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Fajardo VC, Barreto SM, Coelho CG, Diniz MDFH, Molina MDCB, Ribeiro ALP, Telles RW. Adherence to the Dietary Approaches to Stop Hypertension (DASH) and Serum Urate Concentrations: A Longitudinal Analysis from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). J Nutr 2024; 154:133-142. [PMID: 37992809 DOI: 10.1016/j.tjnut.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Increased serum urate (SU) and hyperuricemia (HU) are associated with chronic noncommunicable diseases and mortality. SU concentrations are affected by several factors, including diet, and are expected to rise with age. We investigated whether the Dietary Approaches to Stop Hypertension (DASH) diet alter this trend. OBJECTIVE The objective was to assess whether adherence to the DASH diet predicts a longitudinal change in SU concentrations and risk of HU in 8 y of follow-up. METHODS Longitudinal analyses using baseline (2008-2010, aged 35-74 y), second (2012-2014), and third (2016-2018) visits data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). The inclusion criteria were having complete food frequency questionnaire (FFQ) and urinary sodium measurement, in addition to having SU measurement at the 1st visit and at least 1 of the 2 follow-up visits. For the HU incidence analyses, participants had also to be free from HU at baseline. The final samples included 12575 individuals for the SU change analyses and 10549 for the HU incidence analyses. Adherence to DASH diet was assessed as continuous value. HU was defined as SU>6.8 mg/dL and/or urate-lowering therapy use. Mixed-effect linear and Poisson regressions (incidence rate ratio [IRR] and 95% confidence interval [CI]) were used in the analyses, adjusted for confounders. RESULTS The mean age was 51.4 (8.7) y, and 55.4% were females. SU means (standard deviation) were 5.4 (1.4) at 1st visit, 5.2 (1.4) at 2nd visit, and 5.1(1.3) mg/dL at 3rd visit. The HU incidence rate was 8.87 per 1000 person-y. Each additional point in adherence to the DASH diet accelerated SU decline (P< 0.01) and lowered the incidence of HU by 4.3% (IRR: 0.957; 95% CI: 0.938,0.977) in adjusted model. CONCLUSION The present study findings reinforce the importance of encouraging the DASH diet as a healthy dietary pattern to control and reduce the SU concentrations and risk of HU.
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Affiliation(s)
- Virgínia C Fajardo
- Universidade Federal de Minas Gerais, PhD Student of Post-graduate Program in Ciências Aplicadas à Saúde do Adulto, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carolina G Coelho
- Department of Preventive Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria de Fátima Hs Diniz
- Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Del Carmen B Molina
- Universidade Federal de Ouro Preto, Ouro Preto, Brazil and Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Antonio Luiz P Ribeiro
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center, Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rosa W Telles
- Department of Internal Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Rheumatology Service, Hospital das Clínicas da UFMG/Ebserh, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
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Guan VX, Neale EP, Tapsell LC, Probst YC. Identifying Usual Food Choice Combinations With Walnuts: Analysis of a 2005-2015 Clinical Trial Cohort of Overweight and Obese Adults. Front Nutr 2020; 7:149. [PMID: 33072791 PMCID: PMC7540216 DOI: 10.3389/fnut.2020.00149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
Consumption of nuts has been associated with a range of favorable health outcomes. Evidence is now emerging to suggest that walnuts may also play an important role in supporting the consumption of a healthy dietary pattern. However, limited studies have explored how walnuts are eaten at different meal occasions. The aim of this study was to explore the food choices in relation to walnuts at meal occasions as reported by a sample of overweight and obese adult participants of weight loss clinical trials. Baseline usual food intake data were retrospectively pooled from four food-based clinical trials (n = 758). A nut-specific food composition database was applied to determine walnut consumption within the food intake data. The a priori algorithm of association rules was used to identify food choices associated with walnuts at different meal occasions using a nested hierarchical food group classification system. The proportion of participants who were consuming walnuts was 14.5% (n = 110). The median walnut intake was 5.14 (interquartile range, 1.10–11.45) g/d. A total of 128 food items containing walnuts were identified for walnut consumers. The proportion of participants who reported consuming unsalted raw walnut was 80.5% (n = 103). There were no identified patterns to food choices in relation to walnut at the breakfast, lunch, or dinner meal occasions. A total of 24 clusters of food choices related to walnuts were identified at others (meals). By applying a novel food composition database, the present study was able to map the precise combinations of foods associated with walnuts intakes at mealtimes using data mining. This study offers insights into the role of walnuts for the food choices of overweight adults and may support guidance and dietary behavior change strategies.
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Affiliation(s)
- Vivienne X Guan
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Elizabeth P Neale
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Linda C Tapsell
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Yasmine C Probst
- Faculty of Science, Medicine and Health, School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
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Gómez-Donoso C, Martínez-González MA, Gea A, Murphy KJ, Parletta N, Bes-Rastrollo M. A food-based score and incidence of overweight/obesity: The Dietary Obesity-Prevention Score (DOS). Clin Nutr 2018; 38:2607-2615. [PMID: 30522848 DOI: 10.1016/j.clnu.2018.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/18/2018] [Accepted: 11/08/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND & AIMS Given the enormous health, economic and societal consequences of the obesity pandemic, identifying effective primary prevention strategies represents a global priority. The aim of this study was to provide evidence on the association between adherence to a food-based score reflecting a set of targeted, well-informed, simple dietary recommendations and the incidence of overweight/obesity. METHODS A total of 11,349 initially free of overweight/obesity young adults (mean [SD] age: 34.7 y [10.7]), were followed up biennially during a median of 9.3 years. The Dietary Obesity-Prevention Score (DOS) was created based on a priori evidence of foods associated with weight changes. The DOS positively weighted the consumption of vegetables, fruits, legumes, yogurt, nuts, fish, and a ratio of vegetable to animal protein; whereas the consumption of red meat, processed meat, saturated animal fat, refined grains, ultra-processed food, sugary beverages, beer and spirits were inversely weighted. Energy-adjusted tertiles of each item were used to build the DOS, ranging from 14 (lowest adherence) to 42 points (highest adherence). Adherence to the DOS was calculated at baseline and after 10 years of follow-up. We assessed both incident overweight/obesity (BMI ≥25 kg/m2) and average yearly weight changes in grams per year (g/y). RESULTS During 104,887 person-years, 2153 incident cases of overweight/obesity were identified. A higher adherence to the DOS at baseline was significantly associated with lower risk of future development of overweight/obesity [multivariable-adjusted HR (95% CI) for the highest vs. lowest quintile = 0.63 (0.54-0.74)], with a significant linear dose-response relationship (p for trend < 0.001). When the analyses were updated with repeated measures, the results were similar and remained statistically significant. Consistently, increases in average yearly weight gain were significantly lower with better adherence to the DOS. CONCLUSIONS In this Mediterranean cohort of university graduates, a higher adherence to a food-based score was significantly associated with lower risk of overweight/obesity and lower average annual weight gain. These findings may help counsel patients regarding dietary risks and raise awareness of weight gain before the onset of overweight/obesity.
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Affiliation(s)
- C Gómez-Donoso
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - M A Martínez-González
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
| | - A Gea
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - K J Murphy
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - N Parletta
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - M Bes-Rastrollo
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain; Biomedical Research Center Network on Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), Madrid, Spain; Navarra's Health Research Institute (IDISNA), Pamplona, Spain.
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Abstract
Several dietary patterns, both macronutrient and food based, can lead to weight loss. A key strategy for weight management that can be applied across dietary patterns is to reduce energy density. Clinical trials show that reducing energy density is effective for weight loss and weight loss maintenance. A variety of practical strategies and tools can help facilitate successful weight management by reducing energy density, providing portion control, and improving diet quality. The flexibility of energy density gives patients options to tailor and personalize their dietary pattern to reduce energy intake for sustainable weight loss.
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Affiliation(s)
- Alissa D Smethers
- Department of Nutritional Sciences, The Pennsylvania State University, 226 Henderson Building, University Park, PA 16802-6501
| | - Barbara J Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, 226 Henderson Building, University Park, PA 16802-6501.
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Tapsell LC, Neale EP, Satija A, Hu FB. Foods, Nutrients, and Dietary Patterns: Interconnections and Implications for Dietary Guidelines. Adv Nutr 2016; 7:445-54. [PMID: 27184272 PMCID: PMC4863273 DOI: 10.3945/an.115.011718] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Dietary guidelines provide evidence-based statements on food choices to meet nutritional requirements and reduce the risk of prevailing chronic disease. They involve a substantial amount of research translation, and their implementation has important health consequences. Foods, however, are complex combinations of nutrients and other compounds that act synergistically within the food and across food combinations. In addition, the evidence base underpinning dietary guidelines accesses research that reflects different study designs, with inherent strengths and limitations. We propose a systematic approach for the review of evidence that begins with research on dietary patterns. This research will identify the combinations of foods that best protect, or appear deleterious to, health. Next, we suggest that evidence be sought from research that focuses on the effects of individual foods. Finally, nutrient-based research should be considered to explain the mechanisms by which these foods and dietary patterns exert their effects, take into account the effects of ingredients added to the food supply, and enable assessments of dietary sufficiency. The consideration of individual nutrients and food components (e.g., upper limits for saturated fat, added sugar, and sodium) provides important benchmarks for evaluating overall diet quality. The concepts of core and discretionary foods (nutrient-rich and nutrient-poor foods, respectively) enable distinctions between foods, and this has implications for the relation between food policy and food manufacturing. In summary, evidence supporting healthy dietary patterns provides the foundation for the development of dietary guidelines. Further reference to individual foods and nutrients follows from the foundation of healthy dietary patterns.
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Affiliation(s)
- Linda C Tapsell
- Smart Foods Centre, University of Wollongong, Wollongong, Australia; and
| | - Elizabeth P Neale
- Smart Foods Centre, University of Wollongong, Wollongong, Australia; and
| | - Ambika Satija
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Frank B Hu
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Identification of dietary patterns associated with blood pressure in a sample of overweight Australian adults. J Hum Hypertens 2016; 30:672-678. [PMID: 27011257 DOI: 10.1038/jhh.2016.10] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/23/2015] [Accepted: 11/03/2015] [Indexed: 02/07/2023]
Abstract
The dietary approaches to stop hypertension (DASH) diet provides strong evidence for an optimal dietary pattern for blood pressure (BP) control; however, investigation at the level of key foods in a dietary pattern is sparse. This study aimed to assess the relationship between dietary patterns driven by key foods with BP in a sample of obese Australian adults. Secondary analysis was conducted on baseline data of 118 participants (45.1±8.4 years, mean BP=124.1±15.8/72.6±9.2 mm Hg) recruited in a weight reduction randomized controlled trial (ACTRN12608000425392). Dietary assessment was by a validated diet history interview. The average of three office BP measurements was taken. Factor analysis extracted dietary patterns and their relation to systolic BP (SBP) and diastolic BP (DBP) was analysed using multiple linear regression. Eight dietary patterns were identified based on leading foods: meat and alcohol; seafood; fats; fruits and nuts; legumes; confectionery; sweet foods; and yeast extracts and seasonings. A lower SBP was associated with alignment with the fruit and nuts pattern (β=-4.1 (95% confidence interval -7.5 to -0.7) mm Hg) and with seafood for DBP (β=-2.4 (-4.6 to -0.3) mm Hg). SBP and DBP were higher with yeast extract and seasonings (β=4.3 (1.4-7.3); 2.5 (0.9-4.0) mm Hg, respectively). In obese adults attending for weight loss, dietary patterns that included larger amounts of fruits and nuts and/or seafood were associated with lower BP at baseline, whereas patterns that were characterised by yeast extract and seasonings were associated with higher BP.
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