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Mehrabani-Zeinabad K, Feizi A, Sadeghi M, Roohafza H, Talaei M, Sarrafzadegan N. Cardiovascular disease incidence prediction by machine learning and statistical techniques: a 16-year cohort study from eastern Mediterranean region. BMC Med Inform Decis Mak 2023; 23:72. [PMID: 37076833 PMCID: PMC10116769 DOI: 10.1186/s12911-023-02169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/04/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVD) are the predominant cause of early death worldwide. Identification of people with a high risk of being affected by CVD is consequential in CVD prevention. This study adopts Machine Learning (ML) and statistical techniques to develop classification models for predicting the future occurrence of CVD events in a large sample of Iranians. METHODS We used multiple prediction models and ML techniques with different abilities to analyze the large dataset of 5432 healthy people at the beginning of entrance into the Isfahan Cohort Study (ICS) (1990-2017). Bayesian additive regression trees enhanced with "missingness incorporated in attributes" (BARTm) was run on the dataset with 515 variables (336 variables without and the remaining with up to 90% missing values). In the other used classification algorithms, variables with more than 10% missing values were excluded, and MissForest imputes the missing values of the remaining 49 variables. We used Recursive Feature Elimination (RFE) to select the most contributing variables. Random oversampling technique, recommended cut-point by precision-recall curve, and relevant evaluation metrics were used for handling unbalancing in the binary response variable. RESULTS This study revealed that age, systolic blood pressure, fasting blood sugar, two-hour postprandial glucose, diabetes mellitus, history of heart disease, history of high blood pressure, and history of diabetes are the most contributing factors for predicting CVD incidence in the future. The main differences between the results of classification algorithms are due to the trade-off between sensitivity and specificity. Quadratic Discriminant Analysis (QDA) algorithm presents the highest accuracy (75.50 ± 0.08) but the minimum sensitivity (49.84 ± 0.25); In contrast, decision trees provide the lowest accuracy (51.95 ± 0.69) but the top sensitivity (82.52 ± 1.22). BARTm.90% resulted in 69.48 ± 0.28 accuracy and 54.00 ± 1.66 sensitivity without any preprocessing step. CONCLUSIONS This study confirmed that building a prediction model for CVD in each region is valuable for screening and primary prevention strategies in that specific region. Also, results showed that using conventional statistical models alongside ML algorithms makes it possible to take advantage of both techniques. Generally, QDA can accurately predict the future occurrence of CVD events with a fast (inference speed) and stable (confidence values) procedure. The combined ML and statistical algorithm of BARTm provide a flexible approach without any need for technical knowledge about assumptions and preprocessing steps of the prediction procedure.
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Affiliation(s)
- Kamran Mehrabani-Zeinabad
- Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Biostatistics and Epidemiology Department, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamidreza Roohafza
- Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Talaei
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Nizal Sarrafzadegan
- Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Wang PY, Lin WC, Hsieh PC, Lin SH, Liu PY, Chao TH, Hsu CH. The Effects of Post-Acute Care in Patients with Heart Failure in Taiwan: A Single Center Experience. ACTA CARDIOLOGICA SINICA 2023; 39:287-296. [PMID: 36911546 PMCID: PMC9999181 DOI: 10.6515/acs.202303_39(2).20220923b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/23/2022] [Indexed: 03/14/2023]
Abstract
Background The National Health Insurance Administration in Taiwan has promoted the heart failure post-acute care (HF-PAC) program as a means to provide proactive integrated care within the optimal treatment timeframe to enhance functional recovery after acute decompensated heart failure (HF). Objectives The aim of this program was to reduce HF readmission rates, improved medication prescription rates, and improve the quality of life in HF patients. Methods Patients who had a reduced left ventricular ejection fraction (LVEF) of ≤ 40% were included and followed up for 6 months after discharge. They underwent cardiac rehabilitation and physiological, and nutritional status evaluations. The main clinical outcomes of the HF-PAC program were guideline-directed medical therapy prescription rate and 6-month readmission rate. Results A total of 122 patients were recruited from June 2018 to December 2020 at a medical center in southern Taiwan. The patients' activities of daily living, nutritional status, quality of life and LVEF were significantly improved during the HF-PAC program. More than 95% of the patients received guideline-directed medical prescriptions at the end of the HF-PAC program. The cardiovascular-related 6-month re-admission rate after the HF-PAC program ended was 27.7%, and it could be predicted by the New York Health Association functional class [hazard ratio (HR) 95% confidence interval (95% CI) = 4.12 (1.36-12.46)], value of the Mini Nutritional Assessment - Short Form [HR (95% CI) = 0.46 (0.31-0.68)] and LVEF [HR (95% CI) = 0.95 (0.91-0.99)]. Conclusions By incorporating multidisciplinary healthcare teams, the HF-PAC program improves the guideline- directed medical therapy prescription rate, thus improving patients' cardiac function, physical activity recovery, the quality of life, and also reduces their readmission rate.
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Affiliation(s)
- Pei-Yi Wang
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Department of Nursing, National Taiwan University Hospital, Taipei
| | - Wen-Chih Lin
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan.,Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Chun Hsieh
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University
| | - Ping-Yen Liu
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University.,Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ting-Hsing Chao
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsin Hsu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Mallya J, K T, Shettigar P. Uncovering culinary medicine research themes: Current status and future direction. F1000Res 2023; 12:173. [PMID: 38059134 PMCID: PMC10696491 DOI: 10.12688/f1000research.130947.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 12/08/2023] Open
Abstract
Background: Culinary medicine (CM), an emerging discipline, is a novel approach that focuses on the art of food and cooking to prevent or improve health outcomes among chronic patients suffering from lifestyle diseases. The concept originated in the USA, gaining interest from scholars in medicine, nutrition, nursing, and the gastronomic discipline. Notably, in the last five years, there has been exponential growth in CM literature. In this regard, this study sought to examine the growth, performance and distinct research themes of CM literature over time. Methods: To achieve the study's objectives, this study employs descriptive, performance and bibliometric analysis. The descriptive analysis was applied to examine the growth of the CM literature since its emergence. The performance analysis was used to identify the most influential journals, articles, and authors in the CM domain. The bibliographic coupling analysis was adopted to discover the various research themes of the CM knowledge base. Results: This study identifies three stages of literature development: Early stage, modest growth stage, and emerging stage. Further, the results indicate that most of the studies on CM had been conducted in developed countries. Our findings reveal a clear interest in integrating the CM curriculum into medical/nutrition education programs in recent years. Additionally, the study discovers four distinct main research themes: knowledge assessment, impact measurement, acceptance and efficacy, and implementation of CM. Conclusions: These findings are helpful for scholars in medicine, nutrition, nursing, and gastronomy as they provide an overview of CM's development and research focus. Future studies could focus on expanding the geographical distribution of research on CM and further exploring the identified research themes to gain a deeper understanding of the potential of this approach for improving health outcomes among chronic disease patients.
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Affiliation(s)
- Jyothi Mallya
- Library, Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Thirugnanasambantham K
- Food and Beverage Production, Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Pallavi Shettigar
- Dietetics and Applied Nutrition, Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
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Preparing Registered Dietitian Nutritionists for Leadership in Culinary Medicine: Opportunities, Barriers, and Alternatives in Registered Dietitian Nutritionist Education and Training. J Acad Nutr Diet 2023; 123:865-870. [PMID: 36740186 DOI: 10.1016/j.jand.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
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Peres Valgas Da Silva C, Shettigar VK, Baer LA, Abay E, Pinckard KM, Vinales J, Sturgill SL, Vidal P, Ziolo MT, Stanford KI. Exercise training after myocardial infarction increases survival but does not prevent adverse left ventricle remodeling and dysfunction in high-fat diet fed mice. Life Sci 2022; 311:121181. [PMID: 36372212 PMCID: PMC9712172 DOI: 10.1016/j.lfs.2022.121181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
AIMS Aerobic exercise is an important component of rehabilitation after cardiovascular injuries including myocardial infarction (MI). In human studies, the beneficial effects of exercise after an MI are blunted in patients who are obese or glucose intolerant. Here, we investigated the effects of exercise on MI-induced cardiac dysfunction and remodeling in mice chronically fed a high-fat diet (HFD). MAIN METHODS C57Bl/6 male mice were fed either a standard (Chow; 21% kcal/fat) or HFD (60% kcal/fat) for 36 weeks. After 24 weeks of diet, the HFD mice were randomly subjected to an MI (MI) or a sham surgery (Sham). Following the MI or sham surgery, a subset of mice were subjected to treadmill exercise. KEY FINDINGS HFD resulted in obesity and glucose intolerance, and this was not altered by exercise or MI. MI resulted in decreased ejection fraction, increased left ventricle mass, increased end systolic and diastolic diameters, increased cardiac fibrosis, and increased expression of genes involved in cardiac hypertrophy and heart failure in the MI-Sed and MI-Exe mice. Exercise prevented HFD-induced cardiac fibrosis in Sham mice (Sham-Exe) but not in MI-Exe mice. Exercise did, however, reduce post-MI mortality. SIGNIFICANCE These data indicate that exercise significantly increased survival after MI in a model of diet-induced obesity independent of effects on cardiac function. These data have important translational ramifications because they demonstrate that environmental interventions, including diet, need to be carefully evaluated and taken into consideration to support the effects of exercise in the cardiac rehabilitation of patients who are obese.
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Affiliation(s)
- Carmem Peres Valgas Da Silva
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Vikram K Shettigar
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Lisa A Baer
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Eaman Abay
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Kelsey M Pinckard
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jorge Vinales
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Sarah L Sturgill
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Pablo Vidal
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Mark T Ziolo
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Kristin I Stanford
- Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America; Department of Physiology and Cell Biology, The Ohio State University College of Medicine, Columbus, OH, United States of America; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, United States of America.
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McWhorter JW, LaRue DM, Almohamad M, Danho MP, Misra S, Tseng KC, Weston SR, Moore LS, Durand C, Hoelscher DM, Sharma SV. Training of Registered Dietitian Nutritionists to Improve Culinary Skills and Food Literacy. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:784-793. [PMID: 35644786 DOI: 10.1016/j.jneb.2022.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/28/2022] [Accepted: 04/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand if a culinary medicine training program increases food literacy, culinary skills, and knowledge among practicing registered dietitian nutritionists (RDN). METHODS Prepost study design evaluating pilot test of RDN train-the-trainer curriculum from September, 2019 to January, 2020. RESULTS On average, results indicate an increase in culinary nutrition skills (mean difference, 6.7 ± 4.4; P < 0.001; range, 10-30) and a significant increase in 5 of the 8 food literacy factors. Through process evaluation, RDNs rated the training as extremely useful to their practice (mean, 4.4 ± 0.3). CONCLUSIONS AND IMPLICATIONS Registered dietitian nutritionist participants increased culinary nutrition skills with statistically significant scores across all individual measures. This study describes an RDN training curriculum in culinary medicine across a diverse group of practicing RDNs from a large county health care system. Culinary medicine shows a promising impact on promoting nutrition skills and confidence; however, it warrants further assessment.
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Affiliation(s)
- John Wesley McWhorter
- Department of Health Promotion and Behavioral Sciences, and Nourish Program, UTHealth School of Public Health, Houston, TX.
| | - Denise M LaRue
- Population Health Transformation, Harris Health System, Houston, TX
| | - Maha Almohamad
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
| | - Melisa P Danho
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
| | - Shweta Misra
- Population Health Transformation, Harris Health System, Houston, TX
| | - Karen C Tseng
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
| | | | - Laura S Moore
- Department of Health Promotion and Behavioral Sciences, and Nourish Program, UTHealth School of Public Health, Houston, TX
| | - Casey Durand
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX
| | - Deanna M Hoelscher
- Michael and Susan Dell Center for Healthy Living, UTHealth School of Public Health, Austin, TX
| | - Shreela V Sharma
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX
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Frayna C, Devantier C, Harris B, Kingsley K, Polanski JM. Education Regarding and Adherence to Recommended Nutrition Guidelines among Dental Students. Dent J (Basel) 2021; 9:dj9080093. [PMID: 34436005 PMCID: PMC8393618 DOI: 10.3390/dj9080093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/28/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022] Open
Abstract
The Dietary Guidelines for Americans (DGA) were developed to reduce or prevent many types of chronic illness, including cancer, heart disease and diabetes. Healthcare provider recommendations may be influenced by understanding of and adherence to the DGA, which may be incorporated into provider training, medical and dental clinical curricula—although few studies have evaluated adherence to the DGA among dental students. This approved retrospective study of voluntary student responses from a first-year dental school nutrition course included a short dietary and exercise survey administered as part of the DGA learning module. A total of N = 299 students completed the voluntary nutrition survey, yielding a response rate of 91.4%. Daily fruit and vegetable intake, dairy and whole grain servings among UNLV-SDM students were significantly lower than the DGA recommendations but higher than U.S. averages for 18–30-year-olds—although neither group met DGA recommendations. This study represents one of the first to evaluate the dietary intake of U.S. dental students for comparison with the DGA for positive health behaviors. These data demonstrate a lack of adherence to the DGA among highly educated dental students and the need for the curricular inclusion of diet and nutrition into the dental school curriculum.
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Affiliation(s)
- Camille Frayna
- Pediatric Dentistry Postgraduate Program, School of Dental Medicine, University of Nevada, 1700 W. Charleston Blvd., Las Vegas, NV 89106, USA;
| | - Christoffer Devantier
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, 1700 W. Charleston Blvd., Las Vegas, NV 89106, USA; (C.D.); (B.H.)
| | - Braden Harris
- Department of Clinical Sciences, School of Dental Medicine, University of Nevada, 1700 W. Charleston Blvd., Las Vegas, NV 89106, USA; (C.D.); (B.H.)
| | - Karl Kingsley
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, 1001 Shadow Lane, Las Vegas, NV 89106, USA;
- Correspondence: ; Tel.: +1-702-774-2623; Fax: +1-702-774-2721
| | - Joshua M. Polanski
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, 1001 Shadow Lane, Las Vegas, NV 89106, USA;
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