Variations in Dietary Patterns Defined by the Healthy Eating Index 2015 and Associations with Mortality: Findings from the Dietary Patterns Methods Project

Similar changes in diet quality indices, but not nutrients, among African American participants randomized to follow one of the three dietary patterns of the US Dietary Guidelines: A secondary analysis

The goal of this study was to examine the relationship between diet quality, nutrients, and health outcomes among participants in the Dietary Guidelines: 3 Diets study (3-group randomized 12-week intervention; African American; Southeastern virtual teaching kitchen). Participants (n = 63; ages 18-65 y, BMI 25-49.9 kg/m2) were randomized to the Healthy U.S. (H-US), Mediterranean (Med), or Vegetarian (Veg) groups. Hypotheses tested included (1) that the more plant-based diet patterns (Veg and Med) would have greater improvements in all diet quality indices (Dietary Approaches to Stop Hypertension (DASH), Dietary Inflammatory Index (DII), alternate Mediterranean Diet Index (aMED), healthy Plant-based Dietary Index (hPDI) assessed via three dietary recalls) as compared to the H-US pattern and (2) that each index would separately predict changes in weight loss, hemoglobin A1c (HbA1c), and blood pressure (BP). None of the group-by-time interactions for any of the diet indices were significant. Compared to the H-US group, Veg participants had greater increases in fiber (difference between groups 5.72 ± 2.10 5 g/day; P = .01), riboflavin (0.38 ± 0.19 mg/day; P = .05), and folate (87.39 ± 40.36 mcg/day; P = .03). For every one-point increase in hPDI, there was a 1.62 ± 0.58 mmHg decrease in systolic BP, for every one-point increase in aMED there was a 1.45 ± 0.70 mmHg decrease in diastolic BP, and for every one-point increase in hPDI, there was a 1.15 ± 0.38 mmHg decrease in diastolic BP. Findings indicate that there is significant overlap in the dietary recommendations of the three dietary patterns presented in the USDG and similarities in how African American adults adopt those diet patterns. Clinical Trials registry at clinicaltrials.gov:NCT04981847.

Association between dietary patterns and the risk of all-cause mortality among old adults with obstructive sleep apnea

BACKGROUND

Obstructive sleep apnea (OSA) was associated with the increased cardiovascular events and all-cause mortality. And anti-inflammatory dietary has potential to improve the prognosis of OSA. This study aimed to investigate the association of anti-inflammatory dietary patterns with all-cause mortality among individuals with OSA.

METHODS

This retrospective cohort study involved 1522 older adults with OSA from 2005 to 2008 in the National Health and Nutrition Examinations Survey (NHANES). Mortality status was determined by routine follow-up through December 31, 2019, using the National Death Index. Anti-inflammatory dietary patterns included Alternate Mediterranean Diet Score (aMED), Healthy Eating Index-2015 (HEI-2015), and Alternate Healthy Eating Index-2010 (AHEI-2010). Weighted Cox proportional hazard regression models were performed to investigate the association between anti-inflammatory dietary pattern and all-cause mortality.

RESULTS

After a median follow-up of 131 months, 604 participants were recorded all-cause mortality. The mean age of OSA patients was 68.99 years old, of whom 859 were male (52.34%). Higher adherence of aMED (HR = 0.61, 95%CI: 0.48 to 0.78) and HEI-2015 (HR = 0.75, 95%CI: 0.60 to 0.95) were associated with lower all-cause mortality risk in the elderly with OSA. Conversely, no association was found between AHEI-2010 dietary pattern and all-cause mortality in individuals with OSA. In the component analysis of aMED, it was found that a higher intake of vegetables and olive oil potentially contributes to the reduction all-cause mortality risk in the elderly with OSA (HR = 0.60, 95%CI: 0.48 to 0.76; HR = 0.67, 95%CI: 0.63 to 0.71).

CONCLUSION

Higher adherence to the aMED and the HEI-2015 was associated with a lower risk of all-cause mortality in OSA. Future interventions in the elderly with OSA should considering adopting anti-inflammatory dietary patterns.

Dietary Oncopharmacognosy as a Crosswalk between Precision Oncology and Precision Nutrition

While diet and nutrition are modifiable risk factors for many chronic and infectious diseases, their role in cancer prevention and control remains under investigation. The lack of clarity of some diet-cancer relationships reflects the ongoing debate about the relative contribution of genetic factors, environmental exposures, and replicative errors in stem cell division as determinate drivers of cancer risk. In addition, dietary guidance has often been based upon research assuming that the effects of diet and nutrition on carcinogenesis would be uniform across populations and for various tumor types arising in a specific organ, i.e., that one size fits all. Herein, we present a paradigm for investigating precision dietary patterns that leverages the approaches that led to successful small-molecule inhibitors in cancer treatment, namely understanding the pharmacokinetics and pharmacodynamics of small molecules for targeting carcinogenic mechanisms. We challenge the scientific community to refine the paradigm presented and to conduct proof-in-concept experiments that integrate existing knowledge (drug development, natural products, and the food metabolome) with developments in artificial intelligence to design and then test dietary patterns predicted to elicit drug-like effects on target tissues for cancer prevention and control. We refer to this precision approach as dietary oncopharmacognosy and envision it as the crosswalk between the currently defined fields of precision oncology and precision nutrition with the goal of reducing cancer deaths.

Consumption of Key Food Groups by Individuals Consuming Popular Diet Patterns: Mixed Effects of Replacing Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains

Adults in the United States are increasingly following 'popular' diet patterns that restrict food groups, macronutrients, or eating time. However, the intake of food groups associated with these diet patterns has not been well characterized. The objectives of this study were to (1) characterize the mean intake of food groups among consumers of popular diet patterns in the US, and (2) model the effect of targeted food substitutions on the intake of food groups. Data were acquired from the National Health and Nutrition Examination Survey, 2005-2018 (n = 34,411). A diet model was developed to assess the effects of replacing one serving each of foods highest in added sugar, sodium, saturated fat, and refined grains with healthy alternatives on the intake of key food groups for each diet pattern. Modeled replacement resulted in increased intake of fruit and whole grains and decreased intake of dairy for most diet patterns, while the effects on the intake of vegetables, protein foods, and oils were variable across diet patterns. The complexity of the natural eating environment, in which many people consume mixed dishes that include both healthy and less healthy ingredients, produces a challenge for health professionals when providing dietary counseling. Nevertheless, this substitution approach may help improve adherence to dietary guidelines, especially if used as a steppingstone for further dietary improvement.

Quality of Popular Diet Patterns in the United States: Evaluating the Effect of Substitutions for Foods High in Added Sugar, Sodium, Saturated Fat, and Refined Grains

Background

Many Americans have adopted popular diet patterns for general health improvement that restrict specific foods, macronutrients, or eating time. However, there is limited evidence to characterize the quality of these diet patterns.

Objectives

This study 1) evaluated the quality of popular diet patterns in the United States and 2) modeled the effect of targeted food substitutions on diet quality.

Methods

Dietary data from 34,411 adults ≥20 y old were acquired from the NHANES, 2005-2018. Dietary intake was assessed using the National Cancer Institute's usual intake methodology, and the Healthy Eating Index-2015 was used to evaluate diet quality. A diet model was used to evaluate the effect of targeted food substitutions on diet quality.

Results

A pescatarian diet pattern had the highest diet quality (65.2; 95% CI: 64.0, 66.4), followed by vegetarian (63.0; 95% CI: 62.0, 64.0), low-grain (62.0; 95% CI: 61.6, 62.4), restricted-carbohydrate (56.9; 95% CI: 56.6, 57.3), time-restricted (55.2; 95% CI: 54.8, 55.5), and high-protein (51.8; 95% CI: 51.0, 62.7) diet patterns. Modeled replacement of ≤3 daily servings of foods highest in added sugar, sodium, saturated fat, and refined grains with alternative foods led to an increase in diet quality and a decrease in energy intake for most diet patterns.

Conclusions

Low diet quality was observed for all popular diet patterns evaluated in this study. Modeled dietary shifts that align with recommendations to choose foods lower in added sugar, sodium, saturated fat, and refined grains led to modest improvements in diet quality and larger reductions of energy intake. Greater efforts are needed to encourage the adoption of dietary patterns that emphasize consumption of a variety of high-quality food groups.