Associations of diet quality with health-related quality of life in older Australian men and women

Precision nutrition impact on metabolic health and quality of life in aging population after a 3-month intervention: A randomized intervention

OBJECTIVES

Innovative precision dietary procedures are required to promote healthy aging. This study aimed to evaluate the effects of a personalised strategy based on the inclusion of individualised foods and digital tools on overall health status and quality of life within a follow-up of 3 months in older adults with overweight or obesity.

METHODS

127 men and women aged between 50 and 80 years with overweight/obesity participated in the study-between January 2020 and September 2020 at the Center for Nutrition Research-University of Navarra and IMDEA-ALIMENTACIÓN-and were randomly assigned to a usual-care group (standard recommendations) or precision group (precision nutrition strategy based on the inclusion of individualised foods and a mobile application). Anthropometry, body fat percentage, biochemical parameters, diet, and quality of life (SF-36 Health Survey) were assessed at baseline and after 3 months.

RESULTS

Both strategies were found to improve overall metabolic health; however, the precision approach demonstrated significantly better outcomes. The precision strategy reduced body weight at 3 months (-4.3 kg; p < 0.001) with significant improvements in body fat percentage, blood pressure and general metabolic health (glycated haemoglobin; alanine aminotransferase; aspartate aminotransferase; hepatic steatosis index) in comparison with the standard recommendations. The precision approach significantly enhanced the quality of life (SF-36) of individuals, with additional improvements in emotional well-being (p = 0.024) and vitality (p = 0.008). Adherence to the Mediterranean diet was significantly associated with a higher quality of life and vitality.

CONCLUSION

These results support the benefit of precision nutrition approaches for promoting healthy aging and emotional well-being, enhancing the quality of life in aging populations, during the COVID-19 pandemic.

Exploring the interplay of frailty, physical function, physical activity, nutritional status, and their association with quality of life and depressive symptoms in older adults with the frailty phenotype

OBJECTIVE

This study aimed to explore the interplay between frailty, physical function, physical activity, nutritional status, and their impact on the quality of life and depressive status in older adults with frailty.

METHODS

A cross-sectional study involving 235 pre-frail/frail older adults residing in Spanish communities was conducted. Frailty was assessed using Fried's criteria, physical function was evaluated using the Short Physical Performance Battery, and physical activity levels were measured via wrist-worn accelerometers. Nutritional status was determined using the Mini-Nutritional Assessment alongside anthropometric measurements. Quality of life was gauged using the EuroQoL 5-Dimension 5-Level, while depressive status was assessed using the Yesavage 15-item Geriatric Depression Scale. Multivariate linear regression and logistic regression analyses were employed to elucidate the associations of these factors with quality of life and depression.

RESULTS

Our findings revealed significant correlations between various factors and quality of life. Notably, reported fatigue (β = -0.276, p = 0.002), performance in the 4-m gait test (β = -0.242, p = 0.001), the score on the short version of the Mini-Nutritional Assessment (β = 0.312, p = 0.002), and engagement in light physical activity (β = 0.180, p = 0.023) were all found to be associated with quality of life. In terms of depressive symptoms, the Mini-Nutritional Assessment score emerged as a protective factor (Odds ratio, OR: 0.812, p < 0.001), as did participation in moderate physical activity (OR: 0.988, p = 0.028). Conversely, fatigue (OR: 3.277, p = 0.003) and a slow gait speed (OR: 1.136, p = 0.045) were identified as risk factors for depressive symptoms.

CONCLUSIONS

This study underscores the detrimental association of fatigue and slow gait speed on both quality of life and depressive status among older adults with frailty. In contrast, engaging in physical activity and addressing malnutrition risk emerge as critical protective factors for enhancing quality of life and ameliorating depressive symptoms in this population.

CLINICAL TRIAL REGISTRATION

This is a study that uses cross-sectional data from a trial registered at ClinicalTrials.gov (Identifier: NCT05610605).

The association between lifelines diet score (LLDS) with depression and quality of life in Iranian adolescent girls

BACKGROUND

It has been proposed that a greater degree of adherence to a healthy dietary pattern is associated with a lower risk of depression and a poor quality of life (QoL). The Lifelines diet score (LLDS) is a new, evidence-base scoring system to define the quality of diet. We designed a cross-sectional study to investigate the association between LLDS with depression and QoL in Iranian adolescent girls.

METHODS

A total of 733 female adolescents were recruited from Mashhad and Sabzevar cities, Iran. Depression and QoL were assessed utilizing the Beck Depression Inventory (BDI) and SF-12v2 questionnaires, respectively. The LLDS was defined by dividing intakes of 12 food groups with negative or positive health effects into quintiles ranging 12 to 60 points. To explore the association between LLDS with QoL and depression, logistic regression was used in crude and adjusted models.

RESULTS

The prevalence of depression and poor QoL was 24% and 49%, respectively. After adjusting for confounding factors, adolescent girls in the highest quartile of LLDS compared with the participants in the lowest quartile had a 42% lower probability of reporting depressive symptoms (OR: 0.58; 95% CI: 0.35-0.97, P = 0.03). In addition, the participants in the highest quartile of LLDS had lower odds of poor QoL compared with the subjects in the lowest quartile (OR: 0.65; 95% CI: 0.42-0.92, P = 0.04).

CONCLUSIONS

There is an inverse relationship between LLDS with risk of depression and poor QoL. Prospective and interventional investigations are needed to reach a clear vision.

Associations of Healthy Eating Behavior with Mental Health and Health-Related Quality of Life: Results from the Korean National Representative Survey

BACKGROUND

Healthy eating behaviors may be related to mental health and health-related quality of life. This study investigates the associations between diet quality, mental health, and health-related quality of life among men and women in Korea.

METHODS

A total of 6823 participants, aged 19, from the 7th Korea National Health and Nutrition Examination Survey from 2016 to 2018 were included. Their overall diet quality was estimated using the Korean Healthy Eating Index (KHEI). Multivariate logistic regression was used to identify the associations between diet quality, mental health, and quality of life.

RESULTS

The prevalence of stress perception and depression was highest in the lowest tertile of the KHEI score and higher for women than men. Among men, a significant association was observed only for stress perception and depressive symptoms in the second tertile, with odds ratios of 0.745 (95% CI, 0.585-0.949) and 0.519 (95% CI, 0.275-0.980). In contrast, the multivariate-adjusted odds ratios for stress perception, depressive symptoms, and low EQ-5D index among women in the highest tertile were 0.668 (95% CI, 0.541-0.823), 0.464 (95% CI, 0.288-0.746), and 0.722 (95% CI, 0.566-0.920), and significant dose-response associations were observed.

CONCLUSIONS

A higher-quality diet was associated with a lower risk of stress and depression and a better quality of life. Thus, healthy eating behaviors may improve mental health and quality of life.

Association between food insecurity and quality of life among older adults (60+) in six low and middle-income countries

Food insecurity is a key social determinant of health and nutrition. However, very few studies have examined the association of food insecurity and quality of life outcomes among older adults in low and middle-income settings. In this study, we examine the association of food insecurity with self-rated poor quality of life, low life satisfaction, and WHO quality of life (WHOQol). Nationally representative data from WHO's Study on global AGEing and adult health (SAGE) consisting of 20,026 older adults were analyzed. The association of food insecurity with self-rated poor quality of life and low life satisfaction was assessed using bivariate and multivariate logistic regression analysis. Multivariate linear regression models examine the association between food insecurity and WHOQol score. Pooled data analysis of six countries showed older adults with severe food insecurity were two times more likely to report poor quality of life (OR = 2.49, CI 2.10, 2.96; p < 0.001) and low life satisfaction (OR = 2.36, CI 1.94, 2.87; p < 0.001), respectively. Similarly, older adults with severe food insecurity had 3.60 (CI-4.25, -2.95; p < 0.001) points lower WHO-QoL score than those who are food secure. These results show that the association of food insecurity is statistically significant with all three outcomes of quality of life in all six countries adjusting for sociodemographic and health measures. Public health and social security interventions are important to prevent food insecurity to promote overall wellbeing of the growing older population in low and middle-income countries.

A Scoping Review of Nutrition Health for Older Adults: Does Technology Help?

The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) "track, plan, and execute" nutrition management and for (2) "assessing" technology use. "Track, plan, and execute" includes tracking food intake, planning for changes, and executing a plan. "Assessing" technology use is collecting nutrition data from a provider's or an older adult's self-use of technology to understand dietary intake. Hardware is the second most type of technology used, with tablet computers for software and internet access. The findings reveal that software for older adults lacks standardization, the Internet of Things is a promising area, the current device emphasis is the tablet computer, and broadband internet access is essential for nutrition care. Only 38 studies were published in the last five years, indicating that nutrition management for older adults with hardware or software has not reached a significant research mass.

Impact of an Educational Intervention for Healthy Eating in Older Adults: A Quasi-Experimental Study

The elderly population in Ecuador is increasing rapidly, with an increasing incidence of diet-related diseases. The elderly living in the community seek alternative and complementary methods to improve their diet and quality of life. This study aimed to investigate the impact of an educational intervention on knowledge related to healthy eating among older adults. This intervention is rooted in the principles of meaningful learning and incorporates culturally adapted materials. A quasi-experimental study design was employed using a pre-test-post-test control group. Study participants were a total of 109 elderly (intervention: n = 51, control: n = 58) people in Cuenca, Ecuador. The educational intervention based on Ausubel's theory of significant learning and Vygotsky's sociocultural theory was programmed to be carried out for one session per week, over 24 weeks, with a duration of 120 min per session. The measures were the general characteristics of the study participants and knowledge about necessary amounts, food sources and the consequences of deficits or excesses in the consumption of macro- and micronutrients. Data were collected from August 2018 to February 2019. Statistically significant differences were observed between the intervention group (IG) and the control group (CG) in terms of knowledge about healthy eating for older adults following the educational intervention. The outcomes of this study strongly suggest the efficacy of the program in improving knowledge related to healthy eating among older adults. Healthcare providers should prioritize food education based on meaningful learning, utilizing culturally adapted materials for the elderly individuals residing within the community.

Adherence to the Mediterranean Diet Is Associated with Health-Related Quality of Life and Anthropometric Measurements in University Professors

The main objective of this study was to assess the relationship between Mediterranean diet (MD) adherence and health-related quality of life (HRQOL) according to the anthropometric measurements of teaching and research staff (TRS) at the University of Granada (UGR), Spain. This diagnostic, non-experimental, cross-sectional, and observational study was performed on university lecturers (65 women and 62 men) using a correlational descriptive methodology. The lecturers' anthropometric measurements were taken, while MD adherence was determined using the PREvention with MEDiterranean diet (PREDIMED) questionnaire. The Short Form Health Survey (SF-36) was used for measuring HRQOL. Better results for body composition were associated with improvements in the physical and mental dimensions and MD adherence. Statistically significant differences were found between sexes, with men showing higher values for weight, height, waist circumference, BMI, waist/hip ratio (WHR), muscle mass, and systolic and diastolic pressure than women. Similarly, MD adherence was positively correlated with vitality (r = 0.233; p = 0.009), social functioning (r = 0.229; p = 0.008), and the mental component summary (r = 0.205; p = 0.021). The regression model determined that the mental component summary (β = 0.239, p = 0.041), diastolic pressure (PD) (β = -0.473, p < 0.000), fat percentage (FP) (β = -0.241, p = 0.004), and age (β = -0.231, p = 0.022) significantly predicted MD adherence. The results obtained in this study suggest that healthy dietary patterns such as the MD and an optimum body composition contribute to an improved HRQOL.

Dietary diversity indices v. dietary guideline-based indices and their associations with non-communicable diseases, overweight and energy intake: evidence from China

OBJECTIVES

To evaluate various diet quality indices and to estimate their associations with major non-communicable diseases (NCD) (i.e. diabetes mellitus (DM) and myocardial infarction (MI)) and risk for overweight (OW).

DESIGN

Four dietary diversity indices (namely, count index (Count), dietary diversity score index, berry index (BI) and entropy index (EI)) and three Chinese dietary guideline-based indices (namely, China healthy diet index, Chinese food pagoda score and diet quality divergence index) were employed to evaluate Chinese diet quality. DM, MI and OW were used as diet-related health indicators. Logit regressions were employed to unveil the associations between diet quality indices and NCD and risk for OW. The relationships between diet quality indices and daily energy intakes were checked with ordinary least squares linear regressions.

SETTING

Four recent waves (2004, 2006, 2009, 2011) of longitudinal individual data from China Health and Nutrition Survey.

PARTICIPANTS

Chinese adults (aged 18-64 years) from twelve provinces were included in the analysis (n 30 350).

RESULTS

Count, BI, and EI were positively associated with higher OW risk and daily energy intakes. As dietary guideline-based indices got better, people were exposed to lower DM and OW risks and got lower daily energy intakes. Finally, dietary guideline-based indices properly revealed the expected relationships that high-quality diets would reduce NCD and risk for OW, while high diversity indices were usually correlated with over-nutrition and high risks.

CONCLUSIONS

Increasing diversity of the diet does not necessarily improve the nutrition and health. Dietary guideline-based indices are more robust than dietary diversity indices; thus, they should be highly recommended when evaluating diet quality.

Mediterranean Diet Adherence Is Associated with Favorable Health-Related Quality of Life, Physical Activity, and Sleep Quality in a Community-Dwelling Greek Older Population

BACKGROUND

The Mediterranean diet (MD) is a beneficial dietary pattern with strong antioxidant and anti-inflammatory properties that can promote mental and physical human health. This study aims to assess the impact of MD adherence on health-related quality of life, physical activity levels, and sleep quality in a representative Greek elderly population.

METHODS

This is a cross-sectional study. A total of 3254 persons ≥65 years from 14 different Greek regions, urban, rural and islands participated in this study, of which 48.4% were female and 51.6% were male. Health-Related Quality of Life (HRQOL) was evaluated utilizing a short form healthy survey, physical activity was determined by the International Physical Activity Questionnaire (IPAQ), sleep quality was assessed utilizing the Pittsburgh Sleep Quality Index (PSQI) and MD adherence was assessed via the Mediterranean Diet Score (MedDietScore).

RESULTS

Moderate adherence to the MD and an increased prevalence of poor quality of life, low physical activity levels and inadequate sleep quality among the elderly population were recorded. High MD adherence was independently associated with better quality of life (OR: 2.31, 95% CI: 2.06-2.68, p = 0.0008), higher physical activity (OR: 1.89, 95% CI: 1.47-2.35, p = 0.0141) and adequate sleep quality (OR: 2.11, 95%: 1.79-2.44, p = 0.0018), female sex (OR: 1.36, 95% CI: 1.02-1.68, p = 0.0032) and living with others (OR: 1.24, 95% CI: 0.81-1.76, p = 0.0375), after adjustment for potential confounding factors. In unadjusted analysis, participants' age (p < 0.0001), anthropometric characteristics (p < 0.005), educational (p = 0.0026) and financial status (p = 0.0005) and smoking habits (p = 0.0031) were also identified as indicators of MD adherence; however, their impact on MD adherence was considerably attenuated after adjusting for confounding factors (p > 0.05).

CONCLUSION

High MD adherence was correlated with favorable quality of life, higher levels of physical activity, and a more adequate sleep quality score. Strategies and public health policies that facilitate MD adherence and physical activity in older adults may improve sleep and quality of life, impacting overall wellbeing in this age group.

Healthy Nutrition, Physical Activity, and Sleep Hygiene to Promote Cardiometabolic Health of Airline Pilots: A Narrative Review

Background

Airline pilots experience unique occupational demands that may contribute to adverse physical and psychological health outcomes. Epidemiological reports have shown a substantial prevalence of cardiometabolic health risk factors including excessive body weight, elevated blood pressure, poor lifestyle behaviors, and psychological fatigue. Achieving health guidelines for lifestyle behavior nutrition, physical activity, and sleep are protective factors against the development of noncommunicable diseases and may mitigate the unfavorable occupational demands of airline pilots. This narrative review examines occupational characteristics for sleep, nutrition, and physical activity and outlines evidence-based strategies to inform health behavior interventions to mitigate cardiometabolic health risk factors among airline pilots.

Methods

Literature sources published between 1990 and 2022 were identified through electronic searches in PubMed, MEDLINE (via OvidSP), PsychINFO, Web of Science, and Google Scholar databases, and a review of official reports and documents from regulatory authorities pertaining to aviation medicine and public health was conducted. The literature search strategy comprised key search terms relating to airline pilots, health behaviors, and cardiometabolic health. The inclusion criteria for literature sources were peer-reviewed human studies, meta-analyses, systematic reviews, and reports or documents published by regulatory bodies.

Results

The results of the review show occupational factors influencing nutrition, sleep, and physical activity behaviors and delineate evident occupational disruptions to these lifestyle behaviors. Evidence from clinical trials demonstrates the efficacy of nutrition, sleep, and physical activity interventions for enhancing the cardiometabolic health of airline pilots.

Conclusion

This narrative review suggests that implementing evidence-based interventions focused on nutrition, physical activity, and sleep could help mitigate cardiometabolic health risk factors among airline pilots, who are particularly susceptible to adverse health outcomes due to unique occupational demands.

Comparison of Four Dietary Pattern Indices in Australian Baby Boomers: Findings from the Busselton Healthy Ageing Study

The assessment of dietary patterns comprehensively represents the totality of the diet, an important risk factor for many chronic diseases. This study aimed to characterise and compare four dietary pattern indices in middle-aged Australian adults. In 3458 participants (55% female) from the Busselton Healthy Ageing Study (Phase Two), a validated food frequency questionnaire was used to capture dietary data between 2016 and 2022. Four dietary patterns [Australian Dietary Guideline Index 2013 (DGI-2013); the Mediterranean Diet Index (MedDiet); the Literature-based Mediterranean Diet Index (Lit-MedDiet); and the EAT-Lancet Index], were calculated and compared by measuring total and sub-component scores, and concordance (𝜌_c). Cross-sectional associations between the dietary indices and demographic, lifestyle, and medical conditions were modelled with linear regression and restricted cubic splines. Participants had the highest standardised scores for the DGI-2013 followed by the EAT-Lancet Index and the MedDiet, with the lowest standardised scores observed for the Lit-MedDiet. The DGI-2013 had the lowest agreement with the other scores (𝜌_c ≤ 0.47). These findings indicate that the diets included in this Australian cohort align more closely with the Australian Dietary Guidelines than with the other international dietary patterns, likely due to the wide variation of individual food group weightings in the construction of these indices.

Satisfaction with Life and Nutritional Behaviour, Body Composition, and Functional Fitness of Women from the Kraków Population Participating in the "Healthy Active Senior" Programme

Pro-health behaviours are related to a person's personal resources. The aim of the study was to assess the relationship between satisfaction with life (SWL), nutritional behaviours, somatic indices, and functional efficiency of senior women. The research was conducted among 120 women aged 60-84 (Me = 65) participating in the "Healthy Active Senior" project at the University of Physical Education in Kraków. The Satisfaction with Life Scale (SWLS) and the proprietary validated questionnaire of nutritional behaviour were used. Body composition was assessed using the method of bioelectrical impedance (TANITA SC-330ST analyser), while physical fitness was evaluated via the Senior Fitness test (Fullerton Functional Fitness Test). Correlations between the variables were measured by implementing Spearman's R signed-rank correlation coefficients (with p < 0.05). Positive correlations between SWL and selected nutrition behaviours have been demonstrated, including eating 5-6 meals (p < 0.001) and drinking at least 2 litres of fluids a day (p = 0.023), consuming cereal products daily, including whole-grains (p = 0.001), avoiding alcoholic beverages (p = 0.030), and applying vitamin D supplementation (p = 0.010). At the same time, negative correlations between SWL and limiting the consumption of red as well as processed meats (p = 0.002), animal fats (p = 0.046), and the preference for vegetable oils in one's diet (p = 0.023) were shown. Significant correlations between satisfaction with life and two indicators of functional fitness were also confirmed: negative-with the variable '2.44-m Get-Up and Go' (p = 0.003); and positive-with the '2-Minute Step in Place' test (p = 0.034). The relationships between SWL and somatic indices did not reach the level of statistical significance. Among the women participating in the "Healthy Active Senior" programme, correlations between SWL and rational nutritional behaviours, as well as indices of functional fitness, were found (mostly positive), while the trends in these areas were not fully unambiguous, suggesting the validity of conducting further research.

Examining dietary behaviours, diet quality, motives and supplementation use in physically active individuals following vegetarian-based eating patterns

The adoption of vegetarian-based dietary patterns among athletes has been gaining popularity. However, limited research examines the dietary behaviours within this group. Therefore, the aim of this study was to examine self-reported dietary behaviours in a cohort of physically active individuals following vegetarian-based dietary patterns, recruited via social media. A 52-item online survey was created with questions related to demographics, physical activity, eating patterns and supplementation use. An external link to the Australian Automated Self-Administered 24-h (ASA24-AU) recall was included to examine nutrient intakes. Dietary quality was assessed using the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Dietary Phytochemical Index (DPI) tools. A total of 781 (84.8%) respondents completed the survey in 2018. Principal motives for adhering to a vegetarian-based dietary pattern included animal rights (86.5%), environmental concerns (75.4%), health reasons (69.6%) and improving physical performance (24.1%). Vitamin B12 was the most commonly reported supplement (58.1%) followed by protein powder (36.3%) and vitamin D (35.9%). A total of 133 respondents completed the ASA24-AU dietary recall with generally adequate nutrient intakes and a high-quality diet as assessed by the AHEI-2010 and DPI. A significant minority of physically active individuals following vegetarian-based diets do so with the aspiration of improving their exercise performance. Dietary quality was considered high in this group for recreational physical activity, although intakes of vitamin B12 and LC n-3 PUFA were low.

Trends and Factors Associated with Obesity Prevalence in Rural Australian Adults-Comparative Analysis of the Crossroads Studies in Victoria over 15 Years

This study examined the changes in the prevalence of obesity and associated lifestyle factors using data from repeated cross-sectional, self-reported surveys (Crossroads I: 2001-2003 and Crossroads II: 2016-2018, studies) and clinic anthropometric measurements collected from regional and rural towns in the Goulburn Valley, Victoria. Given that past community studies have only focused categorically on dietary intake, or assessed caloric energy intake, we examined the difference in broad dietary practices at two different times. Clinical assessments from randomly selected household participants aged ≥18 years were analyzed. Differences in obesity prevalence were calculated for each individual variable. Logistic regression was used to determine the odds ratios (95% confidence intervals (CI)) with and without adjustment for key lifestyle factors. There were 5258 participants in Crossroads I and 2649 in Crossroads II surveys. Obesity prevalence increased from 28.2% to 30.8% over 15 years, more among those who ate fried food, but decreased significantly among rural dwellers (31.7: 27.0, 36.8% versus 25.1: 22.9, 27.5%) and those who had adequate fruit intake (28.5: 25.0, 32.3% to 23.9: 21.8, 26.2%). Obesity was associated with older age (≥35 years), use of fat-based spreads for bread (adjusted odds ratio, aOR:1.26: 1.07, 1.48) and physical inactivity. The increase in obesity prevalence especially in the rural towns, was associated with unhealthy dietary behaviour which persisted over 15 years. Understanding and addressing the upstream determinants of dietary intake and choices would assist in the development of future health promotion Programs.

Associations between Food Groups and Health-Related Quality of Life in Korean Adults

This cross-sectional study aimed to determine the associations between food groups and health-related quality of life (HRQoL). The data of 14,979 participants in the Korea National Health and Nutrition Examination Survey from 2016 and 2018 were examined. The HRQoL was assessed with EuroQol-5 Dimension. The 24-h recall test was used to examine the dietary intake of food groups. Males and females accounted for 13.79% and 21.62% of the low HRQoL groups. The males in the lowest tertile of the “vegetables” and “fish and shellfish” food groups were more likely to have a low HRQoL (odds ratio (OR), 95% confidence interval (CI) = 1.25 (1.05–1.65), 1.45 (1.12–1.89), respectively) than those in the highest tertile, whereas those in the lowest tertile of the “cereal and grain products” were less likely to have a low HRQoL (OR (95% CI) = 0.69 (0.52–0.91)). The females in the lowest tertile of the “vegetables” food group were more likely to have a low HRQoL (OR (95% CI) = 1.56 (1.17–3.01)) than those in the highest tertile. After adjusting for confounders indagated with not only dietary but also non-dietary factors such as stress, we found that low HRQoL was significantly associated with food groups of “vegetables”, “fish and shellfish”, and “cereal and grain products” among males and of “vegetables” among females.

Fruit and vegetable consumption and depression symptoms in young women: results from 1973 to 1978 cohort of the Australian Longitudinal Study on Women's Health

PURPOSE

Growing evidence suggests that specific food groups may play an important role in improving mental health. However, very few studies explored the association between individual dietary factors and depression symptoms by following a large cohort of individuals over a long period. We examined the differential effects of fruit and vegetables in relation to depression symptoms over a 15-year follow-up period in the 1973-78 cohort of the Australian Longitudinal Study on Women's Health.

METHODS

Fruit and vegetable consumption was assessed using short questions. The Center for Epidemiologic Studies Depression-10 scale with a cut off ≥ 10 indicated depressive symptoms. Multiple imputations with generalised estimating equations models were performed to estimate odds ratio of depression symptoms according to fruit and vegetable consumption.

RESULTS

A total of 4241 participants with a mean age of 27.6 (SD 1.45) years at baseline were followed up at five surveys (2003-2018). Fruit and vegetable intake (≥ 2 servings) was cross-sectionally associated with lower odds of depressive symptoms. In longitudinal analysis, a higher intake of fruit (≥ 4 servings) and vegetable (≥ 5 servings) was consistently associated with lower odds of depressive symptoms, with a 25% lower odds (OR 0.75; 95% CI 0.57, 0.97; p = 0.031) and a 19% lower odds (OR 0.81; 95% CI 0.70, 0.94; p = 0.007) than consuming one serve or less fruit and vegetable, respectively.

CONCLUSION

These results suggest that a higher intake of fruit and vegetables was associated with a lower risk of depression symptoms over 15 years from a population-based prospective study of Australian women.

Association between dietary protein intake and changes in health-related quality of life in older adults: findings from the AusDiab 12-year prospective study

Background

Adequate dietary protein intake is recommended for older adults to optimise muscle health and function, and support recovery from illness, however, its effect on health-related quality of life (HRQoL) is unclear. The aim of this study was to examine the association between total protein intake and different sources of dietary protein and HRQoL in Australians aged 60 years and older over a 12-year period.

Methods

This study used data from the Australian Diabetes, Obesity and Lifestyle study (AusDiab), a 12-year population-based prospective study. The sample included 752 (386 females) adults aged 60 years and older. Protein intake was estimated at baseline (1999/2000) from a 74-item Food Frequency Questionnaire, and HRQoL using the 36-item Short-form Health Survey assessed at baseline (1999/2000) and after 12 years (2011/12). The association between protein intake and change in HRQoL was evaluated using multivariate regression analysis adjusted for relevant confounders. The difference in change in HRQoL between participants with total protein intakes of < 1.0 g/kg/day, intakes of between 1.0–1.2 g/kg/day and intakes of > 1.2 g/kg/day were assessed using one-way ANCOVA.

Results

Total protein intake at baseline was not associated with 12-year changes in physical component summary (PCS) or mental component summary (MCS) scores of HRQoL. Higher animal, red meat and processed animal protein intakes were associated with deteriorations in PCS scores after adjusting for relevant confounders (β = − 0.04; 95% CI: − 0.07, −0.01 ; p = 0.009; β = − 0.05; 95% CI: − 0.08, − 0.01; p = 0.018; β = − 0.17; 95% CI: − 0.31, − 0.02; p = 0.027 respectively). Higher red meat protein intake was associated with deteriorations in MCS scores after adjusting for relevant confounders (β = − 0.04; 95% CI: − 0.08, − 0.01; p = 0.011). There was no difference in 12-year changes in PCS or MCS between participants consuming total protein of < 1.0 g/kg/day, 1.0–1.2 g/kg/day and intakes of > 1.2 g/kg/day.

Conclusion

There was no relationship between total dietary protein intake and HRQoL, but higher protein intakes from animal, red meat and processed animal sources were associated with a deterioration in HRQoL scores over 12 years. Due to the number of associations examined and high drop out of older less healthy participants, further research is required to confirm the associations detected in healthy and less healthy participants, with a view to making protein intake recommendations for older adults.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02894-y.

Socio-demographic characteristics associated with the dietary diversity of Thai community-dwelling older people: results from the national health examination survey

Background

Dietary diversity (DD) is an indicator of nutrient intake and is related to health outcomes in older people. Currently, limited research exists regarding factors associated with DD in older people in developing countries, such as Thailand, despite rapid growth in this population. Therefore, this study aims to examine the association between socio-demographic characteristics and DD in Thai older people.

Methods

A cross-sectional study based on the fifth Thai National Health Examination Survey (NHES-V) conducted between 2013 and 2015 was performed. A total of 7,300 nationally representative older participants aged ≥ 60 years were included. The individual-level dietary diversity score (DDS) was assessed as the frequency of consumption of eight food groups using food frequency questionnaires. Each food group was scored from 0 to 4 according to the frequency of consumption. The DDS was calculated as the sum of the scores, ranging from 0 to 32. Socio-demographic characteristics, including age, sex, highest education level, wealth index, living conditions, and residential area, were assessed. Data were analyzed using multiple linear regression and adjusted for complex survey design.

Results

The participants had a mean age of 69.7 (SD 7.6) years. The mean DDS of participants was 18.4 (SD 3.9). In the adjusted model, a higher educational level, a higher wealth index, and living in an urban area were positively associated with DDS, with adjusted β (95% CI) values of 1.37 (1.04, 1.70) for secondary education or higher, 0.81 (0.55, 1.06) for the richest group, and 0.24 (0.10, 0.44) for living in an urban area. Nevertheless, living alone had negative associations with DDS, with a β (95% CI) of - 0.27 (- 0.53, - 0.00).

Conclusions

This study showed that a higher educational level, a higher wealth index, and living in an urban area had a positive association, whereas living alone had a negative association with DD among Thai older participants. Interventions aiming to improve dietary diversity among older people might benefit from targeting more vulnerable groups, particularly those with less education and wealth, those living alone, or those in rural areas.

Diet Quality and Measures of Sarcopenia in Developing Economies: A Systematic Review

Sarcopenia refers to common age-related changes characterised by loss of muscle mass, strength, and physical performance that results in physical disability, poorer health status, and higher mortality in older adults. Diet quality is indicated as a potentially modifiable risk factor for sarcopenia. However, the association between diet quality and sarcopenia in developing economies appears to be conflicting. Hence, we conducted a systematic review of the literature from developing economies examining the relationship between diet quality and at least one of the three components of sarcopenia, including muscle mass, muscle strength, and physical performance, and the overall risk of sarcopenia. No restrictions on age and study design were employed. We identified 15 studies that met review inclusion criteria. There was heterogeneity among the studies in the diet quality metric used and sarcopenia-related outcomes evaluated. Longitudinal evidence and studies relating diet quality to a holistic definition of sarcopenia were lacking. Although limited and predominantly cross-sectional, the evidence consistently showed that diet quality defined by diversity and nutrient adequacy was positively associated with sarcopenia components, such as muscle mass, muscle strength, and physical performance.

The association between dietary phytochemical index with depression and quality of life in iranian adolescent girls

Background

There is increasing evidence that the dietary intake of phytochemicals is inversely associated with severity of depression and positively associated with quality of life (QoL). The present study investigated the relationship between dietary phytochemical index (DPI) with depression and QoL scores in Iranian adolescent girls.

Methods

A total of 733 adolescent girls from Mashhad and Sabzevar cities in northeastern Iran were entered into this cross-sectional study. Assessment of depression and QoL was performed utilizing the Beck Depression Inventory (BDI) and SF-12v2 questionnaire, respectively. Assessment of dietary intake was undertaken by a qualified dietitian, using a validated food-frequency questionnaire (FFQ) containing 168 food items. To explore the association between DPI with QoL and depression, logistic regression was used in crude and adjusted models.

Results

The participants in the fourth quartile of DPI compared with the first quartile had a 50% lower odds of depression (OR: 0.50; 95% CI: 0.30-0.84, P = 0.009) This relation remained significant in all adjusted models. The adolescents in highest quartile of DPI compared with the first quartile had 38% lower odds of poor QoL (OR: 0.62; 95% CI: 0.41-0.94, P = 0.02). This association remained significant in adjusted models I and II, but not after adjusting for all confounding variables (OR: 0.67; 95% CI: 0.43-1.02, P = 0.06) (Model III).

Conclusions

DPI was inversely associated with risk of depression. The association between DPI score and QoL remained unclear. Further prospective and interventional studies are required.

Evaluating ‘Power 4 a Healthy Pregnancy’ (P4HP) – protocol for a cluster randomized controlled trial and process evaluation to empower pregnant women towards improved diet quality

Background

In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality.

Methods/design

This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women.

Discussion

This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase.

Trial registration

The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12543-z.

Diet quality in an ethnically diverse population of older men in Australia

BACKGROUND/OBJECTIVES

To compare the Australian Dietary Guideline Index (DGI-2013) and the Pyramid-based Mediterranean Diet Score (pyrMDS) as measures of diet quality in an ethnically diverse group of older men.

SUBJECTS/METHODS

Seven hundred and ninety-four older men aged ≥75 participated in wave 3 (2012-2013) of the Concord Health and Ageing in Men Project. Dietary intake was assessed using a validated diet history questionnaire. Ethnicity was based on self-reported country of birth and categorised as Australian-born (418 men), Italian or Greek migrants (188), and other migrants (188). Incident cardiovascular outcomes until March 2018 were measured using the composite of major adverse cardiovascular events (MACE), which comprises all-cause mortality, acute myocardial infarction, congestive cardiac failure, coronary revascularisation and/or ischaemic stroke. Ability to predict incident cardiovascular outcomes and all-cause mortality were compared between standardised DGI-2013 pyrMDS scores by comparison of hazard ratios, discrimination (Harrell's C-statistic) and calibration (calibration plots).

RESULTS

Italian and Greek migrant men had significantly lower DGI-2013 scores (91.7 vs. 93.9; p = 0.01) but significantly higher pyrMDS scores (8.8 vs. 8.2; p < 0.0001) than Australian-born men. In the whole sample (794 men), the pyrMDS was a better predictor of both MACE (age-adjusted HR = 0.84; 95% CI = 0.75-0.94 vs. HR = 0.92; 95% CI = 0.82-1.03 for DGI-2013) and all-cause mortality (age-adjusted HR = 0.69; 95% CI = 0.60-0.80 vs. HR = 0.86; 95% CI = 0.74-0.99). The pyrMDS also demonstrated superior discrimination for predicting all-cause mortality and superior calibration for MACE and all-cause mortality.

CONCLUSIONS

The DGI-2013 appears to underestimate diet quality in older Italian and Greek migrant men. The pyrMDS appears superior to the DGI-2013 for prediction of incident cardiovascular disease and mortality regardless of ethnic background.

Diet Quality and the Number of Comorbidities Are Associated with General Health Among Older Female Cancer Survivors

Objective: We aimed to investigate the associations between diet quality, general health, and comorbidities among older female cancer survivors. Methods: Participants (n = 171) completed one-time surveys to assess health-related quality of life (RAND-36), diet quality (Healthy Eating Index (HEI-2015)), and number of comorbidities. Additional demographic and clinical variables were collected. Descriptive statistics, analysis of covariance, correlations, and linear regressions were utilized. Results: A positive correlation was found between HEI-2015 and general health subscale scores (r = .26, p = .002). A negative correlation was found between the number of comorbidities and general health (r = -.21, p = .02). Being white (β = -.24, p = .02) and having fewer comorbidities (β = -.22, p = .04) were significantly associated with higher general health. Being unmarried (β = .24, p = .02) and having higher education (β = .32, p = .002) were significantly associated with higher HEI-2015 scores. Discussion: Healthcare providers should seek guidance from registered dietitian nutritionists for nutritional education to promote optimal nutritional status, thus contributing to improved general health among this growing population.

Association of adherence to the Australian Dietary Guidelines with cognitive performance and cognitive decline in the Sydney Memory and Ageing Study: a longitudinal analysis

This study investigated associations of adherence to the Australian Dietary Guidelines (ADG) with cognitive performance and cognitive decline over 6 years. We used longitudinal data from the Sydney Memory and Aging Study comprising 1037 community-dwelling non-demented participants aged 70–90 years. Dietary intake was assessed at baseline using the Dietary Questionnaire for Epidemiological Studies Version 2. Adherence to the ADG was scored using the Dietary Guideline Index 2013 (DGI-2013). Cognition was assessed using neuropsychological tests in six cognitive domains and global cognition at baseline and 2, 4 and 6 years later. Linear mixed models analysed the association between adherence to the ADG and cognitive function and cognitive decline over 6 years. Results indicated that overall adherence to the ADG was suboptimal (DGI-2013 mean score 43⋅8 with a standard deviation of 10⋅1; median score 44, range 12–73 with an interquartile range of 7). The percent of participants attaining recommended serves for the five food groups were 30⋅2 % for fruits, 11⋅2 % for vegetables, 54⋅6 % for cereals, 28⋅9 % for meat and alternatives and 2⋅1 % for dairy consumption. Adherence to the ADG was not associated with overall global cognition over 6 years (β = 0⋅000; 95 % CI: −0⋅007, 0⋅007; P = 0⋅95). Neither were DGI-2013 scores associated with change in global cognitive performance over 6 years (β = 0⋅002; 95 % CI: −0⋅002, 0⋅005; P = 0⋅41) nor in any individual cognitive domains. In conclusion, adherence to the ADG was not associated with cognitive health over time in this longitudinal analysis of older Australians. Future research is needed to provide evidence to support specific dietary guidelines for neurocognitive health among Australian older adults.

Associations of Diet Quality with Midlife Brain Volume: Findings from the UK Biobank Cohort Study

BACKGROUND

Higher quality diets may be related to lower dementia rates. Midlife is emerging as a critical life stage for a number of dementia risk factors.

OBJECTIVE

This study examines whether diet quality is related to brain structure during midlife, and if this differs by sex.

METHODS

This study used data from 19184 UK Biobank participants aged 40-65 years. Diet quality was assessed using three dietary indices including the Mediterranean Diet Score (MDS), Healthy Diet Score (HDS), and Recommended Food Score (RFS). MRI brain measures included total, grey, white and hippocampal volume. Linear regression examined associations between diet quality and brain volume, controlling for potential confounders.

RESULTS

Better quality diet across all indices was significantly related to larger grey matter volume: MDS β= 429.7 (95%CI: 65.2, 794.2); HDS β= 700.1 (348.0, 1052.1); and RFS β= 317.1 (106.8, 527.3). Higher diet scores were associated with greater total volume: HDS β= 879.32 (286.13, 1472.50); RFS β= 563.37 (209.10, 917.65); and white matter volume: RFS β= 246.31 (20.56, 472.05), with the exception of Mediterranean diet adherence. Healthy eating guidelines and dietary variety associations with total and grey matter volume were more prominent in men.

CONCLUSION

Findings suggest that diet quality is associated with brain structure during midlife, potentially decades prior to the onset of dementia.

Irregular daily energy intake and diet quality in Iranian adults

The present cross-sectional study aimed to assess the association of daily irregularity in energy intake and diet quality among apparently healthy adults in Iran. The research was conducted on 850 adult men and women (age range: 20-59 years) who attended health care centres in Tehran. Dietary intake was assessed by three, 24-h dietary recalls. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) diet score and Healthy Eating Index-2015 (HEI-2015). An irregularity score of daily energy intake was calculated based on the deviation from the 3-d mean energy intake, with a higher score indicating more fluctuations in daily energy intake. Multiple linear regression analysis was used to assess the association of irregularity score of daily energy intake with food group intakes and DASH diet score and HEI-2015, controlling for age, sex, BMI, physical activity, education level and occupation status. The range of irregularity score was 0·55-133·3 (22·4 (sd 19·0)). Higher irregularity score of daily energy intake was significantly associated with a lower consumption of fruit, vegetables, legumes, low-fat dairy products and poultry, higher consumption of soft drinks, processed meat and nuts, and lower overall DASH diet score and HEI-2015. Overall, our findings showed that more day-to-day variations in energy intake may be correlated with a lower diet quality. More research is needed to confirm the associations observed in the present study and to clarify potential mechanisms explaining these associations.

Adherence to a Mediterranean diet and health-related quality of life: a cross-sectional analysis of overweight and obese middle-aged and older adults with and without type 2 diabetes mellitus

The relationship between adherence to a Mediterranean diet (MedDiet) and health-related quality of life (HRQoL) is unclear, particularly in vulnerable older adults. This cross-sectional analysis explored the association between adherence to a MedDiet and subscales of HRQoL in two independent cohorts of overweight and obese middle-aged to older adults with and without type 2 diabetes mellitus (T2DM). Both cohorts were community-dwelling (T2DM aged ≥ 50 years; non-T2DM aged ≥ 60 years) with a BMI ≥ 25 kg/m2. Adherence to a MedDiet was assessed using the Mediterranean Diet Adherence Screener, and HRQoL was determined using the 36-item short-form health survey. Multiple regression analysis was used to examine the association between adherence to a MedDiet and HRQoL subscales. A total of 152 middle-aged to older adults were included (T2DM: n 87, 71·2 (sd 8·2) years, BMI: 29·5 (sd 5·9) kg/m2; non-T2DM: n 65, 68·7 (sd 5·6) years, BMI: 33·7 (sd 4·9) kg/m2). Mean adherence scores for the entire cohort were 5·3 (sd 2·2) (T2DM cohort: 5·6(sd 2·3); non-T2DM cohort: 4·9 (sd 2·0)). In the adjusted model, using pooled data from both study cohorts, adherence to a MedDiet was significantly associated with the general health subscale of HRQoL (β = 0·223; 95 % CI 0·006, 0·044; P = 0·001). Similar findings were also observed in the T2DM cohort (β = 0·280; 95 % CI 0·007, 0·054; P = 0·001). However, no additional significant associations between adherence to a MedDiet and HRQoL subscales were observed. We showed that adherence to a MedDiet was positively associated with the general health subscale of HRQoL in middle-aged to older adults with T2DM. However, larger longitudinal data in older adults with a wider range of adherence scores, particularly higher adherence, are required to better understand the direction of this relationship.

Adherence to Lifelines Diet Score (LLDS) is associated with better sleep quality in overweight and obese women

PURPOSE

Previous studies have shown the connection between diet quality to sleep quality and weight status, although the relationship between Lifelines Diet Score (LLDS)-a fully food-based score that uses the 2015 Dutch Dietary Guidelines and underlying international literature-and sleep quality has not been evaluated in overweight and obese individuals yet. This observational study was conducted on overweight and obese adult females to assess the relationship between adherence to a LLDS pattern and sleep quality in Iran.

METHODS

A cohort of 278 overweight and obese women aged above 18 years was enrolled and their dietary intake was assessed using a 147-item, semi-quantitative, validated food frequency questionnaire. Pittsburgh Sleep Quality Index (PSQI), a self-reported questionnaire including 19-items, was applied to estimate sleep quality among the target population. Diet quality indices (LLDS) were calculated using the P.C. Vinke, et al. method, based on the 2015 Dutch Dietary Guidelines and the underlying literature.

RESULTS

Subjects in the highest LLDS tertile (those who had adhered closely to the food-based score) were older, compared to the lowest tertile (37.57 ± 7.77 versus 34.57 ± 9; p = 0.01). It was shown that about 25.5% of our subjects have poor quality sleep and 39% have better sleep quality which were mostly in the third tertile with greater LLDS. The parallel values in the first tertile were 29.9% and 46.8%, respectively (p = 0.02). Binary logistic regression was applied to evaluate the association between adherence of LLDS and sleep quality. The result has shown that the LLDS were correlated with lower risk poor sleep quality, wherein those who were in higher tertile (higher adherence to LLDS) had better sleep quality (odds ratio [OR]:0.586, 95% confidence interval [CI] (0.285-1.207), p = 0.009) and the result was not affected by adjusting for potential cofounders including age, education levels, and economic levels, sleep quality remained significantly associated with [OR]: 0.531, 95% confidence interval [CI] (0.248-1.138, p = 0.014).

CONCLUSIONS

From this observational study, the higher LLDS can be related with better sleep quality in overweight and obese women.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with or without the intervention, such as case studies.

Diet Quality According to Mental Status and Associated Factors during Adulthood in Spain

Common mental disorders (CMD) are characterized by non-psychotic depressive symptoms, anxiety and somatic complaints, which affect the performance of daily activities. This study aimed to analyze prevalence of diet quality among adults with and without CMD from 2006 to 2017, to study the frequency of food consumption and diet quality according to mental status and age, and to determine which sociodemographic, lifestyle and health-related factors are associated with poor/moderate diet quality, according to mental status. A nationwide cross-sectional study was performed in adults with (n = 12,545) and without CMD (n = 48,079). The data were obtained from three Spanish National Health Surveys (2006, 2011/2012 and 2017). Two logistic regression analyses were used to identify factors associated with diet quality in people with and without CMD. Among those with CMD, the probability of having poor/moderate diet quality was significantly lower for overweight or obese people and those who took part in leisure-time physical activity. Among those without CMD, university graduates were less likely to have a poor/moderate diet quality. Good diet quality was observed more in older adults (≥65 years old) than in emerging (18–24 years old) or young adults (25–44 years old), regardless of mental status.

Negative Impact of Fear of COVID-19 on Health-Related Quality of Life Was Modified by Health Literacy, eHealth Literacy, and Digital Healthy Diet Literacy: A Multi-Hospital Survey

Background: The COVID-19 pandemic has been disseminating fear in the community, which has affected people’s quality of life, especially those with health problems. Health literacy (HL), eHealth literacy (eHEAL), and digital healthy diet literacy (DDL) may have potential impacts on containing the pandemic and its consequences. This study aimed to examine the association between the fear of COVID-19 scale (FCoV-19S) and the health-related quality of life (HRQoL), and to examine the effect modification by HL, eHEAL, and DDL on this association. Methods: A cross-sectional study was conducted in 11 hospitals across Vietnam from 7 April to 31 May 2020. Data were collected on 4348 outpatients, including demographic characteristics, HL, eHEAL, DDL, FCoV-19S, and HRQoL. Multiple linear regression and interaction models were used to explore associations. Results: Patients with higher FCoV-19S scores had lower HRQoL scores (unstandardized coefficient, B = −0.78, p < 0.001). HL (B = 0.20, p < 0.001), eHEAL (B = 0.24, p < 0.001), and DDL (B = 0.20, p < 0.001) were positively associated with higher HRQoL scores. The negative impact of FCoV-19S on HRQoL was significantly attenuated by higher eHEAL score groups (from one standard deviation (SD) below the mean, B = −0.93, p < 0.001; to the mean, B = −0.85, p < 0.001; and one SD above the mean, B = −0.77, p < 0.001); and by higher DDL score groups (from one SD below the mean, B = −0.92, p < 0.001; to the mean, B = −0.82, p < 0.001; and one SD above the mean, B = −0.72, p < 0.001). Conclusions: eHealth literacy and digital healthy diet literacy could help to protect patients’ health-related quality of life from the negative impact of the fear of COVID-19 during the pandemic.

Relationship between Dietary Patterns and Cardiovascular Disease Risk in Korean Older Adults

OBJECTIVES

The purpose of this study was to assess the relationship between dietary patterns and the 10-year risk of cardiovascular disease (CVD) in the elderly population in Korea.

METHODS

Cluster analysis was conducted on the data of 1687 elderly participants (797 men and 890 women) aged ≥65 years from the 2014-2016 Korea National Health and Nutrition Examination Survey (KNHANES), using a 24-h dietary recall survey to assess dietary patterns. Dietary patterns were classified into clusters 1 (typical Korean diet), 2 (high carbohydrate diet), and 3 (healthy diet). The 10-year risk of CVD was calculated based on age, total and HDL-cholesterol levels, systolic blood pressure level, antihypertensive medication use, smoking status, and presence of diabetes. A complex sample general linear model was applied to determine the association between dietary patterns and the 10-year risk of CVD.

RESULTS

In total, 275 (33.7%), 141 (17.9%), and 381 (48.3%) men, and 207 (22.6%), 276 (30.9%), and 407(46.6%) women were included in clusters 1, 2, and 3, respectively. The 10-year risk of CVD was lower in men in cluster 3 (healthy diet) than in those in cluster 1 (typical Korean diet) (t = 2.092, p = 0.037). Additionally, the 10-year risk of CVD was lower in men who performed strength training than in those who did not (t = 3.575, p < 0.001). There were no significant differences in women.

CONCLUSIONS

After adjusting for sociodemographic variables, men who consumed a healthy diet had a lower 10-year risk of CVD than those who consumed a typical Korean diet. When organizing nutrition education programs to improve dietary habits in the elderly, content on diets that consist of various food groups to prevent CVD is required. In particular, it is necessary to develop content that emphasizes the importance of healthy eating habits in men.

Dietary Diversity Indicators and Their Associations with Dietary Adequacy and Health Outcomes: A Systematic Scoping Review

Dietary diversity has long been recognized as a key component of diet quality and many dietary diversity indicators (DDIs) have been developed. This systematic scoping review aimed to present a comprehensive inventory of DDIs and summarize evidence linking DDIs and dietary adequacy or health outcomes in adolescents and adults. Two search strategies were developed to identify peer-reviewed articles published in English up until June 2018 and were applied to Medline, Web of Science, and Scopus. A 2-stage screening process was used to select the studies to be reviewed. Four types of DDIs were identified among 161 articles, the majority of them belonging to the food group-based indicator type (n = 106 articles). Fifty studies indicated that DDIs were proxies of nutrient adequacy, but there was a lack of evidence about their relation with nutrients to limit. Associations between DDIs and health outcomes were largely inconsistent among 137 studies, especially when the outcomes studied were body weight (n = 60) and noncommunicable diseases (n = 41). We conclude that the ability of DDIs to reflect diet quality was found to be principally limited to micronutrient adequacy and that DDIs do not readily relate to health outcomes. These findings have implications for studies in low- and lower-middle-income economies where DDIs are often used to assess dietary patterns and overall diet quality.

Individual, social-environmental and physical-environmental correlates of diet quality in young adults aged 18-30 years

Many young adults eat a poor-quality diet. However, understanding of the social-ecological correlates of diet quality in young adults is limited. The aim of the present study was to examine the correlates of diet quality in a cohort of young Australian adults. Data from the cross-sectional Measuring EAting in everyday Life Study were used. Young adults (n = 625; 18-30 years; 73% female) were included if they provided dietary data over three or four non-consecutive days using 'FoodNow', a real-time food diary smartphone application. Diet quality was estimated using the 2013 Dietary Guidelines Index (DGI). Thirty correlates from three levels of the social-ecological framework were collected using an online questionnaire: individual (e.g., self-efficacy), social-environmental (e.g., social support) and physical-environmental (e.g., living situation). Linear regression analyses were used to examine associations between correlates and DGI. Six individual-level correlates were associated with DGI: perceived time scarcity (b = -0.664, CI: 1.160, -0.168), food insecurity (b = -0.962, CI: 1.746, -0.178), self-efficacy (b = 0.230, CI: 0.137, 0.323), being born in Australia (b = -3.165, CI: 5.521, -0.808), being employed in non-trade roles (b = -4.578, CI: 8.903, -0.252) and preparing a meals with vegetables daily (b = 4.576, CI: 1.652, 7.500). No social-environmental or physical-environmental correlates were associated with DGI. Overall, this study showed that young adults had a higher diet quality if they had higher self-efficacy, perceived themselves to be less time scarce and less food insecure, were born in Australia, were employed in non-trade roles and prepared a meal with vegetables daily. Healthy eating policies and interventions in young adults may benefit from targeting individual-level correlates.

Influence of healthy lifestyle behaviors on life satisfaction in the aging population of Thailand: a national population-based survey

BACKGROUND

Understanding the influence of healthy lifestyle behaviors on population-level life satisfaction is few known in the aging population, especially in low- and middle-income countries in Asia. The objective of our study was to analyse the association of lifestyle behaviors with life satisfaction in a nationally-representative sample of older persons in Thailand.

METHODS

The sample was obtained from a baseline phase of a nationally-representative, longitudinal survey of the Thai population. The study employed a multistage sampling technique to recruit study participants age 60 years or older from the five geographic regions of Thailand. In this study, 1460 adults age 60 years or older from 3670 households successfully completed face-to-face interviews by trained staff with a structured questionnaire. Information on self-reported life satisfaction, lifestyle behaviors, and sociodemographic characteristics were collected via survey questionnaire. Life satisfaction was assessed using the Scale with Life Satisfaction (SWLS) [1 to 7] response. Binary logistic regression analysis was used in investigating the association between lifestyle behaviors and life satisfaction.

RESULTS

The median age of the participants was 68.1 (60-93 years). The overall mean life satisfaction score was 24.2 ± 5.6. Regular physical activity (at least 30 min per day) and sufficient fruit and vegetable (FV) intake (at least 400 g per day) were significantly associated with older people's life satisfaction (p ≤ 0.001 and p ≤ 0.10, respectively) after controlling all sociodemographic variables. Participants who had regular physical activity were 1.7 times as likely to be satisfied as those with less physical activity (95% CI 1.284-2.151). Participants with sufficient daily FV intake were 1.3 times as likely to be satisfied with life as those with insufficient daily FV (95% CI 0.994-1.723). Life satisfaction score also differed significantly by sociodemographic characteristics (sex, age, marital status, educational attainment) and presence of chronic disease.

CONCLUSIONS

To improve the life satisfaction of older persons, taking into account sociodemographic characteristics of the population and absence of chronic disease, the need for promotion of healthy lifestyle behaviors, especially regular physical activity and sufficient FV intake, must be recommended.

Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal

Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.

The Mediating and Moderating Effects of Physical Fitness of the Relationship between Adherence to the Mediterranean Diet and Health-Related Quality of Life in University Students

The aim of this study was to estimate the relationship between the adherence to the Mediterranean diet (MD) and health-related quality of life (HRQoL) in university students and to assess whether this relationship is mediated or moderated by cardiorespiratory fitness (CRF) and handgrip strength. A cross-sectional study was performed involving 310 first-year Spanish university students. Adherence to the MD was evaluated with the 14-item Mediterranean Diet Adherence Screener (MEDAS), and the HRQoL was evaluated with the Short Form-12 (SF-12) questionnaire. CRF was assessed by the 20 m shuttle run test, and the handgrip strength was determined by dynamometry. ANCOVA models showed that participants with higher CRF and handgrip strength levels had significantly higher scores in the physical component summary (PCS) and mental component summary (MCS) of the SF-12 and in the MEDAS questionnaire than those with medium and low scores (p < 0.050). Additionally, the ANCOVA models showed that students with good adherence to the MD showed higher scores in the MCS of HRQoL than those with low adherence (p = 0.044, ES = 0.013), but these results did not appear for the PCS of HRQoL (p = 0.728, ES = 0.001). In the mediation analysis, it was found that CRF and handgrip strength acted as full mediators of the relationship between adherence to the MD and the MCS of HRQoL. In the moderation analysis, it was evidenced that CRF and handgrip strength did not act as moderators in the relationship between adherence to the MD and the MCS of HRQoL. In conclusion, adherence to the MD does not seem to have a direct effect on the MCS of HRQoL because this association seems to be fully mediated by CRF and handgrip strength.

A Modified Recommended Food Score Is Inversely Associated with High Blood Pressure in Korean Adults

Hypertension is associated with an increase in cardiovascular disease and mortality. The interplay between dietary intake—especially sodium intake—and high blood pressure highlights the importance of understanding the role of eating patterns on cardiometabolic risk factors. This study investigates the relationship between a modified version of the Recommended Food Score (RFS) and hypertension in 8389 adults aged 19–64 years from the Korea National Health and Nutrition Examination Survey 2013–2015. A dish-based, semi-quantitative, 112-item food frequency questionnaire was used to assess dietary intakes. Modified RFS (mRFS) is based on the reported consumption of foods recommended in the Dietary Approaches to Stop Hypertension (DASH) diet modified for Korean foods. High blood pressure included hypertension and prehypertension, also known as stage 1 hypertension. Men and women with the highest quintile of mRFS had a 27.2% (OR: 0.728, 95% CI: 0.545–0.971, p-trend = 0.0289) and 32.9% (OR: 0.671, 95% CI: 0.519–0.867, p-trend = 0.0087) lower prevalence of high blood pressure than those with the lowest quintile of mRFS, respectively. Our finding suggests that a higher mRFS may be associated with a lower prevalence of high blood pressure among the Korean adult population.

A systematic review of the association between dietary patterns and health-related quality of life

BACKGROUND

Health related quality of life (HRQOL) is a potent indicator of individual's happiness and life satisfaction. The way in which the HRQOL is affected by the diet is a topic of constant interest and debate among researchers. Evaluating the association between single nutrients or foods and HRQOL fails to take into consideration the complex interactions between nutrients. Also, the findings from previous investigations on the relationship between dietary patterns and HRQOL have been inconsistent. Therefore, our aim was to assess the existing evidence regarding the relationship between the dietary patterns and HRQOL by conducting a systematic review.

METHODS

A literature search was conducted in PubMed, Scopus, Web of Sciences and Google scholar databases from inception to March 2020, to identify studies that investigated associations between the dietary patterns (regardless of methods used to define dietary patterns) and HRQOL domains. Two researchers independently checked titles and abstracts, evaluated full-text studies, extracted data, and appraised their quality using the Newcastle-Ottawa Scale (NOS).

RESULTS

Thirteen studies (four longitudinal, and nine cross-sectional studies), with a total of 43,445 subjects, were included. Of the studies included in this review, eight studies evaluated the association between "Mediterranean" dietary patterns (MDP) and HRQOL, while five studies examined the association between different dietary patterns ("Healthy", "Unhealthy", "Western", "Fruit and vegetable", "Bread and butter" and etc.) and HRQOL. Excluding three studies which showed no significant association, healthy dietary patterns such as MDP, "Healthy" and "Fruit and vegetable" dietary patterns were associated with better HRQOL in physical and mental components scores. The quality assessment of included studies according to NOS criteria were ranged between medium to high quality.

CONCLUSION

According to the current evidence, "Healthy" dietary patterns and "Mediterranean" dietary patterns are associated with better dimension scores of HRQOL in both physical and mental summaries. While, unhealthy dietary patterns and "Western" dietary patterns are associated with lower scores of HRQOL. Further longitudinal studies are required to clarify the association between dietary patterns and HRQOL.

Demographic, Behavioural and Anthropometric Correlates of Food Liking: A Cross-sectional Analysis of Young Adults

The degree to which foods are liked or disliked is associated with dietary intake and health behaviours. However, most food liking research has focused on single foods and nutrients and few studies have examined associations with demographics and health behaviours. Thus, this study aimed to investigate the association between food liking and socio-demographics, health behaviours, diet quality and body mass index (BMI) in a sample of young Australian adults. Data from 1728 undergraduate students (21.8 (standard deviation [SD] 6.0) years; 76% female) were used. Food liking scores and a diet quality index (Dietary Guideline Index, DGI) were estimated from a Food Liking Questionnaire and Food Frequency Questionnaire (FFQ), respectively. Multivariate linear regression analyses were used to assess the association between food liking and correlates. Young adults with higher liking for encouraged core foods were older, female, did their own food shopping, consumed less packaged foods and had better diet quality. Higher liking for discretionary foods and beverages was associated with less healthy behaviours, such as smoking, higher BMI and lower diet quality. These results suggest that food liking measures may offer an appropriate methodology for understanding influences on young adults' food choices, adding to the body of literature investigating the potential for food liking scores to assess diet-disease relationships.

Racial Differences in Perceived Food Swamp and Food Desert Exposure and Disparities in Self-Reported Dietary Habits

Both food swamps and food deserts have been associated with racial, ethnic, and socioeconomic disparities in obesity rates. Little is known about how the distribution of food deserts and food swamps relate to disparities in self-reported dietary habits, and health status, particularly for historically marginalized groups. In a national U.S. sample of 4305 online survey participants (age 18+), multinomial logistic regression analyses were used to assess by race and ethnicity the likelihood of living in a food swamp or food desert area. Predicted probabilities of self-reported dietary habits, health status, and weight status were calculated using the fitted values from ordinal or multinomial logistic regression models adjusted for relevant covariates. Results showed that non-Hispanic, Black participants (N = 954) were most likely to report living in a food swamp. In the full and White subsamples (N = 2912), the perception of residing in a food swamp/desert was associated with less-healthful self-reported dietary habits overall. For non-Hispanic Blacks, regression results also showed that residents of perceived food swamp areas (OR = 0.66, p < 0.01, 95% CI (0.51, 0.86)) had a lower diet quality than those not living in a food swamp/food desert area. Black communities in particular may be at risk for environment-linked diet-related health inequities. These findings suggest that an individual's perceptions of food swamp and food desert exposure may be related to diet habits among adults.

How Health Habits Influence the Physiological Response During a Physical Activity in Extreme Temperatures?

Background: The purpose of the study was to determine to what degree the health habits of university students influence their physiological response during a 10-min high-intensity exercise. Methods: We conducted a cross-sectional cohort study with 59 health science students, in which we analyzed their adherence to a Mediterranean and low-fat diet, as well as their activity levels. We correlated these factors with the physiological response (lactic acid and heart rate) and a series of anthropometric parameters in intense physical activity (cardiopulmonary resuscitation (CPR) for 10 min) in three scenarios: extreme cold, extreme heat and a control situation at room temperature. Results: The results of this study demonstrate that in university students, a greater adherence to the Mediterranean diet was associated with a better response to physical exercise, in this case, 10-min CPR, in hostile environments. Conclusions: Following healthy eating guidelines improves physical performance and delays the appearance of fatigue; both are important aspects for a better performance of CPR.

Higher dietary diversity scores and protein-rich food consumption were associated with lower risk of all-cause mortality in the oldest old

BACKGROUND & AIMS

Dietary diversity is widely advocated in national and international recommendations although whether the beneficial effects on survival or longevity still apply in the final phase of the lifespan remains understudied. We aimed to prospectively examine the association of dietary diversity, food items with all-cause mortality among the oldest old (80+) and determine whether dietary diversity recommendations were appropriate for this population.

METHODS

The study included 28,790 participants aged 80+ (9957 octogenarians, 9925 nonagenarians, and 8908 centenarians). A baseline dietary diversity score (DDS) was constructed based on nine food items of a food frequency questionnaire. Cox models with penalized splines evaluated non-linear associations of DDS as continuous variable with mortality to identify cut-offs of DDS.

RESULTS

We documented 23,503 deaths during 96,739 person-years of follow-up. Each one unit increase in DDS was associated with a 9% lower risk of mortality (adjusted hazard ratio (HR): 0.91; 95% confidential interval (CI): 0.90-0.92). Compared to participants whose DDS less than 2 scores, those with a DDS of 2, 3, 4, 5, and higher than 6 scores had a lower mortality risk, the HRs were 0.86 (0.82-0.89), 0.78 (0.75-0.81), 0.69 (0.66-0.72), 0.65 (0.62-0.68), and 0.56 (0.53-0.58) respectively, and a significant trend emerged (p < 0.001). Protein-rich food items were associated with prominent beneficial effects on mortality including meat (HR and 95% CI for high vs low frequency: 0.70 (0.68-0.72)), fish and sea food (HR, 0.74 (0.72-0.77)), egg (HR, 0.75 (0.73-0.77)), and bean (HR, 0.80 (0.78-0.82)).

CONCLUSIONS

Even after the age of 80, the DDS tool may offer a simple and straightforward mean of identifying and screening individuals at high risk for mortality. Recommendation of dietary diversity, especially consumption of protein-rich food, may be advocated to reduce mortality risk and promote longevity in the oldest old.

Regional Differences in the Association between Dietary Patterns and Muscle Strength in Korean Older Adults: Data from the Korea National Health and Nutrition Examination Survey 2014-2016

Objectives: Adequate nutrition is an important factor to prevent sarcopenia in older adults. The purpose of this study was to identify the regional differences in the association between dietary pattern and muscle strength in older Korean adults. Methods: This study was based on data from the Korea National Health and Nutrition Examination Survey (KNHANES) in 2014–2016. Muscle strength was measured by grip strength, and dietary patterns were derived by a cluster analysis using the k-means algorithm. Multiple logistic regression analyses were applied to determine the associations between factors (dietary patterns and residential areas) and grip strength. Results: Most participants in the rural area group (50.4%) had the Cluster Three dietary pattern (diet dominant in white rice and kimchi), while most people in the urban area group (43.8%) and the metropolitan area group (53.2%) had the Cluster One dietary pattern (diet dominant in fruits and fish). Those having poor hand grip strength represented 25.8% of the total in rural, 20.6% in urban, and 17.9% in metropolitan (p = 0.009) areas. Upon adjustment for socio-demographic characteristics, health behaviors, and co-morbidity, the odds ratio of Cluster Two (diet dominant in meat) was 1.601 (95%, CI: 1.001–2.563, p = 0.050) compared to the Cluster Three dietary pattern, but there was no significant difference in residence. Conclusions: Muscle strength in the elderly was more related to dietary pattern than was residence. Education and support for conveying the importance of protein intake in the elderly are required to motivate adequate nutrition. In addition, these actions should lead to prevention of muscle weakness and further prevent frailty.

Adherence to the Australian dietary guidelines and development of depressive symptoms at 5 years follow-up amongst women in the READI cohort study

BACKGROUND

Depression is the single largest contributor to global disability. There is growing evidence that a healthy diet is associated with reduced depression risk. However, beyond the Mediterranean diet, few longitudinal studies have explored the relationship between adherence to national dietary guidelines and depression. Hence, this study investigates the relationship between adherence to Australian Dietary Guidelines and depressive symptoms.

METHODS

Data was drawn from the READI longitudinal study, a prospective cohort study of socioeconomically disadvantaged Australian women. This analysis includes a sub-sample of 837 women. A generalized linear model was used to explore whether baseline diet (assessed using the Dietary Guideline Index (DGI-2013; score range 0 to 85)) was associated with risk of developing depressive symptoms (measured by the Centre for Epidemiologic Studies Depression (CES-D)) at 5 years follow-up, whilst adjusting for potential confounders. A fixed-effects model was used to assess associations between concurrent changes in diet quality and depressive symptoms from baseline to 5 years follow-up.

RESULTS

An association between baseline diet quality and risk of developing depressive symptoms at follow-up was observed, where a 10 unit increase in DGI-2013 score was associated with an estimated 12% lower risk of developing heightened depressive symptoms (RR = 0.875, 95%CI 0.784 to 0.978, p = 0.018). The fixed-effects model indicated that an increase in DGI score over 5 years follow-up was associated with a lower (improved) CES-D score (B = -0.044, 95% CI - 0.08 to - 0.01, p = 0.024).

CONCLUSIONS

Our results provide evidence that better adherence to the Australian Dietary Guidelines may result in improved depressive symptoms. The growing high-quality evidence regarding the diet-depression relationship provides us with a rationale for developing strategies for supporting dietary behaviour change programs to lower depression rates.

Diet quality and cognitive function in mid-aged and older men and women

Background

To date much research into nutrition and cognitive function has been at the nutrient or food level, with inconsistent results. There is increasing interest in the dietary pattern approach to assess whole diet quality and its association with cognitive function. This study investigated if diet quality is associated with cognitive function in men and women aged 55 years and over.

Methods

Adults aged 55–65 years in the Wellbeing, Eating and Exercise for a Long Life (WELL) study in Victoria, Australia (n = 617) completed a postal survey including a 111-item food frequency questionnaire in 2010 and 2014. Diet quality was assessed via the revised dietary guideline index (DGI-2013) and also by its individual components which assessed key food groups and dietary behaviours from the Australian Dietary Guidelines. The Telephone Interview of Cognitive Status (TICS-m) measured cognitive function in 2014. Associations between past (2010) and recent (2014) diet quality and its components, and cognitive function were assessed by linear regression adjusted for covariates.

Results

After adjustment for age, sex, education, urban/rural status and physical activity there were no associations between diet quality in 2010 and cognitive function in 2014. However participants who reported higher dietary variety (B = 0.28, 95% CI 0.03, 0.52) and women who reported “sometimes” adding salt to food after cooking (B = 0.98, 95% CI 0.25, 1.71) in 2010 displayed better cognitive function in 2014. In 2014, usual consumption of higher fibre bread choices in the total sample (B = 1.32, 95% CI 0.42, 2.23), and higher diet quality (B = 0.03, 95% CI 0.00, 0.07) and greater fluid consumption (B = 0.14, 95% CI 0.01, 0.27) in men were all associated with better cognitive function. In addition, men who reported “usually” adding salt to their food during cooking displayed poorer cognitive function (B = -1.37, 95% CI -2.39, − 0.35). There were no other associations between dietary intake and cognitive function observed in the adjusted models.

Conclusion

An association between dietary variety and some limited dietary behaviours and cognitive function was observed, with variation by gender. Future research should consider trajectories of dietary change over longer time periods as determinants of health and function in older age.

Education and lifestyle predict change in dietary patterns and diet quality of adults 55 years and over

Background

Diet is a key risk factor for chronic disease, and an increasing concern among older adults. We aim to examine the changes in dietary patterns using principal component analysis and a diet quality index among older adults and examine the predictors of dietary change over a 4 year period.

Methods

Data was obtained via a postal survey in a prospective cohort, the Wellbeing Eating and Exercise for a Long Life (WELL) study. Australian adults aged 55 years and over (n = 1005 men and n = 1106 women) completed a food frequency at three time points and provided self-reported personal characteristics. Principal component analysis was used to assess dietary patterns and diet quality was assessed using the 2013 Revised Dietary Guideline Index. The relationships between predictors and change in dietary patterns were assessed by multiple linear regression.

Results

Two dietary patterns were consistently identified in men and women at three time points over 4 years. One was characterised by vegetables, fruit and white meat, and the other was characterised by red and processed meat and processed foods. Reduced consumption of key food groups within the principal component analysis-determined dietary patterns was observed. An increase in diet quality over 4 years was observed in men only. Reported higher education levels and favourable lifestyle characteristics, including not smoking and physical activity, at baseline predicted an increase in healthier dietary patterns over 4 years.

Conclusions

There was stability in the main dietary patterns identified over time, however participants reported an overall decrease in the frequency of consumption of key food groups. Compliance with the Australian Dietary Guidelines remained poor and therefore targeting this population in nutritional initiatives is important. Design of nutrition promotion for older adults need to consider those with lower socioeconomic status, as having a lower level of education was a predictor of poorer dietary patterns. It is important to consider how nutrition behaviours can be targeted alongside other lifestyle behaviours, such as smoking and inadequate physical activity to improve health.

Translation of a Mediterranean-Style Diet into the Australian Dietary Guidelines: A Nutritional, Ecological and Environmental Perspective

A Mediterranean diet (MedDiet) has been widely investigated and promoted as one of the 'healthiest' dietary patterns with respect to reductions in chronic disease risk and longevity. Moreover, it also emphasizes a plant-based dietary pattern consistent with an environmentally sustainable healthy reference diet conveyed by the EAT-Lancet Commission report. Nevertheless, the MedDiet does not exclude, but rather moderates consumption of animal-based foods, and therefore has emerged as a dietary pattern that could address both health and environmental concerns. However, whether non-Mediterranean countries such as Australia can adhere to such dietary principles is less clear. In this narrative review, we present evidence from eight randomized control trials conducted in Australia which demonstrates impressive and sustained adherence to a MedDiet intervention. However, we also report heterogeneity in the dietary protocols and prescriptive interpretation of a MedDiet across all studies presented in this review, making interpretations of the efficacy and adherence challenging. Based on the observable health benefits, translating key dietary elements of a Mediterranean-style diet within the Australian population remains attractive. However, adapting or modernizing traditional dietary patterns to satisfy the population's nutritional requirements and/or acceptability warrants further exploration.

Effects of Long-Versus Short-Term Exposure to the Mediterranean Diet on Skin Microvascular Function and Quality of Life of Healthy Adults in Greece and the UK

The beneficial effects of the Mediterranean diet (MD) adherence in reducing cardiovascular disease (CVD) risk and improving CVD-related physiological indices have been well-documented. However, the exact MD adherence duration needed for these effects to occur is under-researched. The aim of the present, two-arm, two-site study clinical trial was to assess the effects of long- vs. short-term MD adherence on the skin microvascular circulation, and quality of life. Two groups were recruited, one being long-term MD adherers (>5 years; from Greece; control group), and one of the non-adherers (from the UK), with the latter participating in a four-week MD intervention (intervention group). Our main outcome was skin microvascular function assessed by cutaneous vascular conductance (CVC). Secondary outcomes included quality of life, dietary intake, blood pressure and lipidemic profile. At the end of the intervention, both groups had high MD adherence. For the intervention group, significantly improved post-intervention CVC values were noted concerning the initial peak phase (2.0 ± 0.6 vs. 2.8 ± 0.8; p < 0.05). CVC values of the control group, were however higher at the plateau phase in comparison to the intervention group (intervention end; 3.8 ± 0.8 vs. 3.1 ± 1.2; p < 0.05). As per QoL, the physical domain was improved post-intervention (13.7 ± 1.2 vs. 15.9 ± 1.2; p < 0.05). No differences were observed in the lipidemic profile between groups, or between the baseline and final intervention phases. The findings indicate that although short-term MD adherence is effective in improving certain microvascular physiological properties and QoL domains, there is room for additional improvement, observed in long-term adherers. Our findings are important in the design of future, MD-based, lifestyle interventions, with the advisable durations differing between target groups.