Effect of weight change on the association between overall and source of carbohydrate intake and risk of metabolic syndrome: Tehran lipid and glucose study.

BACKGROUND: In this prospective cohort study, we aimed to evaluate the association between dietary carbohydrates, whole grains, refined grains, and simple sugar with the risk of metabolic syndrome (MetS) and assess the effect of weight change on these associations. METHODS: This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). We included 1915 healthy participants with complete demographic, anthropometric and dietary measurements, among whom 591 developed MetS during 8.9 years of follow-up. Intake of dietary carbohydrates, whole grains, refined grains, and simple sugar was assessed with a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of dietary variables. Using joint classification, the effect of weight change on the association between dietary variables and risk of MetS was assessed by Cox regression. RESULTS: Carbohydrate intake was not associated with the risk of MetS in multivariable-adjusted models. Whole grains intake was inversely associated with the risk of MetS (HR: 0.78, CI: 0.63-0.98), while this association disappeared after adjustment for weight change. The risk of MetS increased by 11% (1.11, 1.09-1.14) for each 3% energy increment from simple sugar, and by 5% (1.05, 1.03-1.08) for each 1 serving/day increment in refined grains. Consumption of refined grains increased the risk of MetS; an effect modification of this association was found by weight change. Among subjects with weight loss, intake of refined grains < median intake decreased the risk of MetS (0.59, 0.41-0.87). However, consumption of refined grains ≥ median intake increased the risk of MetS in individuals with weight gain (1.47, 1.08-2.01). Simple sugar was positively associated with an increased risk of MetS, after adjustment for weight change (3.00, 2.37-3.82). In joint classification, intake of simple sugar greater than median intake increased the risk of MetS, independent of weight change. CONCLUSION: Our findings suggest an effect modification by weight change on the association between carbohydrates, and refined grains intake and the risk of MetS. Weight loss along with lower consumption of carbohydrates, and refined grains reduced the risk of MetS. However, simple sugar intake, regardless of weight change, was associated with an increased risk of MetS.

Tools to Measure Health Literacy among Adult Hispanic Populations with Type 2 Diabetes Mellitus: A Review of the Literature.

Health literacy (HL) is associated with short- and long-term health outcomes, and this is particularly relevant in Hispanics, who are disproportionally affected by lower HL. Hispanics have become the largest minority population in the United States. Also, Hispanics experience higher burdens of chronic diseases such as type 2 diabetes mellitus (T2DM) than non-Hispanic whites. Thus, effectively choosing culturally appropriate validated instruments that measure a marker found in health assessments should be a serious consideration. Using a systemized approach, we identified and reviewed 33 publications and found eight different HL and numeracy (separate or combined) instruments. We assessed the study designs and instrument structures to determine how HL was measured across these studies. We categorized the results into direct and indirect measurements of HL. The Test of Functional Health Literacy in Adults (TOFHLA) family of HL instruments was favored for direct measures of HL, while the Brief Health Literacy Screen (BHLS) instrument was favored for indirect measures. Despite identified trends in instruments used, more comprehensive measurement tools have been developed but not validated in Hispanic populations. In conclusion, further validation of more comprehensive HL instruments in adult Hispanic populations with T2DM could better assess HL levels and improve health promotion efforts.

Fruit, Vegetable, and Physical Activity Guideline Adherence and Metabolic Syndrome in El Banco por Salud.

Adherence to dietary and physical activity recommendations has been associated with reductions in morbidity and mortality. The association between baseline adherence to fruit, vegetable, and physical activity guidelines and metabolic syndrome (MetS) in El Banco por Salud (El Banco) was examined. El Banco is a wellness biobank for Latino individuals affiliated with partnered Federally Qualified Health Centers in southern Arizona. Study participants (n = 972) were 65% female, 62.3% foreign-born, 56.3% obese, 29.2% food insecure, and with an average age of 51.3 years. Adherence scores were developed using baseline questionnaires for fruits and vegetable consumption and self-reported physical activity. Adherence was low in those fully meeting guidelines for fruit, vegetable, and physical activity at 14.6%, 37.5%, and 23.5%, respectively. Roughly 65% (n = 630) had ≥3 cardiometabolic risk factors. Large waist circumference was the most prevalent risk factor at 77.9%. Adherence to physical activity recommendations differed by MetS status with 32.8% without MetS reporting ≥150 min of physical activity per week compared to 18.5% in those with MetS (p < 0.001). There were no significant associations with adherence to any guidelines and MetS in the fully adjusted model. Overall, in this sample guideline adherence was low and the cardiometabolic risk factors prevalence was high.

Socioeconomic status and lifestyle factors modifies the association between snack foods intake and incidence of metabolic syndrome.

BACKGROUND: Intake of snack foods has been previously associated with an elevated risk of chronic disease; however, studies on snack foods and metabolic syndrome (MetS) while considering the modifying effect of socioeconomic status (SES) and lifestyle factors on this association are lacking. We aimed to investigate the association between snack foods intake and the MetS risk, and the mediatory effects of SES and lifestyle factors on the forenamed association among adults who participated in the Tehran Lipid and Glucose Study (2006-2018). METHODS: This is a prospective study of 1915 participants (male, 40.5%), aged 19-74 year who were free of MetS at baseline. Dietary intakes were gathered using a validated, semi-quantitative food frequency questionnaire at baseline (2006-2008), and with 3-year intervals afterwards. Alternative approach was used for snack foods from all available questionnaires during follow-up. Snack foods were divided into 4 categories, including total snacks, biscuits and cakes, candies and chocolate, and salty snacks. Total snack foods intake and its subgroup (serving/week) were modeled as tertiles. MetS was diagnosed according to the Joint Interim Statement criteria. Physical activity level (PAL) categorized as low/medium and high levels. Information regarding smoking (Smoker/Non-smoker), education (higher/lower education), and occupation (employed/non-employed) was gathered using questionnaire. The Cox regression was used, regarding interaction between snack foods, SES, and PAL on the MetS risk. RESULTS: A total of 591 incident MetS cases were diagnosed during 8.9 years of follow-up. The median total snack foods intake was 5.2 serving/week (IQR: 3.0-9.1). Total snack foods intake was positively associated with the MetS risk after adjusting for potential confounders (adjusted for age and gender, energy intake, total fiber intake, smoking status, PAL, education levels, family history of diabetes, family history of CVD events, and BMI). After adjustment for confounders, among snacks' subgroups, candies and chocolate intake was positively associated with MetS risk. Moreover, among lower-educated and non-employed participants, candies and chocolate intake was positively associated with the MetS risk, by 38 and 43% respectively. Stratification based on PAL resulted a positive association between intake of total snack foods and candies and chocolates and risk of MetS among participants with low PAL. CONCLUSION: Snack foods, especially candies and chocolate, increased the risk of MetS, among individuals with a low PAL.

Trends in dietary food groups and Dietary Approach to Stop Hypertension (DASH) score among adults: A longitudinal study from the Tehran Lipid and Glucose Study, 2006-2017.

OBJECTIVES: This study aimed to examine the secular trends of dietary food groups and diet quality among adults, overall and by sex, education, and employment status. METHODS: This study was conducted within the framework of the Tehran Lipid and Glucose Study. Demographic and anthropometric measurements were gathered using standard questionnaires. In terms of socioeconomic information, participants were divided into two groups according to their educational level and employment status. The regular dietary intakes of participants were gathered with a validated and reliable food frequency questionnaire over the previous year, and Dietary Approaches to Stop Hypertension scores were computed to evaluate diet quality. Generalized estimating equations were used to assess secular trends in food groups within the four phases. RESULTS: From 2006 to 2017, intake of whole grains, legumes, and nuts and seeds increased, and intake of refined grains, dairy products, and solid fats decreased significantly (P for trend < 0.001). Dietary fruit, vegetable, meat, and soft drink intake did not change significantly. According to socioeconomic groups, meat intake decreased significantly among men, uneducated, and unemployed participants, and fruit intake increased in both women and educated participants. Based on a 40-point scale, the Dietary Approaches to Stop Hypertension score increased from 18.1 ± 0.0 in phase1 to 22.7 ± 0.1 in phase 4 of the Tehran Lipid and Glucose Study (P for trend < 0.001). CONCLUSIONS: Over a decade, in addition to improvements in intake of a number of dietary food groups, the estimated overall diet quality of the study population showed a modest improvement. These findings may determine areas for more attention to improve the overall dietary intake of the population.

Socioeconomic and lifestyle factors modifies the association between nut consumption and metabolic syndrome incidence.

BACKGROUND & AIMS: The aim of this study was to evaluate the association of nut consumption and its various types with metabolic syndrome (MetS) risk and to investigate whether lifestyle factors (physical activity and smoking status) and socioeconomic status (education and occupation) modulate the association of nut consumption and the risk of MetS. METHODS: We prospectively studied 1915 participants of the Tehran Lipid and Glucose study, among whom 591 were diagnosed with MetS during 8.9 years of follow-up. Nut consumption and its various types were assessed using a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate Hazard Ratios (HRs) for MetS events across tertiles of nut consumption and its various types. Regarding interaction between nut consumption and physical activity levels, education levels, and smoking status on the risk of MetS, using joint classification, the effect modification of lifestyle factors and socioeconomic status on the association between nut consumption (

TCF7L2 polymorphisms, nut consumption, and the risk of metabolic syndrome: a prospective population based study.

BACKGROUND: The aim of this study was to investigate whether two variants of the TCF7L2 (rs7903146 and rs12255372) modify the association between nut consumption and the risk of metabolic syndrome (MetS). Additionally, the modifying effect of weight change during follow-up on these associations was investigated. MATERIAL AND METHODS: We prospectively studied 1423 participants of the Tehran Lipid and Glucose study aged 19-74 years who were followed-up for dietary assessment using a validated, semi-quantitative food frequency questionnaire. Multivariable-adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events. Genotyping was performed by Human Omni Express-24-v1-0 chip. RESULTS: Over a median 8.9 years of follow-up, 415 new cases of MetS were documented. The median nut consumption was 20.0 g/week (Interquartile Range (IQR): 8.6-38.9 g/week). Regarding the rs7903146 genotype, in carriers of T allele (CT + TT), highest tertile of nut consumption was associated with a reduced risk of MetS after adjusting for confounders (HR: 0.67 (0.50-0.91)). Regarding the rs12255372 genotype, highest versus lowest tertile of nut consumption in participants with T allele (GT + TT) resulted in 34% reduction of MetS risk after adjustment for confounders (HR: 0.66 (0.49-0.69)). After stratification by weigh change (< 7% or ≥ 7% weight gain), in individuals with ≥ 7% weight gain, highest tertile of nut consumption was associated with reduced risk of MetS among the risk allele of rs7903146. In the risk allele of rs12255372, among individuals with < 7% weight gain, third tertile of nuts intake reduced the risk of MetS, after adjustment for confounders. CONCLUSION: Higher consumption of nuts may reduces the risk of MetS in T-risk allele of the TCF7L2 rs7903146 and rs12255372 variants and weight change may modify this association.

Does the association between patterns of fruit and vegetables and metabolic syndrome incidence vary according to lifestyle factors and socioeconomic status?

BACKGROUND AND AIMS: The aim of this study is to investigate the association between the identified patterns of fruits and vegetables and metabolic syndrome (MetS) incidence, and to investigate whether lifestyle factors and socioeconomic status modify the effect of the patterns on MetS risk. METHODS AND RESULTS: We prospectively studied 1915 participants of the Tehran Lipid and Glucose Study, who were aged 19-74 years and followed up for dietary assessment using a validated, semi-quantitative food frequency questionnaire. After adjustment for confounding factors, total vegetable intake was inversely related to the risk of MetS. Total fruit and total fruit and vegetable were not associated with MetS risk. We identified four major patterns of fruits and vegetables by factor analysis: "fresh fruit pattern", "vegetable pattern", "dried fruit and cruciferous vegetable pattern", and "potatoes and fruit juice pattern". "Vegetable pattern" was negatively associated with MetS risk, and "potatoes and fruit juice pattern" increased the risk of MetS. Among participants with weight gain <7% during follow-up, all four identified patterns reduced MetS risk. When stratified by smoking, "vegetable pattern" and "dried Fruit and cruciferous vegetable pattern" lowered MetS risk among non-smokers. Stratification based on education resulted in MetS risk reduction across tertiles of "fresh fruit pattern" and "vegetable pattern". First and second tertiles of "dried fruit and cruciferous vegetable pattern" lowered MetS risk among educated participants, compared to the reference. CONCLUSIONS: The reduction in MetS risk caused by fruits and vegetables intake depends on the modifying effect of lifestyle and socioeconomic factors.

Weight gain, but not macronutrient intake, modifies the effect of dietary branch chain amino acids on the risk of metabolic syndrome.

AIMS: The aim of this study was to investigate whether both weight change and the background intakes of macronutrient modulate the association between dietary branch chain amino acids (BCAAs) and the risk of metabolic syndrome (MetS). METHODS: This prospective study was conducted within the framework of theTehranLipidand Glucose Study. BCAA intakes were collected using a valid and reliable semi-quantitative food frequency questionnaire. MetS components were defined according to the modified national Cholesterol Education Program Adult Treatment Panel III. Weight change was categorized as weight gain (≥ or <7% over 8.9 year follow-up). Dietary fat and carbohydrate intake were categorized as above/below the median intake. RESULTS: Among participants with weight gain ≥ 7% during follow-up, intakes of both dietary BCAAs and its various sources (below or above the median intake) were associated with higher risk of MetS, compared with subjects with lower intakes of BCAAs and weight change ≤ 7%. Background dietary fat and carbohydrate did not modify the association of dietary BCAAs and its various sources with the risk of MetS. CONCLUSIONS: Weight change, but not dietary macronutrient intake, modulates the association between dietary BCAAs and risk of MetS among adults.

Prospective study of total and various types of vegetables and the risk of metabolic syndrome among children and adolescents.

BACKGROUND: Data available on the association between consumption of various types of vegetables and metabolic syndrome (MetS) remain inconsistent. AIM: To investigate the association between the intake of various types of vegetables and MetS among children and adolescents and MetS. METHODS: The Tehran Lipid and Glucose Study cohort included 424 children and adolescents initially free of MetS. At the 3.6 year follow-up, 47 new cases of MetS were identified. A 168-item semi-quantitative food-frequency questionnaire was used to collect information about total and various types of vegetables consumed, including allium-, green leafy-, fruity-, root-, stalk-, starchy-, potatoes, and cabbage. MetS was defined according to the Cook et al[32] criteria. RESULTS: The median (interquartile range) of total vegetable consumption was 217 (146-344) g/d. After adjustment for demographic characteristics and dietary intake, higher total- (≥ 350 g/d) and higher allium vegetable consumption (≥ 30 g/d) in the fourth quartile were significantly and inversely associated with risk of MetS compared to the first quartile. Consumption of green leafy vegetables in the third (21.4-38.3 g/d) versus the first quartile (≤ 13.5 g/d) demonstrated a significant inverse association with lower risk of MetS in children and adolescents; associations for other types of vegetables consumed were not significant. CONCLUSION: Consumption of vegetables, especially allium and green leafy vegetables, in sufficient amounts may be beneficial in reducing the risk of MetS among children and adolescents.