Diet quality and blood pressure among pregnant women with overweight or obesity: A secondary analysis of two randomized controlled trials

INTRODUCTION

Maternal obesity is a significant risk factor for hypertensive disorders of pregnancy. High diet quality may protect against this, yet data regarding the relationship between diet quality and blood pressure among pregnant women with raised body mass index (BMI) is limited.

MATERIAL AND METHODS

This is a secondary analysis (n = 543) of women with BMI ≥25 kg/m2 from two randomized controlled trials; PEARS (Pregnancy Exercise and nutrition Research Study with smartphone application support) and ROLO (Randomized cOntrol trial of LOw glycemic index diet to prevent macrosomia in euglycemic women). Blood pressure was measured at 10-18 weeks and 28 weeks of pregnancy. Mean arterial pressure was calculated as (diastolic blood pressure+ 1 3 × $$ +\frac{1}{3}\times $$ [systolic blood pressure - $$ - $$  diastolic blood pressure]). Diet quality was assessed using 3-day food diaries, and Alternative Healthy Eating Index for Pregnancy (AHEI-P) scores were generated, quantifying alignment of food intakes with dietary guidelines in first and early third trimesters. The cohort was divided based on AHEI-P tertiles to explore differences at an alpha significance value of <0.05.

RESULTS

The mean age of the group was 32.21 ± 4.39 years with a median body mass index (BMI) of 28.13 (IQR 3.47) kg/m2 . Mean arterial pressures in the first and third trimesters were 81.07 ± 9.00 mmHg and 82.33 ± 7.53 mmHg, respectively. Rates of elevated blood pressure (≥120/80 mmHg) were 22.33% in trimester 1 and 24.48% in early trimester 3. Mean AHEI-P scores in trimester 1 and early trimester 3 were 53.90 ± 10.43 and 54.05 ± 10.76, respectively. There was no correlation between AHEI-P score and blood pressure and no differences in blood pressure between AHEI-P tertiles at either timepoint (all P-values <0.05). A higher proportion of those with elevated early third trimester blood pressure had a BMI of ≥30 kg/m2 compared with those with normal blood pressure (40.31% vs 28.64%, P = 0.016).

CONCLUSIONS

While diet remains an important factor in maternal health and wellbeing, we did not find a relationship between diet quality as measured by AHEI-P and blood pressure among pregnant women with BMI ≥25 kg/m2 . High BMI remains a risk factor for hypertensive disorders of pregnancy.

Plasma lipidomic markers of diet quality are associated with incident coronary heart disease in American Indian adults: the Strong Heart Family Study

BACKGROUND

Identifying lipidomic markers of diet quality is needed to inform the development of biomarkers of diet, and to understand the mechanisms driving the diet- coronary heart disease (CHD) association.

OBJECTIVES

This study aimed to identify lipidomic markers of diet quality and examine whether these lipids are associated with incident CHD.

METHODS

Using liquid chromatography-mass spectrometry, we measured 1542 lipid species from 1694 American Indian adults (aged 18-75 years, 62% female) in the Strong Heart Family Study. Participants were followed up for development of CHD through 2020. Information on the past year diet was collected using the Block Food Frequency Questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index-2010 (AHEI). Mixed-effects linear regression was used to identify individual lipids cross-sectionally associated with AHEI. In prospective analysis, Cox frailty model was used to estimate the hazard ratio (HR) of each AHEI-related lipid for incident CHD. All models were adjusted for age, sex, center, education, body mass index, smoking, alcohol drinking, level of physical activity, energy intake, diabetes, hypertension, and use of lipid-lowering drugs. Multiple testing was controlled at a false discovery rate of <0.05.

RESULTS

Among 1542 lipid species measured, 71 lipid species (23 known), including acylcarnitine, cholesterol esters, glycerophospholipids, sphingomyelins and triacylglycerols, were associated with AHEI. Most of the identified lipids were associated with consumption of ω-3 (n-3) fatty acids. In total, 147 participants developed CHD during a mean follow-up of 17.8 years. Among the diet-related lipids, 10 lipids [5 known: cholesterol ester (CE)(22:5)B, phosphatidylcholine (PC)(p-14:0/22:1)/PC(o-14:0/22:1), PC(p-38:3)/PC(o-38:4)B, phosphatidylethanolamine (PE)(p-18:0/20:4)/PE(o-18:0/20:4), and sphingomyelin (d36:2)A] were associated with incident CHD. On average, each standard deviation increase in the baseline level of these 5 lipids was associated with 17%-23% increased risk of CHD (from HR: 1.17; 95% CI: 1, 1.36; to HR: 1.23; 95% CI: 1.05, 1.43).

CONCLUSIONS

In this study, lipidomic markers of diet quality in American Indian adults are found. Some diet-related lipids are associated with risk of CHD beyond established risk factors.

Adherence to the healthy eating index-2010 and alternative healthy eating index-2010 in relation to metabolic syndrome among African Americans in the Jackson heart study

OBJECTIVE

The primary objective of this study was to determine whether Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) scores were associated with incident metabolic syndrome.

DESIGN

This study is a secondary analysis of data from the Jackson Heart Study. HEI and AHEI scores were divided into quintiles and Cox proportional hazards regression models were analysed for 1864 African American adults free from metabolic syndrome at Exam 1 to examine the incidence of metabolic syndrome by quintile of dietary quality score.

SETTING

Hinds, Madison and Rankin counties, Mississippi, USA.

PARTICIPANTS

African American adults, ages 21-94 years, 60·9 % female.

RESULTS

Over a mean follow-up time of 6·7 years, we observed 932 incident cases of metabolic syndrome. After adjusting for multiple covariates, a higher HEI score at Exam 1 was not associated with the risk of incident metabolic syndrome, except when looking at the trend analysis for the subgroup of adults with two metabolic syndrome components at Exam 1 (P-trend = 0·03). A higher AHEI score at Exam 1 was associated with the risk of incident metabolic syndrome (hazard ratio for those in the highest quintile compared to the lowest: 0·80 (95 % CI: 0·65, 0·99), P-trend = 0·03).

CONCLUSION

These findings suggest that a dietary pattern that scores higher on the AHEI may help reduce the risk of metabolic syndrome, even for adults who already have two of the minimum of three components required for a diagnosis of metabolic syndrome.

Association of healthy dietary patterns and cardiorespiratory fitness in the community

AIMS

To evaluate the associations of dietary indices and quantitative cardiorespiratory fitness (CRF) measures in a large, community-based sample harnessing metabolomic profiling to interrogate shared biology.

METHODS AND RESULTS

Framingham Heart Study (FHS) participants underwent maximum effort cardiopulmonary exercise tests for CRF quantification (via peak VO2) and completed semi-quantitative food frequency questionnaires. Dietary quality was assessed by the Alternative Healthy Eating Index (AHEI) and Mediterranean-style Diet Score (MDS), and fasting blood concentrations of 201 metabolites were quantified. In 2380 FHS participants (54 ± 9 years, 54% female, body mass index 28 ± 5 kg/m2), 1 SD higher AHEI and MDS were associated with 5.2% (1.2 mL/kg/min, 95% CI 4.3-6.0%, P < 0.0001) and 4.5% (1.0 mL/kg/min, 95% CI 3.6-5.3%, P < 0.0001) greater peak VO2 in linear models adjusted for age, sex, total daily energy intake, cardiovascular risk factors, and physical activity. In participants with metabolite profiling (N = 1154), 24 metabolites were concordantly associated with both dietary indices and peak VO2 in multivariable-adjusted linear models (FDR < 5%). Metabolites that were associated with lower CRF and poorer dietary quality included C6 and C7 carnitines, C16:0 ceramide, and dimethylguanidino valeric acid, and metabolites that were positively associated with higher CRF and favourable dietary quality included C38:7 phosphatidylcholine plasmalogen and C38:7 and C40:7 phosphatidylethanolamine plasmalogens.

CONCLUSION

Higher diet quality is associated with greater CRF cross-sectionally in a middle-aged community-dwelling sample, and metabolites highlight potential shared favourable effects on cardiometabolic health.

Overall diet quality and proinflammatory diet in relation to risk of obstructive sleep apnea in 3 prospective US cohorts

BACKGROUND

Inflammation-related mechanisms may be important in the development of obstructive sleep apnea (OSA), and diet plays a crucial role in modulating inflammation. Current epidemiologic evidence for the associations between dietary patterns and OSA risk is limited to cross-sectional studies.

OBJECTIVES

We investigated prospectively the associations of overall diet quality and proinflammatory diet with OSA risk.

METHODS

We followed 145,801 participants in the Nurses' Health Study (NHS) (2002-2012), NHS II (1995-2013), and Health Professionals Follow-up Study (1996-2012). Alternative Healthy Eating Index 2010 (AHEI) and Empirical Dietary Inflammatory Pattern (EDIP) scores were calculated based on validated FFQs administered every 4 y. Cox models were used to estimate HRs and 95% CIs.

RESULTS

We documented 8856 incident OSA cases during follow-up. In pooled analyses adjusted for potential confounders, higher diet quality (higher AHEI scores) was associated with lower OSA risk (HR comparing the highest with the lowest quintile of AHEI: 0.76; 95% CI: 0.71, 0.82; P-trend < 0.001), and higher dietary inflammatory potential (higher EDIP scores) was associated with significantly increased risk (HR comparing the highest with the lowest quintile of EDIP: 1.94; 95% CI: 1.81, 2.08; P-trend < 0.001). Additional adjustment for metabolic factors attenuated both associations. The association with AHEI score was no longer statistically significant (comparable HR: 0.98; 95% CI: 0.91, 1.05; P-trend = 0.54), whereas the association with EDIP score remained statistically significant (comparable HR: 1.31; 95% CI: 1.22, 1.41; P-trend < 0.001).

CONCLUSIONS

A healthier diet, particularly one with anti-inflammatory potential, was associated with lower OSA risk.

Diet Quality is Associated with Prodromal Parkinson's Disease Features in Chinese Adults

BACKGROUND

The prodromal phase of Parkinson's disease (PD) is a critical window for prevention by modifying lifestyle factors. However, there is limited knowledge on how diet quality is associated with prodromal PD symptoms in Asian populations.

OBJECTIVE

To examine the association between overall diet quality and prodromal PD features.

METHODS

A total of 71,640 Chinese participants who were free of PD were included in this cross-sectional study. Diet quality was assessed using the modified Alternative Healthy Eating Index (mAHEI) and alternate Mediterranean Diet (aMED). Five prodromal features including probable rapid eye movement sleep behavior disorder (pRBD), hyposmia, excessive daytime sleepiness, constipation, and depressive symptom were measured using validated questionnaires. Logistic regression was used to calculate the odds ratio (OR) for having a combination of prodromal PD symptoms (1 and 2+ symptoms vs. 0 symptoms), adjusting for age, sex, lifestyle factors, total energy intake, and other potential confounders.

RESULTS

In the multivariable-adjusted model, the OR for having 2+ versus 0 prodromal PD features was 0.64 (95% confidence interval [CI]: 0.49, 0.85) comparing the highest versus the lowest mAHEI diet quality quartiles with a significant inverse trend (P-trend = 0.003). For individual prodromal PD features, better diet quality, as assessed by the mAHEI, was associated with lower odds of having excessive daytime sleepiness and constipation (P-trend < 0.05 for both). We observed a marginally significant association between aMED and prodromal PD features (adjusted OR comparing the extreme quartiles = 0.74; 95% CI: 0.55, 0.98; P-trend = 0.09).

CONCLUSION

Better diet quality, as assessed by the mAHEI and the aMED, was associated with lower probability of having prodromal PD features in Chinese adults. © 2022 International Parkinson and Movement Disorder Society.

Impulsivity is longitudinally associated with healthy and unhealthy dietary patterns in individuals with overweight or obesity and metabolic syndrome within the framework of the PREDIMED-Plus trial

Background

Few studies have analyzed the associations between impulsivity and dietary patterns. Some of them have shown a cross-sectional inverse relationship between impulsivity and healthy diet scores, whereas others reported a positive association with unhealthy dietary assessments. We aimed to examine longitudinal associations of impulsivity trait with adherence to healthy and unhealthy dietary patterns in older participants at high risk of cardiovascular disease over 3 years of follow-up.

Methods

A 3-year prospective cohort analysis within the PREDIMED-Plus-Cognition study conducted in 4 PREDIMED-Plus study centers was performed. The PREDIMED-Plus study aimed to test the beneficial effect of a lifestyle intervention on the primary prevention of cardiovascular disease. The participants with overweight or obesity and metabolic syndrome included in the present study (n = 462; mean age of 65.3 years; 51.5% female) completed both the UPPS-P Impulsive Behavior Scale (range: 0–236 points) and the 143-item Food Frequency Questionnaire at baseline, 1-year and 3-years of follow-up. Ten diet scores assessing healthy and unhealthy dietary patterns were evaluated. Linear mixed models were performed adjusting by several confounders to study the longitudinal associations between impulsivity trait and adherence to dietary pattern scores over 3 years of follow-up (also assessing interactions by sex, age, and intervention group).

Results

Impulsivity were negatively associated with adherence to the Healthy Plant-Based [β = -0.92 (95%CI -1.67, -0.16)], Mediterranean [β = -0.43 (95%CI -0.79, -0.07)], Energy-Restricted Mediterranean [β = -0.76 (95%CI -1.16, -0.37)], Alternative Healthy Eating Index [β = -0.88 (95%CI -1.52, -0.23)], Portfolio [β = -0.57 (95%CI -0.91, -0.22)], and DASH [β = -0.50 (95%CI -0.79, -0.22)] diet scores over 3 years of follow-up, whereas impulsivity was positively related with adherence to the unhealthy Western diet [β = 1.59 (95%CI 0.59, 2.58)] over time. An interaction by intervention group was found, with those participants in the intervention group with high impulsivity levels having lower adherence to several healthy dietary patterns.

Conclusions

Heightened impulsivity was longitudinally associated with lower adherence to healthy dietary patterns and higher adherence to the Western diet over 3 years of follow-up. Furthermore, nutritional intervention programs should consider impulsivity as a relevant factor for the intervention success.

Trial registration

Name of registry: Effect of an energy-restricted Mediterranean diet, physical activity and behavioral intervention on the primary prevention of cardiovascular disease. Trial registration number: ISRCTN 89,898,870. Date of registration: 05/28/2014.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01335-8.

Dietary Pattern Trajectories in Middle Age and Physical Function in Older Age

BACKGROUND

Increasingly, lifestyle factors in midlife are reported to impact health and functional status in old age. This work examines associations between dietary trajectories in middle age and subsequent impairments in physical function.

METHOD

Data are from 851 participants (61% men, mean age at first dietary assessment = 47 years, range 30-59 years) from the Baltimore Longitudinal Study of Aging. We used latent class analysis to derive dietary trajectories based on adherence to the Alternative Healthy Eating Index-2010 (AHEI), and further classified them based on tertiles, as poor (score <39.3), intermediate (39.3-48.9), or good (>48.9). Physical function was assessed with the Short Physical Performance Battery (SPPB). Random effects tobit regression models were used to examine associations between dietary trajectories and later physical function.

RESULTS

Two latent classes of AHEI scores were generated and labeled "greatly improved" or "moderately improved." In the greatly improved class, participants showed a trend in overall AHEI score from poor/intermediate to good diet categories across dietary assessments with age, over time. In the moderately improved class, the overall AHEI score shifted from poor to intermediate diet categories over time, and the prevalence of the good diet category remained low. Mean AHEI score between ages 30 and 59 years was higher in the greatly, than moderately, improved class. The moderately improved class had 1.6 points lower SPPB score (indicating poorer physical function) at older age than the greatly improved class (p = .022).

CONCLUSIONS

Findings suggest that improving diet quality in middle age may contribute to better physical function in older age.

The association between diet quality and obesity-related metabolic risks

BACKGROUND

The aim of this study was to examine the association between dietary quality measured by inflammatory potential of a diet and Alternative Healthy Eating Index-2010 (AHEI-2010), and obesity-related metabolic risks in a representative sample of Iranian obese adults.

METHOD

This cross-sectional study was conducted on 300 obese adults. Dietary intake was assessed using a validated 168-item semi-quantitative food frequency questionnaire (FFQ). Diet quality was measured using AHEI-2010 and Empirical Dietary Inflammatory Pattern (EDIP) scores.

RESULTS

Those in the upper quartile of AHEI-2010 were associated with lower serum level of triglycerides (TG), and higher body mass index (BMI), compared to participants in the lower quartile. Those in the higher quartile of EDIP score were associated with higher serum level of TG. Greater adherence to AHEI-2010 had 70% lower odds of high fasting blood glucose (FBG), compared with those in the first quartile [Q4 vs Q1: OR, 0.3 (95% CI: 0.1-0.8), p trend = 0.02] Those in the highest quartile of EDIP score had a 60% higher odds of high diastolic blood pressure, compared with those in the lowest quartile [Q4 vs Q1: OR, 2.4 (95% CI: 1.1-5.5), p trend = 0.05] after controlling for potential covariates.

CONCLUSIONS

High diet quality incorporating more anti-inflammatory diet may have a potential benefit in reducing obesity-related metabolic risks.

Dietary Inflammatory Index is associated with Healthy Eating Index, Alternative Healthy Eating Index, and dietary patterns among Iranian adults

Background

Recent investigations have evaluated the effect of the inflammatory potential of diet in several populations by calculating the Dietary Inflammatory Index (DII) score. We aimed to evaluate the association of the DII with the Healthy Eating Index (HEI), the Alternative Healthy Eating Index (AHEI), and dietary pattern (DP) among healthy Iranian adults.

Methods

A cross‐sectional study was conducted among 4365 middle‐aged adults. Major DPs and DII score were identified using a validated semi‐quantitative food frequency questionnaire (FFQ). Poisson regression was used to evaluate the association of DPs, HEI, and AHEI across tertiles of DII.

Results

After adjustment for confounding variables, a low HEI (HEI < 55) and AHEI (AHEI < 56.5) were more prevalent among the participants in the highest tertile of DII compared to the first tertile (PR: 1.13, P‐value <.05; PR: 1.10, P‐value <.05; respectively). Adherence to a balanced healthy dietary pattern was significantly lower in subjects with a diet that was more pro‐inflammatory compared to those with anti‐inflammatory diet (PR: 0.85, P‐value P < .01). No significant association was found between the DII and a western DP. High levels of HDL and hip and waist circumference were observed in the highest tertile of DII, and high levels of dietary intake of protein and fiber, minerals, fasting blood glucose, and monounsaturated fat were reported in the lowest tertile of DII.

Conclusion

The highest tertile of the DII (a pro‐inflammatory diet) was associated with a lower HEI, AHEI, and lower adherence to balanced DP in a representative sample of adults in Iran.

Changes in Diet Quality over 10 Years Are Associated with Baseline Sociodemographic and Lifestyle Factors in the Multiethnic Cohort Study

BACKGROUND

Trends in diet quality among US adults indicate a steady improvement, but data on longitudinal individual-level changes in diet quality are still limited.

OBJECTIVE

We examined changes in diet quality over 10 y and sought to determine whether baseline sociodemographic and lifestyle factors predicted the changes in a multiethnic population.

METHODS

Data were from 63,255 African American, Native Hawaiian, Japanese American, Latino, and white men and women (45-75 y old at baseline) in the Multiethnic Cohort, who completed a quantitative food frequency questionnaire at baseline (1993-1996) and 10-y follow-up (2003-2007) and had no prevalent cancer or heart disease at either survey. Overall diet quality was measured by use of the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) score. We used a general linear model with adjustment for covariates to compare diet quality changes by baseline characteristics in men and women separately.

RESULTS

Overall diet quality improved over 10 y by 3.2 points in men and 2.9 in women assessed using the HEI-2015, although scores for some components worsened (saturated and trans fats, indicating increased intake) or remained unchanged at a low quality level (whole grains, dairy, and sodium). In multivariable models where changes in HEI-2015, AHEI-2010, and DASH were harmonized to a 100-point score, greater increases in scores in both men and women were found for Japanese American ethnicity (increase by 0.5-4.7 in the 3 scores, P < 0.03), higher education (by 0.5-1.5, P ≤ 0.001), normal weight (BMI 18.5 to <25, by 0.6-2.5, P ≤ 0.01), nonsmoking (by 1.5-2.7, P < 0.001), higher moderate/vigorous physical activity level (by 0.3-0.8, P ≤ 0.04), and multivitamin use (by 0.4-0.7, P < 0.001) at baseline.

CONCLUSIONS

Sociodemographic and lifestyle factors, closely associated with diet quality, also predicted subsequent changes in diet quality over time in this multiethnic population.

Diet quality as a predictor of cardiometabolic disease-free life expectancy: the Whitehall II cohort study

BACKGROUND

Poor diet quality has been linked to increased risk of many chronic diseases and premature mortality. Less research has considered dietary habits in relation to disease-free life expectancy.

OBJECTIVES

Our objective was to investigate the association of diet quality with cardiometabolic disease-free life expectancy between ages 50 and 85 y.

METHODS

Diet quality of 8041 participants of the Whitehall II cohort study was assessed with the Alternative Healthy Eating Index 2010 (AHEI-2010) in 1991-1994, 1997-1999, and 2002-2004. The measurement of diet quality closest to age 50 for each participant was used. We utilized repeat measures of cardiometabolic disease (coronary heart disease, stroke, and type 2 diabetes) from the first observation when participants were aged ≥50 y. Multistate life table models with covariates age, gender, occupational position, smoking, physical activity, and alcohol consumption were used to estimate total and sex-specific cardiometabolic disease-free life expectancy from age 50 to 85 y for each AHEI-2010 quintile, where the lowest quintile represents unhealthiest dietary habits and the highest quintile the healthiest habits.

RESULTS

The number of cardiometabolic disease-free life-years after age 50 was 23.9 y (95% CI: 23.0, 24.9 y) for participants with the healthiest diet, that is, a higher score on the AHEI-2010, and 21.4 y (95% CI: 20.6, 22.3 y) for participants with the unhealthiest diet. The association between diet quality and cardiometabolic disease-free life expectancy followed a dose-response pattern and was observed in subgroups of participants of different occupational position, BMI, physical activity level, and smoking habit, as well as when participants without cardiometabolic disease at baseline were excluded from analyses.

CONCLUSIONS

Healthier dietary habits are associated with cardiometabolic disease-free life expectancy between ages 50 and 85.

Adherence to dietary recommendations and colorectal cancer risk: results from two prospective cohort studies

BACKGROUND

Understanding the association between diet and colorectal cancer (CRC) risk is essential to curbing the epidemic of this cancer. This study prospectively evaluated adherence to the Chinese Food Pagoda (CHFP), and two American Dietary Guidelines: the Alternative Healthy Eating Index (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) in association with CRC risk among Chinese adults living in urban Shanghai, China.

METHODS

Participants included 60 161 men and 72 445 women aged 40-74, from two ongoing population-based prospective cohort studies. Associations between dietary guideline compliance scores and CRC risk were evaluated by Cox proportional hazard regression analyses, with age as time metric, and potential confounders were adjusted.

RESULTS

We identified 1670 CRC incidence cases (691 males and 979 females) during an average 8.1 years of follow-up for men and 13.4 years for women. CHFP score was inversely associated with risk of CRC, with hazard ratios (HRs) (95% confidence intervals) of 0.88 (0.77, 1.00), 0.86 (0.75, 0.98) and 0.84 (0.73, 0.96) for the 2nd, 3rd and 4th quartiles versus 1st quartile, respectively (Ptrend= 0.01). The inverse association appeared stronger for rectal cancer, individuals at younger age (< 50 years), with a lower BMI (<25 kg/m2) or without any metabolic conditions at baseline, although no multiplicative interactions were noted. No consistent association pattern was observed for the modified DASH score and the modified AHEI-2010.

CONCLUSIONS

Compliance with the Dietary Guidelines for Chinese was associated with reduced risk of CRC among Chinese adults. To maximize health impacts, dietary recommendations need to be tailored for specific populations.

The Dietary Inflammatory Index® and Alternative Healthy Eating Index 2010 in relation to leucocyte telomere length in postmenopausal women: a cross-sectional study

Telomeres are nucleoprotein complexes that form the ends of eukaryotic chromosomes where they protect DNA from genomic instability, prevent end-to-end fusion and limit cellular replicative capabilities. Increased telomere attrition rates, and relatively shorter telomere length, is associated with genomic instability and has been linked with several chronic diseases, malignancies and reduced longevity. Telomeric DNA is highly susceptible to oxidative damage and dietary habits may make an impact on telomere attrition rates through the mediation of oxidative stress and chronic inflammation. The aim of this study was to examine the association between leucocyte telomere length (LTL) with both the Dietary Inflammatory Index^® 2014 (DII^®) and the Alternative Healthy Eating Index 2010 (AHEI-2010). This is a cross-sectional analysis using baseline data from 263 postmenopausal women from the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial, in Calgary and Edmonton, Alberta, Canada. No statistically significant association was detected between LTL z-score and the AHEI-2010 (P = 0·20) or DII^® (P = 0·91) in multivariable adjusted models. An exploratory analysis of AHEI-2010 and DII^® parameters and LTL revealed anthocyanidin intake was associated with LTL (P < 0·01); however, this association was non-significant after a Bonferroni correction was applied (P = 0·27). No effect modification by age, smoking history, or recreational physical activity was detected for either relationship. Increased dietary antioxidant and decreased oxidant intake were not associated with LTL in this analysis.

Is the Canadian Healthy Eating Index 2007 an Appropriate Diet Indicator of Metabolic Health? Insights from Dietary Pattern Analysis in the PREDISE Study

The objective of this study was to identify key elements from the 2007 Canada's Food Guide that should be included in a diet quality score aiming to reflect the risk of metabolic syndrome (MetS). Dietary intakes of 998 adults (mean age: 43.2 years, 50% women) were used to obtain the Canadian Healthy Eating Index 2007 (C-HEI 2007) and Alternative Healthy Eating Index 2010 (AHEI) scores, as well as a dietary pattern (DP) generated by the reduced rank regression (RRR) method. Based on these three scores, a modified version of the C-HEI 2007 (Modified C-HEI) was then proposed. The prevalence ratio (PR) of MetS was examined across diet quality scores using multivariate binomial regression analysis. A higher AHEI, Modified C-HEI, and a lower score for DP were all associated with a significantly lower prevalence of MetS (PR = 0.42; 95% confidence interval (CI) 0.28, 0.64; PR = 0.39; 95% CI 0.23, 0.63; and PR = 0.48; 95% CI 0.31, 0.74, respectively), whereas C-HEI 2007 was not (PR = 0.68; 95% CI 0.47, 1.00). Results suggest that a Modified C-HEI that considers key elements from the C-HEI 2007 and the AHEI, as well the DP, shows that participants with a higher score are less likely to have MetS.

Adherence to Alternative Healthy Eating Index (AHEI-2010) is not associated with risk of stroke in Iranian adults: A case-control study

Background: Stroke is a major global health problem that contributes to a significant burden of morbidity and mortality. The association of several foods and nutrients with stroke has been well-established. However, the effect of the whole diet on stroke is poorly understood. In this work, we aimed to examine the association between the quality of whole diet, as measured using Alternate Healthy Eating Index-2010 (AHEI-2010), and risk of stroke in Iranian adults. Methods: In this hospital-based case-control study, 193 stroke patients (diagnosed based on clinical and brain CT findings) and 193 controls with no history of cerebrovascular diseases or neurologic disorders were included. The participants' dietary intakes were examined using a validated 168-item semi-quantitative food frequency questionnaire. AHEI-2010 was constructed based on earlier studies. Participants were classified according to tertiles of AHEI-2010 scores and multivariate logistic regression was used to evaluate the association between whole diet quality and risk of stroke. Results: Individuals with greater adherence to AHEI-2010 had a higher intake of fruits, vegetables, nuts and legumes, whole grains and carbohydrate, and a lower intake of trans-fatty acids, sugar-sweetened beverages, total energy and fat (P < 0.05). After adjusting for potential confounders, adherence to AHEI-2010 was not significantly associated with a reduced risk of stroke (OR: 0.92; 95% CI: 0.56-1.51). Conclusion: We found that adherence to AHEI-2010 was not associated with risk of stroke in Iranian adults. Further prospective studies are warranted to validate this finding and clarify the relationship between whole diet and stroke.

Dietary index scores and invasive breast cancer risk among women with a family history of breast cancer

BACKGROUND

Many epidemiologic studies have analyzed the relations of individual foods and nutrients and breast cancer risk with inconsistent results. Few studies have examined recommendation-based dietary indices and breast cancer risk.

OBJECTIVE

The aim of this study was to determine associations between recommendation-based dietary index scores and incident invasive breast cancer.

METHODS

The Sister Study is a prospective cohort of 50,884 US women (baseline: 2003-2009) who had a sister with breast cancer but no prior breast cancer themselves. We created scores for the Dietary Approaches to Stop Hypertension (DASH) diet, Alternative Mediterranean Diet (AMED), and Alternative Healthy Eating Index-2010 (AHEI-2010) from dietary intakes estimated by a baseline-validated Block food-frequency questionnaire (FFQ). We used Cox regression to estimate multivariable-adjusted HRs and 95% CIs for total invasive breast cancer risk and by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2) status.

RESULTS

We documented 1,700 invasive breast cancer cases through 2015 (mean follow-up, 7.6 y). Individuals in the highest quartile of DASH scores had a lower risk of invasive breast cancer compared with those in the lowest quartile (HR: 0.78; 95% CI: 0.67, 0.90; P-trend = 0.001), with stronger associations for ER- (HR: 0.61; 95% CI: 0.40, 0.94; P-trend = 0.006) as well as ER-/PR- and ER-/PR-/HER2- subtypes. AHEI-2010 (HR for highest compared with lowest quartile: 0.90; 95% CI: 0.78, 1.03; P-trend = 0.15) and AMED (HR for highest compared with lowest quartile: 0.90; 95% CI: 0.77, 1.06; P-trend = 0.07) were weakly and nonsignificantly associated with breast cancer risk, but after excluding alcohol, AHEI-2010 was inversely associated with risk of ER-/PR- (HR: 0.64; 95% CI: 0.42, 0.98; P-trend = 0.04) and ER-/PR-/HER2- subtypes. We did not observe any significant interactions by menopausal status or other participant characteristics.

CONCLUSIONS

DASH scores were inversely associated with breast cancer risk; DASH and AHEI-2010 scores excluding alcohol were particularly inversely associated with risk of ER-/PR- and ER-/PR-/HER2- breast cancers. This trial was registered at clinicaltrials.gov as NCT00047970.

Association of Long-Term Diet Quality with Hippocampal Volume: Longitudinal Cohort Study

BACKGROUND

Diet quality is associated with brain aging outcomes. However, few studies have explored in humans the brain structures potentially affected by long-term diet quality. We examined whether cumulative average of the Alternative Healthy Eating Index 2010 (AHEI-2010) score during adult life (an 11-year exposure period) is associated with hippocampal volume.

METHODS

Analyses were based on data from 459 participants of the Whitehall II imaging sub-study (mean age [standard deviation] (SD) = 59.6 [5.3] years in 2002-2004, 19.2% women). Multimodal magnetic resonance imaging examination was performed at the end of follow-up (2015-2016). Structural images were acquired using a high-resolution 3-dimensional T1-weighted sequence and processed with Functional Magnetic Resonance Imaging of the Brain Software Library (FSL) tools. An automated model-based segmentation and registration tool was applied to extract hippocampal volumes.

RESULTS

Higher AHEI-2010 cumulative average score (reflecting long-term healthy diet quality) was associated with a larger total hippocampal volume. For each 1 SD (SD = 8.7 points) increment in AHEI-2010 score, an increase of 92.5 mm³ (standard error = 42.0 mm³) in total hippocampal volume was observed. This association was independent of sociodemographic factors, smoking habits, physical activity, cardiometabolic health factors, cognitive impairment, and depressive symptoms, and was more pronounced in the left hippocampus than in the right hippocampus. Of the AHEI-2010 components, no or light alcohol consumption was independently associated with larger hippocampal volume.

CONCLUSIONS

Higher long-term AHEI-2010 scores were associated with larger hippocampal volume. Accounting for the importance of hippocampal structures in several neuropsychiatric diseases, our findings reaffirm the need to consider adherence to healthy dietary recommendation in multi-interventional programs to promote healthy brain aging.

Association of the Alternative Healthy Eating Index (AHEI-2010) with depression, stress and anxiety among Iranian military personnel

INTRODUCTION

Psychological disorders have a major role in the incidence of chronic diseases and may result in reductions in the cost-effectiveness of the Armed Forces. Previous civilian studies have shown a protective association between healthy eating guidelines and mental disorders, but evidence to support this for a military population is limited. The aim of this study was to examine the association of Alternative Healthy Eating Index (AHEI-2010) with depression, stress and anxiety among Iranian military personnel.

METHOD

A cross-sectional study was conducted on 246 male Army soldiers. Stress, anxiety, depression and dietary intakes were assessed. The association between variables was determined using multivariate logistic regression.

RESULTS

The prevalence of depression, stress and anxiety in study participants was 15.9%, 10.6% and 27.2% respectively. Participants with the highest adherence to the AHEI-2010 had an 80% lower odds of depression than those with the lowest adherence (OR: 0.20; 95% CI 0.04 to 0.78). Such an association was also found between adherences to the AHEI-2010 and anxiety (OR: 0.28; 95% CI 0.05 to 0.95). No significant association between adherence to the AHEI-2010 and stress was found.

CONCLUSION

An inverse association between adherence to the AHEI-2010 and odds of depression and anxiety was found. Further studies are required to clarify this relationship.

Western Dietary Pattern Increases, and Prudent Dietary Pattern Decreases, Risk of Incident Diverticulitis in a Prospective Cohort Study

BACKGROUND & AIMS

Dietary fiber is implicated as a risk factor for diverticulitis. Analyses of dietary patterns may provide information on risk beyond those of individual foods or nutrients. We examined whether major dietary patterns are associated with risk of incident diverticulitis.

METHODS

We performed a prospective cohort study of 46,295 men who were free of diverticulitis and known diverticulosis in 1986 (baseline) using data from the Health Professionals Follow-Up Study. Each study participant completed a detailed medical and dietary questionnaire at baseline. We sent supplemental questionnaires to men reporting incident diverticulitis on biennial follow-up questionnaires. We assessed diet every 4 years using a validated food frequency questionnaire. Western (high in red meat, refined grains, and high-fat dairy) and prudent (high in fruits, vegetables, and whole grains) dietary patterns were identified using principal component analysis. Follow-up time accrued from the date of return of the baseline questionnaire in 1986 until a diagnosis of diverticulitis, diverticulosis or diverticular bleeding; death; or December 31, 2012. The primary end point was incident diverticulitis.

RESULTS

During 894,468 person years of follow-up, we identified 1063 incident cases of diverticulitis. After adjustment for other risk factors, men in the highest quintile of Western dietary pattern score had a multivariate hazard ratio of 1.55 (95% CI, 1.20-1.99) for diverticulitis compared to men in the lowest quintile. High vs low prudent scores were associated with decreased risk of diverticulitis (multivariate hazard ratio, 0.74; 95% CI, 0.60-0.91). The association between dietary patterns and diverticulitis was predominantly attributable to intake of fiber and red meat.

CONCLUSIONS

In a prospective cohort study of 46,295 men, a Western dietary pattern was associated with increased risk of diverticulitis, and a prudent pattern was associated with decreased risk. These data can guide dietary interventions for the prevention of diverticulitis.

Evaluation of the Alternative Healthy Eating Index as a predictor of 10-year cardiovascular disease risk in a group of Iranian employees

BACKGROUND

Noncommunicable diseases, of which almost half are some form of cardiovascular disease (CVD), have overtaken communicable diseases as the world's major disease burden. There is growing evidence that indices of diet quality could have an association with a decreased risk of CVD in several countries. We aimed to examine the association between diet quality, as measured by the Alternative Healthy Eating Index (AHEI), and 10-year predicted CVD risk based on the Framingham Risk Score (FRS) in a group of Iranian employees.

METHODS

A cross-sectional descriptive study was conducted on 296 (232 male, 64 female) employees aged ≥30 years selected by nonrandom sampling. AHEI was calculated according to a food frequency questionnaire with complementary questions on intake of cooking fats and oils among households. The 10-year risk of CVD was calculated based on FRS. Total and high-density lipoprotein-cholesterol, fasting blood sugar and blood pressure were measured to help in the calculation of FRS.

RESULTS

AHEI did not have a significant relationship with FRS (r = -0.02, P = 0.67). However, some of its components, such as the intake of nuts and soy groups (r = -0.11, P = 0.04) and fruits (r = -0.14, P = 0.01), had a significant relationship with a reduced risk of CVD. According to stepwise multiple linear regression results, for every single increase in the intake of fruit servings, there would be a 0.14 reduction in the 10-year CVD risk score (β = -0.14, P = 0.01).

CONCLUSIONS

The present study showed no significant relationship between AHEI and the 10-year predicted risk of CVD among Iranian employees.

Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort

BACKGROUND

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States, with a 5-y survival rate of ∼65%. Therefore, the identification of modifiable health factors to improve CRC survival is crucial.

OBJECTIVE

We investigated the association of 4 prediagnostic a priori diet quality indexes with CRC-specific and all-cause mortality in the Multiethnic Cohort (MEC).

METHODS

The MEC included >215,000 African-American, Native Hawaiian, Japanese-American, Latino, and white adults living in Hawaii and California who completed a validated quantitative food-frequency questionnaire in 1993-1996. CRC cases and deaths were identified through linkages to cancer registries and to state and national vital registries. Sex-specific HRs and 95% CIs were estimated for the Healthy Eating Index (HEI) 2010, the Alternative HEI (AHEI) 2010, the alternate Mediterranean Diet (aMED) score, and the Dietary Approaches to Stop Hypertension (DASH) index with CRC-specific and overall mortality as the primary outcomes. Ethnicity-specific analyses were the secondary outcomes.

RESULTS

Among 4204 MEC participants diagnosed with invasive CRC through 2010, 1976 all-cause and 1095 CRC-specific deaths were identified. A higher aMED score was associated with lower CRC-specific mortality in women [HR continuous pattern score divided by its respective SD (HR1SD): 0.86; 95% CI: 0.77, 0.96] but not in men (HR1SD: 1.01; 95% CI: 0.92, 1.11). A higher aMED score was also associated with lower all-cause mortality in women (HR1SD: 0.88; 95% CI: 0.81, 0.96) but not in men (HR1SD: 1.00; 95% CI: 0.93, 1.07). The HEI-2010, AHEI-2010, and DASH index were not significantly associated with CRC-specific or with all-cause mortality. The inverse relation for the aMED score was limited to African Americans and to colon (compared with rectal) cancer.

CONCLUSIONS

The aMED score was related to lower mortality only in African-American women (1 of 5 ethnic groups studied). The results should be interpreted with caution due to the small numbers of cases within ethnic groups and the issue of multiple testing.

Diet Quality and Colorectal Cancer Risk in the Women's Health Initiative Observational Study

Diet quality index scores on Healthy Eating Index 2010 (HEI-2010), Alternative HEI-2010, alternative Mediterranean Diet Index, and the Dietary Approaches to Stop Hypertension (DASH) index have been inversely associated with all-cause and cancer-specific death. This study assessed the association between these scores and colorectal cancer (CRC) incidence as well as CRC-specific mortality in the Women's Health Initiative Observational Study (1993-2012), a US study of postmenopausal women. During an average of 12.4 years of follow-up, there were 938 cases of CRC and 238 CRC-specific deaths. We estimated multivariate hazard ratios and 95% confidence intervals for relationships between quintiles of diet scores (from baseline food frequency questionnaires) and outcomes. HEI-2010 score (hazard ratios were 0.81, 0.77, and 0.73 with P values of 0.04, 0.01, and <0.01 for quintiles 3-5 vs. quintile 1, respectively) and DASH score (hazard ratios were 0.72, 0.74, and 0.78 with P values of <0.01, <0.01, and 0.03 for quintiles 3-5 vs. quintile 1, respectively), but not other diet scores, were associated with a lower risk of CRC in adjusted models. No diet scores were significantly associated with CRC-specific mortality. Closer adherence to HEI-2010 and DASH dietary recommendations was inversely associated with risk of CRC in this large cohort of postmenopausal women.

Adherence to Alternative Healthy Eating Index in relation to depression and anxiety in Iranian adults

Earlier studies have shown a protective association between adherence to healthy eating guidelines and mental disorders in Western nations; however, data in this regard are limited from the understudied region of Middle East. We examined the association between adherence to healthy eating guidelines, as measured by Alternative Healthy Eating Index (AHEI)-2010, and prevalence of anxiety and depression in a large sample of Iranian adults. In this cross-sectional study, data on dietary intakes of 3363 adult participants were collected using a validated dish-based 106-item semi-quantitative FFQ. Adherence to healthy eating was quantified using AHEI-2010, as suggested by earlier publications. The Iranian validated version of Hospital Anxiety and Depression Scale was used to assess anxiety and depression in study participants. Data on other covariates were gathered using a pre-tested questionnaire. Overall, the prevalence of anxiety and depression was 15·2 % (males 10·8 % and females 18·3 %) and 30·0 % (males 22·9 % and females 35·1 %), respectively. After controlling for potential confounders, those in the top quartile of AHEI-2010 had a 49 % lower chance of anxiety (OR 0·51; 95 % CI 0·35, 0·72) and a 45 % lower odds of depression (OR 0·55; 95 % CI 0·42, 0·72), compared with those in the bottom quartile. Stratified analysis by sex revealed that women in the highest categories of AHEI-2010 had a 49 % lower odds of having anxiety and depression, after adjustment for confounders, but no significant association was found in men. In addition, among individuals who were 40 years old or younger, those with high adherence to AHEI-2010 were 58 and 51 % less likely to have anxiety and depression, compared with those with less adherence. Adherence to healthy eating was inversely associated with a lower chance of anxiety and depression in Iranian adults. Prospective studies are required to confirm these associations in Middle-Eastern populations.

Long-term adherence to healthy dietary guidelines and chronic inflammation in the prospective Whitehall II study

BACKGROUND

Inflammation plays an important role in the cause of cardiovascular diseases and may contribute to the association linking an unhealthy diet to chronic age-related diseases. However, to date the long-term associations between diet and inflammation have been poorly described. Our aim was to assess the extent to which adherence to a healthy diet and dietary improvements over a 6-year exposure period prevented subsequent chronic inflammation over a 5-year follow-up in a large British population of men and women.

METHODS

Data were drawn from 4600 adults (mean ± standard deviation, age 49.6 ± 6.1 years, 28% were women) from the prospective Whitehall cohort II study. Adherence to a healthy diet was measured using Alternative Healthy Eating Index (AHEI) scores in 1991-1993 (50.7 ± 11.9 points) and 1997-1999 (51.6 ± 12.4 points). Chronic inflammation, defined as average levels of serum interleukin-6 from 2 measures 5 years apart, was assessed in 1997-1999 and 2002-2004.

RESULTS

After adjustment for sociodemographic factors, health behaviors, and health status, participants who maintained a high AHEI score (ie, a healthy diet, n = 1736, 37.7%) and those who improved this score over time (n = 681, 14.8%) showed significantly lower mean levels of interleukin-6 (1.84 pg/mL, 95% confidence interval [CI], 1.71-1.98 and 1.84 pg/mL, 95% CI, 1.70-1.99, respectively) than those who had a low AHEI score (n = 1594, 34.6%) over the 6-year exposure period (2.01 pg/mL, 95% CI, 1.87-2.17).

CONCLUSIONS

These data suggest that maintaining and improving adherence to healthy dietary recommendations may reduce the risk of long-term inflammation.