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Robb C, Carr PR, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a healthy lifestyle with mortality in older people. BMC Geriatr 2023; 23:646. [PMID: 37821846 PMCID: PMC10568769 DOI: 10.1186/s12877-023-04247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their relationship to the health of older people is less certain. METHODS The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with subsequent all-cause and cause-specific mortality. RESULTS In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. CONCLUSIONS In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality. Adherence to all four lifestyle factors resulted in the strongest protection.
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Affiliation(s)
- Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia.
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Anne B Newman
- Department of Epidemiology, Centre for Aging and Population Health, University of Pittsburgh, Pittsburgh, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
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English LK, Ard JD, Bailey RL, Bates M, Bazzano LA, Boushey CJ, Brown C, Butera G, Callahan EH, de Jesus J, Mattes RD, Mayer-Davis EJ, Novotny R, Obbagy JE, Rahavi EB, Sabate J, Snetselaar LG, Stoody EE, Van Horn LV, Venkatramanan S, Heymsfield SB. Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review. JAMA Netw Open 2021; 4:e2122277. [PMID: 34463743 PMCID: PMC8408672 DOI: 10.1001/jamanetworkopen.2021.22277] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022] Open
Abstract
Importance The 2020 Dietary Guidelines Advisory Committee conducted a systematic review of existing research on diet and health to inform the current Dietary Guidelines for Americans. The committee answered this public health question: what is the association between dietary patterns consumed and all-cause mortality (ACM)? Objective To ascertain the association between dietary patterns consumed and ACM. Evidence Review Guided by an analytical framework and predefined inclusion and exclusion criteria developed by the committee, the US Department of Agriculture's Nutrition Evidence Systematic Review (NESR) team searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase and dual-screened the results to identify articles that were published between January 1, 2000, and October 4, 2019. These studies evaluated dietary patterns and ACM in participants aged 2 years and older. The NESR team extracted data from and assessed risk of bias in included studies. Committee members synthesized the evidence, developed conclusion statements, and graded the strength of the evidence supporting the conclusion statements. Findings A total of 1 randomized clinical trial and 152 observational studies were included in the review. Studies enrolled adults and older adults (aged 17-84 years at baseline) from 28 countries with high or very high Human Development Index; 53 studies originated from the US. Most studies were well designed, used rigorous methods, and had low or moderate risks of bias. Precision, directness, and generalizability were demonstrated across the body of evidence. Results across studies were highly consistent. Evidence suggested that dietary patterns in adults and older adults that involved higher consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) were associated with a decreased risk of ACM. These healthy patterns were also relatively low in red and processed meat, high-fat dairy, and refined carbohydrates or sweets. Some of these dietary patterns also included intake of alcoholic beverages in moderation. Results based on additional analyses with confounding factors generally confirmed the robustness of main findings. Conclusions and Relevance In this systematic review, consuming a nutrient-dense dietary pattern was associated with reduced risk of death from all causes.
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Affiliation(s)
- Laural K. English
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Jamy D. Ard
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Marlana Bates
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Lydia A. Bazzano
- Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Carol J. Boushey
- Epidemiology Program, University of Hawai’i Cancer Center, Honolulu
| | | | - Gisela Butera
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Emily H. Callahan
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, US Department of Health and Human Services, Washington, DC
| | - Richard D. Mattes
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana
| | - Elizabeth J. Mayer-Davis
- Departments of Nutrition and Medicine, The University of North Carolina at Chapel Hill, Chapel Hill
| | - Rachel Novotny
- Nutritional Sciences, Human Nutrition, Food and Animal Sciences Department, College of Tropical Agriculture and Human Resources, University of Hawai’i at Mānoa, Honolulu
| | - Julie E. Obbagy
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
| | | | - Joan Sabate
- Center for Nutrition, Healthy Lifestyles, and Disease Prevention, School of Public Health, Loma Linda University, Loma Linda, California
| | | | | | - Linda V. Van Horn
- Nutrition Division, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Sudha Venkatramanan
- Nutrition Evidence Systematic Review, Office of Nutrition Guidance and Analysis (ONGA), Center for Nutrition Policy and Promotion (CNPP), US Department of Agriculture (USDA) Food and Nutrition Service (FNS), Alexandria, Virginia
- Panum Group, Bethesda, Maryland
| | - Steven B. Heymsfield
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge
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Chuang SY, Chang HY, Fang HL, Lee SC, Hsu YY, Yeh WT, Liu WL, Pan WH. The Healthy Taiwanese Eating Approach is inversely associated with all-cause and cause-specific mortality: A prospective study on the Nutrition and Health Survey in Taiwan, 1993-1996. PLoS One 2021; 16:e0251189. [PMID: 33956833 PMCID: PMC8101962 DOI: 10.1371/journal.pone.0251189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Few longitudinal studies have investigated the association between foods/dietary pattern and mortality risk in the Asian population. We investigated the prospective association between foods/dietary pattern and risk of death among ethnic Chinese adults in Taiwan. Methods The study population included 2475 young and middle-aged adults (aged 18–65 years at baseline) who completed the questionnaires and physical examinations in the Nutrition and Health Survey in Taiwan from 1993 to 1996. A food frequency questionnaire was administered to assess food consumption habits in a face-to-face interview. With survey data linked to the Taiwanese Death Registry, Cox proportional hazard model was used to identify the foods associated with all-cause mortality(followed until 2012), which were then tallied to calculate a dietary pattern score called Taiwanese Eating Approach(TEA) score. The TEA scores were then associated with various kinds of mortality outcomes. In addition, data from 431 elders (aged≥65 yrs) with 288 death endpoints were used to conduct a sensitivity analysis. Results A total of 385(15.6%) participants died (111 cardiovascular related deaths and 122 cancer related deaths) during the 17.8-year follow-up period(41274 person-years). Twelve foods (9 inverse [vegetables/fish/milk/tea](+1) and 3 positive[fatty meats/fermented vegetables/sweet drinks](-1)) were significantly associated with all-cause mortality risk. All adults were grouped by their cumulative food score into three diet groups: poor diet(29.3% of all subjects), average diet(44.0%), and healthy diet(26.70%). The better the diet, the lower the total, cardiovascular, and other cause mortality outcomes (trend-p < .001). The hazard ratio for the healthy diet was 0.64 (95% confidence interval:0.47–0.87) for total mortality, and 0.52(0.28–0.95) for cardiovascular death, compared with the poor diet in the multivariable models. This phenomenon was also seen in older adults for all-cause, cancer, and other cause mortalities. Conclusion Consuming a healthy Taiwanese Eating Approach (TEA) diet is negatively associated with all-cause, cardiovascular, and other-cause mortalities in Taiwan.
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Affiliation(s)
- Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
- * E-mail: (SYC); (WHP)
| | - Hsing-Yi Chang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan, R.O.C
| | - Hsin-Ling Fang
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
| | - Shu-Chen Lee
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C
| | - Yueh-Ying Hsu
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
| | - Wen-Ting Yeh
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C
| | - Wen-Ling Liu
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
| | - Wen-Harn Pan
- Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan, R.O.C
- Institute of Biomedical Sciences, Academic Sinica, Taipei, Taiwan, R.O.C
- * E-mail: (SYC); (WHP)
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Abstract
BACKGROUND Fibre is promoted as part of a healthy dietary pattern and in diabetes management. We have considered the role of high-fibre diets on mortality and increasing fibre intake on glycaemic control and other cardiometabolic risk factors of adults with prediabetes or diabetes. METHODS AND FINDINGS We conducted a systematic review of published literature to identify prospective studies or controlled trials that have examined the effects of a higher fibre intake without additional dietary or other lifestyle modification in adults with prediabetes, gestational diabetes, type 1 diabetes, and type 2 diabetes. Meta-analyses were undertaken to determine the effects of higher fibre intake on all-cause and cardiovascular mortality and increasing fibre intake on glycaemic control and a range of cardiometabolic risk factors. For trials, meta regression analyses identified further variables that influenced the pooled findings. Dose response testing was undertaken; Grading of Recommendations Assessment, Development and Evaluation (GRADE) protocols were followed to assess the quality of evidence. Two multicountry cohorts of 8,300 adults with type 1 or type 2 diabetes followed on average for 8.8 years and 42 trials including 1,789 adults with prediabetes, type 1, or type 2 diabetes were identified. Prospective cohort data indicate an absolute reduction of 14 fewer deaths (95% confidence interval (CI) 4-19) per 1,000 participants over the study duration, when comparing a daily dietary fibre intake of 35 g with the average intake of 19 g, with a clear dose response relationship apparent. Increased fibre intakes reduced glycated haemoglobin (HbA1c; mean difference [MD] -2.00 mmol/mol, 95% CI -3.30 to -0.71 from 33 trials), fasting plasma glucose (MD -0.56 mmol/L, 95% CI -0.73 to -0.38 from 34 trials), insulin (standardised mean difference [SMD] -2.03, 95% CI -2.92 to -1.13 from 19 trials), homeostatic model assessment of insulin resistance (HOMA IR; MD -1.24 mg/dL, 95% CI -1.72 to -0.76 from 9 trials), total cholesterol (MD -0.34 mmol/L, 95% CI -0.46 to -0.22 from 27 trials), low-density lipoprotein (LDL) cholesterol (MD -0.17 mmol/L, 95% CI -0.27 to -0.08 from 21 trials), triglycerides (MD -0.16 mmol/L, 95% CI -0.23 to -0.09 from 28 trials), body weight (MD -0.56 kg, 95% CI -0.98 to -0.13 from 18 trials), Body Mass Index (BMI; MD -0.36, 95% CI -0·55 to -0·16 from 14 trials), and C-reactive protein (SMD -2.80, 95% CI -4.52 to -1.09 from 7 trials) when compared with lower fibre diets. All trial analyses were subject to high heterogeneity. Key variables beyond increasing fibre intake were the fibre intake at baseline, the global region where the trials were conducted, and participant inclusion criteria other than diabetes type. Potential limitations were the lack of prospective cohort data in non-European countries and the lack of long-term (12 months or greater) controlled trials of increasing fibre intakes in adults with diabetes. CONCLUSIONS Higher-fibre diets are an important component of diabetes management, resulting in improvements in measures of glycaemic control, blood lipids, body weight, and inflammation, as well as a reduction in premature mortality. These benefits were not confined to any fibre type or to any type of diabetes and were apparent across the range of intakes, although greater improvements in glycaemic control were observed for those moving from low to moderate or high intakes. Based on these findings, increasing daily fibre intake by 15 g or to 35 g might be a reasonable target that would be expected to reduce risk of premature mortality in adults with diabetes.
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MESH Headings
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/diet therapy
- Diabetes Mellitus, Type 1/mortality
- Diabetes Mellitus, Type 2/diagnosis
- Diabetes Mellitus, Type 2/diet therapy
- Diabetes Mellitus, Type 2/mortality
- Diet, Diabetic/adverse effects
- Diet, Diabetic/mortality
- Diet, Healthy/adverse effects
- Diet, Healthy/mortality
- Dietary Fiber/administration & dosage
- Dietary Fiber/adverse effects
- Humans
- Nutritive Value
- Protective Factors
- Recommended Dietary Allowances
- Risk Assessment
- Risk Factors
- Risk Reduction Behavior
- Time Factors
- Treatment Outcome
- Whole Grains/adverse effects
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Affiliation(s)
- Andrew N. Reynolds
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
- Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand
- * E-mail:
| | - Ashley P. Akerman
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
- School of Physical Education, Sports, and Exercise Science, University of Otago, Dunedin, New Zealand
| | - Jim Mann
- Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
- Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin, New Zealand
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Dominguez-Rodriguez A, Avanzas P, Abreu-Gonzalez P, Baez-Ferrer N, Martín-Sanchez FJ, Mirò Ó. Adherence to Mediterranean diet and prognosis in older patients scheduled to undergo cardiac resynchronization therapy. Nutr Metab Cardiovasc Dis 2020; 30:77-83. [PMID: 31662282 DOI: 10.1016/j.numecd.2019.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/11/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Adherence to the Mediterranean diet (MedDiet) has been associated with prolonged survival in older individuals. However, it is unknown whether adherence to MedDiet is associated with the prognosis in older patients scheduled to undergo cardiac resynchronization therapy (CRT). The aim of this study was to evaluate the association between adherence to the MedDiet and clinical outcomes at 12 months follow-up after CRT implantation in older patients. METHODS AND RESULTS Patients adherents to the MedDiet, defined as ≥ 9 of 14 points using the PREDIMED (Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Study) questionnaire, was assessed before device implantation in patient's ≥ 70 years candidates for CRT. The primary outcome was a combined endpoint at 12 months follow-up after CRT implantation, defined as cardiovascular death, cardiac transplantation or decompensated heart failure. The cohort study consisted of 284 patients with a mean age of 73 ± 3 years. One hundred and fifty-nine (55.9%) patients were classified as adherent to the MedDiet. Seventy (24.6%) patients showed the combined endpoint at one year follow-up. Subjects who did not developed the combined endpoint had higher proportion of adherent patients to the MedDiet compared to patients who developed the combined endpoint (85% vs 67.1%, p = 0.002). After adjustment by possible confounders, the adherence to the MedDiet was a protective and significant predictor of the combined endpoint (HR = 0.42, 95% CI 0.22-0.81; p = 0.01). CONCLUSION Adherence to the MedDiet is inversely associated with outcome in older patients following CRT.
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Affiliation(s)
- Alberto Dominguez-Rodriguez
- Servicio de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain; Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Tenerife, Spain.
| | - Pablo Avanzas
- Hospital Universitario Central de Asturias, Servicio de Cardiología, Oviedo, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Spain
| | - Pedro Abreu-Gonzalez
- Departamento de Ciencias Médicas Básicas (Unidad de Fisiología), Universidad de La Laguna, San Cristóbal de La Laguna, Sta. Cruz de Tenerife, Spain
| | - Nestor Baez-Ferrer
- Servicio de Cardiología, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Tenerife, Spain
| | - Francisco J Martín-Sanchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Óscar Mirò
- Área de Urgencias, Hospital Clinic, Barcelona, Spain; Facultad de Medicina, Universidad de Barcelona, Spain
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Van Duong T, Tseng IH, Wong TC, Chen HH, Chen TH, Hsu YH, Peng SJ, Kuo KL, Liu HC, Lin ET, Feng YW, Yang SH. Adaptation and Validation of Alternative Healthy Eating Index in Hemodialysis Patients (AHEI-HD) and Its Association with all-Cause Mortality: A Multi-Center Follow-Up Study. Nutrients 2019; 11:nu11061407. [PMID: 31234433 PMCID: PMC6627491 DOI: 10.3390/nu11061407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/01/2019] [Accepted: 06/20/2019] [Indexed: 12/11/2022] Open
Abstract
A valid diet quality assessment scale has not been investigated in hemodialysis patients. We aimed to adapt and validate the alternative healthy eating index in hemodialysis patients (AHEI-HD), and investigate its associations with all-cause mortality. A prospective study was conducted on 370 hemodialysis patients from seven hospital-based dialysis centers. Dietary data (using three independent 24-hour dietary records), clinical and laboratory parameters were collected. The construct and criterion validity of original AHEI-2010 with 11 items and the AHEI-HD with 16 items were examined. Both scales showed reasonable item-scale correlations and satisfactory discriminant validity. The AHEI-HD demonstrated a weaker correlation with energy intake compared with AHEI-2010. Principle component analysis yielded the plateau scree plot line in AHEI-HD but not in AHEI-2010. In comparison with patients in lowest diet quality (tertile 1), those in highest diet quality (tertile 3) had significantly lower risk for death, with a hazard ratio (HR) and 95% confidence intervals (95%CI) of HR: 0.40; 95%CI: 0.18 – 0.90; p = 0.028, as measured by AHEI-2010, and HR: 0.37; 95%CI: 0.17–0.82; p = 0.014 as measured by AHEI-HD, respectively. In conclusion, AHEI-HD was shown to have greater advantages than AHEI-2010. AHEI-HD was suggested for assessments of diet quality in hemodialysis patients.
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Affiliation(s)
- Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110, Taiwan.
| | - I-Hsin Tseng
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110, Taiwan.
| | - Te-Chih Wong
- Department of Nutrition and Health Sciences, Chinese Culture University, Taipei 110, Taiwan.
| | - Hsi-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan.
| | - Tso-Hsiao Chen
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
- Department of Nephrology, Taipei Medical University-Wan Fang Hospital, Taipei 110, Taiwan.
| | - Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University- Shuang Ho Hospital, Taipei 110, Taiwan.
| | - Sheng-Jeng Peng
- Division of Nephrology, Cathay General Hospital, Taipei 110, Taiwan.
| | - Ko-Lin Kuo
- Division of Nephrology, Taipei Tzu-Chi Hospital, New Taipei 231, Taiwan.
| | - Hsiang-Chung Liu
- Department of Nephrology, Wei Gong Memorial Hospital, Miaoli 351, Taiwan.
| | - En-Tzu Lin
- Department of Nephrology, Lotung Poh-Ai Hospital, Yilan 265, Taiwan.
| | - Yi-Wei Feng
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110, Taiwan.
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110, Taiwan.
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110, Taiwan.
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan.
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Sotos-Prieto M, Bhupathiraju SN, Mattei J, Fung TT, Li Y, Pan A, Willett WC, Rimm EB, Hu FB. Association of Changes in Diet Quality with Total and Cause-Specific Mortality. N Engl J Med 2017; 377:143-153. [PMID: 28700845 PMCID: PMC5589446 DOI: 10.1056/nejmoa1613502] [Citation(s) in RCA: 295] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. METHODS We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses' Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986-1998) were assessed with the use of the Alternate Healthy Eating Index-2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. RESULTS The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower - by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score - than the risk among participants with consistently low diet scores over time. CONCLUSIONS Improved diet quality over 12 years was consistently associated with a decreased risk of death. (Funded by the National Institutes of Health.).
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Affiliation(s)
- Mercedes Sotos-Prieto
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - Shilpa N Bhupathiraju
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - Josiemer Mattei
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - Teresa T Fung
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - Yanping Li
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - An Pan
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - Walter C Willett
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - Eric B Rimm
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
| | - Frank B Hu
- From the Departments of Nutrition (M.S.-P., S.N.B., J.M., T.T.F., Y.L., W.C.W., E.B.R., F.B.H.) and Epidemiology (W.C.W., E.B.R., F.B.H.), Harvard T.H. Chan School of Public Health, Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School (S.N.B., W.C.W., E.B.R., F.B.H.), and Simmons College (T.T.F.) - all in Boston; the Division of Food and Nutrition Sciences, School of Applied Health Sciences and Wellness, Ohio University, Athens (M.S.-P.); and the Department of Epidemiology and Biostatistics and Ministry of Education Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China (A.P.)
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