Associations between healthy eating patterns and indicators of metabolic risk in postmenopausal women

Association between modified youth healthy eating index and nutritional status among Iranian children in Zabol city: a cross-sectional study

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7-12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI  1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI   1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children's health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

The Relationship between Healthy Eating Index and Lipid Profile in Healthy Individuals: A Systematic Review

Background

The Healthy Eating Index (HEI) and Alternate Healthy Eating Index (AHEI) are instruments developed by competing American research teams, aiming to assess the level of adherence to a dietary pattern, claimed to prevent chronic illness conditions such as dyslipidemia. This systematic review evaluated cross-sectional studies examining the association between HEI/AHEI score and the lipid profile in healthy participants.

Methods

The systematic review was Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant, and a search process was conducted through Scopus, Web of Knowledge, Google Scholar, Cochrane, PubMed, and ScienceDirect up to November 2022. Studies assessing the relationship between HEI/AHEI and lipid profile (low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)) were eligible for inclusion. The statistical differences in outcomes, anthropometric indices, and demographic data were extracted from the selected studies. Also, the quality assessment of studies was performed using the Newcastle-Ottawa scale.

Results

The systematic search presented 17 cross-sectional studies. Most of the studies revealed a significant correlation between HEI score and lipid profile (LDL-C, HDL-C, TG, and TC) (P < 0.05), while a few of them indicated a significant relationship between AHEI score and these factors. Overall, the elevation of HEI/AHEI score was associated with the improvement in lipid profile (P < 0.05), though this association was more obvious for HEI compared with AHEI.

Conclusions

Overall, the results of the study indicated that an improved lipid profile in healthy individuals is associated with a higher score in either HEI or AHEI. Further research in the future is required to confirm the claim.

Association between healthy eating index-2015 scores and metabolic syndrome among Iranian women: a cross-sectional study

BACKGROUND

Metabolic syndrome (MetS) is one of the leading public health issues in the world with a reported prevalence of nearly 25% in the past decades in Iran. The present research aimed to identify the association between the Healthy Eating Index (HEI) and MetS components among female teachers.

METHODS

In this cross-sectional study, 97 female teachers aged 31-57 years were enrolled from 2018 to 2019 in Qom, Iran. Usual dietary intakes were assessed using a validated 168-item Food Frequency Questionnaire (FFQ). HEI-2015 was calculated according to the consumption of whole fruits, vegetables, protein foods, beans, seafood, plant proteins, total and refined grain, dairy, fatty acid ratio, saturated fats, added sugars, and sodium. We also measured anthropometric and biochemical parameters. To evaluate the association between HEI-2015 and MetS, multivariate logistic regression was performed.

RESULTS

MetS was found in 59.8% of participants. Total HEI-2015 scores were significantly lower in participants with MetS compared to those without MetS (59.69 ± 8.98 vs. 64.21 ± 8.71, respectively; p = 0.02). Daily energy intake, weight, body mass index, waist circumference, systolic and diastolic blood pressure, serum triglyceride, and fasting blood sugar levels were higher in women with MetS (all p < 0.05). Higher HEI-2015 total scores (OR: 0.94; 95% CI: 0.89-0.99; p = 0.02) and scores of total vegetables (OR: 0.62; 95% CI: 0.42-0.91; p = 0.02), dark green vegetables and beans (OR: 0.62; 95% CI: 0.39-0.98; p = 0.04), fatty acid ratio (OR: 0.83; 95% CI: 0.68-0.99; p = 0.04), refined grain (OR: 0.86; 95% CI: 0.75-0.99; p = 0.04), and added sugars (OR: 0.44; 95% CI: 0.26-0.75; p = 0.002) were all associated with lower odds of having MetS.

CONCLUSIONS

Higher HEI-2015 scores, particularly in total vegetables, dark green vegetables, beans, and fatty acid ratio, as well as refined grain and added sugars were found to be associated with reduced odds of having MetS among Iranian female teachers. However, further prospective studies are required to confirm this finding.

Dietary Patterns in 1125 Iranian Women: Adequacy of Energy and Micronutrient Intakes and Weight Statuses

Background

Women's nutrition status includes significant effects on their children and household health. The purpose of this study was to assess energy and micronutrient intake adequacy in Iranian women.

Methods

This study was a part of the Urban HEART Study, which has jointly been developed by the World Health Organization (WHO) Centre for Health Development, Kobe, Japan. In total, anthropometric and dietary intake data were collected from 1125 women in southern Tehran municipality districts. A 24-h recall questionnaire was completed by the expert nutritionists and the participants' anthropometric statuses were assessed. Food intakes were calculated in grams per capita per day. Micronutrients and energy requirements were adapted from WHO/Food and Agriculture Organization (FAO) tables and Iran National Food Consumption Survey, respectively.

Results

Nearly 71.5% of the women were overweight or obese [body mass index (BMI) ≥25 kg/m2]. Furthermore, 1.2% of the women were underweight (BMI <18.5 kg/m2), while 27.3% had normal weight (BMI = 18.5--24.9 kg/m2). The mean bread/cereal and vegetable intakes were significantly higher in obese group, compared to that in normal/under/overweight group (375.6 g/day ± 151.4, P = 0.05; and 331.4 g/day ± 227.5, P = 0.02), respectively]. Women in the lean group significantly consumed higher quantities of cakes/pastries and had the lowest calcium and iron adequacy ratios, compared to other groups (p = 0.001, P = 0.03, and P = 0.05, respectively).

Conclusions

These findings suggest that Iranian women, especially those who reside in the southern areas of Tehran, need to change their dietary habits to maintain their health. Moreover, being under/normal weight does not necessarily mean following healthy diets.

Coconut Oil Saturated Fatty Acids Improved Energy Homeostasis but not Blood Pressure or Cognition in VCD-Treated Female Mice

Obesity, cardiometabolic disease, cognitive decline, and osteoporosis are symptoms of postmenopause, which can be modeled using 4-vinylcyclohexene diepoxide (VCD)-treated mice to induce ovarian failure and estrogen deficiency combined with high-fat diet (HFD) feeding. The trend of replacing saturated fatty acids (SFAs), for example coconut oil, with seed oils that are high in polyunsaturated fatty acids, specifically linoleic acid (LA), may induce inflammation and gut dysbiosis, and worsen symptoms of estrogen deficiency. To investigate this hypothesis, vehicle (Veh)- or VCD-treated C57BL/6J mice were fed a HFD (45% kcal fat) with a high LA:SFA ratio (22.5%: 8%), referred to as the 22.5% LA diet, or a HFD with a low LA:SFA ratio (1%: 31%), referred to as 1% LA diet, for a period of 23 to 25 weeks. Compared with VCD-treated mice fed the 22.5% LA diet, VCD-treated mice fed the 1% LA diet showed lower weight gain and improved glucose tolerance. However, VCD-treated mice fed the 1% LA diet had higher blood pressure and showed evidence of spatial cognitive impairment. Mice fed the 1% LA or 22.5% LA diets showed gut microbial taxa changes that have been associated with a mix of both beneficial and unfavorable cognitive and metabolic phenotypes. Overall, these data suggest that consuming different types of dietary fat from a variety of sources, without overemphasis on any particular type, is the optimal approach for promoting metabolic health regardless of estrogen status.

Associations of Diet Quality and Heavy Metals with Obesity in Adults: A Cross-Sectional Study from National Health and Nutrition Examination Survey (NHANES)

A poor diet cannot fully explain the prevalence of obesity. Other environmental factors (e.g., heavy metals) have been reported to be associated with obesity. However, limited evidence is available for the combined effect of these factors on obesity. Therefore, we conducted a cross-sectional study and used the data from the National Health and Examination Survey (2007−2018) to explore the associations between diet quality and heavy metals and obesity. Diet quality was evaluated by the Healthy Eating Index-2015 (HEI-2015) score. Heavy metals included serum cadmium (Cd), lead (Pb), and mercury (Hg). We included 15,959 adults, with 5799 of obesity (body mass index ≥ 30 kg/m2). After adjustment for covariates, every interquartile range increase in HEI-2015 scores, Pb, Cd and Hg was associated with a 35% (odds ratios [OR] = 0.65, 95% confidence interval [CI]: 0.60, 0.70), 11% (OR = 0.89, 95% CI: 0.82, 0.98), 9% (OR = 0.91, 95% CI: 0.87, 0.96), 5% (OR = 0.85, 95% CI: 0.82, 0.89) reduction in risk of peripheral obesity, respectively. In addition, the association between the HEI-2015 scores and peripheral obesity was attenuated by higher levels of heavy metals (All p interaction < 0.05). Results remained similar for abdominal obesity. Our study reveals the distinct effects of a high-quality diet and heavy metals on obesity prevalence, and the beneficial effect of a high-quality diet could be weakened by higher levels of heavy metals.

Association of Dietary Pattern with Cardiovascular Risk Factors among Postmenopausal Women in Taiwan: A Cross-Sectional Study from 2001 to 2015

Unhealthy diet and inappropriate lifestyle contribute to an imbalance in cardiometabolic profiles among postmenopausal women. This research aimed to analyze the association between dietary pattern and changes in cardiovascular risk factors among postmenopausal Taiwanese women using binary logistic regression. This cross-sectional study involved 5689 postmenopausal Taiwanese women aged 45 years and above, and the data were obtained from Mei Jau Health Management Institution database between 2001 and 2015. The cardiovascular risk dietary pattern characterized by high intakes of processed food, rice/flour products, organ meat, and sauce was derived by reduced rank regression. Participants in the highest quartile of the cardiovascular risk dietary pattern were more likely to have high levels of systolic blood pressure (OR = 1.29, 95% CI 1.08-1.53), diastolic blood pressure (OR = 1.28, 95% CI 1.01-1.62), atherogenic index of plasma (OR = 1.26, 95% CI 1.06-1.49), triglycerides (OR = 1.38, 95% CI 1.17-1.62), and fasting blood glucose (Q3: OR = 1.45, 95% CI 1.07-1.97). However, this dietary pattern was not correlated with total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and C-reactive protein. Therefore, adherence to the cardiovascular risk dietary pattern increases the risk of having higher levels of blood pressure, triglycerides, fasting blood glucose in postmenopausal Taiwanese women.

Whole-diet interventions and cardiovascular risk factors in postmenopausal women: A systematic review of controlled clinical trials

OBJECTIVES

Menopause is accompanied by many metabolic changes, increasing the risk of cardiometabolic diseases. The impact of diet, as a modifiable lifestyle factor, on cardiovascular health in general populations has been well established. The purpose of this systematic review is to summarize the evidence on the effects of whole diet on lipid profile, glycemic indices, and blood pressure in postmenopausal women.

METHODS

Embase, Medline, Cochrane Central Register of Controlled Trials, and Google Scholar were searched from inception to February 2021. We included controlled clinical trials in postmenopausal women that assessed the effect of a whole-diet intervention on lipid profile, glycemic indices, and/or blood pressure. The risk of bias in individual studies was assessed using RoB 2 and ROBINS-I tools.

SUMMARY OF EVIDENCE

Among 2,134 references, 21 trials met all eligibility criteria. Overall, results were heterogenuous and inconsistent. Compared to control diets, some studies showed that participants experienced improvements in total cholesterol (TC), low-density lipoprotein cholesterol (LDL), systolic blood pressure (SBP), fasting blood sugar (FBS), and apolipoprotein A (Apo-A) after following fat-modified diets, but some adverse effects on triglycerides (TG), very low-density lipoprotein cholesterol (VLDL), lipoprotein(a) (Lp(a)), and high-density lipoprotein cholesterol (HDL) concentrations were also observed. A limited number of trials found some effects of the Paleolithic, weight-loss, plant-based, or energy-restricted diets, or of following American Heart Association recommendations on TG, TC, HDL, insulin, FBS, or insulin resistance.

CONCLUSION

Current evidence suggests that diet may affect levels of some lipid profile markers, glycemic indices, and blood pressure among postmenopausal women. However, due to the large heterogeneity in intervention diets, comparison groups, intervention durations, and population characteristics, findings are inconclusive. Further well-designed clinical trials are needed on dietary interventions to reduce cardiovascular risk in postmenopausal women.

Is any association between alternate healthy eating index (AHEI) with lipid profile and liver enzymes? A cross-sectional Study

PURPOSE

Based on evidence, there is a significant relationship between diet quality and the chronic conditions such as dyslipidemia and liver disorders. In the current study, we investigated the relationship between alternative healthy eating index (AHEI) and some biochemical measurements (lipid profile and liver enzymes).

METHODS

In this cross-sectional study, 127 hospital employees were randomly selected (of 250 screened volunteers). AHEI was estimated based on a 168 items food frequency questionnaire. The laboratory data [triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), alanine transaminase (ALT), aspartate transaminase (AST)] were extracted from periodic examinations. The physical activity was also estimated with international physical activity questionnaire (IPAQ).

RESULTS

Among 127 completed data, the mean AHEI score was 47.1. There was a direct relationship between AHEI score and HDL (P = 0.02). Among the AHEI components, the score of nuts and soybeans was directly associated with HDL level (P = 0.007). There was no association between the other AHEI components and selected biomarkers.

CONCLUSION

Nuts and soybeans consumption-one unit per day-may increase HDL levels. More studies are needed to evaluate the diet quality with the other dietary indices.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40200-021-00898-w.

Is there a relationship between diet quality and bone health in elderly women? A cross-sectional study

OBJECTIVE

To evaluate whether there is a relationship between diet quality and bone health in a group of elderly Brazilian women.

METHODS

A cross-sectional study was performed with 105 elderly women. Participants were evaluated regarding diet quality (good, needing improvement, and poor) and its relationship with bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), and C-telopeptide (CTX).

RESULTS

Fifty eight participants (55.2%) presented a poor-quality diet and 47 (44.8%) required dietary improvements, while no subjects presented a good quality diet. The group requiring dietary improvements had lower CTX [0.35 (0.05;1.09) vs. 0.52 (0.10;1.45); p = 0.03)] and BSAP (38.7 ± 12.9 U/L vs. 46.10 ± 15.2 U/L; p < 0.01) levels than the poor-quality diet group. Groups did not differ in terms of BMD.

CONCLUSION

In this group of elderly Brazilian women, there was a relationship between diet quality and bone health, where worse diet quality was associated with higher levels of bone remodelling markers.

Association between nutrition labelling awareness and the metabolic syndrome: results from the Korean National Health and Nutrition Examination Survey (KNHANES) 2016-2018

Healthy dietary habits reduce the likelihood for the metabolic syndrome (MS). The present study investigated whether awareness of nutrition information is associated with a decreased likelihood for the MS after adjusting for potential confounders among Korean adults aged 20 years and older. Data were obtained from the Korean National Health and Nutrition Examination Survey 2016-2018. Of the 14 490 participants, 4001 (27·6 %) participants had the MS. In total, 3815 (26·3 %) participants checked nutritional facts and made labelling-dependent purchasing decisions (aware + consider), 7001 (48·3 %) checked nutritional facts but did not make labelling-dependent purchasing decisions or were aware of nutrition facts but did not check them when making food purchasing decisions (aware + not consider) and 3674 (25·4 %) were unaware of nutritional facts (not aware). The aware + consider group was less likely to develop the MS than other groups. The aware + not consider, and not aware groups were at higher association with the MS compared with the aware + consider group. Statistically significant associations were observed between the MS and several demographic characteristics including sex, age, household income, education level, employment status, public health insurance status, smoking status, alcohol consumption and aerobic exercise.

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.

Analysis of the Impact of Type 2 Diabetes on the Psychosocial Functioning and Quality of Life of Perimenopausal Women

Menopause is a natural period resulting from the decrease in hormonal activity of the ovaries. Growing hormonal deficiencies and changes in the body influence a variety of functions in women, leading to depression and decreased quality of life. The relationship between body composition, the severity of depressive and climacteric symptoms and the quality of life of women with type 2 diabetes and healthy women in the perimenopausal period was studied. Statistically significant differences were observed between the study and control groups regarding all body composition parameters except for protein and the content of torso soft tissues (p < 0.05). In both the study and control groups, resulting symptoms were significantly correlated with numerous body composition parameters (e.g., body mass, fat tissue mass, minerals, abdominal circumference), while symptoms of depression were significantly correlated with similar parameters only in the control group. A statistically relevant relationship was observed between the study and control groups with respect to quality of life in certain domains. The quality of life of women suffering from type 2 diabetes was worse compared with healthy women. Analysis of body composition showed significant differences between healthy women and those with type 2 diabetes. Healthy women showed a tendency to establish a link between body composition and depressiveness.

FADS1 and FADS2 polymorphism are associated with changes in fatty acid concentrations after calorie-restricted Central European and Mediterranean diets

OBJECTIVE

In the present study, we tested whether calorie-restricted diets differing in their percentage of energy derived from monounsaturated fatty acids and carbohydrates can affect the metabolism of fatty acids (FAs) in postmenopausal women. Moreover, we examined whether polymorphisms of FADS1 and FADS2 are associated with these changes.

METHODS

Postmenopausal women (the mean age: 60.5 ± 5.0 y) were randomized for 16 weeks to two different calorie-restricted diets: a Central European diet (CED) or a Mediterranean diet (MED).

RESULTS

After the intervention, levels of most FAs in red blood cells decreased in both groups. The delta values for the 20:1n-9 and the 20:2n-6 levels differed between the CED and the MED (-1.55 ± 4.02 μg/mL vs 0.39 ± 4.11 μg/mL and -0.62 ± 10.93 μg/mL vs 3.06 ± 8.75 μg/mL; P < 0.05). Women in the CED group with at least one minor allele of FADS genes had greater decreases of α-linolenic acid, dihomo-γ-linolenic acid, total n-6, and total PUFA (by approximately 70%, 40%, 35%, and 35%, respectively) than did women with the major alleles. After the intervention, the change in the lipid accumulation product index was -28.28 ± 27.84 and -32.00 ± 78.55 in the CED and the MED group, respectively.

CONCLUSIONS

The effect of the dietary intervention on FA metabolism seems to depend mostly on calorie restriction, but not on type of diet. FADS1 and FADS2 gene polymorphisms can modify the response to the CED.

Associations between Fatty Acid Intake and Status, Desaturase Activities, and FADS Gene Polymorphism in Centrally Obese Postmenopausal Polish Women

Fatty acid (FA) status is associated with the risk of several diet-related diseases. Since postmenopausal women are at increased risk of cardiometabolic disturbances, determinants of FA metabolism should be fully understood in this group. We hypothesize that FA metabolism in postmenopausal Polish women may depend on current macronutrient intake and on fatty acid desaturase (FADS) gene polymorphism. One-hundred-and-twenty-eight postmenopausal women with central obesity were recruited to the study and their dietary intake, FA composition in red blood cells (RBC), and rs174556, rs174561, rs174547, and rs3834458 polymorphism of the FADS gene were analyzed. Higher levels of 18:2n-6t level in RBC were associated with higher protein or fat intake or with lower carbohydrate intake. The minor allele carriers of rs174561 of the fatty acid desaturase 1 (FADS1) gene had 9.7% lower concentration of 20:4n⁻6 in RBC (p < 0.05), but there were no other associations between other FA in RBC levels and FADS1 or fatty acid desaturase 2 (FADS2) polymorphisms. The mean D5D value was 15.3⁻17.9% lower in the minor allele carriers of each SNPs. We concluded that protein and carbohydrate intake may be associated with FA concentrations in RBC in centrally obese postmenopausal Polish women. The D5D value may be affected by FADS1 or FADS2 polymorphism.

Factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia

OBJECTIVE

To determine factors associated with different symptom domains among postmenopausal Saudi women in Riyadh, Saudi Arabia.

METHODS

In a cross-sectional study, interviews were conducted with 542 postmenopausal Saudi women, comprising sociodemographic history, social support, and the Menopause-specific Quality of Life questionnaire.

RESULTS

The mean age of participants was 58 (±7.0) years, and the mean age at menopause was 49 (±4.7) years. We found that 41% (n = 224), 14.4% (n = 78), 57% (n = 307), and 12.7% (n = 69) of women reported severe/moderate impact of vasomotor, psychosocial, physical, and sexual symptoms, respectively. Multivariate logistic regression revealed that lacking emotional support was associated with severe/moderate vasomotor (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.1, 2.3), psychosocial (aOR 2.0, 95% CI 1.2, 3.4), and physical (aOR 1.7, 95% CI 1.2, 2.6) symptoms. Lack of tangible social support was associated with severe/moderate sexual symptoms (aOR 1.9, 95% CI 1.0, 3.4). In addition, women who worked (aOR 1.8, 95% CI 1.1, 3.2), were obese (aOR 2.0, 95% CI 1.0, 4.1), lived in rented accommodations (aOR 3.9, 95% CI 1.2, 13.1), or had a retired spouse (aOR 1.6, 95% CI 1.0, 2.4) had higher odds for moderate/severe menopausal symptoms.

CONCLUSIONS

Establishing educational and counseling programs for postmenopausal women, their spouses, and other family members could improve social support and hence quality of life of postmenopausal women. Effective preventive strategies to deal with modifiable risk factors, such as obesity and work stress, should also be implemented.

A systematic review of diet quality indices in relation to obesity

Tools, called ‘diet/dietary quality indices’, evaluate the level of adherence to a specified pattern or a set of recommendations in populations. Yet, there are no review studies providing unanimous comprehensive results of dietary indices on obesity. We reviewed observational studies, focusing on the association of diet quality indices with general obesity or abdominal obesity in adults. We systematically conducted a search in all English language publications available on MEDLINE, ISI Web of Science and Embase between January 1990 and January 2016. Among the wide variety of indices and weight-derived variables, studies with dietary-guideline-based indices and mean changes for weight gain or OR for general obesity and abdominal obesity were selected. From a total of 479 articles, thirty-four studies were selected for the current review, ten of which had prospective designs and twenty-six had cross-sectional designs. Associations of weight status with the original Healthy Eating Index (HEI) and other versions of the HEI including alternative HEI, HEI-2005 and HEI-05 were examined in thirteen studies, with ten studies revealing significant associations. The HEI was a better general obesity predictor in men than in women. Diet scores lacked efficacy in assessing overall diet quality and demonstrated no significant findings in developing countries, in comparison with US populations. In addition, indices based on dietary diversity scores were directly associated with weight gain. Despite the insufficient evidence to draw definitive conclusions about the relation between dietary indices and obesity, HEI was found to be inversely associated with obesity and diversity-based indices were positively associated with obesity.

Description of the healthy eating indices-based diet quality in Turkish adults: a cross-sectional study

OBJECTIVES

This study aims to describe the dietary status of Turkish adults using two different versions of the Healthy Eating Index (HEI).

METHODS

In this cross sectional study, 494 healthy participants (311 females) with randomly selected and living in Ankara were included between September 2013 and March 2014. A questionnaire was completed and anthropometric measurements (weight and height) were performed. The 24-h dietary recall of individuals was collected. Diet quality was measured through HEI-2005 and HEI-2010 scores.

RESULTS

The mean age, body mass index (BMI), HEI-2005 and HEI-2010 scores of individuals were 32.9 ± 10.8 years; 25.0 ± 4.8 kg/m²; 56.1 ± 13.9 and 41.5 ± 13.7 points, respectively. Significant differences were found between mean HEI-2005 and HEI-2010 scores (p < 0.05). The individual's whose diet quality needs to be improved according to mean HEI-2005 score, had poorer diet based on mean HEI-2010 scores. The highest mean HEI-2005 and HEI-2010 scores were stated in female, in subjects had low education levels, aged 51 years or older and in overweight groups (p <0.05). Both versions of healthy eating indices were correlated positively with BMI and age CONCLUSION: Diet qualities of the individuals are associated with age, gender, education and BMI. Although the components and scores in HEI-2010 version were changed from the version of HEI-2005, the changes may encourage healthy choices of some food group. HEI-2010 gives more attention to food quality than HEI-2005. Thus, in the present study it was concluded that HEI-2010 provided more precise results about diet quality.

Diet quality in obese/overweight individuals with/without metabolic syndrome compared to normal weight controls

BACKGROUND

Metabolic syndrome (MetS) is a serious public health concern worldwide; however, the pathogenesis of this disease has not been yet cleared. This study aimed to compare diet quality in obese/overweight participants with/without metabolic syndrome with normal weight controls.

METHODS

This was a comparative study on 147 Iranian adults under treatment at the Endocrinology Center of Tehran University of Medical Sciences. They were assigned into three groups (normal weight, obese weight with/without MetS) according to the inclusion- exclusion criteria. Metabolic syndrome was defined according to the NCEP ATPIII consensus criteria. Healthy Eating Index Data were obtained from the validated FFQ to determine the diet quality index scores, using the Healthy Eating Index-2010.

RESULTS

Our findings demonstrated that FBS, TG, SBP, WC and weight were higher among MetS patients compared to the both weight matched and non-weight matched participants, while HDL-c was lowest in this group (p<0.05). A statistically significant difference was found between healthy weight controls and obese/overweight participants with/without MetS in HEI-2010, and 9 of the 12 HEI-2010 components score (p<0.05).

CONCLUSION

Our study revealed that low diet quality was a risk factor in developing MetS.

Association between quality of the diet and cardiometabolic risk factors in postmenopausal women

BACKGROUND

Climateric is a phase of women's life marked by the transition from the reproductive to the non-reproductive period. In addition to overall weight gain, the menopause is also associated with the increase of abdominal fat. We used The Healthy Eating Index as a summary measure to evaluate the major components and the quality of women's diet after the onset of the menopause. This study aims at examining the association between the quality of the diet and cardiometabolic risk factors in postmenopausal women.

METHODS

Cross-sectional study including 215 postmenopausal women attending a public outpatient clinic. The 24-hour dietary recall method was used to assess the food intake and to establish the Healthy Eating Index. Diets were then classified as appropriate diet (>80 points), diet "requiring improvement" (80-51 points), and poor diet (<51 points). Cardiometabolic risk factors included abdominal obesity, dyslipidemia, diabetes mellitus, and hypertension. The Fisher's exact test was utilized for the Statistical analysis.

RESULTS

The analysis of the food intake showed that the average daily intake of lipids (36.7%) and sodium (2829.9 mg) were above the recommended. Only 8.8% of the women performed moderate or intense physical exercises on a regular basis. The diet was considered poor in 16.3%, "requiring improvement" in 82.8%, and appropriate for only 0.9% of the women. The study detected increased waist circumference in 92.1% of the participants. The mean concentration of triglycerides was of 183.3 mg/dl, and 130.7 mg/dl for cholesterol (Low Density Lipoprotein).

CONCLUSION

Women consume a low quality diet, possibly due to the low intake of vegetables and fruits and excessive consumption of sodium. These inappropriate eating habits are associated with and, have a negative impact on the cardiometabolic risk factors such as abdominal obesity.

A randomized clinical trial of nutrition education for improvement of diet quality and inflammation in Iranian obese women

Background. Obesity is considered as a low grade inflammation condition. The aim of this study was to investigate the effect of nutritional education on diet quality and biomarkers of inflammation in Iranian obese women. Method. Sixty obese women voluntarily participated in this randomized clinical trial and were randomly assigned to intervention or control group (n = 30). Intervention group was instructed to attend nutrition education sessions (1 hr/wk, for 3 months) in small groups. Diet quality scores were measured by Healthy Eating Index (HEI). Anthropometric indices and serum concentration of hs-CRP, TNF-α, and adiponectin were measured at the baseline and end of the intervention. Results. There were no significant differences in anthropometric indices of participants between the two groups at the end of intervention (P > 0.05). However, the total HEI score was significantly higher in the educated group compared to the control group after intervention (P < 0.05). The educated group also showed significant lower concentration of TNF-α and hs-CRP and higher levels of adiponectin than the control group at the end of study (P < 0.05). Conclusions. Our results provide limited evidence that higher dietary quality contributes to reduced inflammation in obese women. This effect could be independent of the weight loss.

Mediterranean diet and carotid atherosclerosis in the Northern Manhattan Study

OBJECTIVE

Adherence to a Mediterranean-style diet (MeDi) may protect against clinical vascular events by reducing atherosclerosis, but data is limited. This is the first observational study of the association between MeDi adherence and carotid plaque thickness and area.

METHODS

The study included 1374 participants of the population-based Northern Manhattan Study with diet assessed and carotid intima-media thickness (cIMT) and plaque measured using B-mode ultrasound (mean age 66 ± 9 years, 60% female, 60% Hispanic, 18% White, 19% Black). A MeDi adherence score (range = 0-9, 9 representing maximal adherence) was examined continuously and in quintiles (3/4/5/6-9 vs. 0-2).

RESULTS

Mean cIMT = 0.9 ± 0.1 mm and 57% had plaque (median plaque thickness = 1.5 mm, 75th percentile = 2.2; median plaque area = 4.2 mm(2), 75th percentile = 15.8). There was no association between MeDi and cIMT or plaque presence. MeDi adherence was inversely associated with the 75th percentile of plaque thickness and median of plaque area in quantile regression analyses. These associations persisted after controlling for demographics, smoking, physical activity, and total energy consumption (effect of a 1-point increase in MeDi score on the 75th percentile of plaque thickness = -0.049 mm, p = 0.03; median of plaque area = -0.371 mm(2), p = 0.03), and when additionally controlling for vascular disease biomarkers, medication use, BMI, and previous cardiac disease. The protective associations appeared strongest for those with a MeDi score of 5 (4th quintile) vs. 0-2 (bottom quintile). Differential effects of a MeDi on plaque thickness and area across race/ethnic groups was suggested.

CONCLUSIONS

Moderate and strict adherence to a MeDi may protect against a higher burden of carotid atherosclerotic plaque, which may mediate the protection against clinical vascular events. Efforts to improve adherence to a MeDi are critical to reducing the burden of atherosclerotic disease.

Individual differences as predictors of dietary patterns among menopausal women with arterial hypertension

INTRODUCTION

The aim of this study was to analyze selected individual determinants of dietary choices, important for etiology and prevention of degenerative cardiovascular disorders, in a group of menopausal women diagnosed with arterial hypertension.

MATERIAL AND METHODS

The study included a group of 160 women from the Małopolska region, aged between 45 and 60 years and diagnosed with arterial hypertension. A questionnaire assessing the frequency of food product consumption was used, along with standardized psychological tests (GSES, LOT-R, and SWLS). Spearman's coefficients of rank correlation and the Kruskal-Wallis and Dunn tests were used for statistical analysis.

RESULTS

We revealed that higher levels of self-efficacy were associated with more frequent consumption of whole grains, oatmeal, raw vegetables, fruit, semi-skimmed milk, natural yoghurt, marine fish, legume seeds, soy products, nuts, plant oils, and fruit and vegetable juices, as well as with less frequent consumption of whole milk, high-fat cottage cheese, and sweetened carbonated beverages and alcoholic beverages. The levels of optimism and satisfaction with life correlated positively with the consumption frequency of brown rice, whole grains, oatmeal, fruit, marine fish, legumes, soy products, nuts, butter, and fruit juices, and were inversely correlated with the consumption of white bread, high-fat cottage cheese, pork meat and sausages, and sweets and pastries.

CONCLUSIONS

Postmenopausal women with arterial hypertension who were characterized by lower levels of self-efficacy, optimism, and satisfaction with life made less rational dietary choices which could negatively affect the efficacy of the secondary prevention of cardiovascular degenerative disorders.

Association between dietary intake and seasonal variations in postmenopausal women

Background

Evidence supports that increasing number of postmenopausal women are suffering from one or more chronic diseases. Dietary patterns have a pivotal role in maintaining human health. The aim of this study was to characterize the nutrients and energy intake in postmenopausal women, with the special focus on seasonal variation effect in their food intake.

Methods

The study population consisted of 30 postmenopausal women referred to Dr. Shariati Hospital, Tehran (Iran). Socio-demographic characteristics and BMI were registered. Dietary assessment was performed by a 3 day food records in each season through one year, allowing the estimation of energy, protein, carbohydrate, total fat, monounsaturated fatty acid (MUFA), polyunsaturated fatty acids (PUFA) and saturated fatty acids (SFA) intake. The mean of nutrient intake in each season was adjusted for energy intake. The effect of season on energy and nutrients intake was assessed based on the General linear model (GLM).

Results

The mean of daily intake of vitamin C, B, B2, B12, iron, zinc, phosphorus and chromium was significantly higher than Recommended Dietary Allowance (RDAs ) (p < 0.05). The mean of vitamin D, E, B6, B5, folate, calcium, magnesium, potassium and selenium consumption was significantly less than RDAs (p < 0.05). All the participants meet the goal for vitamins A, K and B3 from food. The mean of energy intake was not different between seasons. However, the mean intake of fat, vitamin C, vitamin K and folate was significantly different between seasons.

Conclusion

These findings highlight some nutrients deficiency in postmenopausal women and therefore suggest nutritional education with emphasis on seasonal variation effect.

Non-alcoholic fatty liver disease and its associated risk factors in Brazilian postmenopausal women

OBJECTIVE

To evaluate the prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) in postmenopausal women.

METHODS

A cross-sectional study was carried involving 188 women (age ≥ 45 years and amenorrhea ≥ 12 months) attending the outpatient unit in south-eastern Brazil. Exclusion criteria were liver disease (hepatitis B and C, cholestatic disease, liver insufficiency), use of drugs that affect liver metabolism; alcoholics; AIDS or cancer history; and morbid obesity. NAFLD was diagnosed by abdominal ultrasound. Clinical, anthropometric (body mass index, waist circumference) and biochemical variables were measured.

RESULTS

Of the 188 women, 73 (38.8%) had NAFLD. Blood pressure, waist circumference, body mass index, LDL cholesterol, triglycerides and glucose were significantly higher in NAFLD patients when compared with women without NAFLD (control group) (p < 0.05). HOMA-IR values indicated insulin resistance only in the NAFLD group (6.1 ± 4.6 vs. 2.4 ± 1.4 in control group, p < 0.05). Metabolic syndrome was detected in 93.1% of the women affected by NAFLD, and 46.1% of the control group (p < 0.05). In multivariate analysis, adjusted for age and weight, the variables considered at risk for the development of NAFLD, were: high waist circumference (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.13), insulin resistance (OR 3.81, 95% CI 2.01-7.13), and presence of metabolic syndrome (OR 8.68, 95% CI 3.3-24.1).

CONCLUSION

NAFLD showed a high prevalence among postmenopausal women. The presence of metabolic syndrome, abdominal obesity and IR were indicators of risk for the development of NAFLD.

Monitoring and benchmarking population diet quality globally: a step-wise approach

INFORMAS (International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support) aims to monitor and benchmark the healthiness of food environments globally. In order to assess the impact of food environments on population diets, it is necessary to monitor population diet quality between countries and over time. This paper reviews existing data sources suitable for monitoring population diet quality, and assesses their strengths and limitations. A step-wise framework is then proposed for monitoring population diet quality. Food balance sheets (FBaS), household budget and expenditure surveys (HBES) and food intake surveys are all suitable methods for assessing population diet quality. In the proposed 'minimal' approach, national trends of food and energy availability can be explored using FBaS. In the 'expanded' and 'optimal' approaches, the dietary share of ultra-processed products is measured as an indicator of energy-dense, nutrient-poor diets using HBES and food intake surveys, respectively. In addition, it is proposed that pre-defined diet quality indices are used to score diets, and some of those have been designed for application within all three monitoring approaches. However, in order to enhance the value of global efforts to monitor diet quality, data collection methods and diet quality indicators need further development work.

Dietary energy density is inversely associated with the diet quality indices among Iranian young adults

Dietary energy density (DED) might be associated with the quality of the consumed diet. Therefore, this study was conducted to report the relationship between dietary energy density and diet quality index in Iranian youths. In this cross-sectional study we enrolled 410 female young adults in Isfahan-Iran who were selected according to the stratified random sampling method from among students of Isfahan University of Medical Sciences. A validated semi quantitative food frequency questionnaire was used to assess the usual dietary intakes. Dietary energy density was calculated as each individual's reported daily energy intake (kcal/d) into total weight of foods (excluding beverages) consumed (g/d). Diet quality was assessed by healthy eating index (HEI), nutrient adequacy ratio (NAR), and mean adequacy ratio (MAR). For calculating the NAR the ratio of daily individual intakes to standard recommended amounts for the subject's sex and age category was used. MAR was calculated as the sum of NARs divided by the number of nutrients (n=10). Mean dietary energy density was 1.5±0.2 kcal/g and mean HEI was 57.5±16.0. Those in the highest quartile of DED had the lowest value for HEI, MAR, and NAR of zinc, calcium, vitamin C, vitamin B12 and vitamin B2 (p<0.05). Those in the highest quartile of DED had the highest prevalence of calcium, zinc, vitamin B2, vitamin B12, and vitamin C deficiency (p<0.05). Dietary energy density was inversely associated with the diet quality indices among Iranian young women adults.

Food habits, socioeconomic status and body mass index among premenopausal and post-menopausal women in Mauritius

BACKGROUND

Although many health disparities arise as a result of socioeconomic inequalities, less is known about the diet quality of women after menopause. The present study aimed to determine the factors affecting food habits and body mass index (BMI) among premenopausal and post-menopausal Mauritian working women.

METHODS

The study was conducted as a cross-sectional survey in different workplaces located in the nine districts of Mauritius. Mauritian women (n = 400; 215 premenopausal, 185 post-menopausal) were recruited using stratified random sampling. Participants completed a self-reported questionnaire comprising a food frequency questionnaire previously constructed and used to address dietary guidelines that assess the intake of vegetables, fruits, dairy products, cereals, high- and low-fat protein sources, fats and sweetened beverages, as well as questions aiming to elicit socioeconomic profile, menopausal status, physical activity level and demographic data. Height, weight, waist and hip circumferences were measured. An independent sample t-test, chi-squared test and one-way analysis of variance were used for the statistical analyses.

RESULTS

The mean dietary guideline score was significantly higher for post-menopausal than premenopausal women, (P = 0.017). Each socioeconomic status (SES) category of post-menopausal women also demonstrated a higher dietary guideline score than that of premenopausal women (P > 0.05). A high BMI was significantly associated with a low SES of participants (P = 0.042) and post-menopausal stage (P = 0.001).

CONCLUSIONS

Low SES and post-menopausal stage are risk factors for obesity among female workers in Mauritius. Although post-menopausal women ate a better diet, their mean BMI was higher than that of premenopausal women.

Baseline determinants of global diet quality in older men and women from the NuAge cohort

Judicious food choices are of prime importance during aging.

OBJECTIVES

This study was conducted to identify individual and collective attributes determining global diet quality (DQ).

METHODOLOGY

Participants were 1,793 adults (52% women) from the NuAge study on nutrition and successful aging. Subjects aged 67 to 84 years in relatively good health were recruited from the Québec Medicare Database. Sociodemographic, affective, and cognitive data, health conditions, perceived physical health and functional status, dietary habits and dietary attributes and community resources were obtained using questionnaires. Body weight and height were measured and body mass index (BMI) was calculated. Three non-consecutive 24-hour diet recalls were collected at recruitment. DQ, assessed using the Canadian Healthy Eating Index (C-HEI, /100), was computed on the mean intakes from the diet recalls. Analyses were stratified by gender. Variables significantly related to DQ in bivariate analyses (p<.05) were entered into backward stepwise multiple regression analyses.

RESULTS

Among men, the final model showed higher education (β=0.23, p=.01), diet knowledge (β=0.96, p<.0001), number of daily meals (β=1.91, p=.02) and perceived physical health (β=0.06, p=.01) to be positive determinants of DQ, whereas alcohol consumption (β=-2.25, p=.05), wearing dentures (β=-2.31, p=.01) and eating regularly in restaurants (β=-1.65, p=.03) were negative determinants of DQ (adjusted R2 = 13.7%). Among women, higher education (β=0.29, p=.002), diet knowledge (β=0.54, p=.002), number of daily meals (β=3.61, p<.0001), and hunger (β=0.61, p<.0001) were positive determinants of global DQ; greater BMI (β=-0.16, p=.03) and chewing problems (β=-0.48, p=.03) were negative determinants of DQ (adjusted R2 = 7.8%).

DISCUSSION

These results point to several key factors influencing global DQ in older adults and also show gender-based differences. More research must be done to better understand how these factors change with aging and exert their impact on diet, particularly since variance in DQ was largely unexplained. As diet knowledge was an independent predictor for both genders, targeted, sustainable interventions are needed to ensure good diet quality as people age.