The state of the economy, changes in federal food assistance programs, and policies related to nutrition and the food supply in the United States may influence dietary quality in children and ...adolescents.
We investigated dietary quality trends from 1999 to 2012 in the US child and adolescent population and their associations with socioeconomic status and participation in federal food assistance programs.
In this study, a nationally representative sample of 38,487 children and adolescents, aged 2-18 y, in the NHANES from 1999 to 2012 were included. Dietary information was collected with the use of a 24-h dietary recall. Dietary quality was measured with the use of the Healthy Eating Index 2010 (HEI-2010).
The mean HEI-2010 increased significantly from 42.5 (95% CI: 41.2, 43.8) to 50.9 (95% CI: 50.0, 51.8) from 1999 to 2012 (P-linear trend < 0.001). The reduction in empty calorie intake contributed to greater than one-third of this improvement in the total HEI-2010. We also observed significant increases in 9 other HEI-2010 component scores. However, the HEI-2010 component score for sodium decreased significantly, which reflected an increase in sodium consumption. We calculated the covariate-adjusted mean HEI-2010 score in subgroups that were defined by sociodemographic status and participation in nutrition assistance program at each NHANES cycle. Non-Hispanic black children and adolescents had a consistently lower HEI-2010 than that of other groups across all NHANES cycles. We observed a trend toward a lower HEI-2010 in Supplemental Nutrition Assistance Program (SNAP) participants than in nonparticipants after the 2003-2004 cycle. We also observed a lower HEI-2010 in participants in the National School Lunch Program (NSLP) and the School Breakfast Program (SBP) than in nonparticipants. In general, participants in the Special Supplemental Nutrition Program for Women, Infants, and Children appeared to have a higher HEI-2010 than that of nonparticipants.
Although HEI-2010 scores in children and adolescents improved steadily, the overall dietary quality remained poor. Participants in the SNAP and participants in the National School Lunch Program, School Breakfast Program, or both have lower dietary quality than do nonparticipants. Future policy interventions are needed to continue improvement in dietary quality and to address disparities.
Vegetarian diets and bone status Tucker, Katherine L
The American journal of clinical nutrition,
07/2014, Letnik:
100
Journal Article
Recenzirano
Odprti dostop
Osteoporosis is a common chronic condition associated with progressive loss of bone mineral density (BMD) and compromised bone strength, with increasing risk of fracture over time. Vegetarian diets ...have been shown to contain lower amounts of calcium, vitamin D, vitamin B-12, protein, and n–3 (ω-3) fatty acids, all of which have important roles in maintaining bone health. Although zinc intakes are not necessarily lower quantitatively, they are considerably less bioavailable in vegetarian diets, which suggests the need for even higher intakes to maintain adequate status. At the same time, healthy vegetarian diets tend to contain more of several protective nutrients, including magnesium, potassium, vitamin K, and antioxidant and anti-inflammatory phytonutrients. On balance, there is evidence that vegetarians, and particularly vegans, may be at greater risk of lower BMD and fracture. Attention to potential shortfall nutrients through the careful selection of foods or fortified foods or the use of supplements can help ensure healthy bone status to reduce fracture risk in individuals who adhere to vegetarian diets.
With the demographic aging of populations worldwide, diseases associated with aging are becoming more prevalent and costly to individuals, families, and healthcare systems. Among aging‐related ...impairments, a decline in cognitive function is of particular concern, as it erodes memory and processing abilities and eventually leads to the need for institutionalized care. Accumulating evidence suggests that nutritional status is a key factor in the loss of cognitive abilities with aging. This is of tremendous importance, as dietary intake is a modifiable risk factor that can be improved to help reduce the burden of cognitive impairment. With respect to nutrients, there is evidence to support the critical role of several B vitamins in particular, but also of vitamin D, antioxidant vitamins (including vitamin E), and omega‐3 fatty acids, which are preferentially taken up by brain tissue. On the other hand, high intakes of nutrients that contribute to hypertension, atherosclerosis, and poor glycemic control may have negative effects on cognition through these conditions. Collectively, the evidence suggests that considerable slowing and reduction of cognitive decline may be achieved by following a healthy dietary pattern, which limits intake of added sugars, while maximizing intakes of fish, fruits, vegetables, nuts, and seeds.
Although dietary patterns have become a common approach to assess diet and health, relatively little has been done in ethnic minority populations. Because eating patterns differ tremendously across ...ethnicities, it is important to look at subgroups separately, particularly in cases where dietary improvement is critically needed to reduce obesity and chronic disease. The Latinx population is a rapidly growing subset of the US population and is expected to reach 27.5% by 2060 (1). However, only the Mexican-American population is oversampled and described in the NHANES. Other major Latinx groups include Puerto Ricans, Dominicans, and Cubans.
Nutrition research has traditionally focused on single nutrients in relation to health. However, recent appreciation of the complex synergistic interactions among nutrients and other food ...constituents has led to a growing interest in total dietary patterns. Methods of measurement include summation of food or nutrient recommendations met, such as the United States Department of Agriculture Healthy Eating Index; data-driven approaches--principal components (PCA) and cluster analyses--which describe actual intake patterns in the population; and, most recently, reduced rank regression, which defines linear combinations of food intakes that maximally explain intermediate markers of disease. PCA, a form of factor analysis, derives linear combinations of foods based on their intercorrelations. Cluster analysis groups individuals into maximally differing eating patterns. These approaches have now been used in diverse populations with good reproducibility. In contrast, because it is based on associations with outcomes rather than on coherent behavioral patterns, reduced rank regression may be less reproducible, but more research is needed. However, it is likely to yield useful information for hypothesis generation. Together, the focus on dietary patterns has been fruitful in demonstrating the powerful protective associations of healthy or prudent dietary patterns, and the higher risk associations of Western or meat and refined grains patterns. The field, however, has not fully addressed the effects of diet in subpopulations, including ethnic minorities. Depending on food group coding, subdietary patterns may be obscured or artificially separated, leading to potentially misleading results. Further attention to the definition of the dietary patterns of different populations is critical to providing meaningful results. Still, dietary pattern research has great potential for use in nutrition policy, particularly as it demonstrates the importance of total diet in health promotion.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Prior studies have documented lower cardiovascular disease (CVD) risk among people with a higher adherence to a plant-based dietary pattern. Non-Hispanic black Americans are an understudied group ...with high burden of CVD, yet studies of plant-based diets have been limited in this population.
We conducted an analysis of prospectively collected data from a community-based cohort of African American adults (n = 3,635) in the Jackson Heart Study (JHS) aged 21-95 years, living in the Jackson, Mississippi, metropolitan area, US, who were followed from 2000 to 2018. Using self-reported dietary data, we assigned scores to participants' adherence to 3 plant-based dietary patterns: an overall plant-based diet index (PDI), a healthy PDI (hPDI), and an unhealthy PDI (uPDI). Cox proportional hazards models were used to estimate associations between plant-based diet scores and CVD incidence and all-cause mortality. Over a median follow-up of 13 and 15 years, there were 293 incident CVD cases and 597 deaths, respectively. After adjusting for sociodemographic characteristics (age, sex, and education) and health behaviors (smoking, alcohol intake, margarine intake, physical activity, and total energy intake), no significant association was observed between plant-based diets and incident CVD for overall PDI (hazard ratio HR 1.06, 95% CI 0.78-1.42, p-trend = 0.72), hPDI (HR 1.07, 95% CI 0.80-1.42, p-trend = 0.67), and uPDI (HR 0.95, 95% CI 0.71-1.28, p-trend = 0.76). Corresponding HRs (95% CIs) for all-cause mortality risk with overall PDI, hPDI, and uPDI were 0.96 (0.78-1.18), 0.94 (0.76-1.16), and 1.06 (0.86-1.30), respectively. Corresponding HRs (95% CIs) for incident coronary heart disease with overall PDI, hPDI, and uPDI were 1.09 (0.74-1.61), 1.11 (0.76-1.61), and 0.79 (0.52-1.18), respectively. For incident total stroke, HRs (95% CIs) for overall PDI, hPDI, and uPDI were 1.00 (0.66-1.52), 0.91 (0.61-1.36), and 1.26 (0.84-1.89) (p-trend for all tests > 0.05). Limitations of the study include use of self-reported dietary intake, residual confounding, potential for reverse causation, and that the study did not capture those who exclusively consume plant-derived foods.
In this study of black Americans, we observed that, unlike in prior studies, greater adherence to a plant-based diet was not associated with CVD or all-cause mortality.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual ...patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension.
Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 86% of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, 95% CI -4.9, -1.6 mmHg). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg -3.3, 1.2), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg -2.2, 1.8; ambulatory 1.1 mmHg -0.3, 2.5). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies.
Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Hypertension is a key risk factor for cardiovascular disease. Currently, around a third of people with hypertension are undiagnosed, and of those diagnosed, around half are not taking ...antihypertensive medications. The World Health Organisation (WHO) estimates that high blood pressure directly or indirectly causes deaths of at least nine million people globally every year.
Purpose of Review
In this review, we examine how emerging technologies might support improved detection and management of hypertension not only in the wider population but also within special population groups such as the elderly, pregnant women, and those with atrial fibrillation.
Recent Findings
There is an emerging trend to empower patients to support hypertension screening and diagnosis, and several studies have shown the benefit of tele-monitoring, particularly when coupled with co-intervention, in improving the management of hypertension.
Summary
Novel technology including smartphones and Bluetooth®-enabled tele-monitoring are evolving as key players in hypertension management and offer particular promise within pregnancy and developing countries. The most pressing need is for these new technologies to be properly assessed and clinically validated prior to widespread implementation in the general population.
IMPORTANCE: Cholesterol is a common nutrient in the human diet and eggs are a major source of dietary cholesterol. Whether dietary cholesterol or egg consumption is associated with cardiovascular ...disease (CVD) and mortality remains controversial. OBJECTIVE: To determine the associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: Individual participant data were pooled from 6 prospective US cohorts using data collected between March 25, 1985, and August 31, 2016. Self-reported diet data were harmonized using a standardized protocol. EXPOSURES: Dietary cholesterol (mg/day) or egg consumption (number/day). MAIN OUTCOMES AND MEASURES: Hazard ratio (HR) and absolute risk difference (ARD) over the entire follow-up for incident CVD (composite of fatal and nonfatal coronary heart disease, stroke, heart failure, and other CVD deaths) and all-cause mortality, adjusting for demographic, socioeconomic, and behavioral factors. RESULTS: This analysis included 29 615 participants (mean SD age, 51.6 13.5 years at baseline) of whom 13 299 (44.9%) were men and 9204 (31.1%) were black. During a median follow-up of 17.5 years (interquartile range, 13.0-21.7; maximum, 31.3), there were 5400 incident CVD events and 6132 all-cause deaths. The associations of dietary cholesterol or egg consumption with incident CVD and all-cause mortality were monotonic (all P values for nonlinear terms, .19-.83). Each additional 300 mg of dietary cholesterol consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.17 95% CI, 1.09-1.26; adjusted ARD, 3.24% 95% CI, 1.39%-5.08%) and all-cause mortality (adjusted HR, 1.18 95% CI, 1.10-1.26; adjusted ARD, 4.43% 95% CI, 2.51%-6.36%). Each additional half an egg consumed per day was significantly associated with higher risk of incident CVD (adjusted HR, 1.06 95% CI, 1.03-1.10; adjusted ARD, 1.11% 95% CI, 0.32%-1.89%) and all-cause mortality (adjusted HR, 1.08 95% CI, 1.04-1.11; adjusted ARD, 1.93% 95% CI, 1.10%-2.76%). The associations between egg consumption and incident CVD (adjusted HR, 0.99 95% CI, 0.93-1.05; adjusted ARD, −0.47% 95% CI, −1.83% to 0.88%) and all-cause mortality (adjusted HR, 1.03 95% CI, 0.97-1.09; adjusted ARD, 0.71% 95% CI, −0.85% to 2.28%) were no longer significant after adjusting for dietary cholesterol consumption. CONCLUSIONS AND RELEVANCE: Among US adults, higher consumption of dietary cholesterol or eggs was significantly associated with higher risk of incident CVD and all-cause mortality in a dose-response manner. These results should be considered in the development of dietary guidelines and updates.
To determine associations of a Mediterranean diet score (MeDS) with 2-year change in cognitive function by type 2 diabetes and glycemic control status and contrast it against other diet quality ...scores.
We used data from the longitudinal Boston Puerto Rican Health Study (
= 913; 42.6% with type 2 diabetes at 2 years). Glycemic control at baseline was categorized as uncontrolled (hemoglobin A
≥7% 53 mmol/mol) versus controlled. Two-year change in glycemic control was defined as stable/improved versus poor/declined. We defined MeDS, Healthy Eating Index, Alternate Healthy Eating Index, and Dietary Approaches to Stop Hypertension scores. Adjusted mixed linear models assessed 2-year change in global cognitive function
score, executive and memory function, and nine individual cognitive tests.
Higher MeDS, but no other diet quality score, was associated with higher 2-year change in global cognitive function in adults with type 2 diabetes (β ± SE = 0.027 ± 0.011;
= 0.016) but not in those without (
= 0.80). Similar results were noted for Mini-Mental State Examination, word recognition, digit span, and clock drawing tests. Results remained consistent for individuals under glycemic control at baseline (0.062 ± 0.020;
= 0.004) and stable/improved over 2 years (0.053 ± 0.019;
= 0.007), but not for individuals with uncontrolled or poor/declined glycemic control. All diet quality scores were associated with higher 2-year memory function in adults without type 2 diabetes.
Both adhering to a Mediterranean diet and effectively managing type 2 diabetes may support optimal cognitive function. Healthy diets, in general, can help improve memory function among adults without type 2 diabetes.
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