Dietary Score Research Articles

The impact of perception bias for cardiovascular disease risk on physical activity and dietary habits

ObjectiveCardiovascular disease (CVD) remains a significant public health challenge in China. Accurate perception of individual CVD risk is crucial for timely intervention and preventive strategies. This study aims to determine the alignment between CVD risk perception levels and objectively calculated CVD risk levels, then investigate the disparity in physical activity and healthy diet habits among distinct CVD risk perception categories. MethodsFrom March to August 2022, a cross-sectional survey was conducted in Zhejiang Province using convenience sampling. Participants aged between 20 and 80 years, without prior diagnosis of CVD were included. CVD risk perception was evaluated with the Chinese version of the Attitude and Beliefs about Cardiovascular Disease Risk Questionnaire (ABCD-C), while objective CVD risk was assessed through the Prediction for Atherosclerotic Cardiovascular Disease Risk (China-PAR) model. Participants’ demographic information, self-reported physical activity, and healthy diet score were also collected. ResultsA total of 739 participants were included in the final analysis. Less than a third of participants (29.3%) accurately perceived their CVD risk, while 64.5% over-perceived it and 6.2% under-perceived it. Notably, half of the individuals (50.0%) with high CVD risk under-perceived their actual risk. Compared to the accurate perception group, individuals aged 60-80 years old (OR = 6.569), currently drinking (OR = 3.059), and with hypertension (OR = 2.352) were more likely to under-perceive their CVD risk. Meanwhile, participants aged 40-<60 years old (OR = 2.462) and employed (OR = 2.352) were more likely to over-perceive their risk. The proportion of individuals engaging in physical activity was lowest in the under-perception group, although the difference among the three groups was not statistically significant (χ2=2.556, P=0.278). In addition, the proportion of individuals practicing healthy diet habits was also lowest in the under-perception group, and a significant statistical difference was observed among the three groups (χ2=10.310, P=0.006). ConclusionOnly a small proportion of participants accurately perceived their CVD risk, especially among those with high actual CVD risk. Individuals in the under-perceived CVD risk group exhibited the lowest rates of physical activity engagement and healthy diet adherence. Healthcare professionals should prioritize implementing personalized CVD risk communication strategies tailored to specific subgroups to enhance the accuracy of risk perception.

Degree of Food Processing Is Associated With Glycemic Control in African American Adults With Type 2 Diabetes: Findings From Texas Strength Through Resilience in Diabetes Education Clinical Trial

BackgroundType 2 diabetes mellitus (T2DM) disproportionately affects African American (AA) populations. Despite the importance of diet in diabetes management, the association of diet quality and/or the degree of food processing with glycemic control in AA adults with T2DM remains unclear. ObjectiveThis study aimed to examine associations between diet quality scores and the degree of processing in the diet with glycosylated hemoglobin (HbA1c) level in AA adults with T2DM. DesignThis cross-sectional study used baseline data from participants in Texas Strength Through Resilience in Diabetes Education, an ongoing clinical trial. Participants/settingParticipants involved in this analysis (N = 273) were AA adults with T2DM recruited through local churches in Austin, TX, and the surrounding areas from August 2020 through April 2023. Main outcome measuresParticipants provided 2 24-hour dietary recalls (1 weekend and 1 weekday) and a blood sample to measure HbA1c level. Healthy Eating Index 2015, Alternative Healthy Eating Index 2010, and Alternate Mediterranean Diet scores were calculated. The NOVA method was used to calculate the percentage of grams and calories that came from ultraprocessed foods and unprocessed or minimally processed foods. Statistical analyses performedLinear regression and analysis of variance models tested associations between the diet quality scores and degree of food processing with HbA1c level, adjusting for demographic covariates. Models were stratified by insulin use after finding a significant interaction with ultraprocessed foods and unprocessed or minimally processed foods. ResultsRegression analyses revealed that the percentage of grams in the total diet from ultraprocessed foods was positively associated with HbA1c level (βadj = .015; Padj = .032), whereas unprocessed or minimally processed foods were inversely associated with HbA1c level (βadj = –.014; Padj = .043). There was no significant association between any diet quality score and HbA1c level. ConclusionsIn AA adults with T2DM, only the degree of food processing was associated with HbA1c level. Future research should explore whether a causal relationship exists between food processing and HbA1c level and investigate mechanisms by which ultraprocessed foods may affect glycemic control.

Development of a CVD mortality risk score using nutritional predictors: A risk prediction model in the Golestan Cohort Study

Background and AimWe aimed to develop a dietary score using prediction model method for evaluating the risk of cardiovascular disease (CVD) mortality and suggesting a simple and practical scoring system within the healthcare context. Method and ResultsA total of 43878 adult participants (aged 37-80 years) from the Golestan Cohort Study (GCS) were included in analysis. A random split of the subjects into the derivation (n=28930) and the validation sets (n=14948) was done. The Cox proportional hazard model was used to develop prediction model for the 8-year risk of CVD mortality. The model’s discrimination and calibration were assessed by C-statistic and calibration plot, respectively. To enhance clinical utility, we devised a point-based scoring system derived from our model. This prediction model was developed by nine predictors including age, physical activity level (MET minutes/week), waist-to-hip ratio, tea intake (cup/day), vegetable intake (gr/1000 kcal/day), white meat intake (gr/1000 kcal/day), salt intake (gr/1000 kcal/day), dairy intake (Cup/1000 kcal/day), and percentage of protein intake. The model had an acceptable discrimination in both derivation (C-statistic: 0.76, p<0.001) and validation (C- statistic: 0.77, p<0.001) samples. Also, the calibration of model in both derivation and validation datasets was 0.81. ConclusionThis is the first attempt to develop a risk prediction model of CVD mortality and the risk scoring system by the majority of nutritional predictors in a large cohort study. This nutritional risk assessment tool is suitable for motivating at-risk individuals to make lifestyle and dietary pattern changes to reduce future risk to prevent health problems.

Dietary patterns and cardiorespiratory fitness in midlife and subsequent all-cause dementia: findings from the Cooper Center Longitudinal Study

BackgroundIdentifying lifestyle factors that independently or jointly lower dementia risk is a public health priority given the limited treatment options available to patients. In this cohort study, we examined the associations between Mediterranean or Dietary Approaches to Stop Hypertension (DASH) diet adherence and cardiorespiratory fitness (CRF) with later-life dementia, and assessed whether the associations between dietary pattern and dementia are modified by CRF.MethodsData are from 9,095 adults seeking preventive care at the Cooper Clinic (1987–1999) who completed a 3-day dietary record and a maximal exercise test. Alzheimer’s disease and related disorders or senile dementia (i.e., all-cause dementia) was identified from Medicare administrative claims (1999–2019). Illness-death models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between Mediterranean or DASH diet adherence (primary exposure), CRF (secondary exposure), and all-cause dementia, adjusted for demographic and clinical factors. An interaction term was included between diet score and CRF to assess effect modification by CRF.ResultsThe mean age at baseline was 50.6 (standard deviation [SD]: 8.4) years, and a majority of the study sample were men (77.5%) and White (96.4%). 1449 cases of all-cause dementia were identified over a mean follow-up of 9.2 (SD: 5.8) years. Neither Mediterranean nor DASH diet adherence was associated with dementia risk in fully adjusted models (HR per SD of Mediterranean diet score: 1.00, 95% CI: 0.94, 1.05; HR per SD of DASH diet score: 1.02, 95% CI: 0.96, 1.08). However, participants with higher CRF had a decreased hazard of dementia (HR, per metabolic equivalent of task [MET] increase, Mediterranean model: 0.95, 95% CI: 0.92, 0.98; HR, per MET increase, DASH model: 0.96, 95% CI: 0.92, 0.97). No effect modification by CRF was observed in the association between diet and dementia.ConclusionsIn this sample of apparently healthy middle-aged adults seeking preventive care, higher CRF at midlife was associated with a lower risk of all-cause dementia, though adherence to a Mediterranean or DASH diet was not, and CRF did not modify the diet-dementia association. CRF should be emphasized in multimodal interventions for dementia prevention and investigated among diverse samples.

Flavonoid-Rich Foods, Dementia Risk, and Interactions With Genetic Risk, Hypertension, and Depression.

A composite score of flavonoid-rich foods (flavodiet) may provide a clear public health message regarding the range of foods with the potential to lower dementia risk. To examine associations of flavodiet score and intakes of flavonoid subclasses with dementia risk according to genetic risk and presence of depression and hypertension. This prospective, population-based cohort study included dietary data from adults aged 40 to 70 years in the UK Biobank, recruited between 2006 and 2010, with a mean (SD) follow-up of 9.2 (1.5) years. The data analyses were conducted from September 1 to 30, 2023. Flavodiet score adherence and intake of flavonoid subclasses derived from 24-hour computerized dietary assessments. The main outcome was incident all-cause dementia and interactions with genetic risk, hypertension, and depressive symptoms using multivariable Cox proportional hazards regression models. The sample included 121 986 participants (mean [SD] age, 56.1 [7.8] years; 55.6% female; 882 with incident dementia). Comparing the highest with lowest quintile of flavodiet score, consuming 6 additional servings per day of flavonoid-rich foods was associated with a lower risk of dementia among all participants (adjusted hazard ratio [AHR], 0.72; 95% CI, 0.57-0.89), those at high genetic risk (AHR, 0.57; 95% CI, 0.42-0.78), and those with depressive symptoms (AHR, 0.52; 95% CI, 0.33-0.81) after multivariable adjustment. The greatest risk reduction was observed in participants consuming at least 2 of the following per day: 5 servings of tea, 1 serving of red wine, and 0.5 servings of berries, compared with those who did not achieve any of these intakes (AHR, 0.62; 95% CI, 0.46-0.84). Higher intakes of flavonoid subclasses, including anthocyanins, flavan-3-ols, flavonols, and flavones, of which tea, red wine, and berries are the main contributors, supported these findings, showing inverse associations with dementia risk. In this cohort study, high adherence to a flavonoid-rich diet score was associated with a lower risk of dementia, with reductions more pronounced in individuals with a high genetic risk, hypertension, and depressive symptoms. These findings suggest that simple dietary changes of increasing intakes of commonly consumed flavonoid-rich foods and drinks may lower dementia risk.

Association Between Periconceptional Diet Quality and Hypertensive Disorders of Pregnancy: The Japan Environment and Children's Study.

Little is known about the relationship of healthy diets, which are widely recommended to prevent diseases in general populations, with the risk of hypertensive disorders of pregnancy (HDP), particular among non-Western populations with different dietary habits. We aimed to investigate the association between periconceptional diet quality and the risk of HDP among pregnant Japanese women. Dietary intake over 1 year before the first trimester of pregnancy was assessed using a validated, self-administered food frequency questionnaire among 81 113 pregnant Japanese women who participated in a prospective cohort of the Japan Environment and Children's Study. Overall diet quality was assessed by the Balanced Diet Score (BDS) based on adherence to the country-specific dietary guidelines and the Dietary Approaches to Stop Hypertension (DASH) score. Cases of HDP were identified by medical record transcription. The association between diet quality and HDP risk was examined using Bayesian logistic regression models with monotonic effects. We identified 2383 (2.9%) cases of HDP. A higher BDS was associated with a lower risk of HDP. When comparing the highest with the lowest quintile of the BDS, the adjusted odds ratio (aOR) of HDP was 0.83 (95% credible interval [CrI], 0.73-0.94). The DASH score and HDP risk were inversely associated in a monotonic dose-response manner (aOR per 1-quintile increase in the DASH score, 0.92 [95% CrI, 0.89-0.95]). A high-quality diet, which is recommended for disease prevention in general populations, before conception may also reduce the risk of HDP among pregnant Japanese women.

The association of dietary inflammatory indices and mortality in patients with cirrhosis: a cohort based study

Dietary intake has an undeniable role in the development and progression as well as the prevention and treatment of cirrhosis. This study was conducted with the aim of investigating the association between dietary inflammatory indices and total mortality in patients with cirrhosis. A total of 166 outpatients with cirrhosis who were diagnosed within the last 6 months were followed up for 48 months in this cohort study. A 168-question valid food frequency questionnaire was used to evaluate dietary intake. Accordingly, the dietary inflammatory index (DII), empirical dietary inflammatory pattern (EDIP) and dietary inflammatory score (DIS) were calculated. Multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated through cox proportional hazards regression models for an association of cirrhosis mortality and three dietary inflammatory indices. After full adjustment for confounders, the results showed that mortality risk increased significantly with increasing dietary inflammatory indices. Compared to the first tertile, the risk of mortality due to cirrhosis was associated with 4.8 times increase in the third tertile of DII (HR = 4.8, 95% CI = 1.1–19.8, p trend = 0.029), 3.3 times in the third tertile of EDIP (HR = 3.3, 95% CI = 1.3–8, p trend = 0.004), and 2.2 times increased in the third tertile of DIS (HR = 2.2, 95% CI = 1–4.7, p trend = 0.032). The results of the present study indicated a significant association between dietary inflammatory indices and total mortality among patients with cirrhosis. Additional research is necessary to confirm our findings.

Nutrients, Diet Quality, and Dietary Patterns in Patients with Inflammatory Bowel Disease: A Comparative Analysis.

(1) Background: Diet plays an important role in the development of inflammatory bowel disease (IBD). There are a number of methods available to assess the diets of patients with IBD, including nutrients, dietary patterns, and various appraisal tools of diet quality. However, research on diet quality and dietary patterns in IBD populations is limited, and comparative evaluations of dietary intake in patients with IBD have not been performed. (2) Objectives: The aim of this study was to assess nutrients, the dietary patterns, and diet quality of patients with IBD and to investigate the relationship between dietary patterns, diet quality, and the adequacy of nutrient intake. (3) Methods: Three-day food records of 268 patients with ulcerative colitis (UC) and 126 patients with Crohn's disease (CD) were collected to estimate nutrients and food groups, while dietary quality was assessed using the Dietary Inflammation Index (DII) and Mediterranean Diet Score (MDS). Dietary patterns were derived using principal component analysis (PCA). Participants' nutrient intake, diet quality, and dietary patterns were compared. We used binary logistic regression to assess the relationship between dietary patterns (independent variable) and nutritional adequacy (dependent variable). (4) Results: In our sample, patients had inadequate energy, protein, and dietary fiber intake compared with Reference Nutrient Intake (RNI). Regarding micronutrients, intakes of potassium, zinc, selenium, vitamin A, vitamin C, vitamin E, sodium, calcium, iron, niacin, thiamin, and riboflavin were inadequate. Regarding food groups, the highest intakes were fruits, legumes, dairy products, and nuts. PCA revealed four dietary patterns, namely DP1, DP2, DP3, and DP4. Among UC patients, 96, 55, 69, and 48 patients adhered to DP1, DP2, DP3, and DP4 dietary patterns, respectively. Among CD patients, 41, 31, 34, and 20 patients complied with the dietary patterns of DP1, DP2, DP3, and DP4, respectively. There was no significant difference in dietary patterns between UC and CD patients. Compared with DP4 (high intake of mixed legumes and low intake of tubers), DP1 (high intake of cereals, tubers, vegetables and eggs) was more likely to ensure adequate intake of energy (OR, 2.96; 95% CI, 1.55, 5.62), protein (OR, 2.05; 95% CI, 1.06, 3.96), carbohydrates (OR, 3.55; 95% CI, 1.51, 6.59), thiamine (OR, 2.59; 95% CI, 1.36,4.93), niacin (OR, 2.75; 95% CI, 1.39, 5.42), phosphorus (OR, 2.04; 95% CI, 1.08, 3.85), zinc (OR, 2.43; 95% CI, 1.28, 4.63), and manganese (OR, 3.10; 95% CI, 1.60, 5.90), and DP2 (high intake of fruits, poultry, aquatic products, and nuts) was more likely to meet niacin requirements than DP4 (OR, 2.65; 95% CI, 1.28, 5.48). (5) Conclusion: This study clarifies our understanding of dietary intake, diet quality, and dietary patterns in adult patients with IBD. Future attention is needed to improve diet quality, emphasizing the importance of assessing and understanding patient dietary habits and increasing understanding of the factors that influence dietary intake in IBD in order to achieve optimal outcomes for patients with IBD.

Association of the Mediterranean diet with arterial stiffness, inflammation, and medication use in women with systemic lupus erythematosus: An exploratory study

Patients with systemic lupus erythematosus (SLE) face increased cardiovascular risk not fully explained by traditional cardiovascular risk factors. Arterial stiffness, inflammation and disease-related therapies may be contributors to augmented cardiovascular risk, whereas healthy dietary habits could help in their management. The aim of the present study was to analyze the association of the adherence to the Mediterranean Diet with arterial stiffness, inflammation, and disease-related medication in women with SLE. A total of 76 women with SLE were included in this cross-sectional exploratory study. The adherence to the Mediterranean Diet was assessed using the Mediterranean Diet Score. Arterial stiffness was measured through pulse wave velocity (PWV). Inflammatory profile was evaluated through high-sensitivity C-reactive protein (hsCRP). The use (yes / no) and doses (mg /day and cumulative dose over the last 3 years) of corticosteroids and immunosuppressants were also registered. No association of the overall adherence to the Mediterranean Diet with PWV, hsCRP or medication use was found (all P>.05). Lower intake of full dairy products was related to greater odds of corticosteroids use (odds=1.72; P=.004), and both higher current (β=0.29; P=.024) and cumulative (β=0.21; P=.040) doses. Lower intake of red wine was associated with lower odds of immunosuppressants use (odds=0.63; P=.008). No association of the adherence to the Mediterranean Diet with arterial stiffness, inflammation or disease-related medication was observed in women with SLE with mild disease activity. However, higher dairy products and lower red wine consumption were related to lower use of disease-related medication. Future intervention studies are needed to better understand how nutritional education promoting Mediterranean Diet food groups can complement conventional SLE treatments.

Relationship between dietary inflammatory index, plant-based dietary index, and bacterial vaginosis: A case-control study.

Bacterial vaginosis (BV) is a common inflammatory condition affecting the vaginal microbiome. In the present study we aimed to explore the relationship between dietary inflammatory index, plant-based dietary index, and BV. In this case-control study, 143 individuals with BV and 151 healthy participants aged 15-45 years were included. Bacterial vaginosis diagnosis was based on the Amsel criteria by a gynecologist. Participants' dietary intakes over the past year were assessed using a 168-item food frequency questionnaire. Logistic regression models were employed to analyze the association between dietary inflammatory index, plant-based dietary index, and BV odds. Our study revealed that elevated dietary inflammatory index scores were strongly associated with higher BV odds in the crude model (odds ratio [OR]: 2.88, 95% confidence interval [CI]: 1.57-5.30, P value <0.001), and even after accounting for potential confounding factors (adjusted OR: 3.52, 95% CI: 1.66-7.46, P value = 0.001). While no significant relationship was observed between total plant-based dietary index and healthy plant-based dietary index scores with BV odds, a clear positive association existed between unhealthy plant-based dietary index and the odds of BV (aOR: 2.13, 95% CI: 1.09-4.15, P value = 0.018). A positive correlation may exist between unhealthy plant-based dietary index and the likelihood of BV. Furthermore, the dietary inflammatory index may remain linked to increased BV odds.

Association between dietary antioxidant indices and hypertension among Chinese adults.

The effect of dietary antioxidants on blood pressure (BP) regulation and hypertension risk remains largely unknown. This study aimed to comprehensively assess the impacts of dietary antioxidants on systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP), and hypertension risk among Chinese adults. The cross-sectional study assessed data from 12,046 Chinese adults, evaluating dietary antioxidant quality scores (DAQS) and total antioxidant capacity (DTAC) via a validated food frequency questionnaire. MAP was derived using the formula DBP + (0.412 ×PP), with PP calculated as SBP - DBP. The relationship between DAQS, DTAC, and hypertension prevalence was analyzed using multivariable logistic regression. Among participants not taking antihypertensive medications, those in the highest groups of DTAC and DAQS had significantly lower SBP, DBP, MAP, and PP compared to those in the lowest groups (all p-trends <0.001). Relative to the lowest quintile (Q1) ofDTAC (adjusted odds ratios (OR) for hypertension decreased in Q2 (OR 0.90, 95%CI 0.79-1.03), Q3 (OR 0.65, 95% CI 0.56-0.76), Q4 (OR 0.51, 95% CI 0.43-0.60), and Q5 (OR 0.38, 95% CI 0.31-0.46) (p trend <0.001). For DQAS, hypertension OR of category 5 was 0.38 (95% CI 0.32-0.46) compared to that of category 1. Increased vitamin A, Zinc, and selenium intake correlated with reduced hypertension risk. A significant non-linear DTAC and linear DAQS relationships were observed and hypertension risk. Antioxidant-rich diets markedly lowered SBP, DBP, MAP, PP, and hypertension risk.

The association between dietary antioxidant quality score and intensity and frequency of migraine headaches among women: a cross-sectional study

BackgroundMigraine is an episodic disorder and a frequent form of headache. An impaired balance between free radical production and an impaired antioxidant defense system leading to oxidative damage may play a major role in migraine etiology. We sought to investigate whether dietary antioxidant quality score (DAQS) is associated with migraine intensity and frequency among women suffering from migraine.MethodsThis cross-sectional study was conducted on 265 women. The data related to anthropometric measures and dietary intake were collected. DAQS score was calculated based on FFQ (food frequency questionnaire) vs. the reference daily intake (RDI) quantity. To measure migraine intensity, the migraine disability assessment questionnaire (MIDAS) and visual analog scale (VAS) were used. The frequency of headaches was defined as the days the participants had headaches in the last month and a 30-day headache diary was used.ResultsThe results of the study demonstrated that VAS, MIDAS, and frequency of headaches were reduced significantly from the low DAQS (poor quality of antioxidants) to high DAQS (high quality of antioxidants) after adjusting covariates. Also, multinomial regression showed there was an inverse association between higher DAQS and the frequency of headaches. In the adjusted model, subjects with the higher DAQS were 69% less likely to have moderate migraine disability, compared with those with the lower DAQS. Linear regression showed, there was an inverse association between vitamin C intake and the grades of pain severity.َAlso in a crude model, a negative association was found between vitamin E and the frequency of headaches.ConclusionIn conclusion, Participants with higher DAQS had lower migraine intensity and headache frequency. In addition, the consumption of vitamin C may potentially associate with decreasing the severity of headaches. Dietary antioxidants should be monitored closely in individuals suffering from migraine.

An Investigatıon of the Adaptation, Physical Activity and Nutrition Habits of First-Year University Students in Online Education

Aim: The COVID-19 pandemic has instigated a profound transformation in the education sector, ushering in comprehensive changes from students' learning habits to the functioning of educational institutions. This study aims to evaluate the adaptations, nutritional habits, and physical activities of first-year university students following the transition to online education. Method: This descriptive cross-sectional study, conducted between April and May 2021, was carried out online with a total of 275 participants. The data collection process involved the utilization of a personal information form developed by the researchers in light of the literature, as well as the Mediterranean Diet Score and University Life Scale. Results: There was no significant difference observed in the Mediterranean diet score and body weight during the university period compared to the pre-university period (p &gt; 0.05). Students living with their families at home demonstrated higher emotional and academic adaptation scores, and those engaging in exercise exhibited significantly higher scores in social adaptation. Conclusion: The pandemic period and the online education process influenced students' supplement usage and dietary habits, but there was no significant change in the exercise participation rate. Furthermore, it was determined that the adjustment to university life, living situation with family, and engagement in exercise had a significant impact on social adaptation.

Dietary patterns and periodontitis: A systematic review.

The systematic review aimed to investigate the associations between index-based dietary patterns and the risk and severity of periodontitis. Four public databases were searched for relevant published articles. Two independent researchers conducted the study selection, quality assessment, and data extraction. Methodological quality of the selected studies was evaluated using Joanna Briggs Institute Checklists. The review was registered with PROSPERO (CRD42023395049). Twenty-five studies were eligible for this review, including 23 cross-sectional studies and two prospective cohort studies. The most utilized dietary indices were the Healthy Eating Index (HEI), the Mediterranean Diet Score (MDS), and the Dietary Inflammatory Index (DII). The results indicated a positive association between higher diet quality (i.e., higher HEI and MDSs and lower DII scores) and healthier periodontal status. Subgroup meta-analysis for four studies utilizing HEI and CDC/AAP case definition indicates the protective effect of higher HEI scores on the risk of periodontitis (OR [95% CI] = 0.77[0.68, 0.88]) with statistical significance (Z = 3.91 [p < 0.0001]). Dietary assessment was conducted by validated food frequency questionnaires (FFQ) in 52% of the studies and 24-h dietary recalls in 36% of the studies. One study utilized a validated 15-item questionnaire to measure patients' adherence to the Mediterranean Diet (QueMD). The quality assessment showed that all studies were of high quality. High HEI and MDSs and low DII scores were associated with a low risk of periodontitis and better periodontal conditions. The standardized and repeatable diet guidelines might be provided for preventing periodontitis. Future prospective studies and clinical trials are needed to confirm this causal association.

High prevalence of multi-drug resistant organisms in the gut flora of healthy rural individuals in northern India.

Background & objectives Presence of resistant gut flora in the community is associated with increasing multi-drug resistance (MDR) infections. In this study, the prevalence of MDR organisms in the gut flora of a healthy rural population residing in northern India was determined. Methods Healthy individuals aged 18-45 yr from Nuh district, Haryana, India were included in this study. Risk factors associated with dysbiosis, diet, lifestyle and exposure to animals was assessed. Qualitative food frequency questionnaire and inflammatory diet score was calculated. Pathogens in stool sample were detected by MALDI-TOF. Evaluation of antimicrobial susceptibility was done by automated Vitek-2 System. The presence of antimicrobial resistance (AMR) genes was evaluated using PCR. An isolate having resistance to at least one antibiotic out of the three or more classes of antibiotics tested was labelled as MDR. Results Among 153 individuals included in this study (mean age-32.5±8.6 yr, females-58.2%, vegetarian-68.6%), the most frequent organism isolated was E. coli (n=137, 89.5%) followed by K. pneumoniae (n=19, 12.4%) and Enterobacter species (n=23, 15%). Forty seven (30.7%) individuals had sensitive and 42 (27.4%) had MDR organisms. Fifty one (33.3%) were positive for ESBL, 5 (3.3%) were positive for carbapenems, and 18 (11.8%) were positive for both genes. Age, gender, body mass index, diet pattern, or diet score were similar between participants with sensitive and resistant organisms. Resistance against fluoroquinolones was highest [92(48.7%)] among all isolates. Forty nine (25.9%), 25 (13.2%), 24 (12.7%) and 21 (11.1%) isolates, respectively were positive for blaTEM, blaSHV, blaCTXM-1 and OXA-48 genes. Interpretation & conclusions Overall the study findings suggest that 27 per cent individuals from rural northern India carry MDR organisms in their fecal flora, with an ESBL carriage rate of 44 per cent.

A higher dietary inflammatory index score is associated with an increased risk of developing dyslipidemia and its components only in women

The dietary inflammatory index (DII) is a tool to evaluate the inflammatory potential of diets. Our research hypothesized that a higher DII score would be associated with an increased risk of dyslipidemia and that this outcome may differ by sex. Data from the Korean Genome and Epidemiology Study were used. The analysis included participants aged 40 to 69 years from the HEXA study (n = 40,500) and the Ansan-Ansung study (n = 4701). The mean follow-up was 5.03 years for the HEXA study and 8.14 years for the Ansan–Ansung study. The DII scores were calculated based on dietary data. Cox proportional hazards regression analysis was used to calculate hazard ratio (HR) and 95% confidence interval (CI). In pooled analyses, a high DII score was associated with a higher risk of dyslipidemia and its components. Sex-specific analyses revealed associations only in women. A pro-inflammatory diet, as indicated by a higher DII score, was associated with an increased risk of hypercholesterolemia, hyper-low-density lipoprotein cholesterolemia, hypertriglyceridemia, and dyslipidemia, with HR of 1.17 (95% CI: 1.06, 1.29), 1.16 (95% CI: 1.03, 1.29), 1.32 (95% CI: 1.12, 1.52), and 1.17 (95% CI: 1.08, 1.26), respectively. However, among men, there was no association between DII and dyslipidemia. These findings emphasize the inflammation feature of existing dietary patterns in influencing the development of dyslipidemia and related health issues. Further research will be needed to identify the mechanisms of how DII scores affect the risk of dyslipidemia.

Joint Trajectories of Lifestyle Indicators and Their Associations with Blood Pressure among Chinese Middle School Students.

Lifestyle behaviors, defined as a combination of dietary behavior, physical activity (PA), screen time (ST), and sleep duration indicators, are strongly associated with blood pressure (BP) in students. Our aim was to characterize the joint trajectories of lifestyle behaviors among middle school students and evaluate their association with BP. Data were obtained from the monitoring dataset on common diseases and health factors among students in Jiading District, Shanghai, China, conducted from 2019 to 2023. Lifestyle behavior data were collected annually from middle school students aged 12-18 years through questionnaires covering dietary behavior score, PA, ST, and sleep duration. Students' BP was measured in 2023. Joint trajectories of lifestyle behaviors were determined using group-based multi-trajectory modeling. Associations between lifestyle trajectories and students' BP were examined using multiple linear regression and modified Poisson regression. A total of 1378 middle school students (759 [58.98%] boys, median age 14.36 years [IQR: 13·30-13.28]) with lifestyle behaviors data assessed at least three times were included, and they were categorized into four joint lifestyle trajectories as follows: "remain unhealthy with low PA and increasing ST" (n = 141, 10.46%), "remain unhealthy with only low PA" (n = 305, 22.63%), "change towards unhealthy with decreasing sleep duration" (n = 776, 57.57%), and "relatively healthy" (n = 126, 9.35%). After adjusting for important confounders, the "remain unhealthy with low PA and increasing ST" group was associated with higher diastolic BP (DBP) [β: 3.49, 95% CI: 0.55-6.44] and higher mean arterial pressure (MAP) [β: 3.19, 95% CI: 0.37-6.01] in students compared with the "relatively healthy" group. Additionally, compared with the "relatively healthy" group, students in the "remain unhealthy with low PA and increasing ST" group had a 1.12-fold increase in the risk of hypertension (risk ratios: 1.12, 95% CI: 1.03-1.24). All trend p values in DBP, MAP, and hypertension from the "relatively healthy" group to the "remain unhealthy with low PA and increasing ST" group were less than 0.05. Four distinct lifestyle trajectories were identified among middle school students. Students who remained in the "unhealthy with low PA and increasing ST" lifestyle trajectory were associated with later elevations in BP.

Association between cMIND diet and hypertension among older adults in China: a nationwide survey

BackgroundExisting research indicates that the Mediterranean diet has a positive impact on preventing and treating hypertension. However, its specific effect on hypertension among elderly Chinese individuals is unclear.AimsThe objective of this research was to explore the association between the Chinese version of the Mediterranean-DASH Intervention for Neurodegenerative Delay (cMIND) diet and hypertension among elderly Chinese individuals, aiming to offer novel strategies for alleviating the burden of hypertension in this demographic.MethodsIn this study, we used cross-sectional data published in 2018 by the China Longitudinal Health and Longevity Survey (CLHLS) to develop a binary logistic regression model to investigate the correlation between cMIND diet and hypertension in a Chinese elderly population. Restricted cubic spline was used to test for linear associations, and further subgroup analyses were performed to test for interactions.ResultsIn total, 7,103 older adults were included in the study, with a prevalence of hypertension of 39.0%. When the cMIND diet score was used as a continuous variable, a significant protective effect against hypertension was present (OR = 0.955, 95% CI:0.923–0.988, p = 0.008); when used as a categorical variable, this protective effect was still present at higher levels (compared to lower levels) of the cMIND diet (OR = 0.869, 95% CI: 0.760–0.995, p = 0.042).DiscussionAlthough the Mediterranean diet has great potential to reduce the chance of hypertension, it should also consider the effect on the Chinese population. The results of this study provide new ways to reduce the disease burden of hypertension in Chinese older adults and improve quality of life in later life.ConclusionThe cMIND diet can considerably reduce the risk of hypertension among older adults in China.

Sex-specific effects of a Mediterranean diet on lower limb bone strength in Polish children

Lifestyle factors have the potential to influence bone health in various ways, whether positively or negatively. As osteoporosis is believed to originate in early years, it is therefore essential to indicate factors that may positively affect bone health during childhood. The aim of our study was to investigate the effects of early and current diet, vitamin D supplementation, and BMI z-score on bone properties in a group of children aged 3–7 years. A cross-sectional sample of 205 preschoolers and their parents participated in the study. Dietary assessment was made using a modified version of the Polish-adapted Mediterranean Diet score (MVP-aMED) on the basis of the data from food frequency questionnaire (FFQ), filled out by the parents. Quantitative ultrasound (QUS) was used in the assessment of bone properties. In the sex-stratified analysis, significant associations were observed between MVP-aMED score (β = 0.193, 95 % CI: 0.005, 0.237; p = 0.04), BMI z-score (β = −0.318, 95 % CI: −1.455, −0.039; p = 0.04) and QUS z-score, exclusively among girls. After adjustment, only the relationship with diet remained significant (β = 0.209, 95 % CI: 0.007, 0.255; p = 0.04), suggesting that a higher adherence to the Mediterranean Diet may be associated with better bone properties in girls aged 3–7 years old. Our results emphasize the importance of fostering healthy dietary habits and maintaining proper weight in children in order to promote optimal bone development.

Dietary Approaches to Stop Hypertension (DASH) and mortality risk among patients with liver cirrhosis: a prospective cohort study

Background and purposeThe relationship between dietary patterns and cirrhosis is undeniable. The present study aimed to investigate the association between the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of mortality in patients with cirrhosis prospectively.MethodsIn this cohort study, 121 cirrhotic patients were enrolled and followed up annually for four years. Nutritional status and dietary intakes were assessed initially, and the DASH score was calculated accordingly. Crude and multivariable-adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazard analyses.ResultsDASH components including fruits, vegetables, legumes, nuts and seeds, and low-fat dairy products were significantly associated with lower mortality risk in cirrhotic patients. Also, a higher DASH score was significantly associated with a reduction in the risk of mortality in patients with cirrhosis, so that after adjusting for all confounders, the risk of mortality in the upper tertile was 89% lower than the first tertile (HR = 0.11, 95% CI: 0.03–0.42, P trend < 0.001). The 4-year survival rate among patients across tertiles of DASH was 32%, 37%, and 46%, respectively (P = 0.005).ConclusionIt can be concluded that a higher DASH diet score may be associated with a reduced risk of mortality in cirrhotic patients. However, larger studies are needed to confirm the findings and determine their potential mechanisms.