Mediterranean-Style Dietary Pattern Score Research Articles

Habitual Dietary Patterns, Nutrient Intakes, and Adherence to the Mediterranean Diet among New Zealand Adults: The NZ MED Cross-Sectional Study.

There is increasing evidence that adherence to a Mediterranean dietary pattern reduces the incidence of diet-related diseases. To date, the habitual dietary intake of New Zealand (NZ) adults has not been examined in relation to its alignment with a Mediterranean-style dietary pattern. This study aimed to define the habitual dietary patterns, nutrient intakes, and adherence to the Mediterranean Diet in a sample of 1012 NZ adults (86% female, mean age 48 ± 16 years) who had their diabetes risk defined by the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK). Dietary intakes were collected using a validated semi-quantitative NZ food frequency questionnaire, and dietary patterns were identified using principal component analysis. Reported intakes from the FFQ were used in conjunction with the Mediterranean-Style Dietary Pattern Score (MSDPS) to determine adherence to a Mediterranean dietary pattern. Mixed linear models were used to analyze the association between dietary patterns and MSDPS with demographics, health factors, and nutrient intakes. Two distinct dietary patterns were identified: Discretionary (positive loadings on processed meat, meat/poultry, fast food, sweet drinks, and sugar, sweets, and baked good) and Guideline (positive loadings on vegetables, eggs/beans, and fruits). Adherence to dietary patterns and diet quality was associated with age and ethnicity. Dietary patterns were also associated with sex. Adherence to a Mediterranean dietary pattern defined by the MSDPS was low, indicating that a significant shift in food choices will be required if the Mediterranean Diet is to be adopted in the NZ population.

The association between Dietary Phytochemical Index and Mediterranean-style Dietary Pattern Score with the risk of cataract

BackgroundHalf of all cases of blindness are due to cataract. It has been debated whether diets high in polyphenols and antioxidants reduce the risk of cataract. In the present case-control study, we aimed to evaluate the possible association between cataract risk and diet, using calculations of the Dietary Phytochemical Index (DPI) and Mediterranean-style Dietary Pattern Score (MSDPS). Methods157 patients with senile cataract were compared to 323 controls who had undergone eye examination during the past year and were not diagnosed with cataract. A validated food frequency questionnaire measured the participant’s habitual diet. The risk of cataract for MSDPS and DPI was assessed by crude and adjusted odds ratios based on multivariate logistic regression analysis, accounting for age and sex. ResultsAnalysis was performed on 157 cases and 323 controls. Age, weight, and energy intake significantly differed between the two groups. MSDPS (p = 0.003) and DPI (p = 0.04) were higher in the patients with cataract. A significant association was found regarding DPI in the crude model, indicating that participants of the third quartile of DPI are at 2.34 times higher risk of cataract than the participants in the first quartile (OR: 2.34, 95% CI= 1.34; 4.09). ConclusionsMSDPS was not significantly associated with cataract risk in crude and adjusted models, although an ascending trend could be observed (p-trend of the crude model= 0.05). A positive association between DPI and cataract risk was found, while this association was not significant for MSDPS. Further studies among newly diagnosed patients with cataract are required.

Adherence to a priori dietary patterns in relation to obesity: results from two cycles of the Canadian National Nutrition Survey.

To test whether adherence to the Mediterranean diet, the Dietary Approaches to Stop Hypertension (DASH) or a dietary pattern in-line with the 2015-2020 Dietary Guidelines for Americans (DGA) was associated with obesity. 24-h dietary recall data from the Canadian Community Health Survey (CCHS)-Nutrition, 2004 and 2015 cycles, were analysed. Diet quality index scores were computed for the Mediterranean-Style Dietary Pattern Score (MSDPS), a DASH index and the 2015 Dietary Guidelines for Americans Adherence Index (DGAI). Higher scores indicated greater adherence. Association between scores and obesity was examined using logistic regression, adjusting for age, sex, physical activity, smoking status, sequence of dietary recall and alcohol and energy intake. Canada (excluding territories and the institutionalised population). Canadian adults (≥ 18 years), non-pregnant and non-breast-feeding; 11 748 from CCHS 2004 and 12 110 from CCHS 2015. The percentage of females in each sample was 50 %. Mean MSDPS, DASH and DGAI scores were marginally but significantly higher in CCHS 2015 than in CCHS 2004. Those affected by obesity obtained lower scores for all indexes in CCHS 2004 (OR 10th v. 90th percentile for DASH: 2·23 (95 % CI 1·50, 3·32), DGAI: 3·01 (95 % CI 1·98, 4·57), MSDPS: 2·02 (95 % CI 1·14, 3·58)). Similar results were observed in CCHS 2015; however, results for MSDPS were not significant (OR 10th v. 90th percentile for DASH: 2·45 (95 % CI 1·72, 3·49), DGAI: 2·73 (95 % CI 1·85, 4·03); MSDPS: 1·30 (95 % CI 0·82, 2·06)). Following DASH or the 2015-2020 DGA was associated with a lower likelihood of obesity. Findings do not indicate causation, as the data are cross-sectional.

Association between adherence to the Mediterranean diet with anthropometric measurements and nutritional status in adolescents.

adolescence is a critical period for developing healthy eating habits. It is crucial to evaluate and encourage adherence to the Mediterranean diet, a sustainable and healthy diet model in this age group. this study aimed to evaluate the relationship between adherence to the Mediterranean diet and anthropometric measurements and nutritional status in Turkish adolescents. the demographic characteristics, health information, nutritional habits, physical activity status, and 24-hour dietary recall of the adolescents were obtained with a questionnaire. Adherence to Mediterranean diet was evaluated with the Mediterranean-Style Dietary Pattern Score (MSDPS). a total of 1,137 adolescents (mean age 14.0 ± 1.37 years) were included; 30.2 % of the boys and 39.5 % of the girls were overweight/obese. The median (interquartile range) value of the MSDPS was 10.7 (7.7), and this value was 11.0 (7.6) for the boys and 10.6 (7.4) for the girls (p > 0.05). The levels of protein, fiber, vitamin A, vitamin C, folate, vitamin B12, iron, magnesium, zinc, and potassium intake increased with adherence to Mediterranean diet (p < 0.001). Age, parental education level, body mass index (BMI), waist circumference, and skipping meals affected MSDPS. adolescents' adherence to the Mediterranean diet was low and correlated with some anthropometric measures. Increasing adherence to the Mediterranean diet may contribute to preventing obesity and adequate and balanced nutrition in adolescents.

Comparison and convergent validity of five Mediterranean dietary indexes applied to Brazilian adults and older adults: data from a population-based study (2015 ISA-Nutrition).

Different dietary indexes are proposed to investigate adherence to the Mediterranean diet (MD). However, they are based on different methodologies, and limited research has compared them to each other, particularly in non-Mediterranean populations. We aimed to compare five indexes intended to measure adherence to the MD. The sample was composed of adults and older adults (n 1187) from 2015 ISA-Nutrition, a cross-sectional population-based study in São Paulo, SP, Brazil. Dietary data obtained through two 24-h dietary recalls (24HDR) from which the Mediterranean diet scale (MDS), Mediterranean diet Score (MedDietscore), Mediterranean dietary pattern (MDP), Mediterranean Adequacy Index (MAI) and Mediterranean-Style Dietary Pattern Score (MSDPS) were calculated. The correlations and agreements between them were analysed by Spearman's correlation and linearly weighted Cohen's Kappa coefficients, respectively. Confirmatory factor analyses (CFAs) were applied to investigate their convergent validity. The highest correlations were found between MDP and MAI (r = 0⋅76; 95% CI 0⋅74-0⋅79) and between MDP and MDS (r = 0⋅72; 95% CI 0⋅69-0⋅75). The greatest agreements observed were moderate, between MDP v. MAI (κ = 0⋅57, P < 0⋅001) and MDP v. MDS (κ = 0⋅48, P < 0⋅001). The goodness-of-fit of CFA for MedDietscore (RMSEA = 0⋅033, 90% CI 0⋅02-0⋅042; SRMR = 0⋅042) and MSDPS (RMSEA = 0⋅028, 90% CI 0⋅019-0⋅037; SRMR = 0⋅031) had acceptable values for absolute fit indices. Vegetables, olive oil, MUFA:SFA ratio and cereals with legumes were more relevant to characterise the MD (factor loadings ≥0⋅50). The MDS, MAI and MDP classified the population similarly, but the MedDietscore showed better performances in evaluating adherence to the MD. These results provided guidance for the most appropriate Mediterranean dietary index to be applied in non-Mediterranean populations.

Adherence to Mediterranean-Style Dietary Pattern and Risk of Bladder Cancer: A Case-Control Study in Iran

Few dietary patterns are related to reduce the Bladder Cancer (BC) risk. One of the well-known dietary patterns is the Mediterranean diet (MD). This case-control study investigated the association between MD and the odds of BC among Iranian population. The present case-control study was performed on 103 eligible cases and 200 controls age 45 to 92 years. Diet of participants was assessed by a validated 168-item food frequency questionnaire (FFQ). Adherence to MD was measured by Mediterranean-Style Dietary Pattern Score (MSDPS). Multivariate logistic regression was used to estimate the relationship between MSDPS and risk of BC. After controlling for potential confounders, a negative association was observed between MSDPS and risk of BC (OR = 0.22; 95%CI = 0.09–0.52; p trend = 0.001). Furthermore, significant negative associations were observed for dairy, fish and other seafood, whole-grain, bread intake and risk of BC (p for trend < 0.05). In contrast, the risk of BC increased for high intake of poultry (OR = 1.09; 95%CI = 1.03–1.15; p trend = 0.003), sweets (OR = 1.24; 95%CI = 1.03–1.48; p trend = 0.018) and egg (p for trend = 0.01). Our results suggested that dietary habit in concordance with the principles of the Mediterranean dietary pattern may protect against BC.

Mortality and Life Expectancy Lost in Canada Attributable to Dietary Patterns: Evidence From Canadian National Nutrition Survey Linked to Routinely Collected Health Administrative Databases.

Using 5 diet quality indexes, we estimated the mortality and life expectancy lost, at the national level, attributable to poor dietary patterns, which had previously been largely unknown. We used the Canadian Community Health Survey 2004, linked to vital statistics (n= 16,212 adults; representing n= 22,898,880). After a median follow-up of 7.5 years, 1,722 deaths were recorded. Population attributable fractions were calculated to estimate the mortality burden of poor dietary patterns (Dietary Guidelines for Americans Adherence Index 2015, Dietary Approaches to Stop Hypertension, Healthy Eating Index, Alternative Healthy Eating Index, and Mediterranean Style Dietary Pattern Score). Better diet quality was associated with a 32%-51% and 21%-43% reduction in all-cause mortality among adults aged 45-80 years and≥20 years, respectively. Projected life expectancy at 45 years was longer for Canadians adhering to a healthy dietary pattern (average of 5.2-8.0 years (men) and 1.6-4.1 (women)). At the population level, 26.5%-38.9% (men) and 8.9%-22.9% (women) of deaths were attributable to poor dietary patterns. Survival benefit was greater for individuals with higher scores on all diet indexes, even with relatively small intake differences. The large attributable burden was likely from assessing overall dietary patterns instead of a limited range of foods and nutrients.

Adherence to the Mediterranean-style diet and high intake of total carotenoids reduces the odds of frailty over 11 years in older adults: Results from the Framingham Offspring Study

The benefit of a Mediterranean-style diet in reducing frailty is not well established in older Americans. We sought to determine associations of a Mediterranean-style dietary pattern and related antioxidants with frailty onset and worsening of the Fried phenotype in adults. This prospective study included 2384 nonfrail adults from the Framingham Offspring Study with a Mediterranean-style dietary pattern score (MSDPS) and data on antioxidant intakes (vitamin C, E, and total carotenoids) estimated from an FFQ at the index examination (1998-2001) and 1 prior examination (if available), as well as a frailty assessment at the index examination and at least 1 follow-up. Frailty onset was defined as ≥3 of 5 Fried frailty phenotype criteria at follow-up and the worsening of the Fried frailty phenotype was defined as an increased number of frailty criteria over follow-up (yes or no). Logistic regression with generalized estimating equations estimated ORs and 95% CIs, adjusting for confounders. Analyses were stratified by age (<60 and ≥60 years) for significant interactions. The mean ± SD age was 60 ± 9 years (range, 33-86 years) and 55% were female. In adjusted models, a 1-unit higher MSDPS reduced the odds of frailty by 3% (OR, 0.97; 95% CI: 0.96-0.99). Each 10-mg higher total carotenoid and vitamin E intake reduced the odds of frailty by 16% (OR, 0.84; 95% CI: 0.73-0.98) and 1% (OR, 0.99; 95% CI: 0.98-1.00), respectively. No association with vitamin C (P = 0.36) was observed. The associations among participants aged <60 years of age were stronger for each 1-unit higher MSDPS (OR, 0.93; 95% CI: 0.89-0.96) and total carotenoid intake (OR, 0.59; 95% CI: 0.41-0.82) than those observed in older individuals [ORs, 0.98 (95% CI: 0.97-1.00) and 0.92 (95% CI: 0.79-1.08), respectively]. Our findings suggest that adherence to a Mediterranean-style diet and higher total carotenoid intake are associated with frailty prevention over time, particularly in adults <60 years.

Development and validation of a cardiovascular disease risk-prediction model using population health surveys and dietary indices: the Cardiovascular Disease Population Risk Tool – Nutrition (CVDPoRT-Nutrition).

ObjectivesOnly a few cardiovascular risk prediction models have been developed based on modifiable exposures and even fewer utilize complex dietary factors. Our objective was to develop and validate the Cardiovascular Disease Population Risk Tool (CVDPoRT)-Nutrition as a tool for estimating 5-year risk of incident cardiovascular disease (CVD) using lifestyle factors and dietary pattern scores.&#x0D; ApproachThe CVDPoRT developed and validated using the Canadian Community Health Survey (CCHS) linked with health administrative databases was modified to remove limited measures of dietary intakes (i.e., fruit and vegetable, potato, and juice intake frequency) and instead incorporate 5 different dietary pattern scores (i.e., Dietary Guidelines for Americans Adherence Index, Dietary Approaches to Stop Hypertension, Healthy Eating Index, Alternative HEI, and Mediterranean Style Dietary Pattern Score). Outcome data (i.e., CVD events and CVD-related mortality) came from linkage with the Canadian Vital Statistics – Death Database and Discharge Abstract Database. CVDPoRT-Nutrition was tested in 61 policy-relevant subgroups.&#x0D; ResultsPerformance after adding in each dietary pattern score was similar to the original CVDPoRT (Brier score=2.6%, Harrell’s c-stat=0.87(0.85-0.88) for female models; Brier score=1.6%, Harrell’s c-stat=0.82(0.81-0.84) for male models). The algorithm was calibrated in 53 (female models) and 57 (male models) of 61 policy relevant subgroups. The most important predictors of CVD and CVD-related mortality were age, sex, and smoking.&#x0D; ConclusionAltering the dietary measures included in the CVDPoRT algorithm did not greatly improve the predictive capacity. The original CVDPoRT can continue to be used for predicting CVD and CVD-related mortality, while CVDPoRT-Nutrition may be used for predicting CVD incidence associated with poor dietary patterns.

Associations of the Mediterranean-Style Dietary Pattern Score with Coronary Artery Calcification and Pericardial Adiposity in a Sample of US Adults.

Several studies have identified improvements in the risks of cardiovascular disease in adults following a Mediterranean dietary pattern. However, data are scarce on its association with coronary artery calcification (CAC) and pericardial adiposity (PAT) in US adults with and without diabetes. To address this gap, we conducted a case-control study using baseline data from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study [n = 1255; Type 1 Diabetes (T1D): n = 563; non-Diabetes Mellitus (non-DM): n = 692]. Participants completed a validated food frequency questionnaire, fasting (12 h overnight fast) biochemical analyses, and a physical examination including anthropometric measures. CAC and PAT were measured using electron beam-computed tomography. Logistic regression models were used to examine the associations of the Mediterranean-Style Dietary Pattern Score (MSDPS) with CAC (presence or absence), and linear regression models were applied to PAT analyses. In all of the adjusted models, no significant associations with CAC were found. For PAT, an increasing MSDPS was consistently associated with its lower volume in models adjusted for age, sex, diabetes status, total calories, and body mass index (all p < 0.05). The association between MSDPS and PAT was attenuated after adjusting for serum lipids and physical activity. In conclusion, the baseline data from the CACTI study show that a greater adherence to MSDPS is associated with a lower PAT volume and provide evidence that the Mediterranean dietary pattern is associated with lower cardiovascular risk markers.

Adherence to a Mediterranean-Style Dietary Pattern and Cancer Risk in a Prospective Cohort Study.

A Mediterranean-style diet is a healthy eating pattern that may benefit cancer risk, but evidence among Americans is scarce. We examined the prospective association between adherence to such a diet pattern and total cancer risk. A Mediterranean-style dietary pattern (MSDP) score was derived from a semi-quantitative food frequency questionnaire at exam 5 (1991–1995). Subjects included 2966 participants of the Framingham Offspring Study who were free of prevalent cancer. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for demographic, lifestyle, and anthropometric measures. Cox-models were also used to examine effect modification by lifestyle and anthropometric measures. During 18 years of median follow-up, 259 women and 352 men were diagnosed with cancer. Women with moderate or higher adherence to the MSDP had ≥25% lower risks of cancer than women with the lowest MSDP (HR (moderate vs. lowest): 0.71, 95% CI: 0.52–0.97 and HR (highest vs. lowest): 0.74; 95% CI: 0.55–0.99). The association between MSDP score and cancer risk in men was weaker except in non-smokers. Beneficial effects of the MSDP in women were stronger among those who were not overweight. In this study, higher adherence to MSDP was associated with lower cancer risk, especially among women.

Mediterranean Diet Is Associated with Lower Breast Cancer Risk in the Framingham Offspring Cohort Study

Abstract Objectives We examined the prospective association between a Mediterranean diet pattern using four separate a priori indices of adherence and breast cancer risk in the Framingham Offspring (FOS) cohort. Methods The four indices included in this study reflect two different approaches to measuring adherence to a Mediterranean diet: a. scores based on population food intake distributions (i.e., the alternate Mediterranean Diet (aMED) and Mediterranean Diet (MDS) score); and b. scores based on recommended intakes of relevant foods (i.e., Mediterranean Style Dietary Pattern (MSDP) and Mediterranean Diet (MeDiet) scores). The scores were derived from a semi-quantitative food frequency questionnaire. Subjects included 1703 women, aged 30 years old and older, who were free of prevalent cancer. Each score was classified into three categories (low, moderate, and high) to evaluate the association between the Mediterranean diet and breast cancer risk (overall, post-menopausal, and hormone receptor positive) from 1991 through 2014. Cox proportional-hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for confounding by age, physical activity, waist-to-height ratio, pack-years of cigarette smoking, supplement use, diabetes status, age at menopause and total calorie intake. Results During a median follow-up of approximately 18 years, 93 breast cancer cases were documented. Women in the highest category of MSDP score or MeDiet score had approximately 45% lower breast cancer risks than women in the lowest categories (MSDP high category HR:0.56, 95% CI: 0.33–0.94; MeDiet high category HR: 0.55, 95% CI: 0.31–0.98). This effect was similar for post-menopausal breast cancer cases. In addition, the high (vs. low) MeDiet score was associated with 55% decreased risk of hormone receptor positive breast cancer (HR:0.45, 95% CI:0.23–0.87). Neither of the scores calculated on the basis of dietary intakes in the study population (i.e., aMED, MDS) was associated with breast cancer risk. Conclusions In this large prospective cohort, scores based on recommended intakes of relevant Mediterranean diet foods may lead to strong evidence of the inverse relation between a Mediterranean dietary pattern and incidence of breast cancer among women aged 30 years old or older in the US. Funding Sources The Framingham Heart Study.

Total Carotenoid Intake Reduces the Odds of Frailty over 9 Years in Older Adults: Results from the Framingham Offspring Study

Abstract Objectives Frailty occurs in 10–15% of community-living older adults. The benefit of a Mediterranean style diet in reducing frailty is not well established in older Americans. The aim was to determine the association of Mediterranean-Style Dietary Pattern and related antioxidants (vitamin C, E and total carotenoids from diet and supplements) with the odds of frailty over 9y in older adults from the Framingham Offspring study. Methods The Mediterranean-style dietary pattern score (MSDPS) was used to characterize a Mediterranean-style diet in 2541 men and women with completed food frequency questionnaires at baseline (1998–2001). Average intake of each antioxidant (vitamin C, E and total carotenoids, mg/d) at baseline and one prior exam (1995–98) was calculated. Total carotenoids were calculated as the sum of intake of α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein and zeaxanthin. Frailty was assessed using Fried's frailty criteria at baseline and follow-up exam (2005–08). Participants categorized as frail at baseline were excluded (n = 27). Logistic regression was used to calculate odds ratios and 95% confidence intervals (95% CI) adjusting for age, sex, follow-up time, BMI, energy intake, current smoking and multivitamin use. Antioxidants were adjusted for each other in the same model. Results Mean age (±SD) was 60 ± 9y (range 33–86), 55% were female and mean follow-up time was 6.6y (range 3.7–9.1). Mean (±SD) was 45 ± 13 (range: 10.8–84.1) for the MSDPS, 36.5 (±32.3) mg/d for vitamin C, 16.4 (±199) mg/d for vitamin E and 1.8 (±0.8) mg/d for carotenoids. Prevalent frailty at follow-up exam was 5%. Although not significant, a 10 unit increase in MSDPS reduced the odds of frailty by 8.7% (95% CI: 0.78–1.08, P = 0.28) in the combined sample of men and women. Each 10 mg increase in total carotenoid intake reduced the odds of frailty by 29% (95% CI: 0.53–1.01, P = 0.02). Neither Vitamin C (P = 0.79) or E (P = 0.25) were individually associated with frailty. Conclusions A Mediterranean style diet was not significantly associated with frailty in this sample of largely older adults. However, total carotenoids intake reduced the odds of frailty. Future work should consider if a Mediterranean style diet and related antioxidants delay the progression of frailty. Funding Sources Boston Claude D. Pepper Center OAIC and Peter and Barbara Sidel Fund.

Healthy Eating Index-2010 and Mediterranean-Style Dietary Pattern Score and the risk of colorectal cancer and adenoma: a case–control study

Background: Several studies have examined the relationship between diet quality indices and colorectal cancer (CRC). However, data on the association of these indices and colorectal adenomas (CRA) as a precursor of CRC are scarce. Our objective was to investigate the association of Healthy Eating Index (HEI-2010) and Mediterranean-Style Dietary Pattern Score (MSDPS) with CRC and CRA risk.Methods: This is a hospital-based case–control study including 259 cases (129 CRC and 130 CRA patients) and 240 controls with non-neoplastic conditions. Dietary intake of subjects was examined using a valid and reliable food frequency questionnaire. The HEI-2010 and MSDPS were then calculated based on a-priori methods. Multivariate logistic regression analyses were conducted to estimate the relationship between HEI-2010 and MSDPS and the risk of CRC and CRA.Results: After adjustment for confounders, compared with the first tertiles, the highest tertiles of HEI-2010 and MSDPS were significantly associated with lower odds of CRC (OR = 0.04; 95% CI = 0.01–0.12, OR = 0.19; 95% CI = 0.09–0.38, respectively). Similarly, the highest tertiles of HEI-2010 (OR = 0.04; 95% CI = 0.08–0.32) and MSDPS (OR = 0.19; 95% CI = 0.17–0.58) were associated with reduced odds of CRA compared to the lowest tertiles.Conclusion: The findings of this study suggested that a high-quality diet assessed by HEI-2010 and MSDPS is inversely associated with the risk of CRC and CRA.

Changes in the Dietary Patterns of Canadian Adults and Likelihood of Obesity: Results from the Canadian Community Health Survey-Nutrition, Cycles 2004 and 2015 (P18-035-19)

ObjectivesHealthy dietary patterns are associated with reduced risk of non-communicable diseases. The relationship between healthy dietary patterns and obesity has not been examined over time at the national level in Canada. The objective of this research was to adopt three diet quality indexes: the Mediterranean-Style Dietary Pattern Score (MSDPS), the Dietary Guidelines for Americans 2015 Adherence Index (DGAI), and a Dietary Approaches to Stop Hypertension (DASH) index to nationally-representative survey data to examine the relationship between these dietary patterns and obesity MethodsIndex scores were computed for adults (≥18 years) using 24-hr dietary recall data from two cross-sectional samples of the Canadian Community Health Survey-Nutrition [CCHS; 2004 (n = 11,748) and 2015 (n = 12,110)]. The National Cancer Institute method was used to estimate usual intake. The association between index scores and likelihood of obesity was examined using weighted multivariate logistic regression with adjustment for age, sex, energy intake, physical activity and smoking status. Odds ratios (OR) and 95% confidence intervals (CI) were reported at the midpoint of each quintile with the 90th percentile as reference. ResultsIn CCHS 2004, estimated mean MSDPS, DASH and DGAI scores were 12.43 ± 0.14 out of 100, 44.18 ± 0.29 out of 90 and 8.82 ± 0.05 out of 19; in CCHS 2015, scores were 13.9 ± 0.13 out of 100, 44.99 ± 0.25 out of 90 and 8.99 ± 0.04 out of 19 respectively. Low scores for all indexes was associated with a greater likelihood of being obese in CCHS 2004 (OR 10th vs. 90th percentile for DGAI: 3.01, CI: 1.98–4.57; DASH: 2.23, CI: 1.50–3.32; MSDPS: 2.02, CI: 1.14–3.58). Similar results were observed in CCHS 2015, however results for MSDPS were not significant (OR 10th vs. 90th percentile for DGAI: 2.73, CI: 1.85–4.03; DASH: 2.45, CI: 1.72–3.49; MSDPS: 1.30, CI: 0.82–2.06). ConclusionsThis research is the first to examine changes in the dietary patterns of Canadians using multiple cycles of national health survey data. Our findings suggest that DASH and Dietary Guidelines for Americans-type dietary patterns may be favourable interventions for the prevention of obesity among Canadian adults, however more research is required. Funding SourcesSupported by grants from the Burroughs Wellcome Fund Innovation in Regulatory Science Award and the Canadian Institutes of Health Research.

Index-Based Dietary Patterns and the Risk of Prostate Cancer among Iranian Men

Background and objective:The second most common cancer in men after lung cancer is prostate cancer (PC). Previous studies assessed the association between food items or food groups and the risk of PC, but diet quality indices are unique approaches to study any relations between diet and disease. Our objective was to investigate the effect of healthy eating index (HEI-2010) and Mediterranean-Style Dietary Pattern Score (MSDPS) on PC risk.Methods:In this case-control study, we recruited 97 patients with MS and 205 control subjects . Dietary intake was evaluted using a valid and reliable food frequency questionnaire. The HEI and MSDPS were calculated. Logistic regression was used to evaluate the relationship between HEI and MSDP scores and PC risk after adjusting the confounders.Results:In comparison to controls, cases had lower score on HEI (61 vs. 70.07; P< 0.001), and higher score on MSDP (26.20 vs. 24.49; P= 0.44). After comparing the highest and the lowest tertile of HEI, we observed a significant decreasing trend in the risk of PC (p for trend<0.001).Conclusion:Our findings suggested that a high quality diet, according to HEI, may decrease the risk of PC.

The association between nutrition knowledge and adherence to a Mediterranean dietary pattern in Iranian female adolescents.

Adherence to a Mediterranean dietary pattern (MDP) has been reported to decrease chronic diseases. The aim of the present study was to determine the association between nutrition knowledge (NK) and adherence to MDP in Iranian female adolescents. This cross-sectional study was conducted on 297 female adolescents aged 15-18 years. The participants were interviewed using a valid and structured questionnaire to collect information on socio-demographic, lifestyle and anthropometric variables. Dietary intakes were assessed using a validated 168-item Food Frequency Questionnaire (FFQ). Adherence to MDP was measured by the Mediterranean-Style Dietary Pattern Score (MSDPS). Each participant's NK was determined using a 20-item NK questionnaire. The mean ± standard deviation (SD) age and body mass index (BMI) of participants were 16.1 ± 0.9 years and 22.3 ± 4.6 kg/m2, respectively. The median [interquartile range (IQR)] of the NK score and the MSDPS were 80.0 (68.0-87.0) and 15.2 (11.9-19.5), respectively. The odds ratio (OR) of higher adherence to MDP in the highest tertile of the NK score was 2.19 [95% confidence interval (CI): 1.22-3.95; p for trend = 0.009], compared to the lowest tertile after adjusting for age and energy intake. In a multivariable-adjusted model, after further adjustment for BMI, mother's/father's education level, mother's/father's employment status, parent's marital status and physical activity, the subjects in the highest tertile of the NK score had higher adherence to MDP compared with those in the lowest tertile (OR = 2.05; 95% CI, 1.09-3.83; p for trend = 0.013). Our findings support the hypothesis that a higher NK score is significantly associated with a higher MDP adherence score in Iranian female adolescents.

Mortality attributable to poor dietary patterns in Canada: Evidence from the nationally-representative nutrition survey linked with health administrative data

IntroductionDietary pattern modeling and linkage with health outcomes is essential for development of evidence-based dietary guidelines to support reduction of chronic diseases. National nutrition surveys are not routinely linked with health administrative databases, resulting in a lack of evidence on the health impact of unhealthy diets at the population level.&#x0D; Objectives and ApproachThis study is the first to use a nationally-representative nutrition survey (i.e., Canadian Community Health Survey-Nutrition-2004) linked with health administrative databases to examine the association of 5 key dietary quality indices with mortality risk. In total, 16,212 adults ≥20 years were followed for an average of 7.3 years. Two 24-hour dietary recalls were used to estimate the usual dietary intakes using the National Cancer Institute’s method. Weighted regression calibration was performed to obtain a true parameter relating diet (continuous) to mortality. Population Attributable Fractions were calculated to estimate the burden of all-cause mortality attributable to poor dietary patterns in Canada.&#x0D; ResultsThe 5 dietary quality indices examined were Dietary Approaches to Stop Hypertension(DASH); Dietary Guidelines for Americans Adherence Index 2015(DGAI); Healthy Eating Index-2010(HEI); Alternative HEI-2010(AHEI); and Mediterranean Style Dietary Pattern Score(MSDPS). Having a better diet quality (90%ile vs. 10%ile of index score) was associated with a significant 31-51% reduction in all-cause mortality hazard ratio among adults 45 to 80 years and 10-35% reduction in those ≥20 years (in order of significance: DASH, DGAI, HEI, AHEI and MSDPS). Survival benefit was incrementally greater for higher diet quality scores; however, even the 90%ile scores (Reference) were notably lower than the recommended levels (45.99% of recommended score). On average, 26.42% of all mortality in Canada was attributable to poor dietary patterns (range: 19.01% for MSDPS to 31.39% for DGAI).&#x0D; Conclusion/ImplicationsThe diet-attributable burden of mortality was higher than those reported for other behavioural risks (e.g., smoking). This research informs future formulation of nutrition interventions and policies with a focus on dietary patterns. This project demonstrates the importance of leveraging linked data and analytical capacity to inform future evidence-based nutrition policies.

Adherence to Mediterranean dietary pattern in female adolescents

PurposeTo the best of our knowledge, the studies on determining adherence to the Mediterranean dietary pattern (MDP) in Iran as a non-Mediterranean country are scarce. Thus, the aim of the study is to determine the adherence to the MDP in a sample of female adolescents who are residents of Tehran, Iran.Design/methodology/approachIn this cross-sectional study, 263 female adolescents aged 15-18 years were studied. Information on socio-demographic, lifestyle and anthropometric variables were obtained using a structured questionnaire. Also, dietary intakes were determined using a validated 168-item food frequency questionnaire. Adherence to MDP was characterized using Mediterranean-style dietary pattern score (MSDPS).FindingsTypically, the mean ± SD MSDPS was low in the present study (15.9 ± 5.6). The mean ± SD age and body mass index of the study population was 16.2 ± 0.9 years and 22.2 ± 4.1 kg/m2, respectively. In this study, the maximum MSDPS was 34.3, which was only one-third of maximum possible score (100). Multiple linear regression analyses showed that higher MSDPS scores were positively associated with age (standardized β = 0.1; p = 0.006), higher energy intake (standardized β = 0.2; p < 0.001) and marginally higher physical activity (standardized β = 0.1; p = 0.079).Originality/valueUnderstanding low adherence to MDP in Tehranian female adolescents can provide basic knowledge to launch systematic programmes for gravitation toward MDP.

Adherence to Mediterranean dietary pattern and depression, anxiety and stress among high-school female adolescents

BACKGROUND: Few studies have shown the protective effects of Mediterranean Dietary Pattern (MDP) in psychological disorders. OBJECTIVE: This cross-sectional study was designed to determine the association between adherence to MDP and depression, anxiety and stress among female adolescents aged 16.20±0.97 in Tehran, Iran. METHODS: Data from 263 participants were analyzed. Adherence to MDP was determined using Mediterranean-Style Dietary Pattern Score (MSDPS). Depression, anxiety and stress scores were characterized by DASS-21 (Depression Anxiety Stress Score-21 items) questionnaire. RESULTS: Multivariable logistic regression was used to determine the prevalence of depression, anxiety, and stress across quintiles of MSDPS. After adjustment for age, the odds ratio (OR) for depression in the highest quintile of MSDPS was 0.44 (95% confidence interval [95%CI], 0.19–0.95), (P for trend = 0.009) compared to the lowest quintile. After additional adjustment for BMI, energy intake, physical activity, ethnicity, parents education level and total family income, subjects in the highest quintile had a 59% lower prevalence of depression compared to those in the lowest quintile of MSDPS (OR = 0.41;95% CI, 0.17–0.97), (P for trend = 0.010). However, the MSDPS was not significantly associated with the presence of anxiety and stress. CONCLUSION: Adherence to MDP is associated with a reduced presence of depressive symptoms in female adolescents.