Changes of dietary patterns during participation in a web-based weight-reduction programme

Lifestyle behaviour patterns in the prevention of type 2 diabetes mellitus: the Fukushima Health Database 2015-2020

OBJECTIVES

Lifestyle behaviours associated with the incidence of type 2 diabetes mellitus (T2DM) need further clarification using health insurance data.

STUDY DESIGN

This is a cohort study.

METHODS

In 2015, 193,246 participants aged 40-74 years attended the specific health checkups and were observed up to 2020 in Fukushima, Japan. Using the principal component analysis, we identified two patterns from ten lifestyle behaviour questions, namely, the "diet-smoking" pattern (including smoking, alcohol drinking, skipping breakfast, eating fast, late dinner, and snacking) and the "physical activity-sleep" pattern (including physical exercise, walking equivalent activity, walking fast, and sufficient sleep). Then, individual pattern scores were calculated; the higher the scores, the healthier the behaviours.

RESULTS

The accumulative incidence rate of T2DM was 630.5 in men and 391.9 in women per 100,000 person-years in an average of 4 years of follow-up. Adjusted for the demographic and cardiometabolic factors at the baseline, the hazard ratio (95% confidence interval) of the highest versus lowest quartile scores of the "diet-smoking" pattern for T2DM risk was 0.82 (0.72, 0.92; P for trend = 0.002) in men and 0.87 (0.76, 1·00; P for trend = 0.034) in women; that of the "physical activity-sleep" pattern was 0.92 (0.82, 1·04; P for trend = 0.0996) in men and 0.92 (0.80, 1·06; P for trend = 0.372) in women. The "physical activity-sleep" pattern showed a significant inverse association in non-overweight men.

CONCLUSIONS

Lifestyle behaviour associated with a healthy diet and lack of smoking may significantly lower the risk of T2DM in middle-aged Japanese adults.

Dietary Patterns and New-Onset Type 2 Diabetes Mellitus in Evacuees after the Great East Japan Earthquake: A 7-Year Longitudinal Analysis in the Fukushima Health Management Survey

Background: Dietary patterns may be linked to the incidence of type 2 diabetes mellitus (T2DM) after disasters. We investigated the association between dietary patterns and new-onset T2DM in evacuees of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident. Methods: Among the 22,740 non-diabetic participants aged 20-89 years who completed the dietary assessment in the Fukushima Health Management Survey between July 2011 and November 2012, the incidence of T2DM was evaluated until 2018. Principal component analysis with varimax rotation was applied to derive dietary patterns based on a validated, short-form food frequency questionnaire. The identified dietary patterns were categorized as typical Japanese, juice, and meat. Results: The cumulative incidence of T2DM was 18.0 and 9.8 per 1000 person-years in men and women, respectively, during the follow-up period. The multiple-adjusted hazard ratio (95% confidence interval) of the highest vs. lowest quartile of the typical Japanese pattern scores for T2DM was 0.80 (0.68, 0.94; P for trend = 0.015) in total, 0.85 (0.68, 1.06; P for trend = 0.181) in men, and 0.76 (0.60, 0.95; P for trend = 0.04) in women. Conclusions: A typical Japanese dietary pattern may be associated with a reduced new-onset T2DM risk in evacuees, especially women, after the Great East Japan Earthquake and the FDNPP accident.

Development of a Japanese Healthy Diet Index: The Fukushima Health Management Survey 2011

A novel healthy diet index for dietary quality can be used to assess food intake. After the Great East Japan Earthquake in 2011, the Fukushima Health Management Survey collected dietary data using a short-form food frequency questionnaire (FFQ). The current study included eligible participants (n = 64,909) aged 16-84 years who answered the FFQ in 2011. The year- and sex-specific dietary patterns were determined via principal component analysis. Based on the typical Japanese, juice/dairy, and meat patterns, healthy diet index (HDI) scores were assigned for food items, resulting in Spearman's correlation coefficients of 0.730, -0.227, and -0.257, respectively. The mean (standard deviation) of the HDI scores (range: 1-18) were 9.89 (2.68) in men and 9.96 (2.58) in women. Older individuals, women, nonsmokers, those in good health and with regular physical exercise, and those who did not transfer residences had a high HDI score. In the confirmatory analysis, the adjusted odds ratio (95% confidence interval) of the highest vs. the lowest quartiles of HDI scores was 0.87 (0.80, 0.94) for overweight, 0.89 (0.81, 0.97) for large waist circumference, and 0.73 (0.66, 0.80) for dyslipidemia. The HDI score obtained using the FFQ can be applied to evaluate dietary profiles.

The future is now: a call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology

The role of comprehensive cardiac rehabilitation is well established in the secondary prevention of cardiovascular diseases such as coronary artery disease and heart failure. Numerous trials have demonstrated both the effectiveness as well as the cost-effectiveness of comprehensive cardiac rehabilitation in improving exercise capacity and quality of life, and in reducing cardiovascular mortality and morbidity. However, the current COVID-19 pandemic has led to closure of many cardiac rehabilitation centres in Europe resulting in many eligible patients unable to participate in the optimisation of secondary prevention and physical performance. This elicits an even louder call for alternatives such as cardiac telerehabilitation to maintain the delivery of the core components of cardiac rehabilitation to cardiovascular disease patients. The present call for action paper gives an update of recent cardiac telerehabilitation studies and provides a practical guide for the setup of a comprehensive cardiac telerehabilitation intervention during the COVID-19 pandemic. This set up could also be relevant to any cardiovascular disease patient not able to visit cardiac rehabilitation centres regularly after the COVID-19 pandemic ceases.

Dietary Patterns and Progression of Impaired Kidney Function in Japanese Adults: A Longitudinal Analysis for the Fukushima Health Management Survey, 2011-2015

To investigate associations between dietary patterns and the risk of impaired kidney function, we analyzed data from 14,732 participants (40–89 years) who completed the baseline diet questionnaire of The Fukushima Health Management Survey in 2011. The incidence of chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² or proteinuria (≥1+ by dipstick test)) and annual changes in eGFR were assessed from 2012 to 2015. Three major dietary patterns were identified. The adjusted cumulative incidence ratio of the highest vs. lowest tertile of a vegetable diet scores was 0.90 (95% confidence interval (CI): 0.82, 1.00) for eGFR < 60 mL/min/1.73 m², 0.68 (95% CI: 0.52, 0.90) for proteinuria, and 0.88 (95% CI: 0.80, 0.97) for CKD (P for trend = 0.031, 0.007, and 0.005, respectively). The incident risk of CKD in the highest tertile of juice diet scores was 18% higher than the lowest tertile. The odds ratio of the highest vs. lowest tertile of vegetable diet scores was 0.85 (95% CI: 0.75, 0.98) in the rapidly decreasing eGFR group (P for trend = 0.009). We did not observe significant associations for the meat dietary pattern. A Japanese vegetable diet could reduce the risk of developing impaired kidney function and CKD.

Changes in dietary patterns when females engage in a weight management programme and their ability to meet Scientific Advisory Committee on Nutrition’s fibre and sugar recommendations

Objective:

To investigate how dietary patterns (DP) change following engagement in a weight management programme. Using the DP identified, to study their relationship with weight loss achieved and ability to meet the Scientific Advisory Committee on Nutrition’s 2015 fibre and sugar recommendations.

Design:

Secondary analysis of FFQ data, which collected dietary information at two time points: retrospectively before (T0) and presently during (T1) Slimming World’s programme, was analysed. Principal component analysis derived the DP present.

Setting:

Online FFQ, hosted by Slimming World (SW) in the UK.

Participants:

Female SW members (n 325; 17–68 years old).

Results:

At T0, two DP, ‘plant based’ and ‘processed meat and sugar added by the consumer’ were identified. At T1, three DP were identified, ‘high meat’, ‘high fat salt and sugar (HFSS) products’ and ‘nuts and oils’. Participants with a diet low in ‘HFSS products’ lost significantly more weight (P for trend = 0·001), were more likely to consume breakfast (P = 0·021) and consumed less free sugar compared with high ‘HFSS product’ consumers. Those initially presenting with a low ‘plant based’ diet score lost more weight at T1 (P for trend = 0·046). With engagement, mean fibre intake increased from 24·3 to 32·4 g/d (P < 0·001) and free sugar intake decreased from 12·6 to 8·7 % total dietary energy (P < 0·001).

Conclusions:

An individual’s DP before and with engagement in a weight management programme may indicate their weight loss success. Advising reduced HFSS product intake may aid initial weight loss. SW appears to promote dietary changes towards UK fibre and sugar recommendations.

Dietary pattern changes in Fukushima residents after the Great East Japan Earthquake: the Fukushima Health Management Survey 2011-2013

OBJECTIVE

Dietary patterns more closely resemble actual eating behaviours because multiple food groups, not a single food group or nutrient, are considered. The present study aimed to identify and assess changes of dietary patterns in Fukushima residents.

DESIGN

Dietary data were collected using a short-form FFQ in annual Fukushima Health Management Survey between 2011 and 2013 after the Great East Japan Earthquake. Year- and sex-specific dietary patterns were determined by the principal component analysis.

SETTING

Evacuation and nonevacuation zones in Fukushima, Japan.

PARTICIPANTS

Eligible participants aged ≥16 years answered the FFQ (n 67 358 in 2011, n 48 377 in 2012 and n 40 742 in 2013).

RESULTS

Three identified dietary patterns were assessed similarly in men and women and among years: typical, juice and meat. In total participants, the Spearman's correlation coefficients between two survey years were 0·70-0·74 for the typical, 0·58-0·66 for the juice and 0·50-0·54 for the meat pattern scores. Adjusted for sociodemographic factors, evacuees had lower typical pattern scores, higher juice pattern scores and the same meat pattern scores compared with non-evacuees. The means of typical pattern scores in evacuees and it of juice pattern scores in non-evacuees continued declining over years. Similar profiles of dietary patterns and trends of pattern scores were observed in participants (n 22 805) who had provided three dietary assessments.

CONCLUSIONS

Changes of dietary patterns have been observed between 2011 and 2013. Careful investigation of those with low intake of typical pattern foods and promotion of them, particularly in evacuees, are needed.

Associations between Dietary Patterns and Cardiometabolic Risks in Japan: A Cross-Sectional Study from the Fukushima Health Management Survey, 2011-2015

Cardiometabolic risks were increasing in Fukushima residents after the Great East Japan Earthquake. We examined the association between dietary patterns and cardiometabolic risks in those aged ≥16 years. Dietary patterns were derived by principal component analysis for participants who underwent at least one diet assessment using a short-form food frequency questionnaire during 2011–2013 and a health checkup in 2014 and 2015 (n = 15,409 and 14,999, respectively). In 2014, the adjusted prevalence ratio (PR) and 95% confidence interval (CI) in the highest versus lowest quartile of accumulative mean scores were 0.97 (0.96–0.99) for overweight/obesity, 0.96 (0.95–0.97) for total cholesterol (TC) ≥ 220 mg/dL, 0.96 (0.95–0.98) for low-density lipoprotein cholesterol (LDL-C) ≥ 140 mg/dL, and 0.97 (0.96–0.99) for triglycerides ≥ 150 mg/dL for a vegetable diet and 1.03 (1.01–1.04) for TC ≥ 220 mg/dL and 1.02 (1.01–1.04) for LDL-C ≥ 140 mg/dL for a juice/milk diet. In 2015, we found consistently significant associations for the vegetable and juice/milk diets, and the PR and 95% CI were 0.99 (0.98–1.00) for HDL-C < 40 mg/dL for a meat diet. The continuous promotion of the vegetable pattern diet is necessary to reduce cardiometabolic risks, particularly dyslipidemia, in Japan.

Dietary modifications for weight loss and weight loss maintenance

Worldwide obesity rates remain at a rise, and to treat obesity is at the top of the global public health agenda. In 2013, the AHA/ACC/TOS obesity management guidelines were published, in essence suggesting that any dietary scheme seems to be effective for weight loss, as long as it can induce a sustainable energy deficit. In the present review, we update and critically discuss available information regarding dietary modifications for weight loss and weight loss maintenance, published after the 2013 guidelines. Regarding weight loss, we found no proof to support that a single dietary scheme, be it nutrient-, food group- or dietary pattern- based, is more efficacious of the other for achieving weight loss. For weight loss maintenance, published interventions point towards the same direction, although inconclusively. Most research explores the effect of weight loss regimes on weight loss maintenance and not the effect of the diet during weight loss maintenance, and this literature gap should be more thoroughly investigated.

Users, Uses, and Effects of Social Media in Dietetic Practice: Scoping Review of the Quantitative and Qualitative Evidence

BACKGROUND

Social media platforms are increasingly used by registered dietitians (RDs) to improve knowledge translation and exchange in nutrition. However, a thorough understanding of social media in dietetic practice is lacking.

OBJECTIVE

The objective of this study was to map and summarize the evidence about the users, uses, and effects of social media in dietetic practice to identify gaps in the literature and inform future research by using a scoping review methodology.

METHODS

Stages for conducting the scoping review included the following: (1) identifying the research question; (2) identifying relevant studies through a comprehensive multidatabase and gray literature search strategy; (3) selecting eligible studies; (4) charting the data; and (5) collating, summarizing, and reporting results for dissemination. Finally, knowledge users (RDs working for dietetic professional associations and public health organizations) were involved in each review stage to generate practical findings.

RESULTS

Of the 47 included studies, 34 were intervention studies, 4 were descriptive studies, 2 were content analysis studies, and 7 were expert opinion papers in dietetic practice. Discussion forums were the most frequent social media platform evaluated (n=19), followed by blogs (n=13) and social networking sites (n=10). Most studies targeted overweight and obese or healthy users, with adult populations being most studied. Social media platforms were used to deliver content as part of larger multiple component interventions for weight management. Among intervention studies using a control group with no exposition to social media, we identified positive, neutral, and mixed effects of social media for outcomes related to users' health behaviors and status (eg, dietary intakes and body weight), participation rates, and professional knowledge. Factors associated with the characteristics of the specific social media, such as ease of use, a design for quick access to desired information, and concurrent reminders of use, were perceived as the main facilitators to the use of social media in dietetic practice, followed to a lesser extent by interactions with an RD and social support from fellow users. Barriers to social media use were mostly related to complicated access to the site and time issues.

CONCLUSIONS

Research on social media in dietetic practice is at its infancy, but it is growing fast. So far, this field of research has targeted few social media platforms, most of which were assessed in multiple-component interventions for weight management among overweight or obese adults. Trials isolating the effects and mechanisms of action of specific social media platforms are needed to draw conclusions regarding the effectiveness of those tools to support dietetic practice. Future studies should address barriers and facilitators related to the use of social media written by RDs and should explore how to make these tools useful for RDs to reach health consumers to improve health through diet.

Socioeconomic predictors of dietary patterns among Guatemalan adults

OBJECTIVES

We aimed to assess the associations of socioeconomic factors with dietary patterns in a Guatemalan population.

METHODS

Cross-sectional data of 1076 participants (42 % men, mean age 32.6 ± 4.2 years) collected between 2002 and 2004 in four rural villages in Guatemala. Dietary patterns were derived using principal component analysis. Chi-square and Poisson regression models were used to assess associations between socioeconomic factors and dietary patterns.

RESULTS

Three dietary patterns were identified: "Western" (high in processed foods), "traditional" (high in traditional foods) and "coffee and sugar", explaining 11, 7 and 6 % of the variance, respectively. Annual expenditures were associated with a higher adherence to the "Western" pattern: prevalence ratios [(PR) (95 % confidence interval)] 1.92 (1.17-3.15) for the highest vs. lowest expenditure group in men and 8.99 (3.57-22.64) in women. A borderline significant (p = 0.06) negative association was found between the "traditional" pattern and higher household expenditures [0.71 (0.49-1.02) in men] and with schooling [0.23 (0.05-1.02)] in women (p = 0.05).

CONCLUSIONS

Dietary patterns in Guatemala are predicted by socioeconomic factors. In particular, high annual expenditures are associated with a more westernized, less traditional diet.