Tertile Of Adherence Research Articles

Diet quality patterns and chronic kidney disease incidence: a UK Biobank cohort study.

Only a few studies have investigated the role of diet on the risk of chronic kidney disease (CKD) in European populations and have mainly focused on the Mediterranean diet. This is the first study to evaluate the association between various diet quality indices and CKD incidence in British adults. A prospective cohort with 106,870 participants from the UK Biobank, followed from 2009 to 2012 through 2021. Food consumption was obtained from ≥2 24-h dietary assessments. Dietary patterns were assessed using previously established indices: Alternate Mediterranean Index (aMED), Alternative Healthy Eating Index 2010, dietary approaches to stop hypertension (DASH), healthful plant-based diet index (hPDI), unhealthful plant-based diet index (uPDI), and dietary inflammatory index (DII). Incident CKD was obtained from clinical records, death registries, and self-reports. Analyses were performed with Cox regression models and adjusted for the main confounders. After a median follow-up of 9.27 y, 2934 cases of CKD were ascertained. Hazard ratios (95% confidence interval) of CKD for the highest compared with lowest tertile of adherence to each diet score were 0.84 (0.76, 0.93) for aMED, 0.94 (0.85, 1.03) for alternative healthy eating index 2010, 0.77 (0.70, 0.85) for DASH, 0.79 (0.72, 0.87) for hPDI, 1.27 (1.16, 1.40) for uPDI, and 1.20 (1.18, 1.33) for DII. The results were robust in sensitivity analyses. In British adults, higher adherence to the aMED, DASH, and hPDI patterns was associated with a lower risk of CKD, whereas greater adherence to the uPDI and DII patterns was associated with greater risk.

Patterns of beverages consumption and prevalence of non-communicable chronic diseases.

Beverages consumption influences diet quality in general and has been associated with the development of non-communicable chronic diseases (NCCD). We aimed to verify the association between beverage consumption patterns and the prevalence of NCCD. A cross-sectional household and population-based study was conducted with 489 individuals aged 20 years and older. The presence of NCCD (arterial hypertension, diabetes, cancer and hypercholesterolemia) was obtained by self-report, while obesity was diagnosed by measuring body weight, height and waist circumference. Beverage consumption patterns were obtained by principal component analysis. The association between beverages patterns and the prevalence of NCCD was verified using Poisson regression, expressed as prevalence ratio (PR) and adjusted for potential confounding factors. Three beverage patterns were identified: ‘ultra-processed beverages’, ‘alcoholic beverages’ and ‘healthy beverages’. Individuals with greater adherence to the Ultra-processed Beverages Pattern had a 2·77 times higher prevalence of cancer (PR: 3·77; 95 % CI 1·57, 9·07). Higher adherence to the Alcoholic Beverages Pattern was associated with a higher prevalence of obesity (PR: 1·97; 95 % CI 1·13, 3·44). In contrast, individuals in the second tertile of adherence to the Healthy Beverages Pattern had a 39 % lower prevalence of hypercholesterolemia (PR: 0·61; 95 % CI 0·40, 0·92), and individuals in the third tertile had a 10 % lower prevalence of abdominal obesity estimated by the waist-to-height ratio (PR: 0·90; 95 % CI 0·83, 0·97). Beverage consumption patterns may be associated with a higher prevalence of NCCD, regardless of other risk factors. It is therefore important to conduct more studies investigating the impact of beverages patterns on health.

Association of dietary patterns with sarcopenia in adults aged 50years and older.

Although numerous studies have investigated the impact of dietary factors on the prevention of decreased muscle mass and function, limited research has examined the relationship between dietary patterns and sarcopenia. This study aimed to assess the associations between dietary patterns, and sarcopenia, muscle strength, and mass in adults following a Mediterranean diet residing in southern Italian cities. This cross-sectional study utilized data from an existing database, comprising 528 individuals aged 50years or older who underwent health-screening tests at the Clinical Nutrition Unit of the "R.Dulbecco" University Hospital. Strength was assessed through handgrip strength, and appendicular skeletal muscle mass was estimated using bioelectrical impedance analysis. Dietary intake information was collected through a food frequency questionnaire linked to the MetaDieta 3.0.1 nutrient composition database. Principal Component Analysis, a statistical technique identifying underlying relationships among different nutrients, was employed to determine dietary patterns. Multinomial logistic regression analysis was conducted to estimate the odds ratio for sarcopenia or low handgrip strength in relation to the lowest tertile of dietary pattern adherence compared to the highest adherence. The participants had a mean age of 61 ± 8years. Four dietary patterns were identified, with only the Western and Mediterranean patterns showing correlations with handgrip strength and appendicular skeletal muscle mass. However, only the Mediterranean pattern exhibited a correlation with sarcopenia (r = - 0.17, p = 0.02). The highest tertile of adherence to the Mediterranean dietary pattern demonstrated significantly higher handgrip strength compared to the lowest tertile (III Tertile: 28.3 ± 0.5kg vs I Tertile: 26.3 ± 0.5kg; p = 0.01). Furthermore, even after adjustment, the highest tertile of adherence to the Mediterranean pattern showed a significantly lower prevalence of sarcopenia than the lowest adherence tertile (4% vs 16%, p = 0.04). The lowest adherence to the Mediterranean dietary pattern was associated with increased odds of having low muscle strength (OR = 2.38; p = 0.03; 95%CI = 1.05-5.37) and sarcopenia (OR = 9.69; p = 0.0295; %CI = 1.41-66.29). A high adherence to the Mediterranean dietary pattern, characterized by increased consumption of legumes, cereals, fruits, vegetables, and limited amounts of meat, fish, and eggs, is positively associated with handgrip strength and appendicular skeletal muscle mass. The highest adherence to this dietary model is associated with the lowest odds of low muscle strength and sarcopenia. Despite the changes brought about by urbanization in southern Italy compared to the past, our findings continue to affirm the superior benefits of the Mediterranean diet in postponing the onset of frailty among older adults when compared to other dietary patterns that are rich in animal foods.

Association of Mediterranean and DASH Diets Adherence with Dyslipidemia: A Cross-Sectional Study

Background: Some dietary patterns like Dietary Approaches to Stopping Hypertension (DASH) and/or Mediterranean Diet (MED) are often recommended to prevent Cardio Vascular Diseases (CVDs) based on their effects on lipid profile. Thus, we aimed to investigate the relationship between the DASH diet score and Mediterranean diet score with lipid profile in healthy individuals aged 20-50 years in Shiraz, Iran. Methods: In this cross-sectional study, 236 participants were selected from Shiraz (Iran) medical centers through random cluster sampling. Information about food intake was collected using a 168-item Food Frequency Questionnaire (FFQ), then DASH score and MED diet score were calculated. Logistic regression was used to evaluate the relation between DASH and MED score adherence and lipid profile. Results: Individuals in the highest tertile of MED and DASH pattern adherence had significantly lower Low-Density Lipoprotein (LDL) compared with those in the first tertile (p<0.05). In both crude and adjusted model, higher adherence to the MED pattern was associated with reduced odds of Total Cholesterol (TC) (OR: 0.30; 95% CI: 0.13–0.66 and OR: 0.27; 95% CI: 0.12–0.61) and LDL (OR: 0.36; 95% CI: 0.17–0.77 and OR: 0.32; 95% CI: 0.15–0.70). Moreover, higher adherence to the DASH pattern was associated with reduced OR of LDL in crude (OR: 0.43; 95% CI: 0.19–0.94) and TC in adjusted model (OR: 0.44; 95% CI: 0.20–0.96). Conclusion: The study illustrated a negative association between the MED diet and serum levels of TC and LDL. Also, a higher DASH score was associated with lower TC. Future studies are necessary to confirm these findings.

Abstract 48: Associations of Diet and Physical Activity With Biological Aging Among US Adults: National Health and Nutrition Examination Survey 1999-2018

Background: Behavioral lifestyle factors are promising for prevention of numerous diseases and mortality risk by contributing to overall healthy ageing. Healthy diet and regular physical activity have been associated with longer telomere length, indicating younger biological aging. More recently, algorithm-based measurements of biological aging, which integrate information across panels of molecular or clinical indicators, have proven both more technically reliable and more precise in their predictions of morbidity and mortality than telomere length. The aim of this study was to examine the association of diet, physical activity, and their interaction with biological ageing measured by PhenoAge blood chemistry algorithm. Methods: This study included adult participants (≥20 years-old) from the National Health and Nutrition Examination Survey (NHANES), 1999-2018. We evaluated adherence to a Mediterranean diet (MeDi) and level of leisure time physical activity (LTPA) using standard instruments. We measured biological aging using the PhenoAge algorithm, developed using data from NAHNES III (1988-1994) and validated as a predictor of morbidity/mortality in the NHANES data we analyzed. We defined PhenoAge advancement as the difference between biological age derived from eight blood biomarkers and chronological age, with higher score indicating being biologically older. We evaluated the associations of MeDi and LTPA with PhenoAge in adjusted linear regressions. We explored synergies between these two health behaviors and heterogeneity in their associations across strata of sex age, gender, and body mass index (BMI). Results: In total, 38,617 participants (mean age 47.1 years, 51% women) were included. Both higher adherence to MeDi and higher level of LTPA were associated with lower PhenoAge advancement, in mutually adjusted model controlled for demographic, socioeconomic and lifestyle variables (β = 0.15 SD [95% CI, -0.18; -0.11] for high vs low tertile of adherence to MeDi, and β = 0.12 SD [-0.15; -0.09] for high LTPA level vs sedentarity). The associations of diet and physical activity phenotypes with biological aging were independent and additive (p-interaction >0.05). Stratified analyses indicated consistent significant associations across strata of age, gender, and BMI, although stronger associations were observed among women and participants with normal weight than among their respective counterparts for MeDi (p-interaction = 0.001 and 0.04, respectively) and among older participants for LTPA (p-interaction <0.001). Sensitivity analysis using the Healthy Eating Index 2015 did not change the results. Conclusion: Healthy diet and regular physical activity are independently associated with lower clinically defined biological aging, regardless of age, sex, and BMI category.

Maternal Adherence to a Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern and the Relationship to Breast Milk Nutrient Content.

Maternal lifestyle factors, such as diet and nutritional status are likely to affect the composition of breast milk (BM). This study aimed to investigate the association between adherence to a Dietary Approaches to Stop Hypertension (DASH) dietary pattern (DP) and BM nutrient content. A total of 700 milk samples were obtained from 350 lactating women. The dietary intakes of the women in the study were estimated using a validated food frequency questionnaire, which included 65 food items. The total antioxidant activity (TAC) of BM samples was evaluated using the Ferric reducing antioxidant power (FRAP), 2,2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARS), and Ellman's assay. Also using commercially available kits, the total protein, calcium, and triglyceride contents in milk were determined. Individuals in the 3rd tertile of adherence to the DASH diet (highest adherence) consumed more dietary fiber, fruits, vegetables, nuts, legumes, and seeds, low-fat dairy, whole grain, less red and processed meat, sweetened beverages, and sodium than those in the first tertile (lowest adherence). Subjects in the 3rd tertile of DASH DP had higher values of milk DPPH and calcium compared to those in the first tertile (P < 0.05). Milk MDA and triglyceride were significantly lower in the 3rd tertile of DASH diet versus the first tertile (P < 0.05). Our study showed that high adherence to the DASH DP was associated with higher BM DPPH and calcium levels and lower amounts of BM MDA and triglyceride. The adherence to the healthy DPs such as the DASH can improve the quality of BM in lactating women.

No association between infant growth and adherence to the dietary approaches to stop hypertension (DASH) diet in lactating women.

Breastmilk is considered an optimal food for infant development especially during the first 6 months of life. However, little evidence exists regarding maternal dietary intake and infant growth. We evaluated how adherence to the DASH diet in lactating women is associated with the infant weight, height and head circumference at birth, 2 and 4 months of age. A cross-sectional study. The present study was conducted with 292 lactating mothers and their infants. A validated and reliable 168-item food frequency questionnaire (FFQ) was used to assess mothers' dietary intakes. To evaluate adherence to the DASH diet among lactating mothers, we scored food items based on the Fung method. Lactating mothers in the highest tertile of adherence to the DASH diet consumed significantly lower amounts of fat, cholesterol, salt, red and process meats and higher amounts of vitamin C, B1, B9, whole grains, low-fat dairy, fruits, vegetables and dietary fiber compared to lactating mothers in the lowest tertile (P < 0.05). No significant association was found between mothers' adherence to the DASH dietary pattern and any of the infant growth indices (P > 0.05). Lactating mothers' adherence to the DASH diet was not associated with growth indices among exclusively breastfed infants.

Plant-based diets and risk of frailty in community-dwelling older adults: the Seniors-ENRICA-1 cohort

Frailty is a geriatric syndrome that leads to increased risk of hospitalization, disability, and death. The effect of plant-based diets defined by the quality of their plant foods is unclear. Our objective is to study the association between two plant-based diet indices and the occurrence of frailty among community-dwelling older adults in Spain. We analyzed data from 1880 individuals aged ≥ 60 years from the Spanish Seniors ENRICA-1 cohort. We used a validated diet history to build two indices: (a) the healthful Plant-based Diet Index (hPDI) where healthy plant foods received positive scores, whereas less-healthy plant foods and animal foods received reverse scores; and (b) the unhealthful Plant-based Diet Index (uPDI), with positive scores to less-healthy plant foods and reverse scores to animal and healthy plant foods. Incident frailty was defined with the Fried phenotype. Study associations were summarized with odds ratios (OR) and 95% confidence intervals (CI) obtained from multivariable logistic models. After 3.3 years of follow-up, 136 incident frailty cases were ascertained. Comparing the highest vs. the lowest tertile of adherence, the OR [95% CI] for frailty was 0.43 (0.25–0.74; p-trend = .003) for the hPDI, and 2.89 (1.73–4.84; p-trend < .001) for the uPDI. Higher consumption of healthy plant foods was inversely associated with frailty (0.39 [0.23–0.66; p-trend < 0.001]); higher consumption of unhealthy plant foods was associated with higher frailty risk (2.40 [1.23–4.71; p-trend = .01]). In older adults, the hPDI was associated with lower risk of frailty, while the opposite was found for the uPDI.

Morning chronotype is associated with higher adherence to the Mediterranean diet in a sample of Italian adults

Background and aimsA growing body of evidence has associated subjects with an evening chronotype with worse eating behaviours and poorer diet quality. However, only few studies have investigated the relationship between chronotype and Mediterranean diet (MD). The aim of this study was to better understand the chronotype influence on dietary habits and MD adherence in a large sample of Italian adults. Methods and resultsA total of 1247 participants (66.7% women) with a mean age of 36.1 ± 14.6 years were included in the analysis. Chronotype was classified as morning in 35.6% of subjects, intermediate in 56.7%, and evening in 7.1%. Regarding meal frequency, evening subjects showed a significantly (p < 0.05) greater tendency to skip breakfast (20.5%) than morning (6.9%) and intermediate (12%) subjects. Similarly, evening subjects were found to skip mid-morning snack more often than morning subjects (59.1% vs. 47.1%; p = 0.04), and lunch more often than intermediate subjects (8% vs. 2.8%; p = 0.01). In addition, all meals were eaten by evening subjects at a significantly delayed time, except for lunch. As to MD adherence a significant (p < 0.001) higher adherence in morning subjects (10.1 ± 2.2) compared to intermediate (9.5 ± 2.1) and evening (9.5 ± 2.2) subjects was observed. At a logistic regression analysis adjusted for possible confounding factors, morning subjects showed an increased probability (OR 1.54, 95%CI 1.19–1.99; p < 0.001) of being in the highest MD adherence tertile. ConclusionChronotype was associated with MD adherence. In particular, morning subjects showed higher MD adherence than intermediate and evening subjects.

Adherence to Mediterranean Diet of Breastfeeding Mothers and Fatty Acids Composition of Their Human Milk: Results From the Italian MEDIDIET Study.

Background and AimsThe content of fatty acids (FA) in human milk may be influenced by maternal nutrition. We evaluated the role of a Mediterranean diet in influencing the content of FA in human milk among 282 breastfeeding mothers participating in the MEDIDIET study.Materials and MethodsMediterranean Diet Score (MDS), a composite index, was used to evaluate adherence to the Mediterranean diet. It includes 9 components (i.e., vegetables, fruit, cereals, legumes, monounsaturated to saturated FA ratio – MUFA/SFA, fish, dairy products, meat, and alcohol) and therefore potentially ranges from 0 (no adherence) to 9 (complete adherence) points. None of the mothers obtained the highest score due to the low alcohol consumption in the study population. Mothers were categorized in approximate tertiles of adherence: 0–3 (34.4%), 4 (26.2%), and 5–8 points (39.4%). The mean content of FA across categories of MDS was compared using ANOVA and test for trend.ResultsA high adherence of breastfeeding mothers to the Mediterranean diet was associated with lower content of SFA in human milk (42.58 ± 4.36 for MDS = 0–3, 42.58 ± 4.89 for MDS = 4, and 40.92 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend = 0.02). Conversely, a high adherence was associated with higher content of MUFA in human milk (43.27 ± 4.27 for MDS = 0–3, 43.27 ± 4.47 for MDS = 4, and 45.24 ± 5.22% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), ω-3 FA (1.07 ± 0.25 for MDS = 0–3, 1.22 ± 0.49 for MDS = 4, and 1.31 ± 0.51% of fats for MDS = 5–8 points; p ANOVA and p for trend < 0.01), and the major types of ω-3 FA (i.e., α-linolenic acid – ALA, eicosapentaenoic acid – EPA, docosahexaenoic acid – DHA, docosapentaenoic acid – DPA). These associations were mainly driven by the adherence to the vegetables, MUFA/SFA, fish, and dairy products components of the Mediterranean diet.ConclusionA high adherence to the Mediterranean diet was associated with human milk showing a lower content of SFA and higher content of MUFA and ω-3 FA, including DHA. The Mediterranean diet may contribute in human milk production with higher content of specific FA which is directly involved in infant’s neural and visual development, as reported by previous studies.

The Environmental Footprint Associated With the Mediterranean Diet, EAT-Lancet Diet, and the Sustainable Healthy Diet Index: A Population-Based Study.

Providing a growing global population with healthy and sustainable diets is an immediate challenge. In the current study, estimates were obtained for the environmental footprints (land, water, and greenhouse gas (GHG) emissions) in association with the Mediterranean diet (MED) and the EAT-Lancet reference diet, which represents a healthy diet derived from sustainable food systems. We used a newly developed Sustainable Healthy Diet (SHED) index that was validated for the Israeli population by Tepper et al. in 2020.MethodsA group of 525 participants were recruited via social media, email, and phone. Demographic characteristics, quality of life, and answers to the SHED-index questionnaire were obtained. Dietary assessment was performed using the 116-item Food Frequency Questionnaire (FFQ), which was developed for the Israeli population. Adherence to the MED was calculated using a 9-point score. Adherence to the EAT-Lancet reference diet was assessed through the consumption of 14 food components. The environmental pressure of these dietary patterns was determined based on the “footprint family indicators,” which include land, water, and carbon footprints per unit of agricultural and food products. We assigned values for each food comprising the FFQ and calculated the environmental load for each dietary pattern. Statistical analyses were performed using the R package version 4.1.1 to compare environmental footprint values according to tertiles of the MED score, EAT-Lancet score, and SHED score.ResultsThe participants (n = 525) were 49% women, educated (82% had academic education), and physically active, and only 13% were smokers. The highest tertiles of adherence to the MED, adherence to the EAT-Lancet reference diet, and the SHED index were associated with the lowest GHG emissions and land use, as well as higher water use. Meat consumption contributed the most to land use, while dairy contributed the most to GHG emissions, and fruits contributed the most to water use.ConclusionsOur analysis reveals that animal protein is the highest contributor to GHG emissions and land use, while fruits and vegetables contribute the most to water consumption. Nevertheless, most of the fruits and vegetables are grown using treated wastewater, which reduces environmental pressure. Given these findings, we suggest that MED and EAT-Lancet dietary patterns should be included in national dietary guidelines.

Adherence to the Mediterranean diet and incident frailty: Results from a longitudinal study

ObjectivesThe aim of the current prospective study was to examine the relationship between adherence to the Mediterranean diet and incident frailty. Study design1075 Greek community-dwelling older adults from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) were included in the present longitudinal analysis. Main outcome measuresAdherence to the Mediterranean diet was evaluated through the MedDietScore, calculated from the information participants provided on a validated food frequency questionnaire. Frailty was assessed using two multidomain tools: the Frailty Index (FI) and the Tilburg Frailty Indicator (TFI). Analysis of the incidence of frailty as a function of the baseline MedDietScore was performed using Cox proportional hazards models. Additionally, Generalized Estimating Equations (GEE) models were used to explore whether the baseline MedDietScore was associated with the change in the total number of frailty criteria met by participants over time. In testing for a dose–response association between Mediterranean diet and frailty, the MedDietScore was treated either as a continuous variable or as tertiles of low, medium and high adherence to MeDi. Results176 and 131 participants developed incident frailty, as measured with the FI and TFI respectively. Each unit of MedDietScore was associated with a 5% (ΗR 0.95, 95% CI 0.91–0.99, p = 0.012) and 10% (ΗR 0.90, 95% CI 0.86–0.95, p ≤ 0.001) decrease in the risk of incident frailty when measured with the FI and TFI respectively. Compared with participants reporting low adherence to the Mediterranean diet (lowest tertile), those with high adherence (highest tertile) had a 41% (ΗR 0.59, 95% CI 0.38–0.91, p = 0.017) and a 57% (ΗR 0.43, 95% CI 0.27–0.70, p ≤ 0.001) lower risk of incident frailty as measured with the FI and TFI respectively. After excluding from the analyses participants diagnosed with dementia at baseline or follow-up, the same results were obtained: each unit of MedDietScore was associated with a 5% (HR 0.95 CI 0.91–0.99, p = 0.023) and a 10% (HR 0.90 CI 0.86–0.94, p ≤ 0.001) decrease in the risk of incident frailty as measured with the FI and TFI respectively. ConclusionsThe present longitudinal study showed that non-frail community-dwelling older adults with high adherence to the Mediterranean dietary pattern had a significantly lower incidence of frailty.

Dietary Patterns and Nonmotor Symptoms in Parkinson’s Disease: A Cross-Sectional Analysis

Objective Evidence-based treatment for nonmotor symptoms in Parkinson’s disease (PD) is limited. Lifestyle-based improvements including dietary changes may be a potential management strategy. The intent of this research was to investigate the extent to which 3 dietary indices (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay [MIND], Dietary Inflammation Index [DII], and Healthy Diet Indicator [HDI-2020]) are associated with overall and individual nonmotor symptom severity among individuals with PD. Method An exploratory cross-sectional analysis of dietary (food frequency questionnaire) and clinical data was undertaken, including measures of overall nonmotor symptom severity, such as fatigue, depression, anxiety, apathy, sleep problems, daytime sleepiness, and cognitive impairment. The relationship between each dietary score and symptom outcome was assessed by linear regression for continuous variables and through general linear model analysis for tertiles of dietary adherence. Results None of the dietary indices significantly predicted the total nonmotor symptom severity score. The HDI predicted a significant decrease in fatigue scores as measured by the NeuroQoL fatigue item (standardized β = −.19, p = 0.022), after adjusting for age, sex, energy intake, years since diagnosis, physical activity level, education, and smoking. Self-reported depression symptoms reduced by .17 (standardized β) for each unit increase in HDI score (p = 0.035), after controlling for age, gender, energy intake, and years since diagnosis. No other significant associations were evident between dietary scores and any other nonmotor symptoms. Conclusions Our results indicate that fatigue and depression in PD may be modified by diet; however, more research is needed using a larger sample to replicate these findings. Supplemental data for this article is available online at https://doi.org/10.1080/07315724.2022.2056544 .

Favorable association between Mediterranean diet (MeD) and DASH with NAFLD among Iranian adults of the Amol Cohort Study (AmolCS)

Nonalcoholic fatty liver disease (NAFLD) is an emerging cause of chronic liver diseases and a major health problem worldwide. Dietary patterns may play a critical role in controlling and preventing this disease, but the available evidence is scarce. The current study aims to ascertain the association of adherence to the Dietary Approach to Stop Hypertension (DASH) diet and Mediterranean diet (MeD) with nonalcoholic fatty liver disease (NAFLD) among Iranian adults of the Amol Cohort Study (AmolCS). In a cross-sectional analysis among 3220 adults (55.3% men), age ≥ 18 years (46.96 ± 14.67), we measured usual dietary intake with a validated food frequency questionnaire (FFQ) and then calculated dietary pattern scores for DASH and MeD. Sociodemographic and lifestyle factors were collected by a structured questionnaire. The presence and degree of NAFLD were also determined by abdominal sonography. Multiple regression models were used to estimate NAFLD odds across tertiles of DASH and Mediterranean dietary scores. Dietary DASH and Mediterranean components were adjusted for total energy intake, based on the residual methods. After adjusting for multiple potential confounders, we found an inverse association of DASH and MeD with NAFLD (Ptrend = 0.02, and Ptrend = 0.002, respectively). Those in the highest tertiles of adherence to the DASH and MeD had the lowest risk for NAFLD (OR = 0.80, 95%CI = 0.66–0.96, OR = 0.64, 95%CI = 0.52–0.78, respectively). The results of logistic analysis of MeD, stratified by gender and abdominal obesity, revealed the favorable association was more pronounced in women (OR = 0.42, 95%CI = 0.29–0.61, Ptrend = 0.004), and in participants with or without abdominal obesity (OR = 0.62, 95% CI = 0.47–0.81, Ptrend = 0.03, OR = 0.64, 95%CI = 0.475–0.91, Ptrend = 0.04, respectively). Similar results were obtained for the adherence to DASH diet score with the prevalence of NAFLD patients with abdominal obesity (OR = 0.75, 95% CI = 0.57–0.97, Ptrend = 0.04). The findings suggested the favorable association between DASH and MeD with NAFLD in Iranian adults, especially women and subjects with or without abdominal obesity. Further prospective investigations are needed to confirm the integrity of our findings.

Adherence to Mediterranean diet and attention-deficit/hyperactivity disorder in children: A case control study.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders. The Mediterranean diet as a plant-based diet has a beneficial effect on mental health. The present study was designed to investigate the association between adherence to Mediterranean diet and odds of ADHD in Iranian children. This age and gender matched case-control study was conducted on 360 children 7-13 years old in Yazd, Iran. Children were categorized into new diagnosed case (n=120) and control groups (n=240). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV-TR) was used to diagnose ADHD. A validated food frequency questionnaire was used to measure food intake. The association of adherence to the Mediterranean with the odds ratio of ADHD examined by logistic regression. After adjusting for potential confounders including energy intake, parents' educational level, economic status, family history ADHD and physical activity, the children in the highest tertile of adherence to Mediterranean diet had a lower odd of ADHD (odds ratio [OR]: 0.49; 95% Confidence Interval [CI]: 0.27-0.89) compared to the children in the lowest. In addition, an association was observed between increasing trend adherence to Mediterranean diet and decrease odds of ADHD after full adjustments (P for trend <0.001). We found that higher adherence to Mediterranean diet containing vegetables, legumes, fruits and nuts, grains, and fish could decrease the odds of ADHD in primary school children. Further studies are suggested to approve our vision.

Mediterranean, DASH, and MIND Dietary Patterns and Cognitive Function: The 2-Year Longitudinal Changes in an Older Spanish Cohort.

Background and Aims: Plant-forward dietary patterns have been associated with cardiometabolic health benefits, which, in turn, have been related to cognitive performance with inconsistent findings. The objective of this study was to examine the relationship between baseline adherence to three a priori dietary patterns (Mediterranean, DASH, and MIND diets) with 2-year changes in cognitive performance in older adults with overweight or obesity and high cardiovascular disease risk.Methods: A prospective cohort analysis was conducted within the PREDIMED-Plus trial, involving 6,647 men and women aged 55–75 years with overweight or obesity and metabolic syndrome. Using a validated, semiquantitative 143-item food frequency questionnaire completed at baseline, the dietary pattern adherence scores were calculated. An extensive neuropsychological test battery was administered at baseline and 2-year follow-up. Multivariable-adjusted linear regression models were used to assess associations between 2-year changes in cognitive function z-scores across tertiles of baseline adherence to the a priori dietary patterns.Results: Adherence to the Mediterranean diet at baseline was associated with 2-year changes in the general cognitive screening Mini-Mental State Examination (MMSE, β: 0.070; 95% CI: 0.014, 0.175, P-trend = 0.011), and two executive function-related assessments: the Trail Making Tests Part A (TMT-A, β: −0.054; 95% CI: −0.110, − 0.002, P-trend = 0.047) and Part B (TMT-B, β: −0.079; 95% CI: −0.134, −0.024, P-trend = 0.004). Adherence to the MIND diet was associated with the backward recall Digit Span Test assessment of working memory (DST-B, β: 0.058; 95% CI: 0.002, 0.114, P-trend = 0.045). However, higher adherence to the DASH dietary pattern was not associated with better cognitive function over a period of 2 years.Conclusion: In older Spanish individuals with overweight or obesity and at high cardiovascular disease risk, higher baseline adherence to the Mediterranean dietary pattern may be associated with better cognitive performance than lower adherence over a period of 2 years.

Abstract 12775: Supervised Exercise Therapy Adherence and Six-Minute Walk Improvement in Peripheral Artery Disease. Findings From Two Randomized Clinical Trials

Introduction: Supervised exercise therapy (SET) is first line therapy for improving walking ability in people with peripheral artery disease (PAD), but adherence to SET is poor. The association of SET adherence with change in six-minute walk distance in PAD is unclear. Methods: Data were combined from two randomized clinical trials of SET for PAD. In both trials, participants with PAD were randomized to exercise or a control group for six months. Those randomized to SET were asked to attend 72 exercise treadmill exercise sessions over six months in the presence of an exercise physiologist. Those randomized to attention control were asked to attend up to 24 educational sessions once weekly for six months. Adherence rates were defined as the number of attended intervention or control sessions divided by the number of expected sessions. Participants randomized to SET were categorized into tertiles of adherence, according to the proportion of exercise sessions attended. Six-minute walk was measured at baseline and at 6-month follow-up. Results: 281 randomized participants (mean age: 68±9 years; 43% female; 61% African American) were included. The mean adherence rate was 75±18 % in the SET group. The adherence rates for the three SET tertiles were: ≤ 69%, 69 – 85%, and ≥ 85% respectively. Baseline characteristics, within group 6-month changes in six-minute walk distance by intervention group, and pairwise comparisons results are shown in table. Conclusion: While greater adherence to SET was associated with greater six-minute walk distance improvement, even participants with PAD in the lowest tertile of adherence had significantly greater six-minute walk improvement, compared to control. These data suggest that even intermittent exercise activity significantly improves six-minute walk in people with PAD.

Association of adherence to the dietary approach to stop hypertension and Mediterranean diets with blood pressure in a non-hypertensive population: Results from Isfahan Salt Study (ISS)

Background and aimsHypertension is among the major risk factors for cardiovascular events in the Iranian population. This cross-sectional study was designed to examine the association of adherence to the dietary approaches to stop hypertension (DASH) and Mediterranean (MED) dietary patterns with the distribution of blood pressure and pre-hypertension prevalence. Methods and resultsThis cross-sectional study was carried out in 1363 non-hypertensive adults. Adherence to the DASH and MED diets was calculated using a semi-quantitative food frequency questionnaire (FFQ). Hypertension was measured by the standard method. Multiple logistic regression was applied to obtain the odds ratio of pre-hypertension in the tertiles of MED and DASH dietary patterns. Compared to the lowest, participants with the highest adherence to the DASH dietary pattern had significantly lower systolic blood pressure (SBP) (111.3 ± 11.8 vs. 112.8 ± 12.5; P = 0.010) and diastolic blood pressure (DBP) (70.7 ± 9.2 vs. 71.8 ± 9.8; 0.042). There was no significant difference in the mean SBP and DBP among the participants across tertiles of MED or diet adherence. Higher scores of the DASH and MED diets were inversely associated with lower SBP after adjustment for all potential confounders (OR = −0.04, 95% CI = −0.29, −0.01, P = 0.039) and (OR = −0.04, 95% CI = −0.72, −0.02, P = 0.044), respectively. Also, DASH and MED dietary patterns was associated with reduced OR of pre-hypertension occurrence by 13% (OR: 0.87; 95% CI: 0.70–0.98; P for trend = 0.042) and 16% ([OR: 0.84; 95% CI: 0.69–0.97; P trend = 0.035), respectively. ConclusionAdherence to the DASH and MED diets was inversely associated with the odds for pre-hypertension and SBP.

Assessment of a strategy combining ambulatory blood pressure, adherence monitoring and a standardised triple therapy in resistant hypertension

Purpose Poor adherence to drug therapy and inadequate drug regimens are two frequent factors responsible for the poor blood pressure (BP) control observed in patients with apparent resistant hypertension. We evaluated the efficacy of an antihypertensive management strategy combining a standardised therapy with three long acting drugs and electronic monitoring of drug adherence in patients with apparent resistant hypertension. Materials and Methods In this multicentric observational study, adult patients with residual hypertension on 24 h ambulatory BP monitoring (ABMP) despite the use of three or more antihypertensive drugs could be included. Olmesartan/amlodipine (40/10 mg, single pill fixed-dose combination) and chlorthalidone (25 mg) were prescribed for 3 months in two separated electronic pills boxes (EPB). The primary outcome was 24 h ambulatory systolic BP (SBP) control at 3 months, defined as mean SBP <130 mmHg. Results We enrolled 48 patients (36.0% women) of whom 35 had complete EPB data. After 3 months, 52.1% of patients had 24 h SBP <130 mmHg. 24 h SBP decreased by respectively −9.1 ± 15.5 mmHg, −22.8 ± 30.6 mmHg and −27.7 ± 16.6 mmHg from the tertile with the lowest adherence to the tertile with the highest adherence to the single pill combination (p = 0.024). A similar trend was observed with tertiles of adherence to chlorthalidone. Adherence superior to 90% was associated with 24 h systolic and diastolic blood pressure control in multiple logistic regression analysis (odds ratio = 14.1 (95% confidence interval 1.1–173.3, p = 0.039). Conclusions A simplified standardised antihypertensive therapy combined with electronic monitoring of adherence normalises SBP in about half of patients with apparent resistant hypertension. Such combined management strategy enables identifying patients who need complementary investigations and those who rather need a long-term support of their adherence.

The association between adherence to a dietary approaches to stop hypertension (DASH) diet and neuro-psychological function in young women

BackgroundThe adherence to a Dietary Approaches to Stop Hypertension (DASH) diet may have a bidirectional relationship with mental wellbeing. We aimed to evaluate the association between compliance with a DASH diet and neuro-psychological function in young women.MethodsIn this cross-sectional study, a total of 181 girls aged between 18 and 25 years were recruited. The dietary intakes of study participants were evaluated using a valid and reliable food frequency questionnaire (FFQ) containing 65 food items. Neuropsychological function of participants was evaluated using standard questionnaires.ResultsAs may be expected, individuals in the highest tertile (T3) of adherence to DASH diet (highest adherence) were found to consume more folate, fruits, vegetables, low fat dairy, nuts, legume, and seed, less sweetened beverage and sodium, compared to the participants in the lowest tertile (T1, lowest adherence). There was a significant negative correlation between cognitive function and consumption of red and processed meat (r = − 0.168; p < 0.05); quality of life score with dietary sodium (r = − 0.151; p < 0.01) and depression score with dietary vegetables (r = − 0.174; p < 0.05). In multivariate multinomial logistic regression analyses adjusted for age, BMI and energy intake, adherence to a DASH-style diet was associated with a lower stress score (OR = 0.70; 95%CI: 0.34–1.47, P = 0.067; T3 vs. T1) and difficulty with sleep initiation (OR = 0.46; 95%CI: 0.21–1.00, P = 0.017; T3 vs. T1).ConclusionAdherence to a DASH diet may be associated with reduced stress and difficulty with initiating sleep.