Adherence to HEI-2010 and odds of breast cancer according to the menopause status: Evidence from Middle Eastern Country

BACKGROUND

Majority of earlier studies have assessed the association between individual healthy eating index-2010 (HEI-2010) and the odds of breast cancer (BC). However, no study has been conducted on the effect of compliance with HEI-2010 and the odds of BC in the Iranian population with a large sample size. Therefore, we aimed to investigate the relationship between the HEI-2010 and the odds of BC in the Iranian population.

METHOD

This population-based case-control study included 350 newly diagnosed cases of BC and 700 healthy controls randomly selected from adult women. HEI-2010 was examined using validated questionnaires. The adherence to HEI-2010 among the participants was divided into four categories. The general characteristics of the participants in the quartiles of the HEI score for categorical variables and continuous variables were evaluated using chi-square and one-way analysis of variance, respectively. Also, using logistic regression analysis, dietary intakes were evaluated in HEI score quartiles. Also, confounding variables were adjusted in different models.

RESULT

People with the highest HEI score had 60% lower odds of BC (OR: 0.40; 95% CI: 0.27, 0.57) than those with the lowest score among post-menopause women. After controlling for age and energy intake, individuals with the highest HEI score were 78% less likely to have BC compared with those with the lowest score (OR: 0.22; 95% CI: 0.14, 0.33). Adjustments for other potential confounders including demographic factors made the association stronger (OR: 0.21; 95% CI: 0.13, 0.32). This association remained significant even after taking BMI into model (OR: 0.27; 95% CI: 0.17, 0.43).

CONCLUSION

Finally, in this study we found an association between HEI-2010 and odds of breast cancer. This association was particularly seen in postmenopausal women. No significant association was found between adherence to HEI-2010 and odds of BC among pre-menopausal.

Association between the dietary antioxidant index and relative telomere length of leucocytes in the Chinese population

Dietary antioxidant indices (DAI) may be potentially associated with relative telomere length (RTL) of leucocytes. This study aimed to investigate the relationship between DAI and RTL. A cross-sectional study involving 1656 participants was conducted. A generalised linear regression model and a restricted cubic spline model were used to assess the correlation of DAI and its components with RTL. Generalised linear regression analysis revealed that DAI (β = 0·005, P = 0·002) and the intake of its constituents vitamin C (β = 0·043, P = 0·027), vitamin E (β = 0·088, P < 0·001), Se (β = 0·075, P = 0·003), and Zn (β = 0·075, P = 0·023) were significantly and positively correlated with RTL. Sex-stratified analysis showed that DAI (β = 0·006, P = 0·005) and its constituents vitamin E (β = 0·083, P = 0·012), Se (β = 0·093, P = 0·006), and Zn (β = 0·092, P = 0·034) were significantly and positively correlated with RTL among females. Meanwhile, among males, only vitamin E intake (β = 0·089, P = 0·013) was significantly and positively associated with RTL. Restricted cubic spline analysis revealed linear positive associations between DAI and its constituents' (vitamin E, Se and Zn) intake and RTL in the total population. Sex-stratified analysis revealed a linear positive correlation between DAI and its constituents' (vitamin E, Se and Zn) intake and RTL in females. Our study found a significant positive correlation between DAI and RTL, with sex differences.

Nutrient patterns in relation to insulin resistance and endothelial dysfunction in Iranian women

Prior studies have mainly focused on the association of one specific nutrient with insulin resistance (IR) and endothelial dysfunction and limited studies have assessed the association with different nutrient patterns (NPs). We examined the association between various NPs and IR and endothelial dysfunction among Iranian women. This cross-sectional study was carried out on a sample of 368 female nurses. A 106-items food frequency questionnaire (FFQ) was applied for dietary assessments. Using factor analysis, the relationships between NPs and markers of insulin resistance (HOMA-IR, HOMA-β, and QUICKY), and endothelial dysfunction (E-selectin, sICAM-1, and sVCAM-1) were assessed. Mean age and body mass index of participants were respectively 35.21 years and 24.04 kg/m2. Three major NPs were identified. NP1, named as "dairy, fruits, and vegetables" had high values of potassium, folate, vitamins A and C, magnesium, and beta carotene. No significant association was observed between this NP and insulin resistance or endothelial dysfunction indices. The second NP was full of chromium, selenium, copper, vitamin B6, monounsaturated fatty acid (MUFA), thiamin, vitamin D, and iron. Adherence to NP2 (named "legumes, nuts, and protein foods") was associated with lower values of insulin (6.8 ± 1.1 versus 8.4 ± 1.1, P = 0.01), homeostasis model assessment-Insulin resistance (HOMA-IR) (1.3 ± 0.2 versus 1.7 ± 0.2, P = 0.02), and vascular adhesion molecule 1 (VCAM-1) (444.2 ± 27.9 versus 475.8 ± 28.4, P = 0.03). However, adherence to the third NP, rich in saturated fatty acid (SFA), cholesterol, sodium, zinc, vitamin E, and B12, described as "animal fat and meat + vitamin E", was associated with higher amounts of homeostasis model assessment-β (HOMA-β) (531.3 ± 176.2 versus 48.7 ± 179.8, P = 0.03). In conclusion, following the NP2, correlated with higher intakes of chromium, selenium, copper, vitamin B6, MUFA and thiamin was associated with lower values of insulin, HOMA-IR, and sVCAM-1. Adherence to NP3, rich in SFA, cholesterol, vitamin E, vitamin B12, and zinc was associated with higher levels of HOMA-β.

Association between plasma and dietary trace elements and obesity in a rural Chinese population

Trace elements may play an important role in obesity. This study aimed to assess the plasma and dietary intake levels of four trace elements, Mn, Cu, Zn and Se in a rural Chinese population, and analyse the relationship between trace elements and obesity. A cross-sectional study involving 2587 participants was conducted. Logistic regression models were used to analyse the association between trace elements and obesity; restricted cubic spline (RCS) models were used to assess the dose-response relationship between trace elements and obesity; the weighted quantile sum (WQS) model was used to examine the potential interaction of four plasma trace elements on obesity. Logistic regression analysis showed that plasma Se concentrations in the fourth quartile (Q4) exhibited a lower risk of developing obesity than the first quartile (Q1) (central obesity: OR = 0·634, P = 0·002; general obesity: OR = 0·525, P = 0·005). Plasma Zn concentration in the third quartile (Q3) showed a lower risk of developing obesity in general obesity compared with the first quartile (Q1) (OR = 0·625, P = 0·036). In general obesity, the risk of morbidity was 1·727 and 1·923 times higher for the second and third (Q2, Q3) quartiles of dietary Mn intake than for Q1, respectively. RCS indicated an inverse U-shaped correlation between plasma Se and obesity. WQS revealed the combined effects of four trace elements were negatively associated with central obesity. Plasma Zn and Se were negatively associated with obesity, and dietary Mn was positively associated with obesity. The combined action of the four plasma trace elements had a negative effect on obesity.

Association of Dietary and Plasma Magnesium with Glycaemic Markers in a Chinese Population

Certain metals play a role in the pathogenesis of diabetes. This study aimed to investigate the potential association of plasma magnesium (Mg) and dietary intake of Mg with glycaemic markers. A cross-sectional study was conducted on 2373 subjects in Guangxi, China. Dietary Mg was obtained through a food frequency questionnaire containing 109 common foods. Plasma Mg concentration was determined by inductively coupled plasma mass spectrometry. Multiple linear regression combined with multivariable restricted cubic spline (RCS) functions was applied to evaluate the association of plasma Mg and dietary Mg with haemoglobin A1c (HbA1c) and fasting plasma glucose (FPG). In linear regression, dietary Mg was significantly associated with FPG in the overall population (β =  - 0.087, P < 0.05) and in women (β =  - 0.098, P < 0.05). Plasma Mg was significantly associated with FPG in the overall population (β =  - 0.096, P < 0.05) and in men (β =  - 0.110, P < 0.05) and women (β =  - 0.088, P < 0.05). In the RCS model, no non-linear association was found between dietary and plasma Mg and HbA1c levels. Dietary and plasma Mg are significantly negatively associated with fasting glucose.

Associations of Dietary and Plasma Copper Levels with Liver Function in a Chinese Population

The potential mechanisms underlying the association between copper (Cu) exposure and impaired liver function are unclear. This study aimed to investigate the potential associations of dietary Cu intake and plasma Cu levels with liver function biomarkers. A cross-sectional study was performed to assess liver function biomarkers-namely, levels of total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), alanine transaminase (ALT), and aspartate transaminase (AST)-in 2376 subjects in Guangxi, China. Dietary Cu intake was determined from a food frequency questionnaire containing 109 common foods. Plasma Cu concentrations were determined by inductively coupled plasma‒mass spectrometry. Multiple linear regression and multivariate restricted cubic splines (RCS) were used to evaluate the correlations of plasma Cu levels and dietary Cu levels with liver function biomarkers. The covariate-adjusted results of the linear regression analysis showed that plasma Cu levels were significantly negatively correlated with serum IBIL (β =  - 0.37), DBIL (β =  - 0.22), and TBIL levels (β =  - 0.32) (all p < 0.05), and dietary Cu was negatively correlated with serum AST levels (β =  - 0.12, p < 0.05). The RCS analysis further indicated a negative linear relationship between dietary Cu levels and AST levels. In summary, our results suggested that the plasma Cu level is associated with serum bilirubin levels and that dietary Cu intake is associated with serum AST levels. Further studies are needed to validate these associations and elucidate the underlying mechanisms.

Dietary Protein Sources, Mediating Biomarkers, and Incidence of Type 2 Diabetes: Findings From the Women's Health Initiative and the UK Biobank

OBJECTIVE

Whether and how dietary protein intake is linked to type 2 diabetes (T2D) remains unclear. The aim of this study was to investigate the associations of protein intake with development of T2D and the potential mediating roles of T2D biomarkers.

RESEARCH DESIGN AND METHODS

We included 108,681 postmenopausal women without T2D at baseline from the Women's Health Initiative (WHI) (primary cohort) and 34,616 adults without T2D from the U.K. Biobank (UKB) (replication cohort). Cox proportional hazard models were used for estimation of protein-T2D associations. Mediation analysis was performed to assess the mediating roles of biomarkers in case-control studies nested in the WHI.

RESULTS

In the WHI, 15,842 incident T2D cases were identified during a median follow-up of 15.8 years. Intake of animal protein was associated with increased T2D risk (hazard ratio in comparing the highest to the lowest quintile = 1.31 [95% CI 1.24-1.37]) and plant protein with decreased risk (0.82 [0.78-0.86]). Intakes of red meat, processed meat, poultry, and eggs were associated with increased T2D risk and whole grains with decreased risk. Findings from the UKB were similar. These findings were materially attenuated after additional adjustment for BMI. Substituting 5% energy from plant protein for animal protein was associated with 21% decreased T2D risk (0.79 [0.74-0.84]), which was mediated by levels of hs-CRP, interleukin-6, leptin, and SHBG.

CONCLUSIONS

Findings from these two large prospective cohorts support the notion that substituting plant protein for animal protein may decrease T2D risk mainly by reducing obesity-related inflammation.

Consumption of “Diabetes Risk Reduction Diet” and Odds of Breast Cancer Among Women in a Middle Eastern Country

Background:

Given the role of insulin resistance in several cancers, we hypothesized that consumption of a diet that reduces insulin resistance might lower the risk of breast cancer.

Objective

The present study was designed to assess the association between consumption of “diabetes risk reduction diet” (DRRD) and odds of breast cancer among a large group of women in a Middle Eastern country.

Methods

This population-based case-control study enrolled 350 newly diagnosed cases of stage I-IV breast cancer and 700 age-matched apparently healthy individuals as controls. We collected dietary data via a validated 106-item Willett-format semi-quantitative dish-based food frequency questionnaire. A DRRD score was included based on 9 dietary factors (cereal fiber, coffee, nuts, whole fruits, ratio of polyunsaturated to saturated, trans fat, sugar-sweetened beverages, red and processed meat, and lower glycemic index). For food and nutrient items with a protective association with diabetes in earlier studies, participants were given the score as the quintile of that food item, but for food groups with unfavorable association with diabetes, we did vice versa. Total DRRD score ranged from 5 to 45.

Results

Mean age of cases and controls was 65.28 and 61.04 years. Mean BMI of patients with breast cancer and controls was 25.5 and 21.0. We found that individuals with the greatest adherence to the DRRD were 0.41 times less likely to have breast cancer than those with the lowest adherence (OR: 0.59; 95% CI: 0.38, 0.90, and P-trend = 0.002). Stratified analysis by menopausal status indicated a significant inverse relationship in postmenopausal women (OR: 0.57; 95% CI: 0.36–0.90), but not in premenopausal women (OR: 0.76; 95% CI: 0.19–2.96). Moreover, by BMI status, we found statistically significant inverse association between adherence to the DRRD and odds of breast cancer among normal-weight women (OR: 0.59; 95% CI: 0.36, 0.98) but not in overweight women (OR: 0.66; 95% CI: 0.31, 1.40). Conclusions: Significant inverse associations were found between adherence to DRRD and breast cancer, especially among postmenopausal and normal-weight women.

The association between adherence to MIND diet and risk of breast cancer: A case-control study

OBJECTIVES

Recently, a new eating pattern called "Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND)" has been coined. This study was aimed to examine the association between adherence to the MIND diet and risk of breast cancer (BC) among Iranian women.

METHODS

In this hospital-based case-control study, 150 newly diagnosed BC cases and 150 age-matched controls were included. All cases were pathologically confirmed BC patients, with no history of any type of other pathologically confirmed cancers. Controls were selected from visitors, relatives and friends of non-cancer patients in other wards, which had no family relationship with cases. Dietary intakes of study participants were assessed using a validated 147-item semi-quantitative food frequency questionnaire (FFQ). The MIND diet score was computed based on participants' dietary intakes obtained from FFQ, Regression logistic models were used to examine the association between the MIND diet score and BC.

RESULTS

Examining the whole study population, we found no significant association between the MIND diet score and odds of BC, either before (ORs for comparing T3 vs. T1: 0.818; 95% CI: 0.469-1.42, P-trend = .48) or after controlling for potential confounders (ORs for T3 vs. T1: 1.32; 95% CI: 0.31-5.64, P-trend = .633). This was also the case for pre-menopausal and post-menopausal when analyzed separately. We also failed to find any significant association between the MIND diet score and odds of BC after controlling for potential confounders in both pre-menopausal and post-menopausal.

CONCLUSION

In conclusion, we found that adherence to the MIND diet was not associated with odds of BC in this case-control study. Further studies are required to confirm these findings.

Red and White Meat Intake in Relation to Mental Disorders in Iranian Adults

Background: The association between meat consumption and mental disorders is less investigated in Iranian population. We examined the association between meat consumption and prevalence of symptoms of depression, anxiety, and psychological distress in Iranian adults. Methods: This cross-sectional study included 3,362 participants aged 18-55 years old. A dish-based 106-item semiquantitative food frequency questionnaire (FFQ) was used to assess usual dietary intake of study population. Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ), all validated in Iranian population, were applied to collect data on symptoms of anxiety, depression, and psychological distress, respectively. Results: The prevalence of symptoms of depression, anxiety, and psychological distress in the study population was 28.6, 13.6, and 22.6%, respectively. After considering potential confounders, individuals in the top quartile of red meat intake had 43% increased risk of depression symptoms [odds ratio (OR) = 1.43; 95% CI: 1.09-1.89] compared to those in the first quartile. No significant relation was observed between red meat intake and anxiety or psychological distress symptoms. White meat consumption was not associated with mental disorders. Stratified analysis by sex showed that male participants in the highest quartile of red meat intake had 92% greater risk of depression symptoms (95% CI: 1.17-3.15) than those individuals in the lowest category. Red and white meat intake was not associated with mental disorders in women. In overweight or obese individuals, despite lack of any association between red meat intake and mental disorders, high intake of white meat was associated with a lower odds of psychological distress symptoms (OR = 0.64; 95% CI: 0.42-0.99) and a lower risk of depression symptoms (OR = 0.68; 95% CI: 0.45-1.00). In normal-weight participants, those in the highest quartile of red meat intake had greater odds for depression symptoms than those in the lowest quartile (OR = 1.66; 95% CI: 1.14-2.42). Conclusions: We found that red meat consumption was associated with increased risk of depression symptoms, especially in men, and normal-weight participants. In overweight or obese participants, white meat intake was inversely associated with psychological distress symptoms.

Moderate Consumption of Red Meat, Compared to Soy or Non-Soy Legume, Has No Adverse Effect on Cardio-Metabolic Factors in Patients with Type 2 Diabetes

BACKGROUND

Recently, it has been proposed that red meat consumption could enhance risk of diabetes and worsen lipid profile and glycemic status, in comparison with soy or non-soy legume, but the results of clinical trials are controversial.

OBJECTIVES

This study aimed to compare the effect of red meat, soy bean, and non-soy legume consumption on cardio-metabolic factors in patients with type 2 diabetes.

METHODS

This was a randomized controlled clinical trial which included 75 patients with diabetes, aged 40-65 years. Participants were randomly allocated to receive two servings of red meat (control group), soy bean, or non-soy legume, 3 days a week for 8 weeks. All groups also received a balanced-macronutrients weight maintenance diet. Body composition and cardio-metabolic factors including fasting blood glucose (FBG), fasting insulin, glycated hemoglobin (HbA1c), serum lipids, and blood pressure were measured at baseline and endpoint of the study. Quantitative insulin sensitivity check index (QUICKI) score and Framingham risk score (FRS) were also computed.

RESULTS

We found no significant differences in changes of FBG, fasting insulin, HbA1c, QUICKI score, serum lipids, FRS, and systolic and diastolic blood pressure among the 3 groups. Within group analysis showed that FRS reduced significantly in all groups (P<0.05). In addition, systolic (P=0.01) and diastolic (P=0.03) blood pressure reduced within red meat group.

CONCLUSIONS

Compared to soy bean or non-soy legume, moderate consumption of red meat had no adverse effect on cardio-metabolic factors including FBG, fasting insulin, HbA1C, QUICKI score, total cholesterol, low-density lipoprotein , high-density lipoprotein , and blood pressure in adults with type 2 diabetes.

Magnesium intake, insulin resistance and markers of endothelial function among women

OBJECTIVE

We investigated the association of dietary Mg intake with insulin resistance and markers of endothelial function among Iranian women.

DESIGN

A cross-sectional study.

SETTING

Usual dietary intakes were assessed using a validated FFQ. Dietary Mg intake was calculated by summing up the amount of Mg in all foods. A fasting blood sample was taken to measure serum concentrations of glycemic indices (fasting plasma glucose and insulin) and endothelial function markers (E-selectin, soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1). Insulin resistance and sensitivity were estimated using the Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), Homeostasis Model Assessment β-cell function (HOMA-β) and quantitative insulin sensitivity check index (QUICKI).

PARTICIPANTS

Iranian female nurses (n 345) selected by a multistage cluster random sampling method.

RESULTS

The Mg intake across energy-adjusted quartiles was 205 (se 7), 221·4 (se 8), 254·3 (se 7) and 355·2 (se 9) mg/d, respectively. After adjustments for potential confounders, QUICKI level was significantly different across quartiles of Mg intake (Q1: 0·34 (se 0·02), Q2: 0·36 (se 0·01), Q3: 0·40 (se 0·01), and Q4: 0·39 (se 0·02), P = 0·02); however, this association disappeared after considering markers of endothelial function, indicating that this relation might be mediated through endothelial dysfunction. After controlling for all potential confounders, Mg intake was inversely, but not significantly, associated with serum concentrations of sICAM (Q1: 239 (se 17), Q2: 214 (se 12), Q3: 196 (se 12), and Q4: 195 (se 17), P = 0·29). There was no other significant association between dietary Mg intake and other indicators of glucose homoeostasis or endothelial markers.

CONCLUSIONS

Higher dietary Mg intake was associated with better insulin sensitivity in Iranian females. This linkage was mediated through reduced endothelial dysfunction.

Consumption of Dietary Fiber in Relation to Psychological Disorders in Adults

Background: Previous observational studies suggested a relationship between dietary fiber consumption and mental health, but the findings were conflicting. We evaluated the link between dietary fiber intake and prevalence of depression, anxiety, and psychological distress among a large population of Iranian adults. Methods: A cross-sectional study among 3,362 Iranian adults working in 50 health centers was done. Data of dietary intakes were collected through a validated semiquantitative dish-based 106-item food frequency questionnaire (FFQ). Anxiety, depression, and psychological distress were defined based on the Iranian validated version of Hospital Anxiety and Depression Scale (HADS) and General Health Questionnaire (GHQ). Results: After adjustment for potential confounders, participants in the top quartile of total dietary fiber intake had a 33% and 29% lower risk of anxiety and high psychological distress [odds ratio (OR): 0.67; 95% CI: 0.48, 0.95 and OR: 0.71; 95% CI: 0.53, 0.94, respectively] compared to the bottom quartile of intake. The highest total dietary fiber intake was also inversely related to a lower risk of depression in women (OR: 0.63; 95% CI: 0.45, 0.88) but not in men. Among overweight or obese participants, higher intake of dietary fiber was related to a decreased risk of high psychological distress (OR: 0.52; 95% CI: 0.34, 0.79). A high level of dietary fiber intake was related to a lower risk of anxiety in normal-weight individuals (OR: 0.50; 95% CI: 0.31, 0.80). Conclusion: Significant inverse associations between total dietary fiber intake with anxiety and high psychological distress were found in Iranian adults. More consumption of dietary fiber was also related to reduced odds of depression in women. More investigations with prospective nature are needed to affirm these findings.

Development, validation and utilisation of dish-based dietary assessment tools: a scoping review

Objective:

To summarise the existing evidence of development, validation and current status of utilisation of dish-based dietary assessment tools.

Design:

Scoping review.

Setting:

Systematic search using PubMed and Web of Science.

Results:

We identified twelve tools from seventy-four eligible publications. They were developed for Koreans (n 4), Bangladeshis (n 2), Iranians (n 1), Indians/Malays/Chinese (n 1), Japanese (n 3) and Chinese Americans (n 1). Most tools (10/12) were composed of a dish-based FFQ. Although the development process of a dish list varied among the tools, six studies classified mixed dishes based on the similarity of their characteristics such as food ingredients and cooking methods. Tools were validated against self-reported dietary information (n 9) and concentration biomarkers (n 1). In the eight studies assessing the differences between the tool and a reference, the mean (or median) intake of energy significantly differed in five studies, and 26–83 % of nutrients significantly differed in eight studies. Correlation coefficients for energy ranged from 0·15 to 0·87 across the thirteen studies, and the median correlation coefficients for nutrients ranged from 0·12 to 0·77. Dish-based dietary assessment tools were used in fifty-nine studies mainly to assess diet–disease relationships in target populations.

Conclusions:

Dish-based dietary assessment tools have exclusively been developed and used for Asian-origin populations. Further validation studies, particularly biomarker-based studies, are needed to assess the applicability of tools.

Association between healthy lifestyle score and breast cancer

BACKGROUND

Majority of earlier studies have assessed the association between individual lifestyle factors and the risk of breast cancer (BC); however, limited information is available linking the whole lifestyle factors to BC. We aimed to examine the association between combined lifestyle score (diet, physical activity (PA) and smoking) and risk of BC in Iranian population.

METHODS

This population-based case-control study included 350 newly diagnosed cases of BC and 700 healthy controls randomly selected from adult women. Dietary intakes, PA and smoking status of study participants were examined using validated questionnaires. The lifestyle risk factors examined in this study included cigarette smoking, physical inactivity, and Healthy Eating Index-2010 (HEI-2010). The lifestyle score ranged from zero (non-healthy) to 3 (most healthy) points. Logistic regression models were fitted to investigate the association between combined lifestyle scores and odds of BC.

RESULTS

Mean age and body mass index (BMI) of study participants were 62.4 years and 24.3 kg/m², respectively. In the whole study population, individuals with the highest healthy lifestyle score (HLS) were 0.38 times less likely to have BC than those with the lowest score (OR: 0.62; 95% CI: 0.40, 0.93, P_trend = 0.01). The analysis by menopausal status showed that postmenopausal women with the highest HLS had 44% lower odds of BC compared with those with the lowest score (OR: 0.56; 95% CI: 0.36, 0.88, P _trend = 0.004). Such association was not seen in premenopausal women. After analyzing each component of HLS, we found that individuals with the highest HEI score were 46% less likely to have BC than those with the lowest score (OR: 0.54; 95% CI: 0.35, 0.82, P_trend <  0.001). No other significant associations were found between PA and smoking and risk of BC.

CONCLUSIONS

Significant inverse associations were found between HLS and HEI with BC especially among postmenopausal women. Prospective studies are required to confirm these findings.

Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies

OBJECTIVE

To summarise the evidence of associations between dietary factors and incidence of type 2 diabetes and to evaluate the strength and validity of these associations.

DESIGN

Umbrella review of systematic reviews with meta-analyses of prospective observational studies.

DATA SOURCES

PubMed, Web of Science, and Embase, searched up to August 2018.

ELIGIBILITY CRITERIA

Systematic reviews with meta-analyses reporting summary risk estimates for the associations between incidence of type 2 diabetes and dietary behaviours or diet quality indices, food groups, foods, beverages, alcoholic beverages, macronutrients, and micronutrients.

RESULTS

53 publications were included, with 153 adjusted summary hazard ratios on dietary behaviours or diet quality indices (n=12), food groups and foods (n=56), beverages (n=10), alcoholic beverages (n=12), macronutrients (n=32), and micronutrients (n=31), regarding incidence of type 2 diabetes. Methodological quality was high for 75% (n=115) of meta-analyses, moderate for 23% (n=35), and low for 2% (n=3). Quality of evidence was rated high for an inverse association for type 2 diabetes incidence with increased intake of whole grains (for an increment of 30 g/day, adjusted summary hazard ratio 0.87 (95% confidence interval 0.82 to 0.93)) and cereal fibre (for an increment of 10 g/day, 0.75 (0.65 to 0.86)), as well as for moderate intake of total alcohol (for an intake of 12-24 g/day v no consumption, 0.75 (0.67 to 0.83)). Quality of evidence was also high for the association for increased incidence of type 2 diabetes with higher intake of red meat (for an increment of 100 g/day, 1.17 (1.08 to 1.26)), processed meat (for an increment of 50 g/day, 1.37 (1.22 to 1.54)), bacon (per two slices/day, 2.07 (1.40 to 3.05)), and sugar sweetened beverages (for an increase of one serving/day, 1.26 (1.11 to 1.43)).

CONCLUSIONS

Overall, the association between dietary factors and type 2 diabetes has been extensively studied, but few of the associations were graded as high quality of evidence. Further factors are likely to be important in type 2 diabetes prevention; thus, more well conducted research, with more detailed assessment of diet, is needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018088106.

[Consumption of red and processed meat, insulin resistance, and diabetes in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)Consumo de carnes rojas y de carne procesada, resistencia a la insulina y diabetes en el estudio longitudinal de salud del adulto (ELSA-Brasil)]

Objetivo.

Investigar a associação entre consumo de carne vermelha e processada e a ocorrência de novos casos de resistência insulínica (RI) e diabetes mellitus (DM) em participantes do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil).

Métodos.

Estudo de coorte com 15 105 servidores públicos (idade: 35 a 74 anos). Dados bioquímicos, antropométricos, socioeconômicos e de estilo de vida foram coletados na linha de base (2008–2010) e na segunda onda (2012–2014). O consumo de carnes (g/dia) foi estimado por questionário de frequência alimentar. Para categorizar baixo, médio e alto consumo as variáveis independentes foram divididas em tercis. DM foi diagnosticado como glicemia de jejum ≥ 126 mg/dL, glicose pós-sobrecarga ≥ 200 mg/dL ou hemoglobina glicada ≥ 6,5. RI foi determinada pelo índice HOMA-IR com pontos de corte construídos a partir do percentil 75 da amostra.

Resultados.

Homens e participantes com menor renda e escolaridade relataram maior consumo de carne vermelha e processada. Maior consumo de carne processada (último tercil, > 27,1 g/dia) associou-se a novos casos de RI em homens (OR = 1,68; IC95%: 1,31 a 2,16) e mulheres (OR = 1,23; IC95%: 1,00 a 1,52). Alto consumo de carne vermelha aumentou em 40% (IC95%: 1,04 a 1,96) a chance de novos casos de DM em homens.

Conclusões.

O consumo elevado de carne vermelha e processada teve impacto negativo na saúde dos participantes. O consumo moderado de carnes pode ser recomendado para a população em geral e para prevenção do DM.

Consumption of fruit and vegetables in relation with psychological disorders in Iranian adults

OBJECTIVE

Findings from observational studies on the relationship between fruit and vegetables consumption and risk of mental disorders are contradictory. We aimed to examine the association between fruit and vegetables intake and prevalence of depression, anxiety, and psychological distress in a large group of Iranian adults.

METHODS

This cross-sectional study was conducted on 3362 people of Iranian adults working in 50 health centers. Dietary data were collected using a validated dish-based 106-item semi-quantitative food frequency questionnaire (FFQ). The Iranian-validated version of Hospital Anxiety and Depression Scale (HADS) was used to screen for anxiety and depression. The General Health Questionnaire (GHQ) was used to assess psychological distress.

RESULTS

The prevalence of depression, anxiety, and high psychological distress among the study population was 30.0, 15.2, and 25.0%, respectively. Women in the top quintile of fruit intake, compared with those in the bottom quintile, had 57, 50, and 60% lower odds of depression, anxiety, and psychological distress. Consumption of vegetables was significantly associated with lower odds of depression (OR 0.65; 95% CI 0.46, 0.93) in women and lower odds of anxiety (OR 0.43; 95% CI 0.22, 0.87) in men. In addition, after adjustment for potential confounders, women in the highest quintile of fruit and vegetables intake, compared with those in the bottom quintile, had significantly lower odds of depression (OR 0.55; 95% CI 0.37, 0.80) and psychological distress (OR 0.60; 95% CI 0.40, 0.90). Furthermore, high intake of total fruit and vegetables was associated with lower odds of psychological distress (OR 0.42; 95% CI 0.21, 0.81) in men.

CONCLUSION

We found significant inverse associations between high intake of fruit with depression, anxiety, and psychological distress in Iranian women. High consumption of vegetables was also associated with lower risk of depression and anxiety, respectively, in women and men. In addition, high intake of total fruit and vegetable was associated with lower odds of depression and psychological distress in women and men.

Biomarkers of the metabolic syndrome: Influence of minerals, oligo- and trace elements

Influences of minerals, oligo- and trace elements on the concentration of biomarkers of the metabolic syndrome (MetS) are reviewed. Since food is a complex mixture of caloric compounds and essential non-caloric food components with multiple interactions and varying bioavailability, it is hard to separate or identify the effect of one single component in a total meal or diet. Moreover the diet contains various non-nutritive biologically active components, which may add some beneficial characteristics. Therefore, conclusions on the effect of components on various biomarkers of MetS are sometimes quite contradictory. Reasons therefore are mentioned. Literature data should be studied in detail to conclude whether a component is related to a reduction of MetS-related symptoms or whether its influence is merely affecting a biomarker.

Dietary patterns and prevalence of irritable bowel syndrome in Iranian adults

BACKGROUND

Although several dietary factors have been reported to alleviate or aggravate the symptoms of irritable bowel syndrome (IBS), no information is available linking habitual dietary patterns to irritable bowel syndrome.

OBJECTIVE

This study was undertaken to assess the association between dietary patterns and the risk of IBS among Iranian adults.

METHODS

In this cross-sectional study, data on 3846 Iranian adults working in 50 different health centers were examined. Dietary intake of study participants was assessed using a 106-item self-administered Dish-based Semi-quantitative Food Frequency Questionnaire (DS-FFQ) which was designed and validated specifically for Iranian adults. To identify major dietary patterns based on the 39 food groups, we used principal component analysis. A modified Persian version of the Rome III questionnaire was used for assessment of IBS.

RESULTS

We identified four major dietary patterns: (i) 'fast food', (ii) 'traditional', (iii) 'lacto-vegetarian', and (iv) 'western' dietary pattern. After adjustment for potential confounders, we found that those in the highest quartile of 'fast food' dietary pattern were tended to have higher risk of IBS than those in the lowest quartile (OR = 1.32; 95% CI: 0.99, 1.75, p_trend = 0.05). An inverse association was also found between 'lacto-vegetarian' dietary pattern and risk of IBS; such that even after adjustment for potential confounders, those in top quartile of this dietary pattern were 24% less likely to have IBS (0.76; 0.59, 0.98; p_trend = 0.02). No overall significant associations were observed between 'traditional' and 'western' dietary patterns and risk of IBS, either before or after adjustment for covariates.

CONCLUSION

We found that 'lacto-vegetarian' dietary pattern was associated with reduced risk, while 'fast food' dietary pattern was associated with a greater risk of IBS in Iranian adults.

Adherence to Healthy Eating Index-2010 is inversely associated with metabolic syndrome and its features among Iranian adult women

BACKGROUND/OBJECTIVES

Nowadays, metabolic syndrome (MetS) is deemed as a major public health challenge in both developed and developing countries. Therefore, the aim of this study was to determine the association between Healthy Eating Index-2010 (HEI-2010) score and MetS and its features among Iranian female nurses.

SUBJECTS/METHODS

This cross-sectional study was performed among 1036 Iranian women. A validated, self-administered, dish-based, semiquantitative food frequency questionnaire was used to assess the habitual intake of participants. HEI-2010 score was used to assess diet quality of participants. MetS was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (ATP III). Multivariate logistic regression adjusted for potential confounders was used to assess the relation between HEI-2010 and MetS.

RESULTS

After adjusting for potential confounders, participants in the highest quartile of HEI-2010 had the lowest risk of MetS compared with those in the first quartile (odds ratio: 0.72; 95% confidence interval: 0.50-0.96). Furthermore, the risk of MetS features including abdominal obesity, high blood pressure, high serum triacylglycerol and low serum high-density lipoprotein-cholesterol significantly decreased across HEI-2010 quartiles (P<0.05).

CONCLUSIONS

Higher HEI-2010 scores were inversely associated with lower risk of MetS and its components among Iranian women.

Adherence to Alternative Healthy Eating Index in relation to depression and anxiety in Iranian adults

Earlier studies have shown a protective association between adherence to healthy eating guidelines and mental disorders in Western nations; however, data in this regard are limited from the understudied region of Middle East. We examined the association between adherence to healthy eating guidelines, as measured by Alternative Healthy Eating Index (AHEI)-2010, and prevalence of anxiety and depression in a large sample of Iranian adults. In this cross-sectional study, data on dietary intakes of 3363 adult participants were collected using a validated dish-based 106-item semi-quantitative FFQ. Adherence to healthy eating was quantified using AHEI-2010, as suggested by earlier publications. The Iranian validated version of Hospital Anxiety and Depression Scale was used to assess anxiety and depression in study participants. Data on other covariates were gathered using a pre-tested questionnaire. Overall, the prevalence of anxiety and depression was 15·2 % (males 10·8 % and females 18·3 %) and 30·0 % (males 22·9 % and females 35·1 %), respectively. After controlling for potential confounders, those in the top quartile of AHEI-2010 had a 49 % lower chance of anxiety (OR 0·51; 95 % CI 0·35, 0·72) and a 45 % lower odds of depression (OR 0·55; 95 % CI 0·42, 0·72), compared with those in the bottom quartile. Stratified analysis by sex revealed that women in the highest categories of AHEI-2010 had a 49 % lower odds of having anxiety and depression, after adjustment for confounders, but no significant association was found in men. In addition, among individuals who were 40 years old or younger, those with high adherence to AHEI-2010 were 58 and 51 % less likely to have anxiety and depression, compared with those with less adherence. Adherence to healthy eating was inversely associated with a lower chance of anxiety and depression in Iranian adults. Prospective studies are required to confirm these associations in Middle-Eastern populations.

Gender Differences in Dietary Patterns and Their Association with the Prevalence of Metabolic Syndrome among Chinese: A Cross-Sectional Study

Few studies have investigated gender differences in dietary intake. The objective of this cross-sectional study was to examine gender differences in dietary patterns and their association with the prevalence of metabolic syndrome. The food intakes of 3794 subjects enrolled by a two-stage cluster stratified sampling method were collected using a valid semi-quantitative food frequency questionnaire (FFQ). Metabolic syndrome (MetS) was defined according to the International Diabetes Federation (IDF) and its prevalence was 35.70% in the sample (37.67% in men and 24.67% in women). Dietary patterns were identified using factor analysis combined with cluster analysis and multiple group confirmatory factor analysis was used to assess the factorial invariance between gender groups. The dominating dietary pattern for men was the “balanced” dietary pattern (32.65%) and that for women was the “high-salt and energy” dietary pattern (34.42%). For men, the “animal and fried food” dietary pattern was related to higher risk of MetS (odds ratio: 1.27; 95% CI: 1.01–1.60), after adjustment for age, marital status, socioeconomic status and lifestyle factors. For women, the “high-salt and energy” dietary pattern was related to higher risk of MetS (odds ratio: 2.27; 95% CI: 1.24–4.14). We observed gender differences in dietary patterns and their association with the prevalence of MetS. For men, the “animal and fried food” dietary pattern was associated with enhancive likelihood of MetS. For women, it was the “high-salt and energy” dietary pattern.

Combined Healthy Lifestyle Is Inversely Associated with Psychological Disorders among Adults

BACKGROUND AND AIMS

Joint association of lifestyle-related factors and mental health has been less studied in earlier studies, especially in Middle Eastern countries. This study aimed to examine how combinations of several lifestyle-related factors related to depression and anxiety in a large group of middle-age Iranian population.

METHODS

In a cross-sectional study on 3363 Iranian adults, a healthy lifestyle score was constructed by the use of data from dietary intakes, physical activity, smoking status, psychological distress and obesity. A dish-based 106-item semi-quantitative validated food frequency questionnaire (FFQ), General Practice Physical Activity Questionnaire (GPPAQ), General Health Questionnaire (GHQ) and other pre-tested questionnaires were used to assess the components of healthy lifestyle score. The Hospital Anxiety and Depression Scale (HADS) was applied to screen for anxiety and depression.

RESULTS

After adjustment for potential confounders, we found that individuals with the highest score of healthy lifestyle were 95% less likely to be anxious (OR: 0.05; 95% CI: 0.01-0.27) and 96% less likely to be depressed (OR: 0.04; 95% CI: 0.01-0.15), compared with those with the lowest score. In addition, non-smokers had lower odds of anxiety (OR: 0.64; 95% CI: 0.47-0.88) and depression (OR: 0.62; 95% CI: 0.48-0.81) compared with smokers. Individuals with low levels of psychological distress had expectedly lower odds of anxiety (OR: 0.13; 95% CI: 0.10-0.16) and depression (OR: 0.10; 95% CI: 0.08-0.12) than those with high levels. Individuals with a healthy diet had 29% lower odds of depression (OR: 0.71; 95% CI: 0.59-0.87) than those with a non-healthy diet.

CONCLUSION

We found evidence indicating that healthy lifestyle score was associated with lower odds of anxiety and depression in this group of Iranian adults. Healthy diet, psychological distress, and smoking status were independent predictors of mental disorders.