A Western dietary pattern is associated with higher blood pressure in Iranian adolescents

The association between dietary patterns and cardiovascular disease risk factors in Iranian adults: a cross-sectional study

BACKGROUND

Dietary patterns are important factors associated with cardiovascular diseases (CVDs). We examined the association between dietary patterns derived from factor analysis and CVD risk factors.

METHODS

In the present cross-sectional study, a total of 3,687 adults (aged 40 to 70 years) with one or more types of CVDs were enrolled as participants. A validated semi-quantitative food-frequency questionnaire was utilized to assess food intakes, and then dietary patterns were extracted by factor analysis. Fasting blood sugar (FBS), lipid profile, anthropometric indices, and blood pressure (BP) were measured. Multivariable-adjusted logistic regression analysis was employed to ascertain the odds ratio (OR) of CVD risk factors associated with posteriori dietary patterns. In this study, healthy and unhealthy dietary patterns were identified.

RESULTS

Adherence to a healthy dietary pattern was associated with a decrease in systolic BP (SBP) (OR = 0.78; 95% confidence interval (CI): 0.62-0.99) and high-density lipoprotein cholesterol (HDL-C) levels (OR = 1.32; 95% CI: 1.06-1.64). Additionally, greater adherence to the unhealthy dietary pattern was positively associated with SBP (OR = 1.43; 95% CI: 1.13-1.80) and diastolic BP (DBP) (OR = 1.33; 95% CI: 1.01-1.76).

CONCLUSIONS

We concluded that greater adherence to an unhealthy dietary pattern was associated with an increase in SBP and DBP. On the other hand, greater adherence to a healthy dietary pattern could be effective in reducing SBP. Further investigation is recommended to validate these findings.

Hypertension-Related Status and Influencing Factors among Chinese Children and Adolescents Aged 6~17 Years: Data from China Nutrition and Health Surveillance (2015-2017)

Hypertension is currently highly prevalent worldwide and serves as one of the significant risk factors for chronic diseases and mortality. Adult hypertension can be traced back to, as well as prevented starting in, childhood and adolescence. However, due to the lack of surveillance among children and adolescents, the prevalence and influencing factors of hypertension-related conditions have not been well described. Hence, a total of 67,947 children and adolescents aged 6 to 17 from China Nutrition and Health Surveillance (2015-2017) were enrolled to describe the weighted average blood pressure level and the weighted prevalence of hypertension, pre-hypertension, and their distribution and to analyze the risk factors for hypertension and pre-hypertension among Chinese children and adolescents at a nationwide level. In summary, the weighted mean values of systolic blood pressure and diastolic blood pressure were 111.8 (95% CI, 111.2-112.5) mmHg and 66.5 (95% CI, 66.0-67.0) mmHg, respectively. The weighted prevalence of hypertension and pre-hypertension was 24.9% and 17.1%, respectively. Moreover, general obesity, overweight, and central obesity served as risk factors for hypertension and pre-hypertension among Chinese children and adolescents. The current study indicated that the prevalence of hypertension and pre-hypertension in Chinese children and adolescents was at a high level. Moreover, blood pressure screening should be further intensified for children and adolescents at a high risk of being overweight or obese.

Association of major dietary patterns with socioeconomic status, obesity, and contracting COVID-19 among Iranian adults

Background

The coronavirus disease 2019 (COVID-19) pandemic clearly affected the lifestyle and dietary habits of millions of people worldwide. The purpose of this study was to evaluate the association of major dietary patterns with socioeconomic status, obesity, and contracting COVID-19.

Methods

We conducted a cross-sectional study using an online survey for data collection with a total of 1,187 participants (over the age of 18 years) who reported their sociodemographic details, anthropometric index (weight and height), and dietary intake. Multivariable logistic regression models were applied to assess the association between major dietary patterns and study outcomes.

Results

A total of 1,106 adults were included in the current analysis. We identified three major dietary patterns (plant-based, meat, and Western dietary patterns). The mean age of participants was significantly higher in the upper tertile of plant-based dietary patterns (DPs) compared to the first tertile, while it was lower in the top tertile of meat and Western DPs. The percentage of participants who lived in urban areas was significantly higher in the third tertile of meat DP than in the first tertile (p < 0.001). Moderate adherence to Western DP was significantly associated with increased odds of obesity (OR: 1.79; 95% CI: 1.17, 2.74). In addition, high adherence to Western DP was significantly related to increased odds of obesity after controlling for confounders. Subjects in the second tertile of the Western DP had higher odds (95% Cl: 1.04, 1.92) for COVID-19 infection than the first tertile.

Conclusion

This study showed that moderate and high adherence to a Western dietary pattern was associated with a higher risk of obesity and COVID-19 infection during the pandemic. Future studies are needed to confirm these findings.

The correlation between nuts and algae-less diet and children's blood pressure: from a cross-sectional study in Chongqing

BACKGROUND

Nuts and algae have been shown to improve BP levels, but their effectiveness is controversial.

AIMS

This study aims to illustrate the effect of dietary pattern with nuts and algae-less on BP levels in children and adolescents from a cross-sectional study.

METHODS

A total of 5645 children from the Chongqing Children's Health Cohort, aged 9.34 ± 1.74 years with 52.05% males, were analyzed. Stratified analysis was conducted to explore the differences between the two dietary patterns in urban or rural areas, as well as the differences in different gender. Logistic regression was used to analyze the influence factors of increased BP. And a GLM was used to analyze the influence of the two dietary patterns on systolic blood pressure (SBP, mmHg), diastolic blood pressure (DBP, mmHg), and mean arterial pressure (MAP, mmHg).

RESULTS

Children with nuts and algae-less dietary patterns had higher SBP (104.68 ± 10.31 vs 103.81 ± 9.74, P = .006), DBP (64.27 ± 7.53 vs 63.55 ± 7.52, P = .002), and MAP (77.74 ± 7.75 vs 76.97 ± 7.52, P = .001) compared with those children with a balanced diet. After adjusting for covariates, the nuts and algae-less diet was a risk factor for hypertension in children when compared with the balanced diet(OR(95%CI):1.455(1.097,1.930), P = .009). The nuts and algae-less diet has a significant influence on SBP (104.68 ± 10.31 mmHg vs.103.81 ± 9.74 mmHg, P = .006). Stratified analysis by sex showed that nuts and algae-less dietary patterns had a more significant impact on females than males.

CONCLUSION

Nuts and algae-less dietary pattern correlated with increased BP levels in children, and a greater impact on SBP levels was found in females, suggesting that a balanced diet with appropriate nuts and algae should be proposed for children in China.

Association of the Protective Dietary Pattern for Blood Pressure with Elevated Blood Pressure and Hypertension among Chinese Children and Adolescents Aged 6-17 Years Old: Data from China Nutrition and Health Surveillance (2015-2017)

Studies focused on the association between dietary patterns and elevated blood pressure (BP) and hypertension (HTN) among children and adolescents remain insufficient. This study aimed to explore a dietary pattern that could be helpful for the prevention of abnormal BP and to investigate the association between this dietary pattern and elevated BP and HTN among Chinese children and adolescents. A total of 52,080 Chinese children and adolescents aged 6~17 years old from the China Nutrition and Health Surveillance (CNHS) 2015-2017 were included in the current study. The reduced rank regression (RRR) method was applied to derive a dietary pattern that is associated with BP. Multivariable logistic regression was used to assess the association between dietary pattern (DP) and elevated BP and HTN. The Dietary Approach to Stop Hypertension (DASH) score was also calculated for each participant as a comparative method to validate the dietary pattern derived with the RRR method. A protective dietary pattern (PDP) for BP among Chinese children and adolescents was derived, which was characterized by high intakes of dairy products, mushrooms/edible fungi, fresh vegetables, fresh fruits, fresh eggs, aquatic products, mixed legumes, soybeans and related products, offal, dried fruits, and coarse cereals, with low intakes of refined grains. After multiple adjustments, there were significant inverse associations between PDP scores and the odds of elevated BP and HTN (elevated BP: Q5 vs. Q1, OR = 0.849, 95%CI = 0.755-0.931, P-trend < 0.05; HTN: Q5 vs. Q1, OR = 0.795, 95%CI = 0.694-0.911, P-trend < 0.05). The DASH diet was also observed to have protective effects on elevated BP in model I (Q5 vs. Q1, OR = 0.899, 95%CI = 0.828-0.975, P-trend < 0.05), but was not observed to have protective effects on HTN (HTN: Q5 vs. Q1, OR = 0.958, 95%CI = 0.876-1.048, P-trend > 0.05). The current study suggested that greater adherence to the PDP for BP among Chinese children and adolescents might be associated with lower odds of elevated BP and HTN.

Healthy eating habits and a prudent dietary pattern improve Nanjing international students' health-related quality of life

Purpose

Low-quality dietary practices, such as fast food consumption and skipping meals, deteriorate the quality of life. However, the available studies on diet and health-related quality of life (HRQoL) used matrices not specific to nutrition. Moreover, how diet affects the HRQoL of international students in China is unknown. Therefore, using a cross-sectional study, the effect of dietary patterns and habits on the HRQoL of international students in Nanjing, China, was examined.

Methods

The researchers collected dietary data using a food frequency questionnaire (FFQ) from February to March 2022. Then, the Food Benefit Assessment (FBA) was used to access HRQoL. Finally, the effect of eating habits and dietary patterns on HRQoL was explored using multilinear regression.

Results

Approximately 454 responses were obtained, with the responses mostly from male subjects (56.4%) and those aged 26 years and above (75.6%). The quality of life according to the food consumed was about average for all the constructs except for aesthetics and disease prevention, as 65.8% skipped meals, particularly breakfast (47.8%). Furthermore, three dietary patterns were identified: prudent, Western, and animal protein patterns. Consequently, by skipping breakfast, vitality (β = -2.362, p = 0.04), wellbeing (β = -3.592, p = 0.007), digestive comfort (β = -4.734, p = 0.008), and disease prevention (β = -5.071, p = 0.031) were all reduced. However, consuming at least three meals daily enhanced vitality (β = 2.254, p = 0.003) and disease prevention (β = 4.441, p = 0.019). Furthermore, aesthetics (β = 4.456, p = 0.05), physical appearance (β = 5.927, p = 0.003), and vitality (β = 3.323, p = 0.009) were also significantly increased by healthy dietary patterns. However, a more Westernized diet led to frequent snacking (β = -4.631, p = 0.032), a decline in wellbeing (β = -5.370, p < 0.001), and discomfort with digestion (β = -5.101, p = 0.01). Finally, increased frequency of snacking (β = -6.036, p = 0.012), a decrease in wellbeing (β = -4.494, p = 0.004), digestive comfort (β = -9.940, p < 0.001), physical appearance (β = -4.926, p = 0.027), and disease prevention (β = -5.835, p = 0.043) were all associated with an increase in animal protein patterns.

Conclusion

This research indicates that healthy eating habits and patterns positively impact international students' HRQoL. Therefore, the appropriate authorities should advise students to consume healthy foods regularly to improve their HRQoL.

Associations between major dietary patterns and blood pressure among Southwest Chinese: A cross-sectional analysis based on the China Multi-Ethnic Cohort (CMEC) study

BACKGROUND AND AIMS

In the less developed multi-ethnic regions (LEMRs) of Southwest China, the associations between dietary patterns and blood pressure (BP) values remain unclear. We aimed to investigate such associations and related effect modifiers.

METHODS AND RESULTS

This study included 81,433 participants from the China Multi-Ethnic Cohort Study. Dietary intakes during the year before the interview were measured with the Quantitative Food Frequency Questionnaire. Three major dietary patterns that were highly in line with geographical and ethnic distributions of the study population, i.e., "Sichuan Basin," "Yunnan-Guizhou Plateau," and "Qinghai-Tibet Plateau," were derived using principal component factor analysis. The multilinear regression model combined with inverse probability of exposure weighting was used to estimate the associations between dietary patterns and BP values. Comparing the highest with the lowest quintiles, the Sichuan Basin dietary pattern (characterized by urban lifestyles) was associated with 2.67 mmHg lower systolic blood pressure (SBP) (95% CI: -3.07 to -2.27) and 0.89 mmHg lower diastolic blood pressure (95% CI: -1.12 to -0.65). In contrast, both the Yunnan-Guizhou Plateau (characterized by agricultural lifestyles) and the Qinghai-Tibet Plateau dietary patterns (characterized by nomadic lifestyles) showed positive associations with BP. In the stratified analysis, the associations between dietary patterns and SBP were significantly stronger in women than in men for all three kinds of dietary patterns.

CONCLUSION

Both major dietary patterns and their associations with BP showed a substantial disparity in LEMRs of Southwest China. Dietary patterns in regions of higher socioeconomic status are more conducive to reducing the rising of BP, especially for women and urban residents, which might provide insights into the BP control in LEMRs of Southwest China.

Associations of VEGF-A-Related Variants with Adolescent Cardiometabolic and Dietary Parameters

Previous research has allowed the identification of variants related to the vascular endothelial growth factor-A (VEGF-A) and their association with anthropometric, lipidemic and glycemic indices. The present study examined potential relations between key VEGF-A-related single-nucleotide polymorphisms (SNPs), cardiometabolic parameters and dietary habits in an adolescent cohort. Cross-sectional analyses were conducted using baseline data from 766 participants of the Greek TEENAGE study. Eleven VEGF-A-related SNPs were examined for associations with cardiometabolic indices through multivariate linear regressions after adjusting for confounding factors. A 9-SNP unweighted genetic risk score (uGRS) for increased VEGF-A levels was constructed to examine associations and the effect of its interactions with previously extracted dietary patterns for the cohort. Two variants (rs4416670, rs7043199) displayed significant associations (p-values < 0.005) with the logarithms of systolic and diastolic blood pressure (logSBP and logDBP). The uGRS was significantly associated with higher values of the logarithm of Body Mass Index (logBMI) and logSBP (p-values < 0.05). Interactions between the uGRS and specific dietary patterns were related to higher logDBP and logGlucose (p-values < 0.01). The present analyses constitute the first-ever attempt to investigate the influence of VEGF-A-related variants on teenage cardiometabolic determinants, unveiling several associations and the modifying effect of diet.

The association between dietary trajectories across childhood and blood pressure in early adolescence: The Longitudinal Study of Australian Children

BACKGROUND

Cardio-metabolic risk factors, including hypertension, are increasingly appearing in childhood. The aims of this study were to examine the associations between dietary trajectories across childhood and subsequent blood pressure (BP) at age 10/11, and to further determine whether these associations were explained by BMI or fat mass.

METHODS

Data from 4360 participants from the Longitudinal Study of Australian Children were analysed. Dietary scores were computed based on similarity of intake to the Australian Dietary Guidelines. Group-based trajectory modelling was used to identify distinct dietary trajectories based on participant's individual dietary scores at up to four timepoints between age 4 and 11. Linear regression models examined the associations between dietary trajectories and BP measured at age 10/11. Models were adjusted for relevant covariates, and BMI or fat mass.

RESULTS

Four dietary trajectories were identified: "never healthy" (4.3%); "moderately healthy" (23.1%); "becoming less healthy" (14.2%); and "always healthy" (58.4%). Children in the "always healthy" trajectory had a lower systolic (-2.19 mmHg; 95% CI -3.78, -0.59) and diastolic BP (-1.71; -2.95, -0.47), compared with children in the "never healthy" trajectory after covariate adjustment. These associations were attenuated after additional adjustment for BMI or fat mass, but remained significant for diastolic BP.

CONCLUSIONS

A dietary trajectory mostly aligned with the Australian Dietary Guidelines across childhood was associated with slightly lower BP at age 10/11, which was not fully explained by BMI or fat mass. These findings support the need to encourage and enable healthy dietary habits early in childhood to attenuate the increasing burden of cardio-metabolic disease.

Dietary patterns and indicators of cardiometabolic risk among rural adolescents: A cross-sectional study at 15-year follow-up of the MINIMat cohort

Background

Diet being a modifiable factor, its relationship with cardiometabolic risk is of public health interest. The vast majority of studies on associations of dietary patterns with cardiometabolic risk indicators among adolescents are from high-income countries and urban settings. We sought to describe dietary patterns and examine their associations with selected cardiometabolic risk indicators-waist circumference (WC), systolic blood pressure, fasting lipid profile and insulin resistance-along with its gender stratification among adolescents in a low-income, rural setting.

Methods

This cross-sectional study utilized data from the 15-year follow-up of the Maternal and Infant Nutrition Interventions in Matlab (MINIMat) cohort in southeast Bangladesh. The children who were born as singletons to the mothers randomized in the MINIMat trial and had valid birth anthropometrics were eligible for the follow-up. We employed a single, qualitative 24-hour recall to assess diet. Dietary patterns were derived from simple K-means cluster analysis, and calculation of dietary diversity score (DDS) using a validated instrument. Anthropometric parameters and systolic blood pressure were recorded. Fasting plasma triglyceride, total cholesterol, low- and high-density lipoproteins, insulin and glucose levels were measured. We calculated insulin resistance using the Homeostasis Model Assessment equation (HOMA-IR). Three right-skewed outcome variables were natural log (Ln) transformed: WC, triglyceride and HOMA-IR. Omnibus and gender-specific multiple linear regression models were fitted.

Results

Among 2,253 adolescents (52.1% girls, 7.1% overweight/obese), we identified four diet clusters: Traditional, Fish-dominant, Meat-dominant, and High-variety. No significant associations were found between the clusters and indicators. On gender-stratification, triglyceride levels were lower among boys in the Fish-dominant (Ln-triglyceride βadjusted: -0.09; 95% confidence interval (CI): -0.15, -0.02) and Meat-dominant (Ln-triglyceride βadjusted: -0.08; 95% CI: -0.15, -0.004) clusters than among boys in the Traditional cluster. Compared to boys in the bottom quartile of DDS, boys in the top quartile had 2.1 mm of Hg (95% CI: 0.5, 3.6) higher systolic blood pressure and 1.9% (95% CI: 0.01-3.8%) higher WC.

Conclusion

While statistically significant, the gender-specific differences in triglyceride, systolic blood pressure, and waist circumference across dietary patterns were small. Associations between dietary patterns and cardiometabolic risk indicators may require a time lag beyond mid-adolescence to manifest in a rural setting. Prospective studies are warranted to delineate the magnitude and direction of those associations.

Western diet augments metabolic and arterial dysfunction in a sex-specific manner in outbred, genetically diverse mice

Western diet (WD), characterized by excess saturated fat and sugar intake, is a major contributor to obesity and metabolic and arterial dysfunction in humans. However, these phenotypes are not consistently observed in traditional inbred, genetically identical mice. Therefore, we sought to determine the effects of WD on visceral adiposity and metabolic/arterial function in UM-HET3 mice, an outbred, genetically diverse strain of mice. Male and female UM-HET3 mice underwent normal chow (NC) or WD for 12 weeks. Body mass and visceral adiposity were higher in WD compared to NC (P < 0.05). Female WD mice had greater visceral adiposity than male WD mice (P < 0.05). The results of glucose and insulin tolerance tests demonstrated that metabolic function was lower in WD compared to NC mice (P < 0.05). Metabolic dysfunction in WD as was driven by male mice, as metabolic function in female WD mice was unchanged (P > 0.05). Systolic blood pressure (BP) and aortic stiffness were increased in WD after 2 weeks compared to baseline and continued to increase through week 12 (P < 0.05). Systolic BP and aortic stiffness were higher from weeks 2-12 in WD compared to NC (P < 0.05). Aortic collagen content was higher in WD compared to NC (P < 0.05). Carotid artery endothelium-dependent dilation was lower in WD compared to NC (P < 0.05). These data suggest sex-related differences in visceral adiposity and metabolic dysfunction in response to WD. Despite this, arterial dysfunction was similar in male and female WD mice, indicating this model may provide unique translational insight into similar sex-related observations in humans that consume WD.

Restricted dietary pattern may contribute to lowering blood pressure in adolescents with obesity: Study of Cardiovascular Risk in Adolescents

OBJECTIVE

Dieting is one of the main target factors for interventions that seek to control and prevent rising blood pressure. This study identified dietary patterns and analyzed their association with adolescents' blood pressure.

METHODS

This is a cross-sectional study with a probabilistic and nationally representative sample of adolescents aged 12-17 years, who participated in the Study of Cardiovascular Risk in Adolescents (ERICA), carried out in 2013-2014 with Brazilian adolescents (N = 36 956). Food consumption was assessed by 24 h recall. Dietary patterns were identified using the Reduced Rank Regression method, and considering waist circumference, fasting insulin, and dietary polyunsaturated fat/saturated fat ratio as intermediate variables. Multiple linear regression models stratified by weight were developed; SBP and DBP were the dependent variables, and dietary pattern scores were the independent ones, with adjustment for potential confounding factors.

RESULTS

The following patterns were identified: 'Brazilian common', 'Restricted' and 'Added sugar'. The 'Restricted' pattern, which included diet/light foods, chicken and chicken-based dishes, leafy greens, vegetables and spices, red meats and dishes based on red meats and tubers, was inversely associated with SBP (β = -1.55; 95% CI = -2.26 to -0.83) and DBP (β = -1.19; 95% CI = -1.70 to -0.68) in adolescents with obesity.

CONCLUSION

In adolescents with obesity, a low-energy density diet was associated with reduced blood pressure. These findings are consistent with international recommendations for preventing elevated blood pressure.

Modeling Parental Influence on Food Consumption among Chinese Adolescents through Self-Efficacy: A Path Analysis

This study aimed to investigate the associations between perceived parental control, perceived parental modeling and parent–teen co-decision making, and fruit and vegetable (F&V) and sugar-sweetened beverage and junk food (S&J) consumption among Chinese adolescents, and examine whether self-efficacy mediates the associations. Data were collected in a cross-sectional survey of Chinese adolescents carried out in the fall of 2019. The questionnaires were adapted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) Study. Ordinary least-squares regressions and a path analysis were performed to evaluate the hypothesized associations. The final sample included 3595 Chinese adolescents (mean (SD) age, 14.67 (1.73) years; 52.82% (n = 1899) males). Perceived parental control was positively associated with adolescents’ F&V consumption, and was negatively associated with adolescents’ S&J consumption. Perceived parental modeling and parent–teen co-decision making were both positively associated with adolescents’ F&V consumption and negatively associated with their S&J consumption. Adolescents’ self-efficacy was positively associated with F&V consumption and negatively associated with S&J consumption. These results suggest that serving as a positive role model, having adolescents participate in the decision-making process, and increasing adolescents’ self-efficacy can be feasible and efficacious strategies to improve the nutritional quality of Chinese adolescents’ diets.

Associations between urinary heavy metal concentrations and blood pressure in residents of Asian countries

BACKGROUND

Previous studies have suggested that exposures to heavy metals (arsenic, cadmium, lead, and selenium) may be associated with differences in blood pressure. However, the findings of these studies have been inconsistent. This study was performed to examine the associations between urinary heavy metal concentrations and blood pressure among residents of four Asian countries (Bangladesh, Indonesia, Nepal, and Vietnam).

METHODS

This cross-sectional study examined 1899 adults in four Asian countries. Urinary concentrations of heavy metals were measured by inductively coupled plasma mass spectrometry. A questionnaire survey was administered regarding individual characteristics. Anthropometric measurements (height and weight) were performed. Systolic and diastolic blood pressures were measured after a short rest. Multiple linear regression models were applied to investigate associations between urinary heavy metal concentrations and blood pressure after adjustments for age, sex, and body mass index.

RESULTS

The geometric means of the urinary concentrations of arsenic, cadmium, lead, and selenium were 84.6, 0.885, 2.09, and 16.5 μg/g creatinine, respectively. The urinary arsenic concentrations were slightly higher than those typically reported in non-polluted populations, while urinary cadmium, lead, and selenium concentrations were equivalent or slightly lower. The urinary lead concentrations were positively associated with both systolic and diastolic blood pressure, but urinary selenium concentrations were negatively associated with them.

CONCLUSIONS

Variations in the urinary concentrations of lead and selenium were associated with blood pressure at low levels of exposure/intake.

Association of dietary patterns with blood pressure and body adiposity in adolescents: a systematic review

This paper aimed to systematically review the results of observational studies that investigated the association of dietary patterns with blood pressure and body adiposity markers in adolescents. Articles were searched in July 2020 in PubMed, Scopus, Web of Science, and Scientific Electronic Library Online (SciELO). Of the 3408 studies found, 24 fulfilled the inclusion criteria and were considered in this review. Almost all studies (n = 23) identified at least one unhealthy pattern, predominantly characterized as consumption of confectionery, refined grains, sweets, sweetened drinks, red meats, and processed meats. Fourteen of the twenty-four studies found a significant association between any dietary pattern and blood pressure and/or body adiposity markers. There was a positive association of dietary patterns - characterized by the consumption of foods rich in sodium, animal fat, refined carbohydrates, and low in fiber - with increased blood pressure and body adiposity. Our findings highlight the importance of studies with this scope, whose results can support the surveillance of adolescent's health. However, considering the limited number of studies that found a significant association and their limitations, the present results should be interpreted carefully. More prospective studies are needed to determine how adherence to dietary patterns could influence blood pressure and body adiposity markers in the long term.

Association between Dietary Patterns and Low HDL-C among Community-Dwelling Elders in North China

We aimed to investigate the association between dietary patterns and low HDL-C among the elderly population living in North China. The data were from a national cross-sectional survey conducted in 2015. General information in terms of living habits, health status, and food intake using 24 h dietary recall for three consecutive days was procured, and the weight of edible oil and condiments recorded. Anthropometric index, blood pressure, and fasting serum lipids were measured using standard methods. Dietary patterns were derived from food categories by exploratory factor analysis, and multivariate logistic regression was used to estimate the odds ratios of low HDL-C across quartiles of dietary patterns. Among 3387 elderly participants, 21.9% had low HDL-C levels. After adjusting for potential confounding factors, participants with highest score versus lowest score in the balanced dietary pattern had a decreased risk of low HDL-C (OR = 0.38, 95% CI: 0.16-0.88, p for trend = 0.013) in the group with a BMI of 27.1 kg/m² and above. Compared to the lowest quartile, there was a statistically significant negative association between the highest scores of the Western dietary pattern and low HDL-C (OR = 0.37, 95% CI: 0.17-0.82, p for trend = 0.018) in the group with a BMI of 21.6-24.8 kg/m². However, greater adherence to a thrifty dietary pattern (highest quartiles vs. lowest quartiles) was associated with increased risk of low HDL-C (OR = 3.31, 95% CI: 1.05-10.40, p for trend = 0.044), especially in the subgroup with a BMI of 21.6 kg/m² and below. The study revealed that it is urgent to develop district-specific dietary improvement plans for dyslipidemia based on the nutritional status of the elderly population in North China.

Association between Eating Patterns and Excess Body Weight in Adolescents

Background: Excess body weight is a risk factor for the development of diseases. Adolescence is a nutritionally vulnerable age group that suffers due to influences on food intake. We aimed to identify the main dietary patterns of adolescents to investigate their association with excess body weight. Methods: This was a cross-sectional study. Anthropometric measurements (weight and height) were collected to calculate the BMI. Nutritional statuses were classified according to World Health Organization classification. Food consumption data were obtained through a 24-hour recall and food patterns were identified through factor analyses of the main components. The patterns were categorized into quintiles and dichotomized into greater (fourth and fifth quintile) and lower (first to third quintile) adherences. Binomial regression was used to assess the association between food patterns and excess body weight. The study was conducted in a capital city in Northeast Brazil from adolescents aged between 10 and 19 years in 826 public schools. Results: Three main food patterns were identified in women and men: coffee with bread (white bread, coffee, fat, and eggs), common Brazilian (white rice, beans, meat, pasta, with negative factor load for regional foods), and mixed pattern (sweets, fruits, biscuits and cakes, vegetables, and dairy products). Adolescents with a greater adherence to the coffee and bread pattern [odds ratio (OR) = 0.68; 95% confidence interval (95% CI): 0.50-0.93] and the common Brazilian pattern (OR = 0.72; 95% CI: 0.53-0.99) had a lower chance of being excess body weight than those with lower adherence. Conclusions: Three main eating patterns were identified among adolescents, and greater adherence to the coffee with bread and common Brazilian patterns implied a lower chance of excess body weight.

Associations between health-related quality of life and health behaviors in Australian nursing students

Health-related quality of life (HRQoL) is being increasingly studied as an indicator of wellbeing. This study evaluated the HRQoL of nursing students and relationships between lifestyle behaviors including smoking, diet, alcohol intake and physical activity. A cross-sectional study was conducted in 2018 using the Short-Form 12V2 to measure the HRQoL of 475 students from both regional and metropolitan universities in Queensland, Australia. z-scores were aggregated into a Physical Composite Score (PCS) and a Mental Composite Score (MCS). Multivariate linear regression was used to explore the associations. Nursing students (94.5% female) had lower HRQoL scores relative to the general Australian population. Students enrolled at the regional university, with higher income; higher intakes of vitamin A, calcium, and iodine; and more physical activity had a higher Mental Composite Score, but those with health conditions and high intakes of meat, fat, carbohydrates, and sugar reported lower Physical Composite Score compared to their counterparts. Skipping breakfast, physical inactivity, and alcohol score were inversely associated with HRQoL. This study highlights the need for strategies to address the poor lifestyle and HRQoL in nursing students to support their physical and mental health.

Association of Dietary Patterns with Weight Status and Metabolic Risk Factors among Children and Adolescents

Unhealthy dietary patterns are associated with obesity in children and adolescents. However, few studies have investigated the relationships between dietary patterns and obesity-related metabolic disorders among Asians. We identified dietary patterns in children and adolescents and examined the associations between these patterns and obesity, insulin resistance, and metabolic syndrome in South Korea. This study is a cross-sectional design. We used baseline data from an intervention study of 435 Korean children and adolescents aged 6–17 years. Insulin resistance was assessed as HOMA-IR ≥ 2.6. Metabolic syndrome was diagnosed by cardiovascular disease risk factor clustering. Dietary intakes were estimated using 3-day food records. Factor analysis was used to obtain dietary patterns, and we examined the associations between dietary patterns and obesity-related markers adjusted for potential covariates. Three dietary patterns were identified as fast food and soda (FFS), white rice and kimchi (WRK), and oil and seasoned vegetable (OSV) patterns. Compared with participants in the lower intake of FFS pattern, those in the top intake were associated with a higher waist circumference (WC) (β = 1.55), insulin level (β = 1.25), and body mass index (BMI) (β = 0.53) and it was positively associated with HOMA-IR ≥ 2.6 (OR = 2.11; 95% CI: 1.227–3.638) (p < 0.05). WRK pattern was associated with lower weight and higher HDL cholesterol, and the OSV pattern was associated with a lower weight, WC, and insulin level (p < 0.05). The FFS pattern showed a positive relation with WC, serum insulin, and BMI, and the other two dietary patterns indicated a preventive effect of those parameters. The FFS pattern was associated with significantly elevated insulin resistance among children and adolescents.

Salt intake and blood pressure in Iranian children and adolescents: a population-based study

BACKGROUND

Previous studies have reported a high prevalence of hypertension in Iranian students, especially in rural areas. The aim of this study was to investigate the daily intake of salt in students and its association with high blood pressure.

METHODS

A random sub-sample was selected from the participants of the second phase of Shahroud schoolchildren eye cohort study and then a random urine sample was tested for sodium, potassium and creatinine. Urine electrolyte esexcretion and daily salt intake were calculated by Tanaka et al.'s formula.

RESULTS

Among 1455 participants (including 230 participants from rural area and 472 girls), the mean age was 12.9 ± 1.7 year and the mean daily salt intake was 9.7 ± 2.6 g (95% CI 9.5-9.8). The mean salt consumption in rural areas [10.8 (95% CI 10.4-11.2)] was higher than urban areas [9.4 (95% CI 9.3-9.6)], in people with hypertension [10.8 (95% CI 10.3-11.3)] was more than people with normal blood pressure [9.4 (95% CI 9.3-9.6)], and in boys [9.8 (95% CI 9.7-10.0)] was more than girls [9.3 (95% CI 9.1-9.6)]. Higher age, BMI z-score, male sex and rural life, were associated with increased daily salt intake. Increased salt intake was associated with increased systolic and diastolic blood pressure.

CONCLUSION

Daily salt intake in Iranian adolescents was about 2 times the recommended amount of the World Health Organization, was higher in rural areas and was associated with blood pressure. Reducing salt intake should be considered as an important intervention, especially in rural areas.

The associations between dietary patterns and cardiovascular risk factors among adults: A cross-sectional study

OBJECTIVE

Cardiovascular diseases (CVDs) are the major causes of death, worldwide. Although for decades the associations between individual foods and nutrients and CVDs have been investigated, little attention has been paid to dietary patterns. Therefore, this study was conducted to examine the association between dietary patterns and CVD risk factors among Iranian adults.

METHODS

This cross-sectional study was performed on 236 adults who attended public health centers. Dietary intakes were collected using a valid food frequency questionnaire. Sociodemographic characteristics, anthropometric measures, and biochemical biomarkers were measured using standardized methods. Dietary patterns derived using the factor analysis. Logistic regression assessed the odds of CVD risk factors across tertiles of data-driven dietary patterns.

RESULTS

We identified three dietary patterns. After adjusting for possible confounders, we observed that participants in the third category of the healthy dietary pattern (HDP) had lower odds of low HDL-C (OR = 0.26; 95% CI: 0.10-0.64) compared to those in the first category. Adherence to the mixed pattern was associated with increased odds of high serum TC in men only (OR = 3.69; 95% CI: 1.06-12.81). However, women with higher adherence to the Western dietary pattern (WDP) had higher odds of high serum TG (OR = 5.61; 95% CI: 1.69-18.59), and those with a greater adherence to HDP had lower odds of low HDL-C (OR = 0.25; 95% CI: 0.07-0.98).

CONCLUSION

This study showed that adherence to HDP may protect against a low level of HDL-C, whereas mixed and Western-type diets may contribute to high serum TG levels. Future longitudinal studies are needed to assess the potential causality of the observed associations.

Healthy and unhealthy dietary patterns and the risk of chronic disease: an umbrella review of meta-analyses of prospective cohort studies

We aimed to fully review the association of empirical dietary patterns with the risk of non-communicable chronic diseases and to rate the quality of the evidence. Published meta-analyses of observational studies investigating the association of empirically derived dietary patterns with the risk of chronic diseases were identified by searching PubMed and Scopus till September 2019. Two independent reviewers extracted the information and rated the quality of the evidence by NutriGrade score. For each meta-analysis, cross-sectional and case–control studies were excluded and then summary relative risk was recalculated by using a random-effects model. Sixteen meta-analyses of prospective cohort studies, reporting eighteen SRR for healthy dietary patterns and sixteen SRR for unhealthy patterns obtained from 116 primary prospective cohort studies with 4·8 million participants, were included. There was moderate quality of evidence for the inverse association of healthy dietary patterns with the risk of type 2 diabetes (T2D), fracture and colorectal and breast cancers. There was also low-quality evidence for the inverse relation between healthy dietary patterns and the risk of all-cause and cardiovascular mortality, depression, CHD and respiratory diseases. There was moderate quality of evidence for a positive association between unhealthy dietary patterns and the risk of T2D, fracture and the metabolic syndrome. Adopting a healthy dietary pattern may reduce the risk of T2D, CHD and premature death. More research is needed for outcomes for which the quality of the evidence was rated low, such as respiratory disease, mental illness and site-specific cancers.

Energy Dense Salty Food Consumption Frequency Is Associated with Diastolic Hypertension in Spanish Children

High blood pressure (BP) is a risk factor for cardiovascular disease and sodium consumption is related to high BP. Moreover, sugar-sweetened beverages (SSB) and the Dietary Approach to Stop Hypertension (DASH) influence BP. For this reason, we investigated whether: 1) children with risk of elevated BP had a higher consumption frequency (CF) of energy-dense salty foods (EDSF), high-sugary foods (HSF) and SSB or a low DASH score; and 2) children with a higher CF of EDSF showed a worse anthropometric and metabolic profile. Anthropometry, BP and general biochemical parameters were measured in 687 Spanish children (5-16 years) with normal or excess weight. A food frequency questionnaire was used to calculate EDSF, HSF and SSB consumption, and modified DASH score. Results showed that sex and pubertal stage influenced modified DASH score. Diastolic hypertension was associated to higher CF of EDSF in the whole sample and to higher CF of SSB in pubertal children, both independently of nutritional status. In addition, CF of EDSF was positively associated with CF of HSF and SSB and inversely associated with modified DASH score. Targeted policies and intervention programs, specific for different age ranges, should be established that aim to reduce salt consumption from snacks and processed foods, which could reduce HSF and SSB consumption as well.

Food insecurity is associated with lower adherence to the Mediterranean dietary pattern among Lebanese adolescents: a cross-sectional national study

PURPOSE

To derive dietary patterns (DPs) of Lebanese adolescents (10-18 years) and evaluate associations between identified DPs and household food insecurity (HFI).

METHODS

Data on adolescents (n = 693) were drawn from a national survey conducted in 2015 on a representative sample of Lebanese households with children. In addition to a sociodemographic questionnaire, data collection included the validated Arabic-version of the Household Food Insecurity Access Scale, used to evaluate HFI. Dietary intake was assessed using a 187-item validated food frequency questionnaire. Associations between HFI scores and DPs were examined using multiple linear regressions.

RESULTS

HFI was observed in 55.2% of the study sample. Two DPs were derived among adolescents: Western and Lebanese-Mediterranean (LM). The Western DP was characterized by higher consumption of sweetened beverages, fast foods, sweets, and refined grains, whereas the LM DP was characterized by higher intakes of fruits, vegetables, dairy products, and whole grains. Scores of the Western DP were negatively associated with fiber, calcium, iron, and vitamins A and D, while the LM DP scores were positively correlated with fiber, proteins, iron, calcium, and vitamins A and D (p < 0.01). LM DP scores were also negatively correlated with total fat, saturated and polyunsaturated fats, p < 0.05. After adjustment for sociodemographics, multiple linear regression showed that higher HFI scores were associated with lower adherence to LM DP among adolescents (β = - 0.026, 95% CI - 0.046, - 0.006).

CONCLUSIONS

HFI was associated with lower adherence to the Mediterranean pattern among Lebanese adolescents. Preventive strategies are needed to promote better diet quality among food-insecure youth.

Identification of dietary patterns associated with elevated blood pressure among Lebanese men: A comparison of principal component analysis with reduced rank regression and partial least square methods

BACKGROUND

To examine the associations of dietary patterns with odds of elevated Blood Pressure (BP) among Lebanese adult males using principal component analysis (PCA), and compare the results to two other data reduction methods, including reduced rank regression (RRR) and partial least-squares (PLS) regression.

METHODS

Data from the National Nutrition and Non-Communicable Disease Risk Factor Survey conducted in Lebanon between years 2008 and 2009 were used. Dietary intake data were collected by a 61-item food frequency questionnaire (FFQ). In addition, anthropometric and blood pressure measurements were obtained following standard techniques. For the purpose of this study, data of males older than 20 years with no history of chronic diseases were selected (n = 673). Elevated BP was indicated if the systolic blood pressure was > = 130mm Hg and/or the diastolic blood pressure > = 85 mm Hg. Dietary patterns were constructed using PCA, PLS and RRR and compared based on the performance to identify plausible patterns associated with elevated BP. For PLS and RR, the response variables were BMI, waist circumference and percent body fat. Multiple logistic regression was used to evaluate the associations between the dietary pattern scores of each method and risk of elevated BP.

RESULTS

Three dietary patterns were identified using PCA: Western, Traditional Lebanese, and Fish and alcohol. Both the Western and the Traditional Lebanese patterns were associated with higher odds of elevated BP in the study population (OR = 1.23, CI 1.03, 1.46; OR = 1.29, CI 1.09, 1.52 respectively). The comparison among the three methods for dietary patterns derivation showed that PLS and RRR derived patterns explained greater variance in the outcome (PCA: 1.2%; PLS: 14.1%; RRR: 15.36%) and were significantly associated with elevated BP, while the PCA dietary patterns were descriptive of the study population's real dietary habits (PCA: 23.6%; PLS: 19.8%; RRR: 11.3%).

CONCLUSIONS

The Western and Traditional Lebanese dietary patterns were associated with higher odds of elevated BP among Lebanese males. The findings of this study showed that, compared to PCA, the use of RRR method resulted in more significant associations with the outcome while the PCA-derived patterns were more related to the real habits in the study population.

The influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents: a systematic review and meta-analysis

OBJECTIVE

The association between diet quality, dietary behavior and health-related quality of life has been mostly examined in children and adolescents with specific chronic diseases. No systematic review has synthesized the influence of diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents. The purpose of this study was to systematically review the primary studies that evaluated the association between diet quality, dietary behavior and health-related quality of life in the general population of children and adolescents and to synthesize the findings for the association.

METHODS

A computer search in the databases of MEDLINE, EMBASE and PSYCINFO was performed to retrieve English language studies that were published from 1946 up to April 8, 2018. We also screened the PubMed-related articles and the reference lists of the existing relevant literature to identify other eligible studies. We synthesized the association between diet quality, dietary behavior and health-related quality of life using both a qualitative method and meta-analysis. We reported the review following up the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline.

RESULTS

Seventeen studies were included in the synthesis including twelve cross-sectional studies and five longitudinal studies. We found that diet quality and dietary behavior were associated with health-related quality of life in children and adolescents. The positive effect of healthy diets on health-related quality of life was observed for multiple domains of health-related quality of life, including physical, school and emotional functioning, and psychosocial quality of life. We observed a dose-response relationship between the diet exposure and health-related quality of life, where an unhealthy dietary behavior or lower diet quality was associated with decreased health-related quality of life among children and adolescents.

CONCLUSION

The findings of the systematic review suggest the importance of promoting healthy diets and nutrition for good health-related quality of life among children and adolescents. Future research is needed to strengthen the evidence for prospective relationships and for the dose-response effect between diet quality, dietary behavior and health-related quality of life among children and adolescents.

Adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students

PURPOSE

Examining the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and mental health in Iranian university students.

METHODS

This cross-sectional study was conducted among 240 university students (mean age 21.5 years; 86.7% female). Mental health was evaluated using validated Persian versions of the 12-item general health questionnaire (GHQ-12) and the 21-item depression, anxiety, and stress scale (DASS-21). The lower the subjects' scores on these questionnaires, the better their mental health. Usual past-year dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. The DASH score was computed based on energy-adjusted intakes of eight major dietary components emphasized or minimized in the DASH pattern. The higher the DASH score of a subject, the greater his/her adherence to the DASH pattern.

RESULTS

The Pearson's correlation coefficients of DASH score with GHQ-12 total score, DASS-21 total score, and DASS-21 depression, anxiety, and stress subscale scores were - 0.431, - 0.441, - 0.434, - 0.325, and - 0.408, respectively (all P < 0.001). Compared to those in the lowest tertile, subjects in the highest tertile of DASH score had lower means of GHQ-12 total score (mean difference - 4.6; P < 0.001), DASS-21 total score (mean difference - 9.1; P < 0.001), and DASS-21 depression, anxiety, and stress subscale scores (mean differences for depression, anxiety, and stress - 3.6, - 2.4, and - 3.2, respectively; all P < 0.001).

CONCLUSIONS

The findings indicate that greater adherence to the DASH dietary pattern is associated with better mental health in Iranian university students. However, prospective studies of sufficient methodological quality are needed to confirm these findings.

Short-Term Isocaloric Intake of a Fructose- but not Glucose-Rich Diet Affects Bacterial Endotoxin Concentrations and Markers of Metabolic Health in Normal Weight Healthy Subjects

SCOPE

Dietary pattern and impairments of intestinal barrier function are discussed to be critical in the development of metabolic impairments. Here, it is determined if an isocaloric exchange of complex carbohydrates with monosaccharides affects markers of intestinal permeability and metabolic health in healthy subjects.

METHODS AND RESULTS

After a dietary standardization for 4 days, all 12 subjects aged 21-33 years receive an isocaloric fructose- and glucose-enriched diet for 3 days separated by a wash-out phase. Anthropometry, blood pressure, markers of intestinal permeability and metabolic as well as inflammatory parameters are determined in blood samples or isolated peripheral blood mononuclear cells collected at baseline, after standardizations and the monosaccharide interventions, respectively. While anthropometric and inflammatory parameters are not changed, the intake of an isocaloric fructose- but not glucose-enriched diet is associated with a significant increase of bacterial endotoxin plasma levels and alanine aminotransferase activity in serum, while total plasma nitrate/nitrite concentrations are significantly decreased. In peripheral blood mononuclear cells, Toll like receptors 4, 2, and MYD88 mRNA expressions are significantly induced after the fructose-rich but not the glucose-rich diet.

CONCLUSION

In metabolically healthy subjects, even a short-term intake of a fructose-rich diet can elevate bacterial endotoxin levels and change markers of liver health and vascular endothelial function.

Influence of Green Leafy Vegetables in Diets with an Elevated ω-6:ω-3 Fatty Acid Ratio on Rat Blood Pressure, Plasma Lipids, Antioxidant Status and Markers of Inflammation

The typical Western dietary pattern has an elevated ω-6:ω-3 fatty acid ratio (FAR), which may exacerbate the risk of chronic disease. Conversely, the consumption of diets containing green leafy vegetables (GLVs) have been demonstrated to attenuate disease risk. This study investigated the effects of collard greens (CG), purslane (PL) and orange flesh sweetpotato greens (SPG) on measures of disease risk in rats fed diets with a 25:1 ω-6:ω-3 FAR. Male spontaneously hypertensive rats (SHRs) were randomly assigned to four dietary groups (n = 10/group) with a 25:1 ω-6:ω-3 FAR. Experimental diets contained 4% (dried weight) CG, PL or SPG. Dietary intake, body weight, blood pressure, plasma adiponectin, high sensitivity C-reactive protein (hsCRP), oxygen radical absorbance capacity and lipid profile were determined using standardized procedures. Following a 6-week consumption period, systolic blood pressure, plasma adiponectin, total and low-density lipoprotein (LDL) cholesterol decreased following the consumption of diets containing GLVs. While hsCRP increased in SHRs fed diets containing CG and PL, plasma antioxidant capacity was significantly reduced (p < 0.05) with the consumption of diets containing the GLVs. These findings suggest that CG, PL and SPG have the potential to decrease risks for cardiovascular disease (CVD) associated with the consumption of diets with an elevated ω-6:ω-3 FAR.

Dietary patterns and cardiometabolic risk factors among adolescents: systematic review and meta-analysis

This study systematised and synthesised the results of observational studies that were aimed at supporting the association between dietary patterns and cardiometabolic risk (CMR) factors among adolescents. Relevant scientific articles were searched in PUBMED, EMBASE, SCIENCE DIRECT, LILACS, WEB OF SCIENCE and SCOPUS. Observational studies that included the measurement of any CMR factor in healthy adolescents and dietary patterns were included. The search strategy retained nineteen articles for qualitative analysis. Among retained articles, the effects of dietary pattern on the means of BMI (n 18), waist circumference (WC) (n 9), systolic blood pressure (n 7), diastolic blood pressure (n 6), blood glucose (n 5) and lipid profile (n 5) were examined. Systematised evidence showed that an unhealthy dietary pattern appears to be associated with poor mean values of CMR factors among adolescents. However, evidence of a protective effect of healthier dietary patterns in this group remains unclear. Considering the number of studies with available information, a meta-analysis of anthropometric measures showed that dietary patterns characterised by the highest intake of unhealthy foods resulted in a higher mean BMI (0·57 kg/m²; 95 % CI 0·51, 0·63) and WC (0·57 cm; 95 % CI 0·47, 0·67) compared with low intake of unhealthy foods. Controversially, patterns characterised by a low intake of healthy foods were associated with a lower mean BMI (−0·41 kg/m²; 95 % CI −0·46,−0·36) and WC (−0·43 cm; 95 % CI −0·52,−0·33). An unhealthy dietary pattern may influence markers of CMR among adolescents, but considering the small number and limitations of the studies included, further studies are warranted to strengthen the evidence of this relation.

Greater adherence to the dietary approaches to stop hypertension (DASH) dietary pattern is associated with lower blood pressure in healthy Iranian primary school children

PURPOSE

The dietary determinants of children blood pressure (BP) are poorly understood. We examined the association between adherence to the dietary approaches to stop hypertension (DASH) dietary pattern and BP in healthy Iranian primary school children.

METHODS

This cross-sectional study was conducted among a representative sample (n = 407) of healthy Shirazi students aged 6-12 years. Subjects' systolic and diastolic BP were measured by a validated oscillometric BP monitor. Usual dietary intakes over the past 12 months were assessed using a valid and reproducible 168-item semi-quantitative food frequency questionnaire via face-to-face interviews. A DASH score was calculated for each subject based on his/her energy-adjusted intakes of 8 major dietary components emphasized or minimized in the DASH dietary pattern. The higher the DASH score of a subject, the more his/her adherence to the DASH dietary pattern.

RESULTS

After controlling for several potential confounders in the analysis of covariance models, multivariable-adjusted means of systolic and mean BP of subjects in the highest tertile of DASH score were significantly lower than those in the lowest tertile (for systolic BP: mean difference -6.2 mmHg, P = 0.010; and for mean BP: mean difference -5.4 mmHg, P = 0.013). Furthermore, a similar but statistically insignificant difference was found in terms of multivariable-adjusted means of diastolic BP (mean difference -3.9 mmHg, P = 0.146).

CONCLUSIONS

The findings suggest that greater adherence to the DASH dietary pattern is associated with lower BP in healthy Iranian primary school children. However, future prospective studies of adequate methodological quality are warranted to confirm these findings.