Food Access, Diet Quality, and Nutritional Status of Older Adults During COVID-19: A Scoping Review.

Background: COVID-19 has imposed challenges for older adults to access food, particularly in minority, lower income, and rural communities. However, the impact of COVID-19 on food access, diet quality, and nutrition of diverse older adult populations has not been systematically assessed. Objective: To examine changes in food access, diet quality, and nutritional status among older adults during the COVID-19 pandemic and the potential differential impacts of the COVID-19 pandemic on these nutrition-related outcomes using the framework of the socio-ecological model. Methods: An electronic search was conducted on 3 databases (PubMed, CINAHL, and Web of Science) on March 7, 2021. Original, peer-reviewed English-language studies published 10/1/2019-3/1/2021 were considered for which the mean age of participants was 50 years and older. In order to be considered, studies must have examined food access, food security, or nutrition constructs as an outcome. Results: The initial search yielded 13,628 results, of which 9,145 were duplicates. Of the remaining 4,483 articles, 13 articles were in scope and therefore selected in the final analysis, which can be characterized as descriptive (n = 5), analytical (n = 6), and correlational (n = 2). Studies were conducted among community-dwelling older adult populations (n = 7) as well as those temporarily residing in hospital settings (n = 6) in 10 countries. None of the in-scope studies examined the impact of food programs or specific public policies or disaggregated data by race/ethnicity. Conclusions: More research is needed to examine the impact of COVID-19 on food access/security and the differential barriers experienced by older adult populations.

The role of cardiorespiratory fitness on quality of life in midlife women.

OBJECTIVE: We aimed to characterize the relationship between cardiorespiratory fitness and quality of life in a sample of healthy midlife women aged 40 to 65 years. METHODS: Cardiorespiratory fitness was measured with a VO2max test. Quality of life was assessed with the menopause-specific Utian Quality of Life scale (UQOL). The UQOL measures overall quality of life, which comprises health, emotional, occupational, and sexual domains. Simple and multiple linear regression models were built to analyze relationships between cardiorespiratory fitness and overall quality of life as well as the separate UQOL domains. RESULTS: Forty-nine women with an average age of 52.5 years were included in the analysis. In simple linear models, cardiorespiratory fitness was related to overall (R2 = 0.34, P < 0.001), health (R2 = 0.55, P < 0.001), emotional (R2 = 0.08, P = 0.05), and occupational (R2 = 0.09, P = 0.03) quality of life. In multiple regression models, cardiorespiratory fitness was associated with overall (P < 0.01) and health (P < 0.001) quality of life, after controlling for physical activity, age, body mass index, and time sedentary. CONCLUSIONS: Higher cardiorespiratory fitness is associated with better quality of life during midlife, particularly in the health domain. Increasing cardiorespiratory fitness may be a useful means to promote quality of life in this population.

Healthy diet is associated with gene expression in blood: the Framingham Heart Study.

BACKGROUND: Genes in metabolic and nutrient signaling pathways play important roles in lifespan in model organisms and human longevity. OBJECTIVE: The aim of this study was to examine the relation of a quantitative measure of healthy diet to gene expression in a community-based cohort. METHODS: We used the 2015 Dietary Guidelines for Americans Adherence Index (DGAI) score to quantify key dietary recommendations of an overall healthy diet. Our current analyses included 2220 Offspring participants (mean age 66 ± 9 y, 55.4% women) and 2941 Third-Generation participants (mean age 46 ± 9 y, 54.5% women) from the Framingham Heart Study. Gene expression was profiled in blood through the use of the Affymetrix Human Exon 1.0 ST Array. We conducted a transcriptome-wide association study of DGAI adjusting for age, sex, smoking, cell counts, and technical covariates. We also constructed a combined gene score from genes significantly associated with DGAI. RESULTS: The DGAI was significantly associated with the expression of 19 genes (false discovery rate <0.05). The most significant gene, ARRDC3, is a member of the arrestin family of proteins, and evidence in animal models and human data suggests that this gene is a regulator of obesity and energy expenditure. The DGAI gene score was associated with body mass index (P = 1.4 × 10-50), fasting glucose concentration (P = 2.5 × 10-11), type 2 diabetes (P = 1.1 × 10-5), and metabolic syndrome (P = 1.8 × 10-32). CONCLUSIONS: Healthier diet was associated with genes involved in metabolic function. Further work is needed to replicate our findings and investigate the relation of a healthy diet to altered gene regulation.

Protein intake and the risk of premenstrual syndrome.

OBJECTIVE: To examine the relationship between protein intake and the risk of incident premenstrual syndrome (PMS). DESIGN: Nested case-control study. FFQ were completed every 4 years during follow-up. Our main analysis assessed protein intake 2-4 years before PMS diagnosis (for cases) or reference year (for controls). Baseline (1991) protein intake was also assessed. SETTING: Nurses' Health Study II (NHS2), a large prospective cohort study of registered female nurses in the USA.ParticipantsParticipants were premenopausal women between the ages of 27 and 44 years (mean: 34 years), without diagnosis of PMS at baseline, without a history of cancer, endometriosis, infertility, irregular menstrual cycles or hysterectomy. Incident cases of PMS (n 1234) were identified by self-reported diagnosis during 14 years of follow-up and validated by questionnaire. Controls (n 2426) were women who did not report a diagnosis of PMS during follow-up and confirmed experiencing minimal premenstrual symptoms. RESULTS: In logistic regression models adjusting for smoking, BMI, B-vitamins and other factors, total protein intake was not associated with PMS development. For example, the OR for women with the highest intake of total protein 2-4 years before their reference year (median: 103·6 g/d) v. those with the lowest (median: 66·6 g/d) was 0·94 (95 % CI 0·70, 1·27). Additionally, intakes of specific protein sources and amino acids were not associated with PMS. Furthermore, results substituting carbohydrates and fats for protein were also null. CONCLUSIONS: Overall, protein consumption was not associated with risk of developing PMS.

A Systematic Review of Mobile Produce Markets: Facilitators and Barriers to Use, and Associations with Reported Fruit and Vegetable Intake.

BACKGROUND: Diet-related chronic diseases are a major public health burden. There is growing awareness that disparities in healthful food access contribute to disparities in health. Mobile produce markets (MPMs) have emerged as a strategy to improve fruit and vegetable access and consumption, particularly among low-income, minority, and other vulnerable populations (eg, older adults and children) in food desert neighborhoods. OBJECTIVE: This review examined research on MPMs in the United States and specifically aimed to assess the relationship between MPM use and fruit and/or vegetable intake, and facilitators and barriers related to MPM use within a social ecological framework. METHODS: A systematic review of the literature consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted. Articles published through December 2017 were identified using the following databases: Web of Science, PubMed, Agricola, and CAB Abstracts. MPM studies published in English and in peer-reviewed journals were eligible for inclusion if they were based on primary research of MPMs in the United States, included results, and if MPMs were analyzed separately from other market venues and sold predominantly fruits and/or vegetables. A total of 24 studies were identified for inclusion, which varied in study types as follows: quantitative (n=15), qualitative (n=3), and mixed methods (n=6). RESULTS: An association was found between MPM use and higher reported fruit and/or vegetable intake, although existing studies that measured fruit and vegetable intake were not rigorous in study design (eg, lack of control group, use of convenience sample, small sample size). MPM location was the most commonly cited facilitator of MPM use. Other institutional factors (eg, nutrition education), as well as policy factors (eg, food-assistance programs), community factors (eg, market site liaisons), interpersonal factors (eg, socializing at market), and intrapersonal factors (eg, awareness of the benefits of fruit and/or vegetable intake) were identified. CONCLUSIONS: MPMs offer a promising strategy to improve access to fruits and vegetables and may further support healthful-food purchasing and consumption through food-assistance incentives and enticements for consumers (eg, opportunities for social networking and nutrition education). Future research on MPMs would benefit from more rigorous experimental designs, such as including a control group, and examining multiple levels within a social ecological framework.

A Prospective Study of Dairy-Food Intake and Early Menopause.

Early natural menopause, the cessation of ovarian function prior to age 45 years, affects approximately 10% of women and increases risk of cardiovascular disease and other adverse conditions. Laboratory evidence suggests a potential role of dairy foods in the ovarian aging process; however, no prior epidemiologic studies have evaluated how dairy-food intake is associated with risk of early menopause. We therefore evaluated how intakes of total, low-fat, high-fat, and individual dairy foods were associated with early menopause in Nurses' Health Study II. Women who were premenopausal at the start of follow-up in 1991 were followed until 2011 for early menopause. Food frequency questionnaires were used to assess dietary intake. In Cox proportional hazards models adjusting for age, smoking, and other factors, total baseline dairy-food intake of ≥4 servings/day versus <4 servings/week was associated with 23% lower risk of early menopause (hazard ratio = 0.77, 95% confidence interval: 0.64, 0.93; P for trend = 0.08). Associations appeared to be limited to low-fat dairy foods (for ≥2 servings/day vs. <3 servings/month, hazard ratio = 0.83, 95% confidence interval: 0.68, 1.01; P for trend = 0.02), whereas high-fat dairy-food intake was not associated with early menopause. Low-fat dairy foods may represent a modifiable risk factor for reducing risk of early menopause among premenopausal women.

Vitamin D Status Is Not Associated with Risk of Early Menopause.

Background: Early natural menopause, the cessation of ovarian function before age 45 y, is positively associated with cardiovascular disease and other conditions. Dietary vitamin D intake has been inversely associated with early menopause; however, no previous studies have evaluated risk with regard to plasma 25-hydroxyvitamin D [25(OH)D] concentrations. Objective: We prospectively evaluated associations of total and free 25(OH)D and vitamin D-binding protein (VDBP) concentrations and the risk of early menopause in a case-control study nested within the Nurses' Health Study II (NHS2). We also considered associations of 25(OH)D and VDBP with anti-Müllerian hormone (AMH) concentrations. Methods: The NHS2 is a prospective study in 116,430 nurses, aged 25-42 y at baseline (1989). Premenopausal plasma blood samples were collected between 1996 and 1999, from which total 25(OH)D and VDBP concentrations were measured and free 25(OH)D concentrations were calculated. Cases experienced menopause between blood collection and age 45 y (n = 328) and were matched 1:1 by age and other factors to controls who experienced menopause after age 48 y (n = 328). Conditional logistic regression models were used to estimate ORs and 95% CIs for early menopause according to each biomarker. Generalized linear models were used to estimate AMH geometric means according to each biomarker. Results: After adjusting for smoking and other factors, total and free 25(OH)D were not associated with early menopause. Quartile 4 compared with quartile 1 ORs were 1.04 (95% CI: 0.60, 1.81) for total 25(OH)D and 0.70 (95% CI: 0.41, 1.20) for free 25(OH)D. 25(OH)D was unrelated to AMH concentrations. VDBP was positively associated with early menopause; the OR comparing the highest with the lowest quartile of VDBP was 1.80 (95% CI: 1.09, 2.98). Conclusions: Our findings suggest that total and free 25(OH)D are not importantly related to the risk of early menopause. VDBP may be associated with increased risk, but replication is warranted.

Mobile produce market influences access to fruits and vegetables in an urban environment.

OBJECTIVE: To assess the influence of a mobile produce market (MPM) on fruit and vegetable access. DESIGN: Novel application of a structured assessment (five dimensions of access framework) to examine fruit and vegetable access through self-administered surveys on shopping behaviours, and perceptions and experiences of shopping at the MPM. SETTING: Low-income neighbourhoods with limited access to fruits and vegetables. SUBJECTS: Older (≥60 years) and younger (18-59·9 years) shoppers. RESULTS: Participants were more likely to be women and non-White, one-third lived alone and nearly half were older adults. Compared with younger, older participants had different shopping behaviours: tended to purchase food for one person (P < 0·001), be long-term shoppers (P=0·002) and use electronic benefit transfer (EBT) cards (P=0·012). Older adults were more likely to like the market location (P=0·03), while younger adults were more likely to want changes in location (P=0·04), more activities (P=0·04), taste sampling (P=0·05) and nutritional counselling (P=0·01). The MPM captured all dimensions of access: availability, indicated by satisfaction with the produce variety for nearly one-third of all participants; accessibility, indicated by participants travelling <1 mile (<1·6 km; 72·2 %) and appreciation of location (72·7 %); affordability, indicated by satisfaction with price (47·6 %); acceptability, indicated by appreciation of produce quality (46·2 %); and accommodation, indicated by satisfaction with safety of location (30·1 %) and high EBT use among older adults (41·8 %). CONCLUSIONS: MPM may influence fruit and vegetable access in low-income urban neighbourhoods by facilitating the five dimensions of access and may especially benefit older adults and individuals living alone.

Carbohydrate and fiber intake and the risk of premenstrual syndrome.

BACKGROUND/OBJECTIVES: Women with premenstrual syndrome (PMS) are encouraged to reduce sugar and increase fiber intake to reduce symptoms. However, research supporting these recommendations is limited, and their role in PMS development is unclear. This study examines the relation between carbohydrate and fiber intake and the risk of PMS nested within the prospective Nurses' Health Study II cohort. SUBJECTS/METHODS: Carbohydrate and fiber intake were assessed at baseline and three additional times during follow up by food frequency questionnaire. Incident cases of PMS were identified by self-reported PMS diagnosis during 14 years of follow up and validated by supplemental questionnaire (n = 1234). Women were classified as controls if they did not report PMS diagnosis during follow up and confirmed minimal or no premenstrual symptoms (n = 2426). We estimated relative risks (RR) and 95% confidence intervals (CI) using multivariable logistic regression. RESULTS: Total carbohydrate intake 2-4 years before reference year was not associated with PMS development (RR quintile 5 versus 1 = 0.99; 95% CI = 0.74-1.33). Intakes of specific carbohydrates or fibers were not associated with PMS development, except maltose. Adjusting for body mass index, smoking, and other factors, women with the highest maltose intake (median = 3.0 g/day) had a RR of 1.45 (95% CI = 1.11-1.88) compared to those with the lowest intake (median = 1.2 g/day). CONCLUSIONS: Overall, carbohydrate and fiber consumption was not associated with risk of PMS. As this is the first study to suggest that maltose may be associated with PMS development, further replication is needed.

Intake of dietary fat and fat subtypes and risk of premenstrual syndrome in the Nurses' Health Study II.

Approximately 8-20 % of reproductive-aged women experience premenstrual syndrome (PMS), substantially impacting quality of life. Women with PMS are encouraged to reduce fat intake to alleviate symptoms; however, its role in PMS development is unclear. We evaluated the association between dietary fat intake and PMS development among a subset of the prospective Nurses' Health Study II cohort. We compared 1257 women reporting clinician-diagnosed PMS, confirmed by premenstrual symptom questionnaire and 2463 matched controls with no or minimal premenstrual symptoms. Intakes of total fat, subtypes and fatty acids were assessed via FFQ. After adjustment for age, BMI, smoking, Ca and other factors, intakes of total fat, MUFA, PUFA and trans-fat measured 2-4 years before were not associated with PMS. High SFA intake was associated with lower PMS risk (relative risk (RR) quintile 5 (median=28·1 g/d) v. quintile 1 (median=15·1 g/d)=0·75; 95 % CI 0·58, 0·98; P trend=0·07). This association was largely attributable to stearic acid intake, with women in the highest quintile (median=7·4 g/d) having a RR of 0·75 v. those with the lowest intake (median=3·7 g/d) (95 % CI 0·57, 0·97; P trend=0·03). Individual PUFA and MUFA, including n-3 fatty acids, were not associated with risk. Overall, fat intake was not associated with higher PMS risk. High intake of stearic acid may be associated with a lower risk of developing PMS. Additional prospective research is needed to confirm this finding.

Vitamin D and calcium intake and risk of early menopause.

Background: Early menopause, defined as the cessation of ovarian function before the age of 45 y, affects ∼10% of women and is associated with higher risk of cardiovascular disease, osteoporosis, and other conditions. Few modifiable risk factors for early menopause have been identified, but emerging data suggest that high vitamin D intake may reduce risk.Objective: We evaluated how intakes of vitamin D and calcium are associated with the incidence of early menopause in the prospective Nurses' Health Study II (NHS2).Design: Intakes of vitamin D and calcium from foods and supplements were measured every 4 y with the use of a food-frequency questionnaire. Cases of incident early menopause were identified from all participants who were premenopausal at baseline in 1991; over 1.13 million person-years, 2041 women reported having natural menopause before the age of 45 y. We used Cox proportional hazards regression to evaluate relations between intakes of vitamin D and calcium and incident early menopause while accounting for potential confounding factors.Results: After adjustment for age, smoking, and other factors, women with the highest intake of dietary vitamin D (quintile median: 528 IU/d) had a significant 17% lower risk of early menopause than women with the lowest intake [quintile median: 148 IU/d; HR: 0.83 (95% CI: 0.72, 0.95); P-trend = 0.03]. Dietary calcium intake in the highest quintile (median: 1246 mg/d) compared with the lowest (median: 556 mg/d) was associated with a borderline significantly lower risk of early menopause (HR: 0.87; 95% CI: 0.76, 1.00; P-trend = 0.03). Associations were stronger for vitamin D and calcium from dairy sources than from nondairy dietary sources, whereas high supplement use was not associated with lower risk.Conclusions: Findings suggest that high intakes of dietary vitamin D and calcium may be modestly associated with a lower risk of early menopause. Further studies evaluating 25-hydroxyvitamin D concentrations, other dairy constituents, and early menopause are warranted.

Endothelial and inflammatory responses to acute exercise in perimenopausal and late postmenopausal women.

Endothelial dysfunction and inflammation are characteristics of subclinical atherosclerosis and may increase through progressive menopausal stages. Evaluating endothelial responses to acute exercise can reveal underlying dysfunction not apparent in resting conditions. The purpose of this study was to investigate markers of endothelial function and inflammation before and after acute exercise in healthy low-active perimenopausal (PERI) and late postmenopausal (POST) women. Flow-mediated dilation (FMD), CD31+/CD42b- and CD62E+ endothelial microparticles (EMPs), and the circulating inflammatory factors monocyte chemoattractant protein 1 (MCP-1), interleukin 8 (IL-8), and tumor necrosis factor-α (TNF-α) were measured before and 30 min after acute exercise. Before exercise, FMD was not different between groups (PERI: 6.4 ± 0.9% vs. POST: 6.5 ± 0.8%, P = 0.97); however, after acute exercise PERI tended to improve FMD (8.5 ± 0.9%, P = 0.09), whereas POST did not (6.2 ± 0.8%, P = 0.77). Independent of exercise, we observed transient endothelial dysfunction in POST with repeated FMD measures. There was a group × exercise interaction for CD31+/CD42b- EMPs (P = 0.04), where CD31+/CD42b- EMPs were similar before exercise (PERI: 57.0 ± 6.7 EMPs/µl vs. POST: 58.5 ± 5.3 EMPs/µl, P = 0.86) but were higher in POST following exercise (PERI: 48.2 ± 6.7 EMPs/µl vs. POST: 69.4 ± 5.3 EMPs/µl, P = 0.023). CD62E+ EMPs were lower in PERI compared with POST before exercise (P < 0.001) and increased in PERI (P = 0.04) but did not change in POST (P = 0.68) in response to acute exercise. After acute exercise, MCP-1 (P = 0.055), TNF-α (P = 0.02), and IL-8 (P < 0.001) were lower in PERI but only IL-8 decreased in POST (P < 0.001). Overall, these data suggest that perimenopausal and late postmenopausal women display different endothelial and inflammatory responses to acute exercise.

Dietary Guideline Adherence Index and Kidney Measures in the Framingham Heart Study.

BACKGROUND: No observational studies have directly considered dietary guidelines when examining the prospective association between dietary intake and kidney measures. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: We examined participants who attended examinations 7 (1998-2001) and 8 (2005-2008) in the Framingham Offspring Cohort. PREDICTORS: Individual components of Dietary Guidelines for Americans Adherence Index (DGAI) that reflect adherence to key dietary recommendations based on the 2005 guideline. OUTCOMES & MEASURES: The primary outcome was incident low estimated glomerular filtration rate (eGFR) at follow-up after exclusion of prevalent low eGFR at baseline. Low eGFR was defined as serum creatinine-based eGFR<60mL/min/1.73m2. RESULTS: Among 1,822 participants (mean age, 59.4 years; 54.6% women), 181 incident cases of low eGFR were identified. After adjustment for potential confounders, compared to optimal adherence to meat and legume recommendations, low adherence was associated with higher odds of incident low eGFR (P for trend = 0.01); ORs in the lowest and intermediate adherence categories were 2.98 (95% CI, 1.13-7.92) and 1.65 (95% CI, 1.02-2.66), respectively. Low adherence to dairy product recommendations was also associated with higher odds of incident low eGFR compared to optimal adherence (P for trend = 0.03); ORs in the lowest and intermediate adherence categories were 1.98 (95% CI, 1.03-3.82) and 1.59 (95% CI, 0.81-3.11), respectively. In addition, low adherence to meat and legume recommendations was associated with rapid eGFR decline (P for trend = 0.01), and low adherence to dairy product recommendations was associated with rapid eGFR decline (P for trend = 0.01) and incident albuminuria (P for trend = 0.03). LIMITATIONS: The DGAI was developed based on the 2005 Dietary Guidelines for Americans. CONCLUSIONS: Better adherence to dietary recommendations for both meat and legumes and dairy products was associated with lower risk for developing adverse kidney measures.

Enhancing Evidence-Based Public Health Policy: Developing and Using Policy Narratives.

Academic researchers and clinicians have a critical role in shaping public policies to improve the health of an aging America. Policy narratives that pair personal stories with research statistics are a powerful tool to share knowledge generated in academic and clinical settings with policymakers. Effective policy narratives rely on a trustworthy and competent narrator and a compelling story that highlights the personal impact of policies under consideration and academic research that bolsters the story. Awareness of the cultural differences in the motivations, expectations, and institutional constraints of academic researchers and clinicians as information producers and U.S. Congress and federal agencies as information users is critical to the development of policy narratives that impact policy decisions. The current article describes the development and use of policy narratives to bridge cultures and enhance evidence-based public health policies that better meet the needs of older adults. [Journal of Gerontological Nursing, 42(6), 11-17.].

Pathways to Advancing Aging Policy-Relevant Research in Academic Settings.

Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research.

Longitudinal association of dairy consumption with the changes in blood pressure and the risk of incident hypertension: the Framingham Heart Study.

We aimed to examine the longitudinal association of dairy consumption with the changes in blood pressure (BP) and the risk of incident hypertension (HTN) among adults. This study included 2636 Framingham Heart Study Offspring Cohort members who participated in the 5th through 8th examinations (1991-2008) and were free of HTN at their first examination during the follow-up. Data collected at each examination included dietary intake (by a validated FFQ), BP (following standardised procedures) and anti-hypertensive medication use (by physician-elicited self-report). HTN was defined as systolic BP (SBP)≥140 mmHg, or diastolic BP (DBP)≥90 mmHg or anti-hypertensive medication use. We used repeated-measure and discrete-time hazard regressions to examine the associations of dairy consumption with the annualised BP change (n 2075) and incident HTN (n 2340; cases=1026), respectively. Covariates included demographic, lifestyle, overall diet quality, metabolic factors and medication use. Greater intakes of total dairy foods, total low-fat/fat-free dairy foods, low-fat/skimmed milk and yoghurt were associated with smaller annualised increments in SBP and a lower risk of projected HTN incidence. However, with the exception of total dairy foods and yoghurt, these inverse associations with HTN risk were attenuated as the follow-up time increased. For yoghurt, each additional serving was associated with 6 (95 % CI 1, 10) % reduced risk of incident HTN. Total dairy and total low-fat/fat-free dairy intakes were found to be inversely related to changes in DBP. Dairy consumption, as part of a nutritious and energy-balanced diet pattern, may benefit BP control and prevent or delay the onset of HTN.

Concordance with DASH diet and blood pressure change: results from the Framingham Offspring Study (1991-2008).

BACKGROUND: Concordance with the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce blood pressure (BP) in short-term intervention studies, but long-term effects are unclear. We evaluated the association of DASH diet concordance with BP trajectories and incidence of hypertension, in 2187 men and women (mean age 52.5 years at baseline) participating in the Framingham Offspring cohort. METHOD: Diet and BP were assessed from 1991 to 2008, with a median follow-up time of 13.4 years. DASH scores (ranging from 0 for worst to 10 for best concordance with DASH diet) were calculated by summing 10 food components that comprise the DASH diet pattern, including fruits and vegetables, low-fat dairy products, lean meat, and plant-based protein. Mixed-effect and Cox regression models were applied, to assess the association of DASH diet concordance with BP longitudinal change and with incidence of hypertension, respectively. All analyses were adjusted for age, sex, smoking status, history of diabetes, BMI, and physical activity. RESULT: Overall, SBP increased by 0.34 mmHg and DBP by 0.10 mmHg annually, in the Framingham Offspring cohort. Every unit increase in the DASH score resulted in a modest increase in SBP of 0.054 mmHg/year (P = 0.028). No associations were observed between DASH diet concordance and DBP or incidence of hypertension. CONCLUSION: Long-term concordance with the DASH diet was not associated with a decreasing BP trajectory over time, or with decreased incidence of hypertension, in this population of middle-aged adults.

Endothelial function, arterial stiffness and adherence to the 2010 Dietary Guidelines for Americans: a cross-sectional analysis.

Endothelial dysfunction and arterial stiffness are early predictors of CVD. Intervention studies have suggested that diet is related to vascular health, but most prior studies have tested individual foods or nutrients and relied on small samples of younger adults. The purpose of the present study was to examine the relationships between adherence to the 2010 Dietary Guidelines for Americans and vascular health in a large cross-sectional analysis. In 5887 adults in the Framingham Heart Study Offspring and Third Generation cohorts, diet quality was quantified with the 2010 Dietary Guidelines Adherence Index (DGAI-2010). Endothelial function was assessed via brachial artery ultrasound and arterial stiffness via arterial tonometry. In age-, sex- and cohort-adjusted analyses, a higher DGAI-2010 score (greater adherence) was modestly associated with a lower resting flow velocity, hyperaemic response, mean arterial pressure, carotid-femoral pulse wave velocity (PWV), and augmentation index, but not associated with resting arterial diameter or flow-mediated dilation (FMD). In multivariable models adjusting for cardiovascular risk factors, only the association of a higher DGAI-2010 score with a lower baseline flow velocity and augmentation index persisted (ß = - 0·002, P= 0·003 and ß = - 0·05 ± 0·02, P< 0·001, respectively). Age-stratified multivariate-adjusted analyses suggested that the relationship of higher DGAI-2010 scores with lower mean arterial pressure, PWV and augmentation index was more pronounced among adults younger than 50 years. Better adherence to the 2010 Dietary Guidelines for Americans, particularly in younger adults, is associated with a lower peripheral blood flow velocity and arterial wave reflection, but not FMD. The present results suggest a link between adherence to the Dietary Guidelines and favourable vascular health.

Whole- and refined-grain intakes are differentially associated with abdominal visceral and subcutaneous adiposity in healthy adults: the Framingham Heart Study.

BACKGROUND: Observational studies have linked higher intakes of whole grains to lower abdominal adiposity; however, the association between whole- and refined-grain intake and body fat compartments has yet to be reported. OBJECTIVE: Different aspects of diet may be differentially related to body fat distribution. The purpose of this study was to assess associations between whole- and refined-grain intake and abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). DESIGN: Cross-sectional associations between whole- and refined-grain intakes, waist circumference measures, and abdominal SAT and VAT volumes were examined in 2834 Framingham Heart Study participants (49.4% women; age range: 32-83 y). Dietary information was assessed with the use of a semiquantitative food-frequency questionnaire. RESULTS: Whole-grain intake was inversely associated with SAT (2895 compared with 2552 cm³ in the lowest compared with the highest quintile category, P for trend < 0.001) and VAT (1883 compared with 1563 cm³, P for trend < 0.001), after adjustment for age, sex, current smoking status, total energy, and alcohol intake. In contrast, refined-grain intake was positively associated with SAT (2748 compared with 2934 cm³, P for trend = 0.01) and VAT (1727 compared with 1928 cm³, P for trend < 0.001) in multivariable models. When SAT and VAT were evaluated jointly, the P value for SAT was attenuated (P = 0.28 for whole grains, P = 0.60 for refined grains), whereas VAT remained associated with both whole grains (P < 0.001) and refined grains (P < 0.001). CONCLUSIONS: Increasing whole-grain intake is associated with lower VAT in adults, whereas higher intakes of refined grains are associated with higher VAT. Further research is required to elicit the potential mechanisms whereby whole- and refined-grain foods may influence body fat distribution.