Utilizing Quality of Life Adjusted Days Alive and Out of Hospital in Heart Failure Clinical Trials.

BACKGROUND: In heart failure (HF) trials, there has been an emphasis on utilizing more patient-centered outcomes, including quality of life (QoL) and days alive and out of hospital. We aimed to explore the impact of QoL adjusted days alive and out of hospital as an outcome in 2 HF clinical trials. METHODS: Using data from 2 trials in HF (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure [GUIDE-IT] and Study of Dietary Intervention under 100 mmol in Heart Failure [SODIUM-HF]), we determined treatment differences using percentage days alive and out of hospital (%DAOH) adjusted for QoL at 18 months as the primary outcome. For each participant, %DAOH was calculated as a ratio between days alive and out of hospital/total follow-up. Using a regression model, %DAOH was subsequently adjusted for QoL measured by the Kansas City Cardiomyopathy Questionnaire Overall Summary Score. RESULTS: In the GUIDE-IT trial, 847 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 59.0 (interquartile range, 40.8-74.3), which did not change over 18 months. %DAOH was 90.76%±22.09% in the biomarker-guided arm and 88.56%±25.27% in the usual care arm. No significant difference in QoL adjusted %DAOH was observed (1.09% [95% CI, -1.57% to 3.97%]). In the SODIUM-HF trial, 796 participants had a median baseline Kansas City Cardiomyopathy Questionnaire Overall Summary Score of 69.8 (interquartile range, 49.3-84.3), which did not change over 18 months. %DAOH was 95.69%±16.31% in the low-sodium arm and 95.95%±14.76% in the usual care arm. No significant difference was observed (1.91% [95% CI, -0.85% to 4.77%]). CONCLUSIONS: In 2 large HF clinical trials, adjusting %DAOH for QoL was feasible and may provide complementary information on treatment effects in clinical trials.

Dichotomous effect of dietary fiber in pediatrics: a narrative review of the health benefits and tolerance of fiber.

Dietary fibers are associated with favorable gastrointestinal, immune, and metabolic health outcomes when consumed at sufficient levels. Despite the well-described benefits of dietary fibers, children and adolescents continue to fall short of daily recommended levels. This gap in fiber intake (i.e., "fiber gap") might increase the risk of developing early-onset pediatric obesity and obesity-related comorbidities such as type 2 diabetes mellitus into adulthood. The structure-dependent physicochemical properties of dietary fiber are diverse. Differences in solubility, viscosity, water-holding capacity, binding capability, bulking effect, and fermentability influence the physiological effects of dietary fibers that aid in regulating appetite, glycemic and lipidemic responses, and inflammation. Of growing interest is the fermentation of fibers by the gut microbiota, which yields both beneficial and less favorable end-products such as short-chain fatty acids (e.g., acetate, propionate, and butyrate) that impart metabolic and immunomodulatory properties, and gases (e.g., hydrogen, carbon dioxide, and methane) that cause gastrointestinal symptoms, respectively. This narrative review summarizes (1) the implications of fibers on the gut microbiota and the pathophysiology of pediatric obesity, (2) some factors that potentially contribute to the fiber gap with an emphasis on undesirable gastrointestinal symptoms, (3) some methods to alleviate fiber-induced symptoms, and (4) the therapeutic potential of whole foods and commonly marketed fiber supplements for improved health in pediatric obesity.

Association between BMI z-score and body composition indexes with blood pressure and grip strength in school-age children: a cross-sectional study.

Childhood obesity is linked to diverse health outcomes, including elevated blood pressure (EBP). Emerging evidence showed that excess fat mass (FM) may have a deleterious impact on blood pressure even in normal-weight children. The primary objective of this study was to assess the association between body weight status by BMI z-score and body composition parameters by conventional bioelectrical impedance analysis (BIA) and bioelectrical impedance vector analysis (BIVA). Also, we aimed to explore the performance of BMI z-score, %FM, and FM index (FMI) in discriminating EBP in a sample of school-age Mexican children. Children were classified as having normal weight, overweight or obesity according to WHO criteria for BMI z-score. FMI was considered high when above 75th percentile, and fat free mass index (FFMI) was considered low when below 25th percentile of the reference population. Body composition was also classified according to the BIVA method and EBP was determined when systolic and/or diastolic blood pressure ≥ 90th percentile. BMI z-score groups were compared by Student´s t-test or the Mann-Whitney U test, or by the chi-square test or Fisher exact test. Receiving operating characteristic (ROC) analysis was performed. 61 children were included (52.5% boys, median age 9.8 (25th, 75th percentiles: 8.5, 11.0)) years. High FMI was observed in 32.3% of children with normal weight. Low FFMI was present in 93.5% of children with normal weight and 53.3% of those with overweight/obesity. According to BIVA, 58.1% and 43.3% of children with normal weight and overweight/obesity were classified as having cachexia. All the three adiposity indicators showed significant areas under the ROC curve (AURC) greater than 0.775 for EBP, with the largest one displayed for FM% (0.794). Hight FMI and low FFMI are common in children with normal weight. Identifying deficiency of FFM might be limited by using solely BMI indicators. Cachexia by BIVA was present in a high proportion of children with either normal weight or overweight/obesity. Both BMI z-score and FM (% and FMI) performed well at discriminating EBP, with a numerically greater AURC observed for FM%. Body composition in pediatric population is relevant for identifying body composition abnormalities at early age.

The current state of evidence for sodium and fluid restriction in heart failure.

The field of heart failure has evolved in terms of the therapies that are available including pharmaceutical and device therapies. There is now substantial randomized trial data to indicate that dietary sodium restriction does not provide the reduction in clinical events with accepted heterogeneity in the clinical trial results. Dietary sodium restriction should be considered for some but not all patients and with different objectives than clinical outcomes but instead for potential quality of life benefit. In addition, fluid restriction, once the mainstay of clinical practice, has not shown to be of any additional benefit for patients in hospital or in the ambulatory care setting and therefore should be considered to be used cautiously (if at all) in clinical practice. Further developments and clinical trials are needed in this area to better identify patients who may benefit or have harm from these lower cost interventions and future research should focus on large scale, high quality, clinical trials rather than observational data to drive clinical practice.

The Need for Fiber Addition in Symptomatic Heart Failure (FEAST-HF): A Randomized Controlled Pilot Trial.

Background: Preclinical and observational studies suggest that the gut microbiome plays a role in the pathogenesis of heart failure (HF); the gut microbiome may be modified by fermentable dietary fibre (FDF). The Need for Fiber Addition in Symptomatic Heart Failure (FEAST-HF) trial evaluated feasibility of recruitment and supplementation with FDF in HF and whether FDF (acacia), compared to control, reduced the level of N-terminal pro-b-type natriuretic peptide (NT-proBNP) and growth stimulation expressed gene 2 (ST2), and produced changes in the gut microbiome. Methods: Participants were randomly allocated 1:1:1 to either of the intervention arms (5 g/d or 10 g/d acacia) or to the control arm (10 g/d microcrystalline cellulose (MCC; nonfermentable active control). Adherence and tolerance were assessed, and clinical events were monitored for safety. All outcomes (NT-proBNP, ST2, New York Heart Association class, Kansas City Cardiomyopathy Questionnaire scores, 6-minute walk test score, gut microbiome) were measured at baseline, and at 6 and 12 weeks. Results: Between September 13, 2018 and December 16, 2021, 51 patients were randomly allocated to either MCC (n = 18), acacia 5 g daily (n = 13), or acacia 10 g daily (n = 18). No differences occurred between either dose of acacia and MCC in NT-proBNP level, ST2, New York Heart Association class, or questionnaire scores over 12 weeks. Dietary treatment arms had a negligible impact on microbial communities. No safety, tolerability, or adherence issues were observed. Conclusions: Dietary supplementation with acacia gum was both safe and well tolerated in ambulatory patients with HF; however, it did not change NT-proBNP level, ST2, or the composition of the gut microbiome.ClinicalTrials.gov: NCT03409926.

Contexte: Des études précliniques et observationnelles donnent à penser que le microbiome intestinal joue un rôle dans la pathogenèse de l'insuffisance cardiaque (IC). Or, ce microbiome pourrait être modifié par la consommation de fibres alimentaires fermentescibles (FAF). L'essai pilote contrôlé avec répartition aléatoire FEAST-HF (pour The Need forFiberAddition inSymptomaticHeartFailure) visait à évaluer la possibilité d'administrer un supplément de FAF (l'acacia) et à déterminer si celui-ci entraîne une réduction du taux du propeptide natriurétique de type B N-terminal (NT-proBNP) et du récepteur ST2 (growth stimulation expressed gene 2) ou une modification du microbiome intestinal comparativement au placebo. Méthodologie: Les participants ont été répartis de façon aléatoire selon un rapport 1:1:1 dans l'un des groupes d'intervention (recevant 5 g/jour ou 10 g/jour d'acacia) ou dans le groupe témoin (recevant 10 g/jour de cellulose microcristalline [CMC], une fibre de référence non fermentescible). La tolérance et l'observance du traitement ont été évaluées, et les événements cliniques ont été surveillés pour évaluer l'innocuité. Tous les indicateurs (NT-proBNP, ST2, classe d'IC selon l'échelle de la New York Heart Association, score au questionnaire de cardiomyopathie de Kansas City, score à un test de marche de 6 minutes et microbiome intestinal) ont été évalués au début de l'étude, à la semaine 6 et à la semaine 12. Résultats: Entre le 13 septembre 2018 et le 16 décembre 2021, 51 patients ont pris, après répartition aléatoire, de la CMC (n = 18), 5 g d'acacia par jour (n = 13) ou 10 g d'acacia par jour (n = 18). Aucune différence n'a été observée quant au taux de NT-proBNP ou de ST2, à la classe d'IC selon la New York Heart Association ou aux scores au questionnaire entre les groupes prenant l'une ou l'autre des doses d'acacia et le groupe prenant la CMC au cours d'une période de 12 semaines. L'effet sur la flore microbienne était négligeable dans les groupes de traitement alimentaire. Par ailleurs, aucun problème lié à l'innocuité, à la tolérabilité ou à l'observance du traitement n'a été observé. Conclusions: Les suppléments alimentaires d'acacia (gomme arabique) sont sûrs et bien tolérés; toutefois, ces suppléments n'ont pas entraîné de changement dans les taux de NT-proBNP ou de ST2, ni dans la composition du microbiome intestinal.ClinicalTrials.gov : NCT03409926.

Genetic Determinants of Atherogenic Indexes.

Atherogenesis and dyslipidemia increase the risk of cardiovascular disease, which is the leading cause of death in developed countries. While blood lipid levels have been studied as disease predictors, their accuracy in predicting cardiovascular risk is limited due to their high interindividual and interpopulation variability. The lipid ratios, atherogenic index of plasma (AIP = log TG/HDL-C) and the Castelli risk index 2 (CI2 = LDL-C/HDL-C), have been proposed as better predictors of cardiovascular risk, but the genetic variability associated with these ratios has not been investigated. This study aimed to identify genetic associations with these indexes. The study population (n = 426) included males (40%) and females (60%) aged 18-52 years (mean 39 years); the Infinium GSA array was used for genotyping. Regression models were developed using R and PLINK. AIP was associated with variation on APOC3, KCND3, CYBA, CCDC141/TTN, and ARRB1 (p-value < 2.1 × 10-6). The three former were previously associated with blood lipids, while CI2 was associated with variants on DIPK2B, LIPC, and 10q21.3 rs11251177 (p-value 1.1 × 10-7). The latter was previously linked to coronary atherosclerosis and hypertension. KCND3 rs6703437 was associated with both indexes. This study is the first to characterize the potential link between genetic variation and atherogenic indexes, AIP, and CI2, highlighting the relationship between genetic variation and dyslipidemia predictors. These results also contribute to consolidating the genetics of blood lipid and lipid indexes.

Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

BACKGROUND: Sodium restriction is a nonpharmacologic treatment suggested by practice guidelines for the management of patients with heart failure (HF). In this study, we synthesized the data from randomized controlled trials (RCTs) evaluating the effects of sodium restriction on clinical outcomes in patients with HF. METHODS: In this aggregate data meta-analysis, Cochrane Central, MEDLINE (Medical Literature Analysis and Retrieval System Online), Embase Ovid, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus databases were searched up to April 2, 2022. RCTs were included if they investigated the effects of sodium/salt restriction as compared to no restriction on clinical outcomes in patients with HF. Outcomes of interest included mortality, hospitalization, change in New York Heart Association functional class, and quality of life (QoL). RESULTS: Seventeen RCTs were identified (834 and 871 patients in intervention and control groups, respectively). Sodium restriction did not reduce the risk of all-cause death (odds ratio, 0.95 [95% CI, 0.58-1.58]), hospitalization (odds ratio, 0.84 [95% CI, 0.62-1.13]), or the composite of death/hospitalization (odds ratio, 0.88 [95% CI, 0.63-1.23]). The results were similar in different subgroups, except for the numerically lower risk of death with reduced sodium intake reported in RCTs with dietary sodium at the 2000 to 3000 mg/d range as opposed to <2000 mg/d (and in RCTs with versus without fluid restriction as a co-intervention). Among RCTs reporting New York Heart Association change, 2 RCTs (which accounted for two-thirds of the data) showed improvement in New York Heart Association class with sodium restriction. Substantial heterogeneity existed for QoL: 6 RCTs showed improvement of QoL and 4 RCTs showed no improvement of sodium restriction on QoL. CONCLUSIONS: In a meta-analysis of RCTs, sodium restriction was not associated with fewer deaths or hospitalizations in patients with HF. Dietary sodium restriction may be associated with improvements in symptoms and QoL.

Functional improvement in individuals with chronic spinal cord injury treated with 4-aminopyridine: A systematic review.

Study design: Systematic review. Objective: To provide current evidence on the efficacy of 4-aminopyridine (4-AP) to bring about functional improvement in individuals with chronic traumatic spinal cord injury (SCI). Methods: The Medline (PubMed), Web of Science and SCOPUS databases were systematically searched for relevant articles on the efficacy of 4-AP to treat SCI, from the dates such articles were first published until May 2022. Full-text versions of all the articles selected were examined independently by two reviewers. Methodological quality was rated using the Modified Jadad Scale, and risk of bias was assessed with the RoB-2 test. Data extracted included human models/types, PRISMA assessment protocols, and the results of each study. Descriptive syntheses are provided. Results: In total, 28 articles were initially identified, 10 of which were included after screening. Most of the studies reviewed reported some degree of patient improvement in one or more of the following parameters: motor, sensitivity and sexual function, sphincter control, spasticity, ability to function independently, quality of life, central motor conduction, pain, and pulmonary function. Conclusions: This review confirms the efficacy of 4-AP in improving several conditions resulting from SCI but further research on this topic is warranted. Additional randomized clinical trials with 4-AP involving larger sample sizes are needed, as are consistent outcome measures in order to obtain adequate data for analysis with a view to enhance treatment benefits. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=334835, PROSPERO CRD42022334835.

Hydration status according to impedance vectors and its association with clinical and biochemical outcomes and mortality in patients with chronic kidney disease / Estado de hidratación por vectores de impedancia y su asociación con desenlaces clínicos, bioquímicos y mortalidad en pacientes con enfermedad renal crónica

Background: the evaluation of hydration status and body composition in patients with kidney disease is vital for proper management, since overhydration is associated with cardiovascular complications. Patients with chronic kidney disease (CKD) begin to show perceptible alterations in hydration during the intermediate stages of the disease; however, there is little information regarding the evaluation of blood volume status through bioelectrical impedance vector analysis (BIVA) in this population. Objective: to determine the association between hydration status measured with BIVA and biochemical and clinical parameters and mortality in patients with stage G3a, G3b and G4 CKD. Material and methods: a cross-sectional study was conducted with patients with stage G3a, G3b and G4 CKD who underwent bioelectrical impedance analysis (BIA). The following biochemical and clinical parameters were determined: serum and urinary albumin, hematocrit, serum electrolytes and creatinine, estimated glomerular filtration rate (eGFR, using the CKD-EPI formula), 24-hour urine output and blood pressure. The clinical and biochemical variables were associated with the components of the BIA. According to the resistance/height (R/H) and reactance/height (Xc/H) values, the BIVA results were individually plotted on reference ellipses to identify patients with abnormal hydration states. The patients were classified by group according to hydration status and CKD stage z-scores, and differences in clinical, biochemical and BIA parameters were identified. Mortality was determined by hydration status. (AU)

Antecedentes: la evaluación del estado de hidratación y la composición corporal es imprescindible para los pacientes con enfermedad renal crónica (ERC) en estadios intermedios, ya que en esta etapa inician con alteraciones hídricas perceptibles; sin embargo, existe poca información en dicha población sobre la evaluación del estado de volemia mediante el análisis de vectores de bioimpedancia eléctrica (BIVA). Objetivo: asociar el estado de hidratación medido por BIVA con parámetros bioquímicos, clínicos y mortalidad en pacientes con ERC G3a G3b y G4 Material y métodos: estudio transversal en el cual se incluyó a pacientes con ERC en estadios G3a G3b y G4 a los que se les realizó un análisis de impedancia bioeléctrica (IBE) y en los que se determinaron parámetros bioquímicos y clínicos: albúmina sérica y urinaria, hematocrito, electrólitos y creatinina séricos, tasa de filtrado glomerular estimada (TFGe) (fórmula CKD-EPI), diuresis de 24 horas y presión arterial. Las variables clínicas y bioquímicas se asociaron con los componentes de la IBE. Los valores de resistencia/estatura (R/H) y reactancia/estatura (Xc/H) se graficaron individualmente sobre las elipses de referencia para identificar a pacientes con estados de hidratación anormales. Se ubicaron grupos según el estado de hidratación y estadio de ERC en z-score y se identificaron las diferencias de parámetros clínicos, bioquímicos y de IBE. Se determinó la mortalidad según el estado de hidratación. (AU)

Serum Asprosin Concentrations in Children with Prader-Willi Syndrome: Correlations with Metabolic Parameters.

Children with Prader-Willi syndrome (PWS) are characterized by severe obesity. Asprosin is a newly discovered protein hormone produced by the white adipose tissue and is correlated with insulin resistance. The aim of our study was to describe the concentrations of serum asprosin in children with PWS compared to those with overweight/obesity and normal weight, and to explore the postprandial change in asprosin concentrations in participants with PWS and BMI-z matched controls. We enrolled 52 children, 23 with PWS, 8 with overweight/obesity, and 21 with normal weight. Fasting levels of asprosin, glucose, and insulin were collected in all children, and postprandial asprosin and fasting levels of acyl ghrelin (AG) and leptin were also determined in a subsample of participants. There were no significant differences among groups in fasting levels of asprosin, glucose, insulin, and HOMA-IR. Fasting serum asprosin and 1-h post-meal serum asprosin did not differ in children with PWS nor in BMI-z matched controls. Fasting asprosin showed an adjusted positive correlation with glucose in children with obesity (r = 0.93, p = 0.007) but not in children with PWS nor children with normal weight. Circulating asprosin might be a predictor of early alterations in glucose metabolism in children with obesity. More research is needed to further explain the association between asprosin, food intake, metabolism, and obesity in PWS.

Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial.

BACKGROUND: Dietary restriction of sodium has been suggested to prevent fluid overload and adverse outcomes for patients with heart failure. We designed the Study of Dietary Intervention under 100 mmol in Heart Failure (SODIUM-HF) to test whether or not a reduction in dietary sodium reduces the incidence of future clinical events. METHODS: SODIUM-HF is an international, open-label, randomised, controlled trial that enrolled patients at 26 sites in six countries (Australia, Canada, Chile, Colombia, Mexico, and New Zealand). Eligible patients were aged 18 years or older, with chronic heart failure (New York Heart Association [NYHA] functional class 2-3), and receiving optimally tolerated guideline-directed medical treatment. Patients were randomly assigned (1:1), using a standard number generator and varying block sizes of two, four, or six, stratified by site, to either usual care according to local guidelines or a low sodium diet of less than 100 mmol (ie, <1500 mg/day). The primary outcome was the composite of cardiovascular-related admission to hospital, cardiovascular-related emergency department visit, or all-cause death within 12 months in the intention-to-treat (ITT) population (ie, all randomly assigned patients). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT02012179, and is closed to accrual. FINDINGS: Between March 24, 2014, and Dec 9, 2020, 806 patients were randomly assigned to a low sodium diet (n=397) or usual care (n=409). Median age was 67 years (IQR 58-74) and 268 (33%) were women and 538 (66%) were men. Between baseline and 12 months, the median sodium intake decreased from 2286 mg/day (IQR 1653-3005) to 1658 mg/day (1301-2189) in the low sodium group and from 2119 mg/day (1673-2804) to 2073 mg/day (1541-2900) in the usual care group. By 12 months, events comprising the primary outcome had occurred in 60 (15%) of 397 patients in the low sodium diet group and 70 (17%) of 409 in the usual care group (hazard ratio [HR] 0·89 [95% CI 0·63-1·26]; p=0·53). All-cause death occurred in 22 (6%) patients in the low sodium diet group and 17 (4%) in the usual care group (HR 1·38 [0·73-2·60]; p=0·32), cardiovascular-related hospitalisation occurred in 40 (10%) patients in the low sodium diet group and 51 (12%) patients in the usual care group (HR 0·82 [0·54-1·24]; p=0·36), and cardiovascular-related emergency department visits occurred in 17 (4%) patients in the low sodium diet group and 15 (4%) patients in the usual care group (HR 1·21 [0·60-2·41]; p=0·60). No safety events related to the study treatment were reported in either group. INTERPRETATION: In ambulatory patients with heart failure, a dietary intervention to reduce sodium intake did not reduce clinical events. FUNDING: Canadian Institutes of Health Research and the University Hospital Foundation, Edmonton, Alberta, Canada, and Health Research Council of New Zealand.

La adherencia al tratamiento no farmacológico se asocia con metas de control cardiovascular y mejores hábitos dietéticos en pacientes mexicanos con diabetes mellitus tipo 2 / Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus

OBJETIVO: Identificar la asociación de la educación en diabetes y terapia médica en nutrición con metas de control de indicadores de riesgo cardiovascular y hábitos dietéticos en pacientes con diabetes mellitus tipo 2. MATERIAL Y MÉTODOS: Estudio transversal analítico en 395 pacientes de atención primaria. Se realizaron mediciones de HbA1c, glucosa y perfil de lípidos en ayuno, presión arterial, peso, circunferencia de cintura y composición corporal. Los hábitos dietéticos se midieron a través del «Instrumento para medir el estilo de vida en los pacientes con diabetes mellitus tipo 2» (IMEVID), en la dimensión nutrición. La terapia médica nutricional (TMN) y la educación en diabetes (ED), se consideró como recibida por el paciente cuando esta fue otorgada en su clínica de atención. RESULTADOS:Se incluyeron 68% mujeres, con una mediana de seis años de diagnóstico de diabetes. Recibieron ED y TMN un 21%, solo ED o TMN 28% y 51% ninguna de ellas. La HbA1c fue menor en pacientes con ED y TMN (7,7 ± 1,9% vs. 8,7 ± 2,3%, 8,4 ± 2,2%; p = 0,003), respectivamente. En pacientes con ED y TMN hubo una mayor proporción que realizó ejercicio físico, menor consumo de tabaco, mejores hábitos dietéticos (p < 0,05). Los pacientes que recibieron ED y TMN alcanzaron metas de control de la HbA1c y HDL-c. Mostraron mayor riesgo de tener una HbA1c > 7% cuando solo recibieron ED o TMN o ninguna de ellas, mayor tiempo de diagnóstico de la enfermedad y seguir con menor frecuencia una dieta para el control de la enfermedad (p < 0,05). CONCLUSIÓN: La educación en diabetes y la terapia médica nutricional favorecen las metas de control de riesgo cardiovascular y mejores hábitos dietéticos del paciente con diabetes tipo 2.

OBJETIVE: To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS: Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus» (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS: Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSIONS: Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

Adherence to non-pharmacological treatment is associated with the goals of cardiovascular control and better eating habits in Mexican patients with type 2 diabetes mellitus. / La adherencia al tratamiento no farmacológico se asocia con metas de control cardiovascular y mejores hábitos dietéticos en pacientes mexicanos con diabetes mellitus tipo 2.

OBJECTIVE: To identify the association of diabetes education or medical nutrition therapy with the goals of control of cardiovascular risk indicators and dietary habits in patients with type 2 diabetes mellitus. METHODS: Analytical cross-sectional study in 395 primary care patients. HbA1c, fasting glucose and lipid profile, blood pressure, weight, waist circumference, and body composition were measured. Dietary habits were measured using the «Instrument for measuring lifestyle in patients with type 2 diabetes mellitus¼ (IMEVID), in the nutrition dimension. Medical nutrition therapy (MNT) and diabetes education (DE) were considered as received by the patient when provided in their healthcare clinic. RESULTS: Women comprised 68% of the patients, with a median of 6 years from diabetes diagnosis. Of the patients, 21% received DE and MNT, 28% DE or MNT, and 51% received neither. The HbA1c was lower in the patients with DE and MNT (7.7% ± 1.9% vs. 8.7% ± 2.3%, 8.4% ± 2.2%; p = .003) respectively. In the patients with DE and MNT, a higher proportion took physical exercise, consumed less tobacco, and had better dietary habits (p < .05). Patients who received DE and MNT achieved HbA1c and HDL-c control levels. A greater risk of HbA1c > 7% was identified when they only received DE or MNT or neither, a longer time since diagnosis of the disease and less frequent adherence to a diet to control the disease (p < .05). CONCLUSION: Diabetes education and medical nutritional therapy favour the goal of cardiovascular risk control and better dietary habits in the patient with type 2 diabetes.

A dietary pattern high in full-fat dairy and sweetened beverages is associated with glycated hemoglobin and weight in Mexican patients with type-2 diabetes.

INTRODUCTION: Objective: the aim of this study was to identify dietary patterns in a sample of patients with type-2 diabetes, and to evaluate their association with markers of metabolic control. Methods: a cross-sectional study in 395 patients with type-2 diabetes in primary care was conducted. Fasting blood levels of glycated hemoglobin (A1c), glucose, total cholesterol, low- (LDL-c) and high-density lipoprotein cholesterol (HDL-c), and triglycerides were measured. Waist circumference, body mass index (BMI), and blood pressure were evaluated. Dietary intake was assessed by a food frequency questionnaire, and dietary patterns were derived by cluster analysis. Three dietary patterns were identified: 'fruits and vegetables', 'dairy and sweetened beverages', and 'diverse with alcohol'. Results: an association between the 'dairy and sweetened beverages' dietary pattern and A1c levels was identified (ß = 0.61; 95 % CI: 0.09, 1.12, p = 0.021), considering the 'fruits and vegetables' dietary pattern as the reference group. We also observed a trend towards an adjusted increased risk of A1c ≥ 7 % (odds ratio [OR]: 1.56; 95 % CI: 0.92, 2.64; p = 0.099) and an increased risk of BMI ≥ 25 kg/m2 (OR: 2.62, 95 % CI: 1.20, 5.71, p = 0.015) among patients in the 'dairy and sweetened beverages' dietary pattern as compared to the reference group. Conclusions: a dietary pattern characterized by a high intake of full-fat dairy and sweetened beverages was associated with higher A1c levels and increased risk of high glucose and BMI when compared to a dietary pattern with a higher consumption of fruits and vegetables.

INTRODUCCIÓN: Objetivo: el objetivo de este estudio fue identificar los patrones dietéticos de una muestra de pacientes con diabetes de tipo 2 y evaluar su asociación con los marcadores de control metabólico. Métodos: se realizó un estudio transversal de 395 pacientes con diabetes de tipo 2 en atención primaria. Se estimaron los niveles de hemoglobina glicosilada (A1c), glucosa, colesterol total, colesterol de lipoproteínas de baja (LDL-c) y alta densidad (HDL-c), y triglicéridos en ayunas. Se evaluaron el perímetro de la cintura, el índice de masa corporal (IMC) y la presión arterial. La ingesta dietética se evaluó mediante un cuestionario de frecuencia de alimentos y los patrones dietéticos se obtuvieron mediante un análisis de conglomerados. Se identificaron tres patrones dietéticos: "frutas y verduras", "lácteos y bebidas azucaradas" y "diversos con alcohol". Resultados: se identificó una asociación entre el patrón dietético de "productos lácteos y bebidas azucaradas" y los niveles de A1c (ß = 0,61; IC del 95 %: 0,09, 1,12, p = 0,021), considerando el patrón dietético de "frutas y verduras" como grupo de referencia. También se observó una tendencia a un mayor riesgo ajustado de A1c ≥ 7 % (odds ratio [OR]: 1,56; IC del 95 %: 0,92, 2,64; p = 0,099) y un mayor riesgo de IMC ≥ 25 kg/m2 (OR: 2,62; IC del 95 %: 1,20, 5,71, p = 0,015) entre los pacientes del patrón "lácteos y bebidas azucaradas" en comparación con el grupo de referencia. Conclusiones: el patrón dietético caracterizado por un alto consumo de lácteos y bebidas azucaradas se asoció con niveles más altos de A1c y un mayor riesgo de elevación de la glucosa y el IMC, en comparación con un patrón dietético con mayor consumo de frutas y verduras.

Adherence to the DASH dietary pattern is associated with blood pressure and anthropometric indicators in Mexican adults.

INTRODUCTION: Background: adherence to Dietary Approach to Stop Hypertension (DASH) has demonstrated to be effective in lowering blood pressure and other cardiovascular risk markers in different populations, but has never been evaluated in the Mexican population. Objective: to assess adherence to the DASH dietary pattern by using an adapted DASH adequacy index (DASH-AI), and to evaluate its association with cardiovascular risk markers in an adult Mexican population. Methods: we conducted a cross-sectional analysis of data of 1,490 adults aged 20-50 years. Diet was assessed with a Food Frequency Questionnaire and sodium intake by 24-hour urinary sodium excretion; the DASH-AI score was calculated based on the DASH nutrient targets. Multivariable linear and logistic regression analyses were performed to estimate the association between the DASH-AI score and cardiovascular risk markers (body mass index [BMI], waist circumferences, systolic (SBP) and diastolic blood pressure (DBP), glucose, triglycerides, total cholesterol, and high- and low-density lipoproteins). Results: we observed an association of the DASH-AI score with BMI, WC and DBP in the linear (BMI, : -0.55, 95 % CI: -0.77, -0.33; WC, : -1.66, 95 % CI: -2.19, -1.13; DBP, : -0.65, 95 % CI: -1.07, -0.24), and logistic (BMI > 25 kg/m2, OR: 0.82, 95 % CI: 0.74, 0.93; elevated WC, OR: 0.72, 95 % CI: 0.64, 0.81; DBP, OR: 0.83, 95 % CI: 0.72, 0 .95) models. Conclusion: compliance to the DASH-style diet was inversely associated with BMI, WC and DBP in this Mexican population. Promoting adherence to this dietary pattern in the context of Mexican diet is needed to improve cardiovascular health in this population.

INTRODUCCIÓN: Antecedentes: la adherencia al patrón de alimentación DASH ha mostrado ser eficaz para reducir la presión arterial y los marcadores de riesgo cardiovascular en diferentes poblaciones, pero nunca en la mexicana. Objetivo: evaluar la adherencia al patrón de alimentación DASH mediante un índice adapatado a los lineamientos DASH (DASH-AI) y evaluar su asociación con marcadores de riesgo. Métodos: análisis transversal de datos de 1490 adultos de entre 20 y 50 años de edad. La ingesta dietética se evaluó utilizando un cuestionario de frecuencia de consumo de alimentos y el sodio a través de la excresión urinaria en 24 horas; la puntuación DASH-AI se calculó de acuerdo con la adherencia a las recomendaciones DASH. Se realizaron modelos logísticos y lineales para estimar la asociación entre el puntaje DASH-AI y los marcadores de riesgo cardiovascular (índice de masa corporal [IMC], circunferencia de cintura (CC), presión arterial sistólica (PAS) y diastólica (PAD), glucosa, triglicéridos, colesterol total, lipoproteínas de alta y baja densidad). Resultados: observamos una asociación del DASH-AI con el IMC, la CC y la PAD en los modelos lineales (IMC : -0,55, IC del 95 %: -0,77, -0,33; CC : -1,66, IC del 95 %: -2,19, -1,33; PAD, : -0,65, IC del 95 %: -1,07, -0,24) y logístico (IMC > 25 kg/m2, OR: 0,82, IC del 95 %: 0,74, 0,93; CC elevado, OR: 0,72; IC del 95 %: 0,64, 0,81; PAD, OR: 0,83, IC del 95 %: 0,72, 0,95). Conclusión: la adherencia a la dieta DASH se asoció inversamente con el IMC, la CC y la PAD en la población estudiada. Es necesario promover la adherencia a este patrón dietético para mejorar la salud cardiovascular.

Diet Quality Is Associated with a High Newborn Size and Reduction in the Risk of Low Birth Weight and Small for Gestational Age in a Group of Mexican Pregnant Women: An Observational Study.

A high-quality diet during pregnancy may have positive effects on fetal growth and nutritional status at birth, and it may modify the risk of developing chronic diseases later in life. The aim of this study was to evaluate the association between diet quality and newborn nutritional status in a group of pregnant Mexican women. As part of the ongoing Mexican prospective cohort study, OBESO, we studied 226 healthy pregnant women. We adapted the Alternated Healthy Eating Index-2010 for pregnancy (AHEI-10P). The association between maternal diet and newborn nutritional status was investigated by multiple linear regression and logistic regression models. We applied three 24-h recalls during the second half of gestation. As the AHEI-10P score improved by 5 units, the birth weight and length increased (ß = 74.8 ± 35.0 g and ß = 0.3 ± 0.4 cm, respectively, p < 0.05). Similarly, the risk of low birth weight (LBW) and small for gestational age (SGA) decreased (OR: 0.47, 95%CI: 0.27-0.82 and OR: 0.55, 95%CI: 0.36-0.85, respectively). In women without preeclampsia and/or GDM, the risk of stunting decreased as the diet quality score increased (+5 units) (OR: 0.62, 95%IC: 0.40-0.96). A high-quality diet during pregnancy was associated with a higher newborn size and a reduced risk of LBW and SGA in this group of pregnant Mexican women.

A two-component pictured-based appetite assessment tool is capable of detecting appetite sensations in younger children: A pilot study.

Visual analogue scales (VAS) have commonly been used to assess appetite in children 8 years and older; however, these tools have been considered unreliable for children 7 years old and under. The objective of this pilot study was to develop a picture-based appetite assessment (PBAA) tool for children aged 4-10 years and pilot test it compared to a VAS-based appetite assessment. The study hypothesis was that the PBAA scores would decrease following the consumption of an ad libitum snack compared to the scores in the fasted state in children 4 to 10 years old; furthermore, there would be a good level of agreement (intraclass correlation coefficients >0.75) between the appetite scores by the PBAA and VAS tools in children aged 8 years or older. At Visit 1, in a fasted state, all children (n = 15) completed the PBAA. Children who were 8-10 years old (n = 8) also completed the VAS-based appetite assessment. Then, an ad libitum snack was provided, and appetite assessments were repeated at 5-, 30- and 60-minutes post-snack. The same assessments were completed at visit 2 pre (fasting)- and post-consumption of a snack containing 25% of the amount consumed at visit 1 (limited snack). PBAA scores were different across time (P < .001) and between types of meal (ad libitum vs limited snack) (P = .015) in all children. A good agreement between the PBAA and VAS scores at 30 and 60 minutes after both types of meal was found (intraclass correlation coefficients >0.75). The PBAA tool was able to detect expected changes in appetite sensations and was in good agreement with the VAS instrument.