Mediterranean Diet score (aMED), and Alternative Healthy Eating Index (AHEI). A cross-sectional single-center study. Hospital fertility center and university. A total of 280 men attending fertility center from 2012 to2015. Food frequency questionnaire (FFQ) and semen and sperm analysis. Food consumption with the use of FFQ and HEI, AHEI, aMED, DASH nutritional individual scoring indexes. Semen parameters, including semen volume, sperm concentration, motility, total count, and morphology. Comparing the highest and lowest quartiles of the nutritional indexes, men in the highest quartiles of HEI, AHEI, aMed, and DASH indexes had significantly higher adjusted means of sperm concentration (by 10%, 45%, and 24% for HEI, AHEI, and DASH, respectively), normal sperm morphology (by 21% and 8% for AHEI and DASH, respectively), total sperm count (by 29% for AHEI), and sperm motility (by 6% and 11% for aMed and HEI, respectively). Adherence to any of the four dietary indexes is associated with better overall sperm quality, with AHEI best associated. Following our novel findings, we recommend using AHEI as a clinical and practical tool for public whole nutritional recommendation for semen quality.

Mediterranean diet and risk of frailty syndrome among women with type 2 diabetes

Previous research indicates that patients with type 2 diabetes are at higher risk of becoming frail. Emerging evidence also indicates that the Mediterranean diet may prevent frailty in the older population. The aim of this study was to assess whether a Mediterranean-style diet pattern was associated with lower risk of frailty among older women with diabetes. This was a prospective cohort study in 8970 women aged ≥60 y with type 2 diabetes from the Nurses' Health Study. Adherence to the alternate Mediterranean diet (aMED) score was first measured in 1990 and repeated every 4 y until 2010. Frailty occurrence was ascertained up to 2012 and was defined as having ≥3 of the following 5 criteria from the fatigue, resistance, aerobic, illnesses, loss of weight (FRAIL) scale: Fatigue, low Resistance, low Aerobic capacity, having ≥5 Illnesses, and weight Loss of ≥5%. Those with frailty at baseline were excluded. During follow-up, we identified 569 incident cases of frailty. After adjustment for lifestyle factors and medication use, the HR (95% CI) of frailty was 1 for the lowest quartile of the aMED score, 0.88 (0.71, 1.10) for the second quartile, 0.69 (0.53, 0.88) for the third quartile, and 0.54 (0.42, 0.71) for the highest quartile (P-trend < 0.001). A 2-point (∼1 SD) increase in the aMED score was associated with a 28% (95% CI: 19%, 36%) reduced risk of frailty. The largest reduction in the risk was observed for a higher consumption of vegetables and fruit, as well as for alcohol intake. A Mediterranean-style diet pattern was associated with reduced risk of frailty syndrome in older women with type 2 diabetes.

A modified Mediterranean diet score is inversely associated with metabolic syndrome in Korean adults.

Findings from studies in Western countries showed that Mediterranean diet is inversely associated with metabolic syndrome, but little is known about this association in Asian countries. To evaluate the association between Mediterranean diet and metabolic syndrome in Korean population, this study was conducted. A total of 8387 adults 19-64 years of age from the Korea National Health and Nutrition Examination Survey 2012-2015 were assessed. A 112-item dish-based semiquantitative food frequency questionnaire was used to assess dietary intakes. Mediterranean diet was assessed by a modified Mediterranean diet score, which was based on the alternate Mediterranean diet score of Fung et al. Multivariable logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for other dietary and lifestyle variables. Participants with 5-6 and 7 or higher modified Mediterranean diet scores had a lower prevalence of metabolic syndrome by 27% (OR = 0.73, 95% CI: 0.56-0.96) and 36% (OR = 0.64, 95% CI: 0.46-0.89; P-trend = 0.0031), compared with those with 2 or lower modified Mediterranean diet scores, respectively. Higher modified Mediterranean diet scores were associated with a lower prevalence of abdominal obesity and hypertriglyceridemia, which are components of metabolic syndrome CONCLUSIONS: Our findings suggest that diet rich in fruit, vegetables, whole grains, legumes, peanuts and fish is associated with a lower prevalence of metabolic syndrome in Korean adults.

Association between Diet Quality Scores and Risk of Hip Fracture in Postmenopausal Women and Men Aged 50 Years and Older

BackgroundAlthough a number of studies showed a lower risk of hip fractures with high-quality diets, few of them were conducted in the United States. ObjectiveThis prospective analysis examined the association between several diet quality indexes and risk of hip fractures in US men and women. DesignThis is a prospective cohort study. Participants/settingThe participants were 74,446 postmenopausal women from the Nurses’ Health Study and 36,602 men aged 50 years and older from the Health Professionals Follow-Up Study in the United States. Main outcome measureHip fractures were self-reported on biennial questionnaires between 1980-2012 in women, and between 1986-2012 in men. Statistical analysisDiet was assessed every 4 years with a validated food frequency questionnaire. Relative risks were computed for hip fracture by quintiles of the Alternate Mediterranean Diet score (aMed), the Alternate Healthy Eating Index-2010 (AHEI-2010), and the Dietary Approaches to Stop Hypertension score using Cox proportional hazards models, adjusting for potential confounders. ResultsTwo thousand one hundred forty-three incident hip fractures in women and 603 in men were reported during follow-up. A significant inverse trend was observed with the cumulative AHEI-2010 score in women (relative risk comparing extreme quintiles 0.87, 95% CI 0.75 to 1.00; P for trend=0.02). There was also a suggestion of an inverse association with the Dietary Approaches to Stop Hypertension score (P for trend=0.03). In addition, significant inverse trends were observed between all three diet quality scores and hip fractures in women younger than age 75 years but not older women. There was no clear association between diet quality indexes and hip fracture in men. ConclusionsHigher AHEI-2010 scores were associated with a lower risk of hip fractures in US women. The inverse associations with diet quality may be more apparent among those younger than age 75 years.