Popular Dietary Patterns: Alignment With American Heart Association 2021 Dietary Guidance: A Scientific Statement From the American Heart Association.

The evolution of dietary guidelines from isolated nutrients to broader dietary pattern recommendations results from growing knowledge of the synergy between nutrients and their food sources as they influence health. Macronutrient and micronutrient needs can be met by consuming various dietary patterns, but guidance is often required to facilitate population-wide adherence to wise food choices to achieve a healthy dietary pattern. This is particularly true in this era with the proliferation of nutrition misinformation and misplaced emphasis. In 2021, the American Heart Association issued a scientific statement outlining key principles of a heart-healthy dietary pattern that could be operationalized in various ways. The objective of this scientific statement is to assess alignment of commonly practiced US dietary patterns with the recently published American Heart Association criteria, to determine clinical and cultural factors that affect long-term adherence, and to propose approaches for adoption of healthy dietary patterns. This scientific statement is intended to serve as a tool for clinicians and consumers to evaluate whether these popular dietary pattern(s) promote cardiometabolic health and suggests factors to consider when adopting any pattern to improve alignment with the 2021 American Heart Association Dietary Guidance. Numerous patterns strongly aligned with 2021 American Heart Association Dietary Guidance (ie, Mediterranean, DASH [Dietary Approaches to Stop Hypertension], pescetarian, vegetarian) can be adapted to reflect personal and cultural preferences and budgetary constraints. Thus, optimal cardiovascular health would be best supported by developing a food environment that supports adherence to these patterns wherever food is prepared or consumed.

Food Is Medicine: A Presidential Advisory From the American Heart Association.

Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the recommended clinical guidelines. An abundance of barriers, including food and nutrition insecurity, how food is marketed and advertised, access to and affordability of healthy foods, and behavioral challenges such as a focus on immediate versus delayed gratification, stand in the way of healthier dietary patterns for many Americans. Food Is Medicine may be defined as the provision of healthy food resources to prevent, manage, or treat specific clinical conditions in coordination with the health care sector. Although the field has promise, relatively few studies have been conducted with designs that provide strong evidence of associations between Food Is Medicine interventions and health outcomes or health costs. Much work needs to be done to create a stronger body of evidence that convincingly demonstrates the effectiveness and cost-effectiveness of different types of Food Is Medicine interventions. An estimated 90% of the $4.3 trillion annual cost of health care in the United States is spent on medical care for chronic disease. For many of these diseases, diet is a major risk factor, so even modest improvements in diet could have a significant impact. This presidential advisory offers an overview of the state of the field of Food Is Medicine and a road map for a new research initiative that strategically approaches the outstanding questions in the field while prioritizing a human-centered design approach to achieve high rates of patient engagement and sustained behavior change. This will ideally happen in the context of broader efforts to use a health equity-centered approach to enhance the ways in which our food system and related policies support improvements in health.

Healthy Eating Report Card for Pre-school Children in Hong Kong.

INTRODUCTION: This study aimed to develop the Healthy Eating Report Card for Pre-school Children in Hong Kong for evaluating the prevalence of healthy eating behaviours and favourable family home food environments (FHFEs) among pre-school children in Hong Kong. METHODS: In this cross-sectional study, 538 parent-child dyads from eight kindergartens in Hong Kong were recruited. Parents or guardians completed a questionnaire comprising Report Card items. The Report Card included two indicators of Children's Eating Behaviours (ie, Children's Dietary Patterns and Children's Mealtime Behaviours) and three indicators of FHFEs (ie, Parental Food Choices and Preparation, Avoidance of Unhealthy Foods, and Family Mealtime Environments). Each indicator and its specific items were assigned a letter grade representing the percentage of participants achieving the predefined benchmarks. The grades were defined as A (≥80%, Excellent); B (60%-79%, Good); C (40%-59%, Fair); D (20%-39%, Poor); and F (<20%, Very poor). Plus (+) and minus (-) signs were used to indicate the upper or lower 5% of each grade. RESULTS: Overall, Children's Eating Behaviours were classified as Fair (average grade of 'C'), whereas FHFEs were classified as Good (average grade of 'B'). The sub-grades ranged from 'C' to 'A-', as follows: Children's Dietary Patterns, 'C+'; Children's Mealtime Behaviours, 'C'; Parental Food Choices and Preparation, 'C+'; Avoidance of Unhealthy Foods, 'B'; and Family Mealtime Environments, 'A-'. CONCLUSION: The findings highlight areas for improvement in healthy eating among children. The Healthy Eating Report Card could offer novel insights into intervention tools that promote healthy eating.

An environmental scan of food and drink advertising on public transport around Adelaide schools.

ISSUE ADDRESSED: Children and adolescents are particularly receptive to cues from food and drink advertising. Several policies recommend restricting unhealthy or discretionary ('junk') food advertising on government infrastructure such as public transport. Prior research in New South Wales (NSW) and Western Australia (WA) reveals a high proportion of discretionary food advertising outdoors and on public transport. The aim of this study was to identify the landscape of food and drink advertising on public transport assets around Adelaide schools. METHODS: An environmental scan of food and drink advertising on public transport assets within 500 m of 65 Adelaide schools was conducted. The Council of Australian Governments Health Council's interim guide was used to categorise advertisements as 'suitable' or 'unsuitable' for promotion. RESULTS: Almost four in every five food and drink advertisements on public-transport assets observed around Adelaide schools included discretionary food or drink, and therefore were categorised as unsuitable for promotion. Advertisements on bus exteriors were more likely to promote discretionary foods, compared with bus shelters. CONCLUSIONS: This proportion of 'unhealthy' food advertising was comparable to previous research conducted in WA and NSW. SO WHAT?: In light of historic state/territory actions such as the ACT preventing discretionary food advertising on public transport, these findings should prompt a review and discussion of the suitability of food and drink promotion on government-owned South Australian transport and their associated assets.

Strengthening US Food Policies and Programs to Promote Equity in Nutrition Security: A Policy Statement From the American Heart Association.

Nutritionally inadequate dietary intake is a leading contributor to chronic cardiometabolic diseases. Differences in dietary quality contribute to socioeconomic and racial and ethnic health disparities. Food insecurity, a household-level social or economic condition of limited access to sufficient food, is a common cause of inadequate dietary intake. Although US food assistance policies and programs are designed to improve food security, there is growing consensus that they should have a broader focus on nutrition security. In this policy statement, we define nutrition security as an individual or household condition of having equitable and stable availability, access, affordability, and utilization of foods and beverages that promote well-being and prevent and treat disease. Despite existing policies and programs, significant gaps remain for achieving equity in nutrition security across the life span. We provide recommendations for expanding and improving current food assistance policies and programs to achieve nutrition security. These recommendations are guided by several overarching principles: emphasizing nutritional quality, improving reach, ensuring optimal utilization, improving coordination across programs, ensuring stability of access to programs across the life course, and ensuring equity and dignity for access and utilization. We suggest a critical next step will be to develop and implement national measures of nutrition security that can be added to the current US food security measures. Achieving equity in nutrition security will require coordinated and sustained efforts at the federal, state, and local levels. Future advocacy, innovation, and research will be needed to expand existing food assistance policies and programs and to develop and implement new policies and programs that will improve cardiovascular health and reduce disparities in chronic disease.

[Telehealth, food consumption, and eating behavior in adults: a rapid review of systematic reviewsTelesalud, consumo de alimentos y comportamiento alimentario de la población adulta: examen rápido de revisiones sistemáticas]. / Telessaúde no consumo e comportamento alimentar em adultos: uma revisão rápida de revisões sistemáticas.

Objective: To synthesize the evidence about the effects of telehealth interventions provided through smart-phone apps and text messages on the behavior of adults regarding healthy food consumption. Method: A rapid systematic review of the literature was performed through searches in nine electronic databases to identify systematic reviews published in English, Portuguese, and Spanish that evaluated telehealth strategies compared to face-to-face interventions to improve dietary intake in the adult population (18 to 59 years old). Searches were performed in November 2020 and updated in April 2022. The included systematic reviews were assessed for methodological quality using the AMSTAR 2 tool. Results: Five systematic reviews were included. Methodological quality was moderate in one review and critically low in four. There was a dearth of studies comparing the use of telehealth strategies with face-to-face interventions for the promotion of healthy eating in adults. The most consistent results refer to an increase in the consumption of fruits and vegetables with the use of an app or text messages, in addition to improvement in the dietary habits of people with diabetes or glucose intolerance with the use of text messages. Conclusion: Positive effects were observed on healthy eating outcomes for most interventions using mobile apps or text messages; however, the findings refer to a few clinical trials with small samples that were analyzed in the systematic reviews covered in the present rapid review, most of which had low methodological quality. Thus, the current knowledge gap warrants the performance of further methodologically robust studies.

Objetivo: Sintetizar la evidencia sobre los efectos de las intervenciones de telesalud ofrecidas por medio de aplicaciones de telefonía móvil y mensajes de texto en el comportamiento de la población adulta relacionado con una alimentación saludable. Métodos: Se realizó un examen rápido mediante búsquedas en nueve bases bibliográficas electrónicas para localizar revisiones sistemáticas publicadas en español, inglés y portugués en las que se evaluaran estrategias de telesalud en comparación con atención presencial para mejorar la alimentación de la población adulta (de 18 a 59 años). Las búsquedas se realizaron en noviembre del 2020 y se actualizaron en abril del 2022. La calidad metodológica de las revisiones sistemáticas incluidas se evaluó con la herramienta AMSTAR 2. Resultados: Se incluyeron cinco revisiones sistemáticas, una con un grado de confianza moderado y las otras con un grado de confianza sumamente bajo. Se comprobó una falta de estudios en los que se compararan el uso de estrategias de telesalud con la atención presencial para promover la alimentación saludable de la población adulta. Los resultados más coherentes se refieren al aumento del consumo de frutas y verduras con el uso de aplicaciones móviles o de mensajes de texto, así como a la mejora del patrón alimentario de las personas con diabetes o con intolerancia a la glucosa con el uso de mensajes de texto. Conclusión: La mayoría de los análisis de las intervenciones en las que se emplearon aplicaciones de telefonía móvil o mensajes de texto mostraron efectos positivos en los resultados relativos a una alimentación saludable. Sin embargo, estos hallazgos se refieren a unos pocos ensayos clínicos con pequeñas muestras de participantes incluidos en las revisiones sistemáticas del presente examen rápido, en su mayoría de baja calidad metodológica. En conclusión, existe una laguna en los conocimientos y es importante realizar estudios con una metodología más sólida.

2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association.

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

Strategies for Promotion of a Healthy Lifestyle in Clinical Settings: Pillars of Ideal Cardiovascular Health: A Science Advisory From the American Heart Association.

Engagement in healthy lifestyle behaviors is suboptimal. The vast majority of the US population does not meet current recommendations. A healthy lifestyle is defined by consuming a healthy dietary pattern, engaging in regular physical activity, avoiding exposure to tobacco products, habitually attaining adequate amounts of sleep, and managing stress levels. For all these health behaviors there are well-established guidelines; however, promotion in clinical settings can be challenging. It is critical to overcome these challenges because greater promotion of heathy lifestyle practices in clinical settings effectively motivates and initiates patient behavior change. The 5A Model (assess, advise, agree, assist, and arrange) was developed to provide a framework for clinical counseling with requisite attention to the demands of clinical settings. In this science advisory, we present strategies, based on the 5A Model, that clinicians and other health care professionals can use for efficient lifestyle-related behavior change counseling in patients at all levels of cardiovascular disease risk at every visit. In addition, we discuss the underlying role of psychological health and well-being in lifestyle-related behavior change counseling, and how clinicians can leverage health technologies when providing brief patient-centered counseling. Greater attention to healthy lifestyle behaviors during routine clinician visits will contribute to promoting cardiovascular health.

Efficacy of different front-of-package labeling systems in changing purchase intention and product healthfulness perception for food products in Argentina.

Objectives: To identify the front-of-package scheme-Multiple Traffic Light (MTL), Nutri-Score (NS), and black octagon Warning System (WS)-most effective in reducing purchase intention and perceived product healthfulness of drinking yogurts, cookies and cheese spreads, and to assess the joint influence of nutrient claims on the effects. Methods: Randomized-controlled experiment. A within-subjects factorial design was used to evaluate the influence of three independent factors on perceived product healthfulness and purchase intention. A total of 704 adults in Argentina were shown three mock-up products and asked to indicate which product they would buy choosing between pairs of products from different categories and to rate product healthfulness on a 7-point Likert scale. Results: The WS was the most effective in reducing purchase intention in drinking yogurts (OR:0.16, 95%CI: 0.09;0.28), cookies (OR:0.10, 95%CI: 0.05;0.18) and cheese spreads (OR:0.10, 95%CI: 0.05;0.18), and the perception of healthfulness (WS Mean score 3,63 vs No label 4,24, p<0.001), regardless of the participants' gender, age, and level of education. NS was inefficacious in reducing product healthfulness perception, while MTL had significantly increased how healthful the product was perceived (p<0.001). Nutrient claims increased purchase intention and perception of healthfulness, thus reducing the effectiveness of front-of-package labels (p<0.001). Conclusions: In line with growing evidence, our findings support that WS perform better than NS and MTL in reducing purchase intention and healthfulness perception of products with excessive amounts of critical nutrients associated with the greatest burden of diseases. Front-of-package WS are expected to facilitate the population in Argentina to make healthier decisions.

Evaluation of a Social Media Campaign in Saskatchewan to Promote Healthy Eating During the COVID-19 Pandemic: Social Media Analysis and Qualitative Interview Study.

BACKGROUND: The beginning of the COVID-19 pandemic presented many sudden challenges regarding food, including grocery shopping changes (eg, reduced store hours, capacity restrictions, and empty store shelves due to food hoarding), restaurant closures, the need to cook more at home, and closures of food access programs. Eat Well Saskatchewan (EWS) implemented a 16-week social media campaign, #eatwellcovid19, led by a dietitian and nutrition student that focused on sharing stories submitted by the Saskatchewan public about how they were eating healthy during the COVID-19 pandemic. OBJECTIVE: The goal of this study was to describe the implementation of the #eatwellcovid19 social media campaign and the results from the evaluation of the campaign, which included campaign performance using social media metrics and experiences and perspectives of campaign followers. METHODS: Residents of Saskatchewan, Canada, were invited to submit personal stories and experiences to EWS about how they were eating healthy during the COVID-19 pandemic from April to August 2020. Each week, one to three stories were featured on EWS social media platforms-Facebook, Instagram, and Twitter-along with evidence-based nutrition information to help residents become more resilient to challenges related to food and nutrition experienced during the COVID-19 pandemic. Individuals who submitted stories were entered into a weekly draw for a Can $100 grocery gift card. Social media metrics and semistructured qualitative interviews of campaign followers were used to evaluate the #eatwellcovid19 campaign. RESULTS: In total, 75 stories were submitted by 74 individuals on a variety of topics (eg, grocery shopping, traditional skills, and gardening), and 42 stories were featured on social media. EWS shared 194 #eatwellcovid19 posts across social media platforms (Facebook: n=100; Instagram: n=55; and Twitter: n=39). On Facebook, #eatawellcovid19 reached 100,571 followers and left 128,818 impressions, resulting in 9575 engagements. On Instagram, the campaign reached 11,310 followers, made 14,145 impressions, and received 823 likes and 15 comments. On Twitter, #eatwellcovid19 made 15,199 impressions and received 424 engagements. Featured story submission posts had the best engagement on Facebook and the most likes and comments on Instagram. The EWS social media pages reported increases in their following during the campaign (Instagram: +30%; Facebook: +14%; and Twitter: +12%). Results from the interviews revealed that there were two types of campaign followers: those who appreciated hearing the stories submitted by followers, as it helped them to feel connected to the community during social isolation, and those who appreciated the evidence-based information. CONCLUSIONS: Numerous stories were submitted to the #eatwellcovid19 social media campaign on various topics. On Instagram and Facebook, posts that featured these stories had the highest engagement. During this campaign, EWS's social media following increased by more than 10% on each platform. The approach used for the #eatwellcovid19 campaign could be considered by others looking to develop health promotion campaigns.

J-shaped association between dietary thiamine intake and the risk of cognitive decline in cognitively healthy, older Chinese individuals.

Background: The prospective association of dietary thiamine intake with the risk of cognitive decline among the general older adults remains uncertain. Aims: To investigate the association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals. Methods: The study included a total of 3106 participants capable of completing repeated cognitive function tests. Dietary nutrient intake information was collected through 3-day dietary recalls and using a 3-day food-weighed method to assess cooking oil and condiment consumption. Cognitive decline was defined as the 5-year decline rate in global or composite cognitive scores based on a subset of items from the Telephone Interview for Cognitive Status-modified. Results: The median follow-up duration was 5.9 years. There was a J-shaped relationship between dietary thiamine intake and the 5-year decline rate in global and composite cognitive scores, with an inflection point of 0.68 mg/day (95% confidence interval (CI): 0.56 to 0.80) and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake. Before the inflection point, thiamine intake was not significantly associated with cognitive decline. Beyond the inflection point, each unit increase in thiamine intake (mg/day) was associated with a significant decrease of 4.24 (95% CI: 2.22 to 6.27) points in the global score and 0.49 (95% CI: 0.23 to 0.76) standard units in the composite score within 5 years. A stronger positive association between thiamine intake and cognitive decline was observed in those with hypertension, obesity and those who were non-smokers (all p<0.05). Conclusions: This study revealed a J-shaped association between dietary thiamine intake and cognitive decline in cognitively healthy, older Chinese individuals, with an inflection point at 0.68 mg/day and a minimal risk at 0.60-1.00 mg/day of dietary thiamine intake.

Aerobic Exercise Attenuates Pressure Overload-Induced Myocardial Remodeling and Myocardial Inflammation via Upregulating miR-574-3p in Mice.

BACKGROUND: Exercise training can promote cardiac rehabilitation, thereby reducing cardiovascular disease mortality and hospitalization rates. MicroRNAs (miRs) are closely related to heart disease, among which miR-574-3p plays an important role in myocardial remodeling, but its role in exercise-mediated cardioprotection is still unclear. METHODS: A mouse myocardial hypertrophy model was established by transverse aortic coarctation, and a 4-week swimming exercise training was performed 1 week after the operation. After swimming training, echocardiography was used to evaluate cardiac function in mice, and histopathologic staining was used to detect cardiac hypertrophy, myocardial fibrosis, and cardiac inflammation. Quantitative real-time polymerase chain reaction was used to detect the expression levels of miR-574-3p and cardiac hypertrophy markers. Western blotting detected the IL-6 (interleukin-6)/JAK/STAT inflammatory signaling pathway. RESULTS: Echocardiography and histochemical staining found that aerobic exercise significantly improved pressure overload-induced myocardial hypertrophy (n=6), myocardial interstitial fibrosis (n=6), and cardiac inflammation (n=6). Quantitative real-time polymerase chain reaction detection showed that aerobic exercise upregulated the expression level of miR-574-3p (n=6). After specific knockdown of miR-574-3p in mouse hearts with adeno-associated virus 9 using cardiac troponin T promoter, we found that the protective effect of exercise training on the heart was significantly reversed. Echocardiography and histopathologic staining showed that inhibiting the expression of miR-574-3p could partially block the effects of aerobic exercise on cardiac function (n=6), cardiomyocyte cross-sectional area (n=6), and myocardial fibrosis (n=6). Western blotting and immunohistochemical staining showed that the inhibitory effects of aerobic exercise on the IL-6/JAK/STAT pathway and cardiac inflammation were partially abolished after miR-574-3p knockdown. Furthermore, we also found that miR-574-3p exerts cardioprotective effects in cardiomyocytes by targeting IL-6 (n=3). CONCLUSIONS: Aerobic exercise protects cardiac hypertrophy and inflammation induced by pressure overload by upregulating miR-574-3p and inhibiting the IL-6/JAK/STAT pathway.

The Association between Post-Partum Depression and Nutrition and Dietary Patterns: Systematic Review.

Background: Postpartum Depression (PPD) is a common illness with long-term effects on mother and child. Nutrition is a crucial factor in mental health, but research findings on its connection to PPD are inconsistent. This review aims to explore the correlation between PPD and dietary patterns. Materials and Methods: We conducted a comprehensive search of several databases including PubMed/MEDLINE, Embase, ISI and ISI/Web of Science (WOS), Scopus, and Iranian databases such as Magiran, Scientific Information Database (SID), and IRANDOC from 2003 to 2020. Our search was based on the keywords "postpartum depression" and "nutrition, vitamin D, Folic acid, iron, zinc, and vitamins." We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to select articles based on inclusion/exclusion criteria. Of the 100 articles identified, only 24 articles met our criteria and were selected for further analysis. Results: Research suggests that low levels of vitamin D, iron, folate, and carbohydrates, and an unhealthy diet lacking in vegetables are potential causes of PPD. However, the impact of zinc, omega-3 essential fatty acids, and other nutrients such as antioxidants, vitamin E, and vitamin C on PPD is unclear due to conflicting information. Additionally, limited research has been conducted on the association between group B vitamins and PPD. Conclusions: In conclusion, we can lower the risk of PPD by providing dietary guidance and working with healthcare providers. It is important to pay attention to our diet and make sure we are consuming enough vitamins and nutrients to support our mental health.

Gender differences in the association between food costs and obesity in Korean adults: an analysis of a population-based cohort.

BACKGROUND/OBJECTIVES: Prior studies, mostly conducted in Western countries, have suggested that the low cost of energy-dense foods is associated with an increased risk of obesity. This study aimed to investigate the association between food costs and obesity risk among Koreans who may have different food cost and dietary patterns than those of Western populations. SUBJECTS/METHODS: We used baseline data from a cohort of 45,193 men and 83,172 women aged 40-79 years (in 2006-2013). Dietary intake information was collected using a validated food frequency questionnaire. Prudent and Western dietary patterns extracted via principal component analysis. Food cost was calculated based on Korean government data and market prices. Logistic regression analyses were performed to investigate the association of daily total, prudent, and Western food cost per calorie with obesity. RESULTS: Men in the highest total food cost quintile had 15% higher odds of obesity, after adjusting for demographic characteristics and lifestyle factors (adjusted odds ratio, 1.15; 95% confidence interval, 1.08-1.22; P-trend < 0.001); however, this association was not clear in women (P-trend = 0.765). While both men and women showed positive associations between prudent food cost and obesity (P-trends < 0.001), the association between Western food cost and obesity was only significant in men (P-trend < 0.001). CONCLUSIONS: In countries in which consumption of Western foods is associated with higher food costs, higher food costs are associated with an increased risk of obesity; however, this association differs between men and women.

The association of dietary patterns with incident chronic kidney disease and kidney function decline among middle-aged Korean adults: a cohort study.

OBJECTIVES: This study assessed the association of dietary patterns with the incidence of chronic kidney disease (CKD) and kidney function decline among Korean adults. METHODS: Data were collected from the records of 20,147 men and 39,857 women who participated in the Health Examinees study. Principal component analysis was used to identify 3 dietary patterns (prudent, flour-based food and meat, and white rice-based), and CKD risk was defined using the Epidemiology Collaboration equation for estimated glomerular filtration rate: (eGFR) <60 mL/min/1.73 m2. A kidney function decline was defined as a >25% decrease in eGFR from baseline. RESULTS: During the 4.2-year follow-up, 978 participants developed CKD and 971 had a 25% decline in kidney function. After adjusting for potential impact variables, compared with the lowest quartile of the prudent dietary pattern, participants in the highest quartile had a 37% lower risk of kidney function decline among men (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.47 to 0.85); while higher adherence to the flour-based food and meat dietary pattern was associated with an increased risk of CKD in both men (HR, 1.63; 95% CI, 1.22 to 2.19) and women (HR, 1.47; 95% CI, 1.05 to 2.05) as well as a decline in kidney function in both men (HR, 1.49; 95% CI, 1.07 to 2.07) and women (HR, 1.77; 95% CI, 1.33 to 2.35). CONCLUSIONS: Although a higher adherence to the prudent dietary pattern was inversely associated with the risk of kidney function decline in men, there was no association with CKD risk. In addition, a higher adherence to the flour-based food and meat dietary pattern increased the risk of CKD and kidney function decline. Further clinical trials are needed to confirm these associations.

The association between dietary quality scores with C-reactive protein and novel biomarkers of inflammation platelet-activating factor and lipoprotein-associated phospholipase A2: a cross-sectional study.

Healthy dietary patterns are associated with lower inflammation and cardiovascular disease (CVD) risk and adherence can be measured using diet quality scores. Inflammation is traditionally measured with C-reactive protein (hsCRP), however there is interest in novel pro-inflammatory markers platelet-activating factor (PAF) and lipoprotein-associated phospholipase A2 (Lp-PLA2) that are specifically involved in endothelial dysfunction and inflammation. This cross-sectional study investigated the association between PAF, Lp-PLA2, hsCRP, and six diet scores. One hundred adults (49 ± 13 years, 31% male) with variable CVD risk were recruited. Fasting PAF, Lp-PLA2 and hsCRP and usual dietary intake were measured. Adherence to Dietary Approaches to Stop Hypertension (DASH), Dairy-adjusted DASH, Vegetarian Lifestyle Index, Healthy Eating Index for Australians (HEIFA), Mediterranean Diet Adherence Screener (MEDAS) and PREDIMED-Plus (erMedDiet) scores were calculated. Correlations and multiple regressions were performed. hsCRP, but not PAF, independently correlated with several diet scores. Lp-PLA2 independently correlated with Vegetarian Lifestyle Index only in unadjusted models. A one-point increase in adherence to the DASH Index, the Dairy-adjusted DASH Index and the Vegetarian Lifestyle Index was associated with a 30%, 30%, and 33% reduction in hsCRP levels, respectively. Smaller effects were seen with the other diet scores with a one-point increase in adherence resulting in a 19%, 22% and 16% reduction in hsCRP with HEIFA, MEDAS, erMedDiet scores, respectively. The lack of stronger associations between the novel markers of inflammation and diet scores may be due to confounding by COVID-19 infection and vaccination programs, which prevents any firm conclusion on the relationship between PAF, Lp-PLA2 and healthy dietary patterns. Future research should aim to examine the relationship with these novel markers and healthy dietary patterns in a non-pandemic setting.

Comparison of weight change between face-to-face and digital delivery of the English National Health service diabetes prevention programme: An exploratory non-inferiority study with imputation of plausible weight outcomes.

Worldwide evidence suggests face-to-face diabetes prevention programmes are effective in preventing and delaying the onset of type 2 diabetes by encouraging behaviour change towards weight loss, healthy eating, and increased exercise. There is an absence of evidence on whether digital delivery is as effective as face-to-face. During 2017-18 patients in England were offered the National Health Service Diabetes Prevention Programme as group-based face-to-face delivery, digital delivery ('digital-only') or a choice between digital and face-to-face ('digital-choice'). The contemporaneous delivery allowed for a robust non-inferiority study, comparing face-to-face with digital only and digital choice cohorts. Changes in weight at 6 months were missing for around half of participants. Here we take a novel approach, estimating the average effect in all 65,741 individuals who enrolled in the programme, by making a range of plausible assumptions about weight change in individuals who did not provide outcome data. The benefit of this approach is that it includes everyone who enrolled in the programme, not restricted to those who completed. We analysed the data using multiple linear regression models. Under all scenarios explored, enrolment in the digital diabetes prevention programme was associated with clinically significant reductions in weight which were at least equivalent to weight loss in the face-to-face programme. Digital services can be just as effective as face-to-face in delivering a population-based approach to the prevention of type 2 diabetes. Imputation of plausible outcomes is a feasible methodological approach, suitable for analysis of routine data in settings where outcomes are missing for non-attenders.

Effectiveness of a Patient-Centered Dietary Educational Intervention.

Background: A healthy diet is an important component of preventive medicine. With the changing landscape of medicine, physicians are encountering more challenges in educating patients about a healthy diet, so finding innovative ways to educate patients is imperative. This study investigated the effectiveness of an innovative educational intervention based on the United States Department of Agriculture-recommended MyPlate diet. Methods: Based on the assessed need for dietary education, patients were exposed to an educational video and received a handout on the MyPlate diet. The educational video was created to be culturally relevant with patient-informed edits. The handout was taken from www.ChooseMyPlate.gov. The patients who received the intervention were compared to those who were not exposed to the intervention. Data were collected in a primary care clinic for an underserved population in fall 2018 and analyzed in spring 2019 through patient-completed surveys and physician reporting on patient interactions. Data were analyzed using descriptive statistics, t tests, chi-squared models, and repeated measures analysis of variance. Results: Among 320 patients, 169 patients were exposed to the educational intervention. Intervention patients had better knowledge of the MyPlate diet (P=0.009), felt it would be easier to change their diet (P=0.03), and were more motivated to have conversations about diet with their physician (P=0.04) compared to those who were not exposed. Patients also enjoyed the video overall. Conclusion: This study shows that using multiple modalities including a patient-centered video and handouts to educate patients about diet is enjoyable to patients and effective in teaching, motivating change, and encouraging communication between patients and physicians.

Effects of a Brazilian cardioprotective diet and nuts on cardiometabolic parameters after myocardial infarction: study protocol for a randomized controlled clinical trial.

BACKGROUND: Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIeta CArdioprotetora Brasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI). METHODS: DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data. DISCUSSION: It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT03728127 . First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105.

Association of Dietary Variety Status and Sarcopenia in Korean Elderly.

BACKGROUND: Sarcopenia is associated with a variety of factors including age, diseases, exercise, and heredity. In particular, diet is known to affect changes in muscle mass loss. METHODS: The purpose of this study was to analyze the diversity of food intake according to the presence of sarcopenia in elderly people over 65 years old using the 2008 to 2011 Korea National Health and Nutrition Examination Survey. The differences in subjects' general characteristics, lifestyle, and intake of 15 food groups were compared, and the risk odds ratio (OR) for sarcopenia was calculated for each food intake by gender. RESULTS: The proportion of sarcopenia was 27.7% for males and 24.3% for females. The sarcopenia group had significantly lower intakes of nuts and seeds, meats, and milks than the non-sarcopenia group in males. The females had significantly lower intake of fruits, milks, and beverages in non-sarcopenia group. The dietary diversity score was significantly lower in females with sarcopenia than non-sarcopenia group. Regression analysis of the risk OR for sarcopenia according to food group intake showed that the subjects in the lowest tertile (<31.1 g) had a 1.83 times (95% confidence interval [CI], 1.13-2.42) risk for sarcopenia in males. In case of milks intake of females, the risk for sarcopenia increased 1.39 times (95% CI, 1.11-1.86) in subjects with the lowest tertile (<30.1 g). CONCLUSIONS: Dietary diversity status was the most vulnerable to female with sarcopenia. Sarcopenia was associated with meat intake in male and milk intake in female.