Diets for Health: Goals and Guidelines Locke, Amy; Schneiderhan, Jill; Zick, Suzanna M
American family physician,
06/2018, Letnik:
97, Številka:
11
Journal Article
Recenzirano
Diet is the single most significant risk factor for disability and premature death. Patients and physicians often have difficulty staying abreast of diet trends, many of which focus primarily on ...weight loss rather than nutrition and health. Recommending an eating style can help patients make positive change. Dietary patterns that support health include the Mediterranean diet, the Dietary Approaches to Stop Hypertension diet, the 2015 Dietary Guidelines for Americans, and the Healthy Eating Plate. These approaches have benefits that include prevention of cardiovascular disease, cancer, type 2 diabetes mellitus, and obesity. These dietary patterns are supported by strong evidence that promotes a primary focus on unprocessed foods, fruits and vegetables, plant-based fats and proteins, legumes, whole grains, and nuts. Added sugars should be limited to less than 5% to 10% of daily caloric intake. Vegetables (not including potatoes) and fruits should make up one-half of each meal. Carbohydrate sources should primarily include beans/legumes, whole grains, fruits, and vegetables. An emphasis on monounsaturated fats, such as olive oil, avocados, and nuts, and omega-3 fatty acids, such as flax, cold-water fish, and nuts, helps prevent cardiovascular disease, type 2 diabetes, and cognitive decline. A focus on foods rather than macronutrients can assist patients in understanding a healthy diet. Addressing barriers to following a healthy diet and utilizing the entire health care team can assist patients in following these guidelines.
Background
The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of ...life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies.
Methods
Following the Institute of Medicine’s guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system.
Results
The search (January 1, 1990–December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I).
Conclusions
Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.
Use of complementary and alternative medicine (CAM) by women with breast cancer is often said to be increasing, yet few data exist to confirm this commonly held belief. The purpose of this paper is ...to compare overall patterns of CAM use, as well as use of specific products and therapies at two different points in time (1998 vs 2005) by women diagnosed with breast cancer.
Surveys were mailed to women randomly selected from the Ontario Cancer Registry (Canada) in the spring of 1998 (n = 557) and again in the spring of 2005(n = 877).
The response rates were 76.3% in 1998 and 63% in 2005. In 1998, 66.7% of women reported using either a CAM product/therapy or seeing a CAM therapist at some time in their lives as compared with 81.9% in 2005 (p = 0.0002). Increases were seen in both use of CAM products/therapies (62% in 1998 vs. 70.6% in 2005) and visits to CAM practitioners (39.4% of respondents in 1998 vs 57.4% of respondents in 2005). Women in 2005 reported that 41% used CAM for treating their breast cancer. The most commonly used products and practitioners for treating breast cancer as reported in 2005 were green tea, vitamin E, flaxseed, vitamin C, massage therapists and dietitians/nutritionists.
CAM use (both self-medication with products and visits to CAM practitioners) increased significantly from 1998 to 2005. Now that more than 80% of all women with breast cancer report using CAM (41% in a specific attempt to management their breast cancer), CAM use can no longer be regarded as an "alternative" or unusual approach to managing breast cancer.
Immune dysregulation associated with mercury has been suggested, although data in the general population are lacking. Chronic exposure to low levels of methylmercury (organic) and inorganic mercury ...is common, such as through fish consumption and dental amalgams.
We examined associations between mercury biomarkers and antinuclear antibody (ANA) positivity and titer strength.
Among females 16-49 years of age (n = 1,352) from the National Health and Nutrition Examination Survey (NHANES) 1999-2004, we examined cross-sectional associations between mercury and ANAs (indirect immunofluorescence; cutoff ≥ 1:80). Three biomarkers of mercury exposure were used: hair (available 1999-2000) and total blood (1999-2004) predominantly represented methylmercury, and urine (1999-2002) represented inorganic mercury. Survey statistics were used. Multivariable modeling adjusted for several covariates, including age and omega-3 fatty acids.
Sixteen percent of females were ANA positive; 96% of ANA positives had a nuclear speckled staining pattern. Geometric mean (geometric SD) mercury concentrations were 0.22 (0.03) ppm in hair, 0.92 (0.05) μg/L blood, and 0.62 (0.04) μg/L urine. Hair and blood, but not urinary, mercury were associated with ANA positivity (sample sizes 452, 1,352, and 804, respectively), after adjusting for confounders: for hair, odds ratio (OR) = 4.10 (95% CI: 1.66, 10.13); for blood, OR = 2.32 (95% CI: 1.07, 5.03) comparing highest versus lowest quantiles. Magnitudes of association were strongest for high-titer (≥ 1:1,280) ANA: hair, OR = 11.41 (95% CI: 1.60, 81.23); blood, OR = 5.93 (95% CI: 1.57, 22.47).
Methylmercury, at low levels generally considered safe, was associated with subclinical autoimmunity among reproductive-age females. Autoantibodies may predate clinical disease by years; thus, methylmercury exposure may be relevant to future autoimmune disease risk.
Introduction Diet-related disease is disproportionately concentrated in low-income communities where fruit and vegetable consumption is far below guidelines. To address financial barriers, Double Up ...Food Bucks (DUFB)—a statewide healthy food incentive—matches Supplemental Nutrition Assistance Program (SNAP) funds spent at farmers markets. However, incentive use is limited. This study examined the impact of a brief waiting room–based intervention about DUFB on program utilization and produce consumption. Study design Longitudinal, repeated measures, quasi-experimental trial. Setting/participants SNAP-enrolled adults at a health center in a low-income, racially and ethnically diverse area of Southeast Michigan. Intervention Participants received a brief explanation of DUFB, written program materials, a map highlighting market locations and hours, and an initial $10 market voucher. DUFB use and produce consumption were measured through four surveys over 5 months (August 2014–January 2015). Main outcome measures Outcome measures included DUFB use and fruit and vegetable consumption (analyses conducted in 2015–2016). Results A total of 302 eligible adults were identified, and 177 (59%) enrolled. One hundred twenty-seven (72%) completed all surveys. At baseline, 57% of participants reported shopping at a farmers market within the last year; 18% had previously used DUFB. By the end of the DUFB season, participants were significantly more likely to report DUFB use than at baseline (AOR=19.2, 95% CI=10.3, 35.5, p <0.001), with 69% of participants reporting use of DUFB at least once, and 34% reporting use of DUFB three or more times. Adjusted fruit and vegetable consumption increased from baseline by 0.65 servings/day (95% CI=0.37, 0.93, p <0.001) at 3 months, and remained 0.62 servings/day (95% CI=0.32, 0.92, p <0.001) higher than baseline 2 months post-DUFB season. Conclusions A brief clinic-based intervention was associated with a nearly fourfold increase in uptake of a SNAP incentive program, as well as clinically and statistically significant increases in produce consumption. Results suggested sustained behavior change even once the financial incentive was no longer available. Providing information about healthy food incentives is a low-cost, easily implemented intervention that may increase produce consumption among low-income patients.
Ginger shows promising anticancer properties. No research has examined the pharmacokinetics of the ginger constituents 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol in humans. We conducted a ...clinical trial with 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol, examining the pharmacokinetics and tolerability of these analytes and their conjugate metabolites.
Human volunteers were given ginger at doses from 100 mg to 2.0 g (N = 27), and blood samples were obtained at 15 minutes to 72 hours after a single p.o. dose. The participants were allocated in a dose-escalation manner starting with 100 mg. There was a total of three participants at each dose except for 1.0 g (N = 6) and 2.0 g (N = 9).
No participant had detectable free 6-gingerol, 8-gingerol, 10-gingerol, or 6-shogaol, but 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol glucuronides were detected. The 6-gingerol sulfate conjugate was detected above the 1.0-g dose, but there were no detectable 10-gingerol or 6-shogaol sulfates except for one participant with detectable 8-gingerol sulfate. The C(max) and area under the curve values (mean +/- SE) estimated for the 2.0-g dose are 0.85 +/- 0.43, 0.23 +/- 0.16, 0.53 +/- 0.40, and 0.15 +/- 0.12 microg/mL; and 65.6.33 +/- 44.4, 18.1 +/- 20.3, 50.1 +/- 49.3, and 10.9 +/- 13.0 microg x hr/mL for 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol. The corresponding t(max) values are 65.6 +/- 44.4, 73.1 +/- 29.4, 75.0 +/- 27.8, and 65.6 +/- 22.6 minutes, and the analytes had elimination half-lives <2 hours. The 8-gingerol, 10-gingerol, and 6-shogaol conjugates were present as either glucuronide or sulfate conjugates, not as mixed conjugates, although 6-gingerol and 10-gingerol were an exception.
Six-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol are absorbed after p.o. dosing and can be detected as glucuronide and sulfate conjugates.
Objective
Medication access and adherence are important determinants of health outcomes. We investigated factors associated with access and cost‐related nonadherence to prescriptions in a ...population‐based cohort of systemic lupus erythematosus (SLE) patients and controls.
Methods
Detailed sociodemographic and prescription data were collected by structured interview in 2014–2015 from participants in the Michigan Lupus Epidemiology and Surveillance (MILES) cohort. We compared access between cases and frequency‐matched controls and examined associated factors in separate multivariable logistic regression models.
Results
A total of 654 participants (462 SLE patients, 192 controls) completed the baseline visit; 584 (89%) were female, 285 (44%) were Black, and the mean age was 53 years. SLE patients and controls reported similar frequencies of being unable to access prescribed medications (12.1% versus 9.4%, respectively; P was not significant). SLE patients were twice as likely as controls to report cost‐related prescription nonadherence in the preceding 12 months to save money (21.7% versus 10.4%; P = 0.001) but were also more likely to ask their doctor for lower cost alternatives (23.8% versus 15.6%; P = 0.02). Disparities were found in association with income, race, and health insurance status, but the main findings persisted after adjusting for these and other variables in multivariable models.
Conclusion
SLE patients were more likely than controls from the general population to report cost‐related prescription nonadherence, including skipping doses, taking less medicine, and delaying filling prescriptions; yet, <1 in 4 patients asked providers for lower cost medications. Consideration of medication costs in patient decision‐making could provide a meaningful avenue for improving access and adherence to medications.
Objective
To examine associations between dietary intake of omega‐3 (n‐3; generally antiinflammatory) and omega‐6 (n‐6; generally proinflammatory) fatty acids and patient‐reported outcomes in ...systemic lupus erythematosus (SLE).
Methods
This study was based on the population‐based Michigan Lupus Epidemiology and Surveillance cohort. Estimates of n‐3 and n‐6 intake were derived from Diet History Questionnaire II items (past year with portion size version). Patient‐reported outcomes included self‐reported lupus activity (Systemic Lupus Activity Questionnaire SLAQ). Multivariable regression, adjusted for age, sex, race, and body mass index, was used to assess associations between absolute intake of n‐3 and n‐6, as well as the n‐6:n‐3 ratio, and patient‐reported outcomes.
Results
Among 456 SLE cases, 425 (93.2%) were female, 207 (45.4%) were African American, and the mean ± SD age was 52.9 ± 12.3 years. Controlling for potential confounders, the average SLAQ score was significantly higher by 0.3 points (95% confidence interval 95% CI 0.1, 0.6; P = 0.013) with each unit increase of the n‐6:n‐3 ratio. Both lupus activity and Patient‐Reported Outcomes Measurement Information System (PROMIS) sleep disturbance scores were lower with each 1‐gram/1,000 kcal increase of n‐3 fatty acids (SLAQ regression coefficient β = –0.8 95% CI –1.6, 0.0; P = 0.055; PROMIS sleep β = –1.1 95% CI –2.0, –0.2; P = 0.017). Higher n‐3 intakes were nonsignificantly associated with lower levels of depressive symptoms and comorbid fibromyalgia, and with higher quality of life, whereas results for the n6:n3 ratio trended in the opposite direction.
Conclusion
This population‐based study suggests that higher dietary intake of n‐3 fatty acids and lower n‐6:n‐3 ratios are favorably associated with patient‐reported outcomes in SLE, particularly self‐reported lupus activity and sleep quality.
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