Healthy Diet Indicator Research Articles

The Cost of Diets According to Nutritional Quality and Sociodemographic Characteristics: A Population-Based Assessment in Belgium

BackgroundPrices of foods can influence purchase and, therefore, overall quality of diet. However, a limited number of studies have analyzed the cost of diets according to the overall quality of diets taking into account sociodemographic characteristics. ObjectiveOur aim was to estimate cost variations according to diet quality and to identify sociodemographic characteristics associated with such cost differences in adults’ diets in Belgium. DesignThis cross-sectional study used nationally representative data from Belgium. Participants/settingsParticipants were adults (aged 18 to 64 years; n = 1,158) included in the 2014-2015 Belgian National Food Consumption Survey. Main outcome measuresDietary assessment was based on two 24-hour dietary recalls and a food frequency questionnaire. The Mediterranean Diet Score and the Healthy Diet Indicator were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the 2014 GfK ConsumerScan Panel food price data. Statistical analyses performedAssociations were estimated using linear regressions. ResultsThe mean daily diet cost was US$6.51 (standard error of mean [SEM] US$0.08; €5.79 [€0.07]). Adjusted for covariates and energy intake, mean (SEM) daily diet cost was significantly higher in the highest tercile (T3) of both diet quality scores than in the T1 (Mediterranean Diet Score: T1 = US$6.29 [US$0.10]; €5.60 [€0.09] vs T3 = US$6.78 [US$0.11]; €6.03 [€0.10]; Healthy Diet Indicator: T1 = US$6.09 [US$0.10]; €5.42 [€0.09] vs T3 = US$7.13 [US$0.11]; €6.34 [€0.10]). Both diet quality and cost were higher in 35- to 64-year-old respondents (vs 18- to 34-year-olds), workers (vs students), and those with higher education levels (vs the lowest). The association between quality and cost of diets was weaker in men and among individuals with higher education levels. ConclusionsIn Belgium, a high-quality diet was more expensive than a low-quality diet. These findings can be used to inform public health policies.

Diet Quality: A Neglected Parameter in Children With Food Allergies. A Cross-Sectional Study.

Background-Objective: With recent evidence suggesting that growth is no longer considered a major issue in children with food allergies (FA) on elimination diet, priority has shifted to diet quality to establish healthy eating patterns and prevent non-communicable diseases. The Diet Quality Index – International (DQI-I) could be useful for assessing the overall diet quality of FA-children. This study aimed to evaluate the impact of elimination diet on DQI-I in children with FA and the accuracy of DQI-I in reflecting nutrient intake.Materials-methods: In a prospective, cross-sectional, cohort study of FA-children (2–14 years), nutritional intake was evaluated using a 7-day food frequency questionnaire, 24-h dietary recall, and the DQI-I.Results: Of the 76 children recruited, 44.7% had multiple allergies. Mean overall DQI-I score was 52 points, with only 28% of participants having good overall DQI-I (≥60 points). DQI-I moderation and balance were the most affected domains. Participants with multiple allergies had higher DQI-I moderation and balance and lower vitamin D and Ca intake. Compared to toddlers, schoolchildren had higher DQI-I variety and lower moderation and received higher vitamin B2, vitamin B12, Ca, P, and Zn. The number of allergies, age, and milk avoidance were independently associated with adjusted DQI-I moderation and balance, energy, and certain micronutrient intake. Higher percentages of participants with good DQI-I received adequate amounts of Mn and vitamins A, B6, C, and folate than those with poor DQI-I.Conclusions: In children with FA on elimination diet, the DQI-I accurately captured the deflection of diet quality related to the development of chronic, non-communicable diseases through its moderation and balance components. This is DQI-I's main purpose as a healthy diet indicator and as such it would be a useful tool responding to the needs of the contemporary shifting of priorities in FA-children's diet from quantity to quality. Nevertheless, it does not accurately reflect the intake of certain micronutrients potentially compromised by elimination diets. Therefore, regular nutritional assessment utilizing both the DQI-I and tools assessing individual nutrient intakes along with professional nutrition counseling should be integral parts of the individualized management of children with FA to ensure adequate nutrient intake and establish healthy dietary patterns.

Diet quality indices, genetic risk and risk of cardiovascular disease and mortality: a longitudinal analysis of 77 004 UK Biobank participants

ObjectivesTo examine associations of three diet quality indices and a polygenic risk score with incidence of all-cause mortality, cardiovascular disease (CVD) mortality, myocardial infarction (MI) and stroke.DesignProspective cohort study.SettingUK Biobank,...

Deteriorated Dietary Patterns with Regards to Health and Environmental Sustainability among Hungarian Roma Are Not Differentiated from Those of the General Population.

Nutritional epidemiology studies on Roma people are scarce and, to date, their nutrient-based dietary patterns with regards to both healthy and sustainable dietary considerations have never been reported. We report, for the first time, adherence to healthy and sustainable dietary patterns using scoring and regression models, based on recommendations defined by the World Health Organization, in the Dietary Approaches to Stop Hypertension (DASH) study and the EAT-Lancet report, as well as dietary quality based on Dietary Inflammatory Index (DII) among the Hungarian Roma (HR) population living in North East Hungary, with Hungarian general (HG) adults as reference. Data were obtained from a complex, comparative health survey involving dietary assessment, structured questionnaire-based interview, physical and laboratory examinations on 359 HG and 344 HR subjects in Northeast Hungary. Poisson regressions were fit to models that included DASH, EAT, DII and Healthy Diet Indicator as dependent variables to assess the influence of ethnicity on healthy and sustainable nutrient-based patterns. Adjusted models controlled for all relevant covariates using the residual method indicated poor dietary quality with regards to the selected dietary patterns. These associations were not ethnicity-sensitive, except for DII, where Roma ethnicity was linked to a decrease of DII score (β = −0.455, 95%CI: −0.720; −0.191, p < 0.05). Currently, HR dietary patterns appear to be relatively unhealthy and unsustainable, rendering them vulnerable to elevated risk of ill-health. Nevertheless, their dietary patterns did not strongly differ from HG, which may contribute to Hungarians being one of the most obese and malnourished nations in Europe. Further prospective research on the potential public and environmental health effects of these findings is warranted.

Genetic and Environmental Influences of Dietary Indices in a UK Female Twin Cohort.

A healthy diet is associated with the improvement or maintenance of health parameters, and several indices have been proposed to assess diet quality comprehensively. Twin studies have found that some specific foods, nutrients and food patterns have a heritable component; however, the heritability of overall dietary intake has not yet been estimated. Here, we compute heritability estimates of the nine most common dietary indices utilized in nutritional epidemiology. We analyzed 2590 female twins from TwinsUK (653 monozygotic [MZ] and 642 dizygotic [DZ] pairs) who completed a 131-item food frequency questionnaire (FFQ). Heritability estimates were computed using structural equation models (SEM) adjusting for body mass index (BMI), smoking status, Index of Multiple Deprivation (IMD), physical activity, menopausal status, energy and alcohol intake. The AE model was the best-fitting model for most of the analyzed dietary scores (seven out of nine), with heritability estimates ranging from 10.1% (95% CI [.02, .18]) for the Dietary Reference Values (DRV) to 42.7% (95% CI [.36, .49]) for the Alternative Healthy Eating Index (A-HEI). The ACE model was the best-fitting model for the Healthy Diet Indicator (HDI) and Healthy Eating Index 2010 (HEI-2010) with heritability estimates of 5.4% (95% CI [-.17, .28]) and 25.4% (95% CI [.05, .46]), respectively. Here, we find that all analyzed dietary indices have a heritable component, suggesting that there is a genetic predisposition regulating what you eat. Future studies should explore genes underlying dietary indices to further understand the genetic disposition toward diet-related health parameters.

Introducing a Suite of Low-Burden Diet Quality Indicators That Reflect Healthy Diet Patterns at Population Level.

ABSTRACTBackgroundFew low-burden indicators of diet quality exist to track trends over time at low cost and with low technical expertise requirements.ObjectiveThe aim was to develop and validate a suite of low-burden indicators to reflect adherence to global dietary recommendations.MethodsUsing nationally representative, cross-sectional, quantitative dietary intake datasets from Brazil and the United States, we tested the association of food-group scores with quantitative consumption aligned with 11 global dietary recommendations. We updated the Healthy Diet Indicator (HDI) to include current quantifiable recommendations of the WHO (HDI-2020). We developed 3 food-group–based scores—an overall Global Dietary Recommendations (GDR) score as an indicator of all 11 recommendations composed of 2 subcomponents: GDR-Healthy, an indicator of the recommendations on “healthy” foods, and GDR-Limit, an indicator of the recommendations on dietary components to limit. We tested associations between these scores and the HDI-2020 and its respective subcomponents. We developed 9 dichotomous food-group–based indicators to reflect adherence to the global recommendations for fruits and vegetables, dietary fiber, free sugars, saturated fat, total fat, legumes, nuts and seeds, whole grains, and processed meats. We conducted receiver operating characteristic and sensitivity-specificity analyses to determine whether the dichotomous indicators were valid to predict adherence to the recommendations in both countries.ResultsThe GDR score and its subcomponents were moderately to strongly associated with the HDI-2020 and its respective subcomponents (absolute values of rank correlation coefficients ranged from 0.55 to 0.66). Of the 9 dichotomous indicators, 8 largely met the criteria for predicting individual global dietary recommendations in both countries; 1 indicator (total fat) did not perform satisfactorily.ConclusionsFood-group consumption data can be used to indicate adherence to quantitative global dietary recommendations at population level. These indicators may be used to track progress of countries and populations toward meeting WHO guidance on healthy diets.

Adherence to healthy dietary patterns and its association with physical fitness in military personnel

IntroductionPoor nutritional status might impact in unintentional weight loss and decreased muscle mass and strength. The levels of physical fitness (PF) is a predictor of chronic diseases in future years....

The cost of diets according to nutritional quality and sociodemographic characteristics in Belgium

Abstract Introduction Prices of foods may influence purchases and therefore, the overall quality of diets. Our objective was to estimate cost variations according to the nutritional quality of diets and to identify sociodemographic characteristics associated with the cost differences in adults' diets. Methods Data from adults (N = 1,158; 18-64 years) included in the 2014-2015 Belgian National Food Consumption Survey were used. Dietary assessment was based on two 24-h dietary recalls and a food frequency questionnaire. The “Mediterranean Diet Score” (MDS) and the “Healthy Diet Indicator” (HDI) were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the 2014 GfK ConsumerScan panel food price data. Associations were estimated using linear regressions. Results The mean diet cost was 5.79€/day (SEM: 0.07). Adjusted for covariates and energy intake, it was significantly higher in the highest (T3) tercile of both scores than in the lowest tercile (T1) (MDS: T1=5.60€/d (0.09) vs. T3=6.03€/d (0.10); HDI: T1=5.42€/d (0.09) vs. T3=6.34€/d (0.10)). Higher intake of fruits, vegetables, fish, dairy products, vegetable oil, fibre and potassium and lower intake of free sugars were associated with higher diet cost. Both diet quality and cost were higher in 35-64-year-old (vs. 18-34 years), active (vs. students) and post-secondary education (vs. secondary education or lower) respondents. The association between quality and cost of diets was weaker in males and among individuals with higher education levels. Conclusions Healthier diets are more expensive than less healthy diets in Belgium. These findings contribute to a better understanding of social inequalities in diet in order to support public health policies and actions. Key messages Strategies need to be developed to improve the affordability to a healthy diet. In particular, messages promoting healthy diet targeted to the vulnerable populations should better consider the food cost.

Assessment and State of Nutrition of Patients with Gastroenteropancreatic Neuroendocrine Neoplasms.

Introduction: In recent decades, the number of gastro-entero-pancreatic neuroendocrine neoplasms (GEP-NENs) cases, associated with coexisting metabolic disorders, has been continuously increasing. Patients with progressing neoplastic disease are at a risk of malnutrition. To improve the quality of life of neuroendocrine neoplasms (NEN) patients, the therapeutic approach should be supported by a well-balanced diet. The aim of the study was to analyze the nutritional errors and deficits in a group of GEP-NET patients. Materials and methods: The study group included 26 GEP-NET patients; 13 men and 13 women. The mean age of women was 68.77 ± 8.0, and the mean age of men was 64.69 ± 8.1. Three interviews on consumption in the last 24 h were performed, in order to evaluate the quality and quantity of nutrition. The data was incorporated into a dietetics software, which allows one to calculate the number of over 58 micronutrients and macronutrients with the participation of 52 menus. Subsequently, the mean values were compared with the current nutritional standards. Results: An energy deficit was observed in the group of women—76.9%, and men—100%, as well as high fat consumption in 23.1% in both groups. The proportions of SFA/MUFA/PUFA were very negative, whereas the consumption of saccharose was too high. Vitamin D deficiency was observed in 100% of men and women. Moreover, both men and women experienced the deficiency of vitamin E, folates and niacin. The consumption of sodium and phosphorus was twice as high as recommended, and an insufficient supply of calcium was observed in 80% of women and 90% of men. The insufficient consumption of magnesium, iodine and potassium in a significant part of the studied group was observed. All participants consumed too much cholesterol and insufficient amounts of fiber. The healthy diet indicator (HDI) and diet quality index (DQI) scores were 3.1 ± 1.8 (HDI) and 3.7 ± 1.6 (DQI) for women, and 7.2 ± 2.6 (HDI) and 8.5 ± 2.4 (DQI) for men. Conclusions: When analyzing the nutrition of GEP-NET patients, we highlight that they do not have a proper diet, despite the fact that they changed the way they eat. Dietetics support and the development of official nutritional standards seem to be a necessary element in the therapy of GEP-NET patients.

0411 Association Between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men

Abstract Introduction Ageing is often accompanied by an increased prevalence of sleep problems. Healthy lifestyle choices, including diet, are especially important to mitigate such impairments. To date, little is known about how dietary patterns may link to measures of sleep quality in older subjects. Therefore, we investigated in a Swedish older male population, whether adherence to the Mediterranean Diet (MD) or the Healthy Diet Indicator (HDI; based on recommendations from the World Health Organization) is linked to a decrease in sleep disturbances. Methods We studied 970 men (age: 71 ± 1yr) from the ULSAM dataset. Sleep initiation or maintenance problems were evaluated by self-reporting questionnaires. Dietary intake was recorded with a pre-coded seven-day food diary. To calculate the adherence scores, intake of dietary components was assessed. Traditional MD components included fat quality, vegetables, fruits, cereals, fish, meat, dairy, and alcohol. The HDI components included saturated-, polyunsaturated fatty acids, proteins, carbohydrates, sucrose, fiber, fruits and vegetables, cholesterol, and fish. Reasonable dietary reporting was calculated to identify possible under- or over-reporters. Results When adjusted for potential confounders, no associations between dietary scores and sleep parameters were found. In contrast, low consumption of dairy products —one of the dietary features of the MD —was associated with better subjective sleep initiation. This association was, however, not found in men with adequate reports of daily energy intake (~54% of the cohort). Conclusion Our findings do not suggest that older men can mitigate perceived sleep problems by adhering to the MD or HDI. Whether low consumption of dairy products can facilitate sleep initiation must be confirmed in future studies by utilizing objective measures of sleep, such as polysomnography. Finally, when investigating associations between dietary patterns and sleep, particular attention should be paid to the potential confounder of inadequate reporting of energy intake. Support This research was funded by Novo Nordisk Foundation (NNF14OC0009349), Swedish Brain Foundation, Swedish Research Council (2015-03100), Åke Wiberg Foundation (M17-0088), Fredrik and Ingrid Thuring Foundation (2017-00313) and the Swedish Medical Research Society.

Food neophobia and its association with food preferences and dietary intake of adults.

To assess the association of food neophobia (FN) with food preferences, dietary intake and dietary quality. A cross-sectional study was conducted in a non-probabilistic sample of 229 Portuguese adults, aged 18 to 84 years. FN was measured with the FN Scale. Dietary intake over the previous 12 months was assessed by a validated semi-quantitative food frequency questionnaire. We defined a dietary pattern the Healthy Diet Indicator, to summarise the effects of overall dietary intake. Generalised linear models were performed to test associations in multivariate analyses (controlled for sex, age and education). FN was negatively associated with a general liking for the act of eating ( ) and with reduced preferences for specific foods (fruit and vegetables, some types of meat and fish and traditional Portuguese dishes with blood). Those with higher FN showed a lower consumption of fruits and vegetables, but a higher consumption of milk and codfish, a popular Portuguese ingredient. However, FN did not affect the macronutrients and energy intake, as well as sodium, added sugars and fibre intake. Adherence to a healthy dietary pattern was not significantly associated with FN. FN was associated with a decreased consumption and preference for specific foods, but it had no impact on a healthy dietary pattern.

Adequacy of Critical Nutrients Affecting the Quality of the Spanish Diet in the ANIBES Study.

Diet is one of the key modifiable behaviors that can help to control and prevent non-communicable chronic diseases. Therefore, it is important to evaluate the overall diet composition of the population through non-invasive and independent indexes or scores as diet quality indexes (DQIs). The primary aim of the present work was to estimate the adequacy of the intake of critical nutrients in the Spanish “Anthropometry, Intake, and Energy Balance Study” (ANIBES) (n = 2285; 9–75 years), considering, as a reference, the European Food Scientific Authority (EFSA) values for nutrients for the European Union. We also assessed the quality of the diet for adults and older adults using four internationally accepted DQIs, namely the Healthy Diet Indicator (HDI), the Mediterranean Diet Score (MDS), the Mediterranean Diet Score-modified (MDS-mod), and the Mediterranean-Diet Quality Index (MED-DQI), as well as the ANIBES-DQI, stratified by education and income. The ANIBES-DQI was based on compliance with EFSA and Food and Agriculture Organization recommendations for a selected group of nutrients (i.e., total fat, saturated fatty acids (SFAs), simple sugars, fiber, calcium, vitamin C, and vitamin A), with a total range of 0–7. Misreporting was assessed according to the EFSA protocol, which allowed us to assess the DQIs for both the general population and plausible reporters. The majority of the Spanish population had high intakes of SFAs and sugars and low intakes of fiber, folate, and vitamins A and C. In addition, about half of the population had low DQI scores and exhibited low adherence to the Mediterranean diet pattern. Overall, older adults (>65–75 years) showed better DQIs than adults (18–64 years), without major differences between men and women. Moreover, primary education and low income were associated with low MDS and ANIBES-DQI scores. For the ANIBES-DQI, the percentage of the population with low scores was higher in the whole population (69.5%) compared with the plausible energy reporters (49.0%), whereas for medium and high scores the percentages were higher in plausible reporters (41.2% vs. 26.2% and 9.8% vs. 4.3%, respectively). In conclusion, the present study adds support to marked changes in the Mediterranean pattern in Spain, and low education and income levels seem to be associated with a low-quality diet. Additionally, the misreported evaluation in the ANIBES population suggests that this analysis should be routinely included in nutrition surveys to give more precise and accurate data related to nutrient intake and diet quality.

A novel dietary inflammatory index reflecting for inflammatory ageing: Technical note.

ObjectiveChronic inflammation plays an important role in the development of several chronic diseases. Existing dietary inflammatory indexes require complicated calculations, which are difficult to use in clinical practice. We developed a new and simple index, based solely on the frequency of consumption of only 16 foods, to capture the inflammatory potential of diet.MethodsThe new index, an empirical dietary inflammatory index (eDII), is based on 8 pro-inflammatory and 8 anti-inflammatory components. First, in a validation study, 168 community-dwelling persons were invited to participate and an inflammatory aging disease (IAD) score of each participant was calculated by total number of IADs. Second, in the nutritional epidemiologic study, we calculated the eDII for 1464 participants and compared the eDII with healthy diet quality scores.ResultsIn a validation study, when subjects were classified by eDII tertile, a higher eDII was significantly associated with a higher IAD score. In the nutritional epidemiologic study, a higher eDII was inversely associated with the Mediterranean diet score, the World Health Organization's healthy diet indicator, and the American Heart Association's recommended healthy diet score.ConclusionsThe eDII is an easy and valid instrument to assess the inflammatory potential of dietary factors. This index is easy to use and does not require detailed estimations of nutrient intake.

The Consumption of Nuts is Associated with Better Dietary and Lifestyle Patterns in Polish Adults: Results of WOBASZ and WOBASZ II Surveys.

In recent years, the concept of the health benefits of synergistic dietary patterns as opposed to individual foods or food constituents has been developed. The aim of this study was to determine whether nut consumption is associated with healthier nutrition and lifestyle. The research was based on complete data obtained during two Polish National Multi-Centre Health Examination Surveys—WOBASZ (2003–2005) and WOBASZ II (2013–2014). Of the 12,946 participants who completed dietary assessments, 299 subjects reported consuming any quantity of whole nuts. A control group of 1184 non-nut consumers from both surveys was randomly selected for the study, with age, gender, study (WOBASZ, WOBASZ II), educational level, and season-related interactions taken into account. In this study, nut consumption was associated with favorable food and lifestyle choices, excluding smoking. Better dietary quality consisted of having a higher Healthy Diet Indicator score, an increased intake of polyphenols and antioxidants, lower intake of red meat, but higher of poultry and fruit, more frequent consumption of antiatherogenic food products, and less frequent consumption of processed meats. There was also greater interest in special diets, such as weight-loss diet. In addition, nut eaters were more physically active in their leisure time. While limited by 24-h recall of nut intake and possible misclassification of nut/non-nut consumer status, this research supports the synergistic health-promoting attitudes of those who were classified as nut consumers.

Association between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men: The ULSAM Study.

To date, little is known about how dietary patterns may link to measures of sleep quality in older subjects, who often suffer from sleep problems. Here, we investigated, in an older male population from Sweden (n = 970; aged 71 ± 1 year), whether adherence to the Healthy Diet Indicator (HDI; based on recommendations from the World Health Organization) or the Mediterranean Diet (MD) is linked to sleep disturbances. The diet scores were calculated using a seven-day food diary, and self-reported sleep initiation or maintenance problems were assessed by questionnaires. When adjusted for potential confounders, no associations between dietary scores and sleep parameters were found. In contrast, low consumption of milk and dairy products —one of the dietary features of the MD —was associated with better subjective sleep initiation. This association was, however, not found in men with adequate reports of daily energy intake (~54% of the cohort). To summarize, our findings do not suggest that older men can mitigate perceived difficulties to fall and stay asleep by adhering to either the HDI or MD. Whether low consumption of milk and dairy products can facilitate sleep initiation must be confirmed in future studies by utilizing objective measures of sleep such as polysomnography. Finally, when investigating associations between dietary patterns and sleep, particular attention should be paid to the potential confounder of inadequate reporting of energy intake.

Associations between dietary patterns at age 71 and the prevalence of sarcopenia 16 years later

The growing recognition of the significance of sarcopenia has highlighted the need to understand etiologic factors, where food intake likely plays a role. The aim was to investigate the association between dietary patterns at mean age 71 and the prevalence of sarcopenia at mean age 87 in a Swedish cohort of community dwelling men. Dietary habits were assessed using a 7-day food record. Adherences to official dietary guidelines, defined by the World Health Organization (WHO) by using the Healthy Diet Indicator, and Mediterranean-like dietary habits by using the Mediterranean Diet Score, were calculated. Sarcopenia was determined using the definition from the European Working Group on Sarcopenia in Older People (EWGSOP) and associations to each dietary pattern were analyzed using logistic regression, adjusted for potential confounders. Our study population included 254 men, mean age 71at baseline, and 53 (21%) were defined as sarcopenic 16 years later. There was no linear relationship between increased adherence to WHO dietary guidelines and future prevalence of sarcopenia, although those with medium adherence seemed to be protected (crude OR=0.41, 95% CI 0.19-0.92). On the other hand, an inverse relationship to sarcopenia was found for each SD increment in the Mediterranean diet score (crude OR=0.68, 95% CI 0.46-0.99), which remained after adjusting for potential confounders. Sensitivity analysis indicated relationships to be independent of changes in physical activity and dietary misreporting. In this prospective study of elderly men, using a single measure of diet at age 71 as a reflection of habitual dietary habits, healthy dietary patterns tended to protect against the development of sarcopenia over 16 years. In particular, we found indications that increased adherence to a Mediterranean dietary pattern might be advantageous.

Physical frailty in older men: prospective associations with diet quality and patterns.

increasing numbers of older adults are living with frailty and its adverse consequences. We investigated relationships between diet quality or patterns and incident physical frailty in older British men and whether any associations were influenced by inflammation. prospective study of 945 men from the British Regional Heart Study aged 70-92 years with no prevalent frailty. Incident frailty was assessed by questionnaire after 3 years of follow-up. Frailty was defined as having at least three of: low grip strength, low physical activity, slow walking speed, unintentional weight loss and feeling of low energy, all based on self-report. The Healthy Diet Indicator (HDI) based on WHO dietary guidelines and the Elderly Dietary Index (EDI) based on a Mediterranean-style dietary intake were computed from questionnaire data and three dietary patterns were identified using principal components analysis: prudent, high fat/low fibre and high sugar. men in the highest EDI category and those who followed a prudent diet were less likely to become frail [top vs bottom category odds ratio (OR) (95% CI) 0.49 (0.30, 0.82) and 0.53 (0.30, 0.92) respectively] after adjustment for potential confounders including BMI and prevalent cardiovascular disease. No significant association was seen for the HDI. By contrast those who had a high fat low fibre diet pattern were more likely to become frail [OR (95% CI) 2.54 (1.46, 4.40)]. These associations were not mediated by C-reactive protein (marker of inflammation). the findings suggest adherence to a Mediterranean-style diet is associated with reduced risk of developing frailty in older people.

Factors Associated with Alzheimer's Disease: An Overview of Reviews.

Alzheimer's disease (AD) is a frequent pathology, with a poor prognosis, for which no curative treatment is available in 2018. AD prevention is an important issue, and is an important research topic. In this manuscript, we have synthesized the literature reviews and meta-analyses relating to modifiable risk factors associated with AD. Smoking, diabetes, high blood pressure, obesity, hypercholesterolemia, physical inactivity, depression, head trauma, heart failure, bleeding and ischemic strokes, sleep apnea syndrome appeared to be associated with an increased risk of AD. In addition to these well-known associations, we highlight here the existence of associated factors less described: hyperhomocysteinemia, hearing loss, essential tremor, occupational exposure to magnetic fields. On the contrary, some oral antidiabetic drugs, education and intellectual activity, a Mediterranean-type diet or using Healthy Diet Indicator, consumption of unsaturated fatty acids seemed to have a protective effect. Better knowledge of risk factors for AD allows for better identification of patients at risk. This may contribute to the emergence of prevention policies to delay or prevent the onset of AD.

The World Health Organization's Healthy Diet Indicator and its associated factors: A cross-sectional study in central Kinki, Japan.

The Healthy Diet Indicator (HDI), which is based on adherence to World Health Organization's (WHO) nutrition guidelines, is used worldwide. In 2015, the WHO updated the Fact Sheet for their recommended healthy diet. We investigated diet quality assessed by the updated HDI (HDI-2015) and factors related to adherence to this diet in a Japanese population. We conducted a cross-sectional study of 1370 participants from 8 workplaces, 1 college, and 2 communities. All participants completed a brief-type self-administered diet history questionnaire. The HDI-2015 assesses 7 components: fruits and vegetables, total fat, saturated fatty acid, polyunsaturated fatty acid, free sugar, dietary fiber, and potassium. Only 6.6% of subjects demonstrated high adherence to HDI-2015 (met ≥6 components), whereas 52.0% demonstrated moderate adherence (4–5 components), and 41.4% demonstrated low adherence (0–3 components). Male sex, older age, and regular physical activity were associated with higher adherence. The contemporary Japanese population has an overall low diet quality as evaluated by the updated HDI score. Improving adherence to healthier dietary patterns may promote better health in Japan.

Diet-Quality Indexes Are Associated with a Lower Risk of Cardiovascular, Respiratory, and All-Cause Mortality among Chinese Adults

Diet-quality indexes have been associated with a lower risk of chronic disease mortality in Western populations, but it is unclear whether these indexes reflect protective dietary patterns in Asian populations. We examined the association between Alternative Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and Healthy Diet Indicator (HDI) scores and the risk of all-cause cardiovascular disease (CVD), cancer, and respiratory disease mortality. We used data from a prospective cohort of 57,078 Singapore Chinese men and women (aged 45-74 y) who were free of cancer and CVD at baseline (1993-1998) and who were followed up through 2014. The diet-quality index scores were calculated on the basis of data from a validated 165-item food-frequency questionnaire. Cox regression models with adjustment for potential confounders including sociodemographic and lifestyle variables, body mass index, and medical history were used to estimate HRs and 95% CIs. During a total of 981,980 person-years of follow-up, 15,262 deaths (CVD: 4871; respiratory: 2690; and cancer: 5306) occurred. Comparing the highest with the lowest quintiles, the multivariable adjusted HRs (95% CIs) for all-cause mortality were 0.82 (0.78, 0.86) for AHEI-2010, 0.80 (0.76, 0.85) for aMED, 0.80 (0.75, 0.84) for DASH, and 0.88 (0.83, 0.92) for HDI scores (all P-trend<0.001). Higher diet index scores were associated with a 14-28% lower risk of CVD and respiratory mortality, but only a 5-12% lower risk of cancer mortality. Higher consumption of vegetables, fruit, nuts, and long-chain n-3 (ω-3) fatty acids, lower consumption of red meat, and avoidance of high alcohol consumption were the diet index components associated with a lower risk of mortality. Adherence to several recommended dietary patterns that emphasize healthy plant-based foods was associated with a substantially lower risk of chronic disease mortality in an Asian population. The Singapore Chinese Health Study was registered at www.clinicaltrials.gov as NCT03356340.