Total Diet Score Research Articles

Olfactory impairment in older adults is associated with poorer diet quality over 5 years.

Decreased smell could cause appetite suppression and malnutrition. However, there is a paucity of longitudinal data between olfaction and nutritional status in older adults. We aimed to prospectively examine the relationship between olfactory impairment and overall diet quality (reflecting adherence to dietary guidelines) in a population-based cohort of older adults. We used 5-year follow-up data from 557 adults (aged 60+ years at baseline) whose olfaction was measured using the San Diego Odor Identification Test (SDOIT). Dietary data were collected using a validated semiquantitative food frequency questionnaire. A total diet score (TDS) was calculated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Final scores ranged from 0 to 20; higher scores indicated closer adherence to dietary guidelines. After adjusting for all potential confounders, older adults with moderate/severe olfactory impairment (SDOIT score ≤ 3; lower scores indicate impairment) compared with those with no olfactory impairment had significantly lower adjusted mean (±SE) TDS, 9.09 (0.40) versus 9.94 (0.10), p = 0.04. Women with moderate/severe impaired olfaction (i.e., scored poorly on the odor identification test) compared with those with normal olfaction had significantly lower adjusted mean TDS, 8.87 (0.69) versus 10.31 (0.13), p = 0.04. No associations were observed between olfaction and TDS in men. Olfactory impairment in older women could signal an increased risk of poorer diet quality, defined as adherence to national dietary guidelines. Additional longitudinal studies are needed to confirm or refute the observed link between olfactory loss and overall patterns of food intake in older adults.

Adherence to Dietary Guidelines and Successful Aging

Increases in life expectancy make it important to remain disease‐free and fully‐functional for as long as possible. We aimed to prospectively examine the relationship between overall diet quality (reflecting adherence to dietary guidelines) and successful aging in a population‐based cohort of older adults. We used 10‐year follow‐up data from 2519 adults, aged 49+ years and free of cancer, coronary artery disease and stroke at the baseline examination. Dietary data were collected using a semi‐quantitative food‐frequency questionnaire. Total diet scores (TDS) were allocated for intake of selected food groups and nutrients for each participant as described in the national dietary guidelines. Higher scores indicated closer adherence to dietary guidelines. Successful aging was defined as the absence of: disability, depressive symptoms, cognitive impairment, respiratory symptoms and chronic diseases (cancer, coronary artery disease and stroke). After 10 years, 842 participants had died and 281 participants qualified as successfully aging. After multivariable‐adjustment, each unit increase in TDS at baseline was associated with a 10% increased odds of successful aging 10 years later, odds ratio, OR, 1.10 (95% confidence intervals, CI, 1.03‐1.18). Participants in the highest (high adherence to dietary guidelines) versus lowest quartile of TDS at baseline had 2‐fold higher odds of aging successfully after 10 years, OR 2.41 (95% CI 1.40‐4.17). In summary, greater compliance with published dietary guidelines was associated with an increased likelihood of good functional status and absence of chronic diseases in older age.

Adherence to Dietary Guidelines and the 10-Year Cumulative Incidence of Visual Impairment: The Blue Mountains Eye Study

To assess whether adherence to dietary guidelines at baseline is associated with the incidence of visual impairment among older persons after 10 years. A population-based cohort of 3654 participants of the Blue Mountains Eye Study were examined at baseline and were reexamined after 5 and 10 years. The incidence of visual impairment was defined as best-corrected visual acuity (VA)<20/40 at follow-up in 1 or both eyes. Dietary information was obtained at baseline using a validated food frequency questionnaire (FFQ). Total Diet Score (TDS) was calculated based on the Australian diet quality index. TDS includes components of diet quality; poor dietary habits; and energy balance. Discrete logistic regression models with time-dependant outcome variables were used to calculate hazard risk ratios (HR) and 95% confidence intervals (CI) associated with incidence of visual impairment for each unit/quartile increase in TDS, adjusting for potential confounders. Of the 3654 baseline participants, 1963 had up to 10 years follow-up with completed FFQs. With each unit increase in TDS, the risk of visual impairment decreased (HR 0.94, 95% CI 0.88-1.00). The risk of developing visual impairment was lower among persons in the highest compared to the lowest TDS quartile (HR 0.71, 95% CI 0.47-1.05). This association was significant among persons aged 65+ years (HR 0.63, 95% CI 0.38-0.98) but not those aged <65 years (HR 0.95, 95% CI 0.46-1.97). Compliance to dietary guidelines was associated with a decreased long-term risk of visual impairment in this sample of Australians aged 65+ years.

Abstract P070: A Low Carbohydrate Diet from Plant or Animal Sources and Mortality Among Myocardial Infarction Survivors

Background: The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long-term benefits of a low carbohydrate diet (LCD) is unknown, whether it mainly be from animal or vegetable sources. Objective: To examine the associations between post-MI adherence to a low carbohydrate diet (LCD), measured by a total, plant- and animal-based low carbohydrate diet score (LCDS), in relation to all-cause and cardiovascular mortality. Design: We included 2,258 women from the Nurses’ Health Study and 1,840 men from the Health Professional Follow-Up Study, who had survived a first MI during follow-up, provided pre-MI and at least one post-MI food frequency questionnaire (FFQ). Results: Adherence to a LCD high in animal sources of protein and fat was associated with higher all-cause and cardiovascular mortality (HR=1.31, 95% CI: 1.05-1.63 for all-cause mortality; HR= 1.49, 95% CI: 1.08-2.06 for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal-based LCD prospectively assessed from the pre- to post-MI period was associated with higher all-cause mortality and cardiovascular mortality (HR=1.29, 95% CI: 1.03-1.63 for all-cause mortality; HR=1.53, 95% CI: 1.10-2.12 for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant-based LCD was not associated with lower all-cause or cardiovascular mortality. Conclusions: Greater adherence to a LCD high in animal sources of fat and protein was associated with higher all-cause and cardiovascular mortality post-MI. We did not find a health benefit from greater adherence to an overall LCD post MI.

Adherence to Dietary Guidelines Positively Affects Quality of Life and Functional Status of Older Adults

BackgroundNutritional parameters could influence self-perceived health and functional status of older adults. ObjectiveWe prospectively determined the association between diet quality and quality of life and activities of daily living. DesignThis was an observational cohort study in which total diet scores, reflecting adherence to dietary guidelines, were determined. Dietary intakes were assessed using a food frequency questionnaire at baseline. Total diet scores were allocated for intake of selected food groups and nutrients for each participant as described in the Australian Guide to Healthy Eating. Higher scores indicated closer adherence to dietary guidelines. Participants/settingIn Sydney, Australia, 1,305 and 895 participants (aged ≥55 years) with complete data were examined over 5 and 10 years, respectively. Main outcome variablesThe 36-Item Short-Form Survey assesses quality of life and has eight subscales representing dimensions of health and well-being; higher scores reflect better quality of life. Functional status was determined once at the 10-year follow-up by the Older Americans Resources and Services activities of daily living scale. This scale has 14 items: seven items assess basic activities of daily living (eg, eating and walking) and seven items assess instrumental activities of daily living (eg, shopping or housework). Statistical analyses performedNormalized 36-Item Short-Form Survey component scores were used in analysis of covariance to calculate multivariable adjusted mean scores. Logistic regression analysis was used to calculate adjusted odds ratios and 95% CIs to demonstrate the association between total diet score with the 5-year incidence of impaired activities of daily living. ResultsParticipants in the highest vs lowest quartile of baseline total diet scores had adjusted mean scores 5.6, 4.0, 5.3, and 2.6 units higher in these 36-Item Short-Form Survey domains 5 years later: physical function (Ptrend=0.003), general health (Ptrend=0.02), vitality (Ptrend=0.001), and physical composite score (Ptrend=0.003), respectively. Participants in the highest vs lowest quartile of baseline total diet scores had 50% reduced risk of impaired instrumental activites of daily living at follow-up (multivariable-adjusted Ptrend=0.03). ConclusionsHigher diet quality was prospectively associated with better quality of life and functional ability.

Association between diet quality with concurrent vision and hearing impairment in older adults.

Published literature shows that individual nutrients could influence the risk of developing vision and hearing loss. There is, however, a lack of population-based data on the relationship between overall patterns of food intake and the presence of concurrent vision and hearing impairment. We aimed to assess the associations between diet quality with the prevalence and 5-year incidence of dual sensory impairment (DSI). Cross-sectional and 5-year longitudinal analyses. Blue Mountains, Sydney, Australia. 2443 participants aged ≥50 from baseline were examined and followed over 5 years. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet score (TDS). Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500-4000 Hz, better ear). After adjusting for age, sex, education, noise exposure, current smoking, and type 2 diabetes, participants in the lowest compared to the highest quintile of TDS had a 2-fold increased likelihood of having prevalent DSI, odds ratio, OR, 2.62 (95% confidence intervals, CI, 1.08-6.36), P-trend=0.04. Significant associations were not observed between TDS and the prevalence of having a single sensory impairment (vision or hearing loss). Baseline TDS was not significantly associated with the 5-year incidence of DSI. Adherence to dietary guidelines was associated with a reduced likelihood of having DSI in cross-sectional, but not in longitudinal analyses. Further studies with adequate power are warranted to assess the prospective relationship between diet quality and DSI.

Is quality of diet associated with the microvasculature? An analysis of diet quality and retinal vascular calibre in older adults

It is unknown whether diet quality is associated with microvascular structure. The present study aimed to investigate the relationship between diet quality, reflecting adherence to dietary guidelines, with retinal microvascular calibre in older adults. The dietary data of 2720 Blue Mountains Eye Study participants, aged 50+ years, were collected using a semi-quantitative FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Fundus photographs were taken and retinal vascular calibre measured using computer-assisted techniques and summarised. After adjusting for age, sex, BMI, mean arterial blood pressure, smoking, serum glucose, leucocyte count and history of diagnosed stroke or CHD, persons with higher TDS had healthier retinal vessels cross-sectionally, with wider retinal arteriolar calibre (by approximately 3 μm, comparing the highest with the lowest quartile of TDS, Ptrend = 0·0001) and narrower retinal venular calibre (by approximately 2·5 μm; Ptrend = 0·02). In younger subjects aged ≤65 years, increasing TDS (lowest to the highest quartile) was associated with healthier retinal vessels: approximately 4·4 μm wider retinal arteriolar (Ptrend < 0·0001) and approximately 2·3 μm narrower venular calibre (Ptrend = 0·03). After multivariable adjustment, however, baseline TDS were not associated with retinal arteriolar (Ptrend = 0·89) or venular calibre (Ptrend = 0·25), 5 years later. Also, baseline TDS were not associated with the 5-year change in retinal arteriolar (β = 0·14; P=0·29) or venular calibre (β = - 0·26; P=0·07). Greater compliance with published dietary guidelines (higher diet quality) was cross-sectionally associated with wider retinal arterioles and narrower venules, indicating better retinal microvascular health.

Diet quality is prospectively associated with incident impaired fasting glucose in older adults

Dietary modifications may play an important role in the prevention of diabetes. We aimed to assess the temporal association between diet quality and both impaired fasting glucose and Type 2 diabetes among older adults. A total of 2564 participants aged 49+ years at baseline were examined between 1992 and 1994 and 2002-2004 and had their fasting blood glucose measured. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine Total Diet Score. Incident diabetes (or impaired fasting glucose) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level ≥ 7.0 mmol/l (or 6.1-6.9 mmol/l). After adjusting for age, sex, current smoking, body mass index, hypertension and serum triglycerides, comparing highest with lowest tertile of total diet score, a significant 75% decrease in risk of incident impaired fasting glucose was observed in men (P(trend) = 0.02). Also, in men, each two-point increase in Total Diet Score was associated with a 52% reduction in the 10-year incidence of impaired fasting glucose, (OR 0.48, 95% CI 0.33-0.69). No significant associations were observed among women or with the 10-year incidence of diabetes. Greater compliance with published dietary guidelines (better diet quality) was associated with a reduced risk of pre-diabetes in men, but not women.

A better diet quality is associated with a reduced likelihood of CKD in older adults

Background and aimsStudies of diet in relation to chronic kidney disease (CKD) have focused on individual nutrients. The relationship between overall patterns of food intake and renal function has not been well explored. We aimed to investigate the associations between diet quality with the prevalence, incidence and progression of CKD in a cohort of older adults. Methods and Results1952 participants aged ≥50 years at baseline were examined between 1992–1994 and 2002–2004. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet scores (TDS). Baseline biochemistry including serum creatinine was measured. CKD was defined as MDRD estimated glomerular filtration rate (eGFR) <60 mL min−1.1.73 m−2.Participants in the highest quartile of mean TDS compared to those in the first quartile (reference), had a 41% reduced likelihood of having eGFR <60 mL min−1.1.73 m−2, [multivariable-adjusted odds ratio, OR, 0.59 (95% confidence intervals, CI, 0.41–0.85), P-trend = 0.005]. Each unit increase in TDS was associated with a 15% decrease in the odds of having prevalent CKD, multivariable-adjusted OR 0.85 (95% CI 0.74–0.97). A non-significant, inverse association between TDS and CKD incidence was observed (P-trend = 0.10). ConclusionOlder adults with better diet quality had a reduced likelihood of having eGFR <60 mL min−1.1.73 m−2. Adherence to dietary guidelines were not prospectively associated with CKD incidence or progression. Further studies with adequate power are warranted to assess the longitudinal association between diet quality and CKD.

Adherence to dietary guidelines and 15-year risk of all-cause mortality

Past investigation of diet in relation to disease or mortality has tended to focus on individual nutrients. However, there has been a recent shift to now focus on overall patterns of food intake. The present study aims to investigate the relationship between diet quality reflecting adherence to dietary guidelines and mortality in a sample of older Australians, and to report on the relationship between core food groups and diet quality. This was a population-based cohort study of persons aged 49 years or older at baseline, living in two postcode areas west of Sydney, Australia. Baseline dietary data were collected during 1992-4, from 2897 people using a 145-item Willett-derived FFQ. A modified version of the Healthy Eating Index for Australians was developed to determine diet quality scores. The Australian National Death Index provided 15-year mortality data using multiple data linkage steps. Hazard risk (HR) ratios and 95 % CI for mortality were assessed for diet quality. Subjects in quintile 5 (highest) of the Total Diet Score had a 21 % reduced risk of all-cause mortality (HR 0·79, 95 % CI 0·63, 0·98, P(trend)=0·04) compared with those in quintile 1 (lowest) after multivariate adjustment. The present study provides longitudinal support for a reduced risk of all-cause mortality in an older population who have greater compliance with published dietary guidelines.

Dietary factors in erectile dysfunction

The role of dietary factors in erectile dysfunction (ED) has never been addressed. In the present case-control study, we investigated the relation of the Mediterranean diet with ED. A total of 100 men with ED were compared with 100 age-matched men without ED. A scale indicating the degree of adherence to the Mediterranean diet was constructed: the total Mediterranean diet score ranged from 0 (minimal adherence to the Mediterranean diet) to 9 (maximal adherence). The percentage of physical inactivity was greater in the ED group (35 vs 19%, P=0.04), whereas the diet score was lower (4.7+/-0.5 vs 5.4+/-0.5, P<0.01), indicating a reduced adherence to the Mediterranean diet. In analyses adjusted for the prevalence of associated risk factors (hypertension, hypercholesterolemia), body mass index, waist, physical inactivity and total energy intake, the intake of fruits and nuts, and the ratio of monounsaturated lipids to saturated lipids remained the only individual measures associated with ED. In conclusion, the results of the present study show that dietary factors may be important in the development of ED: adoption of healthy diets would hopefully help preventing ED.

Evaluation of the Nutrient Guide as a dietary assessment tool

The purpose of this study was to evaluate the validity of the Nutrient Guide as a quantitative estimate of dietary adequacy. Using 24-hour dietary recalls of 300 men, food group and overall diet scores based on the Nutrient Guide were compared with nutrient adequacy ratios for eight nutrients and a mean adequacy ratio derived from nutrient analysis. Caloric, fat, and sodium intakes estimated using Nutrient Guide ratings were also compared with nutrient Nutrient Guide ratings were also compared with nutrient analysis estimates. Correlations between food group scores and nutrient adequacy ratios were all positive and significant. Regression analyses revealed a strong linear relationship between caloric, fat, and sodium intakes estimated by the two methods and a curvilinear relationship between mean adequacy ratio and total diet score. These results suggest that the Nutrient Guide can be used to provide a reasonable estimate of adequacy for the nutrients upon which the guide is currently based. Food group and total diet scores in either the upper or lower ends of the score ranges seemed to be better predictors of individual nutrient or overall dietary adequacy than did mid-range scores, which slightly underestimated dietary adequacy of the selected nutrients.