Factors Affecting Adherence to a Low Phenylalanine Diet in Patients with Phenylketonuria: A Systematic Review.

Phenylketonuria (PKU) is an inherited metabolic disorder that requires lifelong adherence to a low-phenylalanine (Phe) diet to prevent severe neurological complications. However, maintaining dietary adherence can be challenging for patients and their families. This systematic review aimed to comprehensively evaluate the factors affecting adherence to a low-Phe diet in patients with PKU. A systematic search of multiple databases was conducted, and 49 studies were included in the final analysis. The quality of evidence was assessed using the Joanna Briggs Institute levels of evidence and the Quality Assessment with Diverse Studies tool. The review identified four main categories of factors influencing dietary adherence: family-related factors (social, psychological, behavioral, and educational), patient-specific factors (psychological, behavioral, educational, and demographic), environmental factors (healthcare professional support, educational and camp-based interventions, and the COVID-19 pandemic), and therapy-related factors (protein substitute formulation, clinic visits, blood tests, and telemedicine). The findings highlight the complex interplay between elements contributing to dietary adherence in PKU patients and underscore the importance of a multifaceted approach to support patients and their families. Future research should prioritize high-quality longitudinal and experimental studies to provide stronger evidence for the PKU community.

Impact of diet adherence on weight and lipids among African American participants randomized to vegan or omnivorous diets.

Objective: Prior research has found that plant-based diets (PBDs) are rated as acceptable and have similar levels of adherence as compared to other therapeutic dietary approaches; however, previous studies were mostly among white populations. Plant-based diets can produce clinically meaningful weight loss, but outcomes may vary by level of adherence. The goal of this study was to examine the differences in weight and lipids among participants in the Nutritious Eating with Soul study based on adherence to their diet assignment. Methods: African American adults (n = 159; 79% female) with overweight or obesity (mean BMI 36.9 ± 6.9 kg/m2) were recruited to participate in a 24-month intervention. Participants were randomized to a plant-based vegan (n = 77) or a low-fat omnivorous (n = 82) diet, both emphasizing soul food cuisine. Participants attended nutrition classes and had dietary intake/adherence (three 24-h recalls; adherence score 1-5), body weight, lipids, and other secondary outcomes assessed at baseline, 6-, 12-, and 24 months. Participants who met at least half of the adherence criteria (≥2.5 out of 5) were categorized as adherents. Results: At 24 months, adherent vegans lost 5% of their body weight, non-adherent vegans lost -0.005%, adherent omnivores lost -0.03%, and non-adherent omnivores lost -0.02%. Adherent vegans lost more weight (kg) than all other participants at both 6- (-3.32 ± 0.92 (-5.14, -1.49), p < 0.001) and 24 months (-3.27 ± 1.49 (-6.23, -0.31), p = 0.03). Adherent vegans also lost more weight than less adherent vegans (-3.74 ± 1.05 (-5.82, -1.65)), adherent omnivores (-4.00 ± 1.27 (-6.51, -1.48)), and less adherent omnivores (-2.22 ± 0.98 (-4.15, -0.28)) at 6 months and lost more weight than less adherent vegans at 24 months (-4.96 ± 1.8 (-8.54, -1.37)) (all p < 0.05). Adherent vegans had greater improvements in cholesterol-to-HDL ratio at 24 months (-0.47 ± 0.22 (-0.92, -0.03), p = 0.04) and greater decreases in insulin (-4.57 ± 2.16 (-8.85, -0.29), p = 0.04) at 6 months than all other participants combined. Conclusions: The study points to the benefit of the use of a PBD for reducing weight, lipids, and insulin in African American adults, but also highlights the importance of supporting adherence to the PBD. Clinical TrialsGov ID: Nutritious Eating With Soul (The NEW Soul Study); NCT03354377.

Assessment of barriers to the dietary adherence among type 2 diabetic patients in Pakistan: A cross-sectional study.

OBJECTIVE: To assess the common barriers responsible for non-adherence to dietary recommendations among type 2 diabetic patients. METHODS: The cross-sectional study was conducted from October 4, 2021, to March 6, 2022, at the National Institute of Diabetes and Endocrinology, Dow University of Health Sciences, Karachi, and comprised type 2 diabetes patients of either gender aged 18-80 years who had previously been given recommended dietary advice. Dietary barriers were assessed using a 27-item validated questionnaire, and the subjects were compared in terms of age and diabetes duration. Anthropometric measurements and laboratory parameters were also measured. Data were analysed using Stata 17. RESULTS: Of the 312 subjects, 234(75%) were females. The overall mean age was 52.2±11.2 years, and mean body mass index was 27.2±5.5kg/m2. The reliability of the questionnaire was established with Cronbach's alpha 0.89. Factor analysis yielded 8 common barriers; lack of knowledge about dietary recommendations (variance: 14.7%), situational barrier (variance: 10.7%), lack of family support (variance: 9.5%), stress-related eating problems (variance: 9.1%), boring and monotonous diet (variance: 8.0%), expensive and ineffective diet recommended (variance: 6.5%), work conditions/don't like food in diet (variance: 5.5%), and feeling hungry and weak (variance: 5.4%). The total variation explained by all the 8 factors was 69.4%. CONCLUSIONS: Lack of knowledge regarding dietary recommendations was reported to be the most common barrier towards recommended dietary adherence.

Importance of an Ongoing Nutritional Counselling Intervention on Eating Habits of Newly Diagnosed Children with Celiac Disease.

A strict lifelong gluten-free diet (GFD) is the current treatment for the management of celiac disease (CD). Several studies have demonstrated that without proper dietary assessment, this diet leads to nutritional deficiencies and/or imbalances. The present study aimed to improve the dietary habits of newly diagnosed children with CD through ongoing and face-to-face dietary counseling. Forty-three participants were followed during the first year after CD diagnosis. Dietary data were collected at diagnosis (Vt0), after 3 months on a GFD (Vt3), and after 1 year following a GFD (Vt12). Participants completed a 3-day 24-h food recall, a food frequency questionnaire, and the KIDMED index. After each data collection, participants received dietary assessment and nutritional education. Participants consumed more plant-origin foods after the intervention, with most of them reaching the daily recommendations. Fresh food intake increased and that of ultra-processed foods decreased. Compliance with the Mediterranean diet also improved. Personalized dietary assessment and ongoing follow-up improved the dietary patterns of children recently diagnosed with CD, highlighting the importance of dietitian involvement in the management of CD.

With or without biopsy in coeliac children?-Impact on dietary compliance and quality of life.

Critics of the ESPGHAN guidelines on CD question the acceptance of the no-biopsy policy by patients and parents against the backdrop of a lifelong diagnosis. The aim of this study was to investigate the impact of the no-biopsy approach on dietary adherence and health-related quality of life (HRQOL). In this retrospective cohort study, patients ≤ 18 years diagnosed with CD between 2007 and 2017 were sent two questionnaires: a dietary interview and a CD-specific HRQOL questionnaire (CDDUX). Included patients were divided into group A (with biopsies <2012), B (with biopsies >2012) and C (without biopsies >2012). Fisher exact test and ANOVA were used to analyze the impact of the new diagnostic strategy. Forty-seven percent (82/173 patients) consented to participate in the study. Of them, 63% had a biopsy-confirmed diagnosis (40% before 2012 (group A), 23% after 2012 (group B)), and 37% were diagnosed without biopsies (group C). Dietary compliance was similar in all groups (p = 0.67). Group A scored significantly better on the subscale 'Having CD' compared to both groups diagnosed after 2012 (p = 0.003). Group A and group C seemed to score better on the total CDDUCX score when compared to group B (86 and 80% versus 61% respectively, p = 0.13). This was also observed within the subscale Diet; Group A and C scored significantly better than group B (62 and 72% versus 39% respectively, p = 0.09). CONCLUSIONS: Omitting duodenal biopsies in the diagnostic approach of our CD cohort had no adverse effect on dietary adherence and HRQOL. WHAT IS KNOWN: • Since the publication of the ESPGHAN guideline of 2012, duodenal biopsies are no longer obligatory in the diagnostic approach of CD if IgA-antibodies for transglutaminase 2 are ≥10× ULN, endomysial antibodies are positive in a second blood sample and the patient/family agrees with the no-biopsy approach. • Literature on the effect of the no-biopsy approach on dietary adherence and HRQOL is scarce. WHAT IS NEW: • Omitting duodenal biopsies does not influence dietary adherence and quality of life. • In our cohort, lower quality of life measured with the CDDUX subscale 'Having CD' is more likely to be related to shorter disease duration than to the diagnostic approach.

Global Approach to Follow-Up of Celiac Disease.

Celiac disease, an autoimmune disorder induced by the ingestion of gluten, affects approximately 1.4% of the population. Gluten damages the villi of the small intestine, producing symptoms such as abdominal pain, bloating and a subsequent loss of nutrient absorption, causing destabilization of the nutritional status. Moreover, gluten can trigger extra intestinal symptoms, such as asthma or dermatitis, but also mental disorders such as depression or anxiety. Moreover, people suffering from celiac disease sometimes feel misunderstood by society, mainly due to the lack of knowledge about the disease and the gluten-free diet. Thus, the treatment and follow-up of patients with celiac disease should be approached from different perspectives, such as the following: (1) a clinical perspective: symptomatology and dietary adherence monitorization; (2) nutritional assessment: dietary balance achievement; (3) psychological assistance: mental disorders avoidance; and (4) social inclusion: educating society about celiac disease in order to avoid isolation of those with celiac disease. The aim of this narrative review is to gain deep insight into the different strategies that currently exist in order to work on each of these perspectives and to clarify how the complete approach of celiac disease follow-up should be undertaken so that the optimum quality of life of this collective is reached.

Health-Related Quality of Life and Injuries in Physical Education Students: A Multi-Group Model According to the Degree of Adherence to the Mediterranean Diet.

The Mediterranean diet is considered a healthy eating pattern. It has been shown to improve people's quality of life. When a person suffers injuries, their quality of life suffers. This research aims to accomplish the following: (a) to study the differences in the effect of the health-related quality of life on injuries according to the degree of adherence to the Mediterranean diet, (b) to analyse the existing differences in the variables that make up the health-related quality of life according to the degree of adherence to the Mediterranean diet, and (c) to analyse the degree of adherence to the Mediterranean diet according to whether the participants have suffered any injury. The study was descriptive, cross-sectional, and exploratory in a sample of 556 physical education students. The PREDIMED questionnaire, the SF-36 questionnaire, and a self-administered questionnaire were used. The results showed that high adherence to the Mediterranean diet was associated with higher quality of life and lower injury rates. It was also observed that high adherence to the Mediterranean diet improved the effect of the quality of life on injuries. In conclusion, the Mediterranean diet is beneficial for the quality of life of young university students.

Past, Present, and Future of Noninvasive Tests to Assess Gluten Exposure, Celiac Disease Activity, and End-Organ Damage.

Although many biomarkers have been proposed, and several are in widespread clinical use, there is no single readout or combination of readouts that correlates tightly with gluten exposure, disease activity, or end-organ damage in treated patients with celiac disease. Challenges to developing and evaluating better biomarkers include significant interindividual variability-related to immune amplification of gluten exposure and how effects of immune activation are manifest. Furthermore, the current "gold standard" for assessment of end-organ damage, small intestinal biopsy, is itself highly imperfect, such that a marker that is a better reflection of the "ground truth" may indeed appear to perform poorly. The goal of this review was to analyze past and present efforts to establish robust noninvasive tools for monitoring treated patients with celiac disease and to highlight emerging tools that may prove to be useful in clinical practice.

Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery.

PURPOSE: Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery. MATERIALS AND METHODS: We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used. RESULTS: Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor. CONCLUSION: Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.

Factors associated with dietary and exercise compliance among elderly with chronic conditions of hypertension and type 2 diabetes mellitus residing in rural areas of coastal Karnataka: A community-based cross-sectional study.

BACKGROUND: Compliance with diet, exercise regimen, and medication is vital to maintain an acceptable range of blood pressure and glycemic level among elderly with hypertension and diabetes mellitus. However, these are considered to be more challenging tasks among elderly. The aim of this study is to identify dietary and exercise compliance among elderly with hypertension and type 2 diabetes mellitus and to find its influencing factors. MATERIALS AND METHODS: The community-based survey was done in rural areas of five randomly selected clusters of primary health centers (PHC) using PPS sampling technique. After ethical clearance, a total of 360 consented participants residing in selected clusters were interviewed using pre-designed rating scale and questionnaire on dietary and exercise compliance, respectively. In this study, compliance refers to practicing prescribed diet and exercise regimen regularly by the elderly with HTN and T2DM. The data were analyzed using SPSS version 16.0. RESULTS: Eighty percent (n = 287) of study participants had moderate adherence to diet and only, 37.8% (n = 136) of them practice physical exercise. A Chi-square test report confirmed that there is a significant association (P < 0.05) between dietary compliance and level of education, occupation, family income, procurement of insurance, poor memory, multiple functional impairments, duration of hypertensive, and diabetes illness. Exercise compliance is influenced by factors such as gender, level of education, family income, and procurement of insurance (P < 0.05). CONCLUSION: Adherence to diet and exercise among elderly with chronic conditions are influenced by various socio-demographic or environmental, poor health or physiological and cognition or psychological factors.

Dietary Adherence and Cognitive Performance in Older Adults by Nativity Status: Results from the National Health and Nutrition Examination Survey (NHANES), 2011-2014.

Although adherence to dietary guidelines is associated with better cognitive performance, there may be differences by nativity status. This study aimed to investigate the association between adherence to the healthy eating index (HEI) and cognitive performance (CP) among United States (US)-born and foreign-born older adults (60+ years). Data were obtained from the 2011-2014 NHANES (n = 3065). Dietary adherence was assessed with HEI quintiles. CP (adequate vs. low) was examined using word listing (CERAD), animal naming (AFT), and the digit symbol substitution test (DSST). Weighted multivariable logistic regressions were used to examine associations. The US-born participants in higher dietary quintiles had adequate CP when compared to foreign-born participants. In adjusted models, the US-born participants in the highest HEI quintile had increased odds of adequate DSST scores (odds ratio: 1.95, 95% confidence interval: 1.15-3.28) compared with those in the lowest quintile. Patterns of association were generally reversed for foreign-born participants and were non-statistically significant. Future research should consider the influence of diets in delaying or preventing decline in cognition and evaluate nutritional factors that contribute to cognitive outcomes for the foreign-born population.

Dietary Adherence Is Associated with Perceived Stress, Anhedonia, and Food Insecurity Independent of Adiposity.

We examined whether perceived stress, anhedonia, and food insecurity were associated with dietary adherence during a 6-week intervention. Sixty participants (23 m; 53 ± 14 y) completed psychosocial measures and were provided with full meals. Individuals with obesity were randomized to a weight-maintaining energy needs (WMENs) (n = 18; BMI 33 ± 4) or a 35% calorie-reduced diet (n = 19; BMI 38 ± 9); normal-weight individuals (n = 23; BMI 23 ± 2) were assigned to a WMENs diet. Adherence scores were determined via weekly assessments and daily ecological momentary assessments (EMAs) of real-time behavior in a natural environment. Perceived stress and anhedonia were associated with % body fat (all r-values > 0.25, all p-values < 0.05), but food insecurity and adherence were not. Higher perceived stress (r = -0.31, p = 0.02), anhedonia (r = -0.34, p = 0.01), and food insecurity (r = -0.27, p = 0.04) were associated with lower adherence scores, even after adjusting for age, sex, and % body fat. In all adjusted models, % body fat was not associated with adherence. Higher measures of stress, anhedonia, and food insecurity predicted lower adherence independently of body fat, indicating that psychosocial factors are important targets for successful adherence to dietary interventions, regardless of body size.

Celiac Disease Dietary Adherence on the Rural-Urban Continuum.

Poor adherence to a gluten-free diet for those with celiac disease is a well-established risk factor, leading to gastrointestinal symptoms, malabsorption of nutrients, and psychiatric complications. Previous studies have shown that those outside urban areas encounter unique barriers to dietary adherence and are less likely to engage in health management behaviors than those in urban regions. This study aimed to examine the relationship between gluten-free dietary adherence and individual, relationship, and community factors, including the geographic location of residence on the rural-urban continuum, for 253 adults with celiac disease living in the United States. Those with celiac disease residing in urban regions had significantly better dietary adherence than those residing in nonurban areas (p < 0.05). Those living in nonurban communities had, on average, poor enough adherence scores to suggest ongoing intestinal damage from gluten consumption. Geographic location, age, years since diagnosis, and annual income significantly predicted compliance with a gluten-free diet for those with celiac disease, accounting for nearly 20% of the variance. Those living outside urban areas with a lower income, younger age, and more recent diagnosis of celiac disease had the worst dietary adherence, placing them at the most risk for ongoing disease progression and complications.

Actions speak louder than words: Home visits and its effect on dietary adherence in patients with phenylketonuria.

AIM: Phenylketonuria (PKU) is an inherited metabolic disorder in which accumulation of phenylalanine (Phe) leads to poor neurological outcomes without treatment. Dietary therapy is the main treatment and nonadherence is associated with elevated blood Phe levels and correspondingly poor neuropsychiatric outcomes. This study aimed to examine the effect of home visits on blood Phe levels in PKU patients. METHODS: Sixty-five paediatric PKU patients who were on low-phenylalanine diet were visited monthly at home for 6 months. At each visit, dietary education was provided, patients' height and weight were measured and blood samples were collected. RESULTS: Twenty-eight (43.1%) patients had classic PKU and 37 (56.9%) had moderate PKU. Blood Phe levels decreased statistically significant at first, second, fifth, and sixth months compared with screening visit. Blood Phe levels in moderate PKU patients decreased significantly at the last visit unlike classic PKU patients. A significant decrease in blood Phe levels was observed in patients older than 10 years. Anthropometric parameters improved. CONCLUSIONS: Dietary nonadherence is the main treatment failure in PKU. Home visits for education are a promising way to improve treatment outcomes by providing quality education, better assessment, and correction of mistakes but they should be ongoing and supported by different interventions that address patients' special needs.

Barriers to and Strategies for Dietary Adherence: A Qualitative Study Among Hemodialysis/Peritoneal Dialysis Patients and Health Care Providers.

OBJECTIVES: The objectives of this study were: (1) investigate hemodialysis (HD)/peritoneal dialysis (PD) patients' barriers to dietary adherence, (2) identify strategies to overcome these barriers, and (3) examine dialysis providers' perceptions toward patients' barriers to dietary adherence and strategies to overcome these barriers. METHODS: A qualitative descriptive approach was conducted from February-May 2022. A total of 21 HD/PD participants and 11 health care providers participated in individual interviews. HD/PD participants also responded to a 57-item food frequency questionnaire. Six months of serum laboratory values were obtained from the medical charts. Content analysis methodology was used to identify themes. Mann-Whitney U tests were conducted to examine diet quality and laboratory values of the HD and PD participants using SPSS v.27 with statistical significance of P < .05. RESULTS: The median (interquartile range) diet quality score for HD/PD patients was 36 (26-43) with no differences observed between the patient populations. Mann-Whitney U tests showed no differences between serum laboratory values between the patient populations. Barriers identified by the HD/PD patients were communication/patient education and dietary habits. Barriers identified by the health care providers were communication/patient education and socioeconomic status. Strategies to overcome these barriers were enhancing communication between all parties involved in the care and tailoring educational information to the patient's background. CONCLUSIONS: Communication and patient education were themes identified among both health care providers and patients. Therefore, open communication among the patients and providers and enhancement of the nutrition education handouts may improve dietary adherence.

Hunger, temptation, and dietary adherence during weight management.

Preliminary evidence suggests that hunger and temptation may predict nonadherence to dietary intake goals; however, no studies have investigated the potential interaction between hunger and temptation in relation to dietary nonadherence nor have any investigated whether these associations may be different after the end of active behavioral intervention. Thus, the current study examined the week-to-week associations between hunger, temptation, and dietary adherence in 74 adults with overweight or obesity (mean ± SD age = 50.7 ± 10.4, BMI = 31.2 ± 4.5 kg/m2) enrolled in a 12-week, Internet-based weight loss program followed by a 40-week post-intervention observational maintenance period. Each week during the study, participants completed a questionnaire on which they rated their hunger, temptation, and dietary adherence on 7-point scales. Multilevel models demonstrated that higher levels of hunger and temptation were associated with lower ratings of dietary adherence during the same week, ps < 0.0001, such that 1-point higher ratings of hunger or temptation were associated with 0.2- and 0.5-point lower ratings of dietary adherence, respectively. Further, there was an interaction between hunger and temptation such that the association between temptation and dietary nonadherence was stronger when ratings of hunger were lower, p = .028. There were no differences in associations between the initial weight loss period and the maintenance period. Results suggest that hunger and temptation may serve as potential treatment targets for interventions aimed at improving adherence to dietary intake goals. Future studies should investigate whether interventions targeting hunger and temptation can improve dietary adherence and weight loss outcomes.

Adherence to medical nutrition therapy and it's challenges among antenatal women with gestational diabetes mellitus in South India- A sequential explanatory mixed-method study.

BACKGROUND: Globally, one in ten pregnant women have diabetes; out of which, 90% contribute to gestational diabetes mellitus (GDM). Medical Nutrition Therapy (MNT) is the cornerstone for GDM treatment yet adherence to MNT among the masses is not adequately monitored as part of the routine antenatal services. The study aimed to estimate the proportion of adherence to MNT and determine the factors related toadherence among antenatal women with GDM. This study also explores the facilitators, barriers, and possible suggestions for improving adherence. MATERIALS AND METHODS: This facility-based sequential explanatory mixed-method study was conducted among 341 antenatal women with GDM at, Puducherry. The study was conducted in 2021. Dietary adherence was evaluated using Perceived Dietary Adherence Questionnaire and based on the scores obtained they were selected for in-depth interviews to explore the facilitators and barriers. Collected data wereanalysed by Chi-square test using STATA version 16. RESULTS: Out of 341 participants, the proportion of participants adherent to MNT was 135 (39.6%) with 95% CI of 34%-44%. Thepredictors for poor adherence were unemployment (PR: 0.65; 95%CI: 0.48-0.88) and good adherence was antenatal women in the 2nd trimester (PR: 1.541; 95%CI: 1.18-2.025). Barrierstonon-adherence were financial crisis, lack of awareness ofthe need for MNT, and joint family pressure. CONCLUSIONS: About two-thirds of antenatal women with GDM are non-adherent to MNT. Unemployment and period of gestation were found to be theirdeterminants. Appropriate action has to be implemented for improving the adherence rate.

In Cochrane nutrition reviews assessment of dietary adherence varied considerably.

OBJECTIVES: Our aim was to investigate if and how Cochrane nutrition reviews assess dietary adherence to a specific dietary regimen. STUDY DESIGN AND SETTING: Cochrane nutrition reviews fulfilling the following criteria were included: systematic review of randomized controlled trials including adults and investigating the effect of caloric restriction, dietary pattern, foods, nutrients, supplements, or other nutrition-related-interventions. Extensive data extraction and descriptive statistics were conducted. RESULTS: Overall, 226 Cochrane reviews were included. Most reviews mentioned dietary adherence in the main text (n = 174), predominantly in the Methods and Results. Dietary adherence was assessed in 76 reviews and defined in 19. It was included in the risk of bias (RoB) assessment in 20 reviews with nine using a newly created RoB domain for dietary adherence, and considered as outcome in 37 reviews. Seventy-five reviews addressed degree of adherence and five treatment effects considering the degree of adherence. CONCLUSION: Dietary adherence was reported in a heterogeneous manner in Cochrane nutrition reviews. Due to its high importance, we suggest that systematic reviews report the assessment and degree of dietary adherence measured in primary studies. Dietary adherence can further be examined as outcome, evaluated within the RoB (deviations from intended interventions) and included in sensitivity analyses.