Patterns of Food Consumption are Associated with Obesity,Self-Reported Diabetes and Cardiovascular Disease in Five American Indian Communities

The relationship between dietary patterns and chronic disease is underexplored in indigenous populations. We assessed diets of 424 American Indian (AI) adults living in 5 rural AI communities. We identified four food patterns. Increased prevalence for cardiovascular disease was highly associated with the consumption of unhealthy snacks and high fat–food patterns (OR 3.6, CI = 1.06, 12.3; and OR 6.0, CI = 1.63, 22.1), respectively. Moreover, the food-consumption pattern appeared to be different by community setting (p < .05). We recommend culturally appropriate community-intervention programs to promote healthy behavior and to prevent diet-related chronic diseases in this high-risk population.     

Application of Mediterranean Diet in Cardiovascular Diseases and Type 2 Diabetes Mellitus: Motivations and Challenges

Objective: Cardiovascular disease (CVD) is the leading cause of disability and death in many countries. Together with CVD, Type 2 diabetes mellitus (T2DM) accounts for more than 80% of all premature non-communicable disease deaths. The protective effect of the Mediterranean diet (MedDiet) on CVD and its risk factors, including T2DM, has been a constant topic of interest. Notwithstanding, despite the large body of evidence, scientists are concerned about the challenges and difficulties of the application of MedDiet. This review aims to explore the motivations and challenges for using MedDiet in patients with CVD and T2DM. Design: An electronic search was conducted for articles about MedDiet published in PubMed, ScienceDirect, Scopus, and Web of Science up to December 2021, particularly on CVD and T2DM patients. From a total of 1536 studies, the final eligible set of 108 studies was selected. Study selection involved three iterations of filtering. Results: Motivation to apply MedDiet was driven by the importance of studying the entire food pattern rather than just one nutrient, the health benefits, and the distinct characteristics of MedDiet. Challenges of the application of MedDiet include lacking universal definition and scoring of MedDiet. Influences of nutritional transition that promote shifting of traditional diets to Westernized diets further complicate the adherence of MedDiet. The challenges also cover the research aspects, including ambiguous and inconsistent findings, the inexistence of positive results, limited evidence, and generalization in previous studies. The review revealed that most of the studies recommended that future studies are needed in terms of health benefits, describing the potential benefits of MedDiet, identifying the barriers, and mainly discussing the effect of MedDiet in different populations. Conclusions: In general, there is consistent and strong evidence that MedDiet is associated inversely with CVD risk factors and directly with glycemic control. MedDiet is the subject of active and diverse research despite the existing challenges. This review informs the health benefits conferred by this centuries-old dietary pattern and highlights MedDiet could possibly be revolutionary, practical, and non-invasive approach for the prevention and treatment CVD and T2DM.     

Association of Total,Added, and Natural Phosphorus Intakes with Biomarkers of Health Status and Mortality in Healthy Adults in the United States

The Western diet is high in dietary phosphorus, partially due to added phosphorus, (i.e., phosphates) predominantly present in processed food products. Elevated serum phosphate levels, otherwise known as hyperphosphatemia, have been associated with changes in health status, of note detrimental effects on cardiovascular and renal health. However, the extent to which highly absorbed added phosphorus contributes to these changes is relatively unknown, due to its poor characterization among food composition databases. Industry-provided data on phosphorus source ingredients and ranges of added phosphorus present in food categories to enable a more accurate estimation of the total, added, and natural phosphorus intakes in the U.S. population. Using regression analyses, we then assessed relationships between estimated total, added, and natural phosphorus intakes on biomarkers of health status and mortality in individuals enrolled in the National Health and Nutrition Examination Survey (NHANES) 1988–1994 and 2001–2016 datasets. Total, added, and natural phosphorus intakes were associated with several biomarkers of health status. Added phosphorus intake was consistently inversely associated with HDL cholesterol in both men and women, whereas naturally occurring phosphorus intake was inversely correlated with the risk of elevated blood pressure. However, in most cases, the predicted impact of increases in phosphorus intake would result in small percentage changes in biomarkers. No meaningful associations between phosphorus and mortality were found, but indications of a correlation between mortality with quintiles of naturally occurring phosphorus were present, depending on covariate sets used. The disparate results for natural and added phosphorus intakes within the current study provide increased support for updating current food composition databases to more accurately account for dietary phosphorus intake as total, naturally occurring, and added phosphorus.     

Effects of length of stay and language proficiency on health care experiences among immigrants in Canada and the United States

This study sought to examine the influence of length of stay and language proficiency on immigrants' access to and utilization of care in Canada and the United States (U.S,). Data came from the 2007-2008 Canadian Community Health Survey and the National Health Interview Survey. Analyses were limited to foreign-born, non-elderly adults in each country (n = 12,870 in Canada and n = 7440 in the U.S.). Health care indicators included having a usual source of care; annual consultation with a health professional, dentist, and eye doctor; flu shot in the past year; and Pap test in the past 3 years. Logistic regression models were employed to estimate the relative odds of access or use of care, adjusting for need, demographic factors, socioeconomic status, and insurance coverage. In general, rates of health care access and utilization were higher in Canada than the U.S. among all immigrant groups. In both countries, adjusted analyses indicated that immigrants with shorter length of stay (less than 10 years) and limited language proficiency generally had lower rates of access/use compared with those with longer length of stay (10 years or more) and proficiency in each country's official language(s), respectively. There was one exception to this pattern in the U.S.: immigrants with limited English had higher odds of having a recent Pap test relative to English-proficient immigrants. The persistence of disparities in health care experiences based on length of stay and language proficiency in Canada suggests that universal health insurance coverage may not be sufficient for ensuring access to and utilization of primary and preventive care for this population.     

Higher Adherence to a Mediterranean Diet Is Associated with Improved Insulin Sensitivity and Selected Markers of Inflammation in Individuals Who Are Overweight and Obese without Diabetes

Insulin resistance (IR) and chronic low-grade inflammation are risk factors for chronic diseases including type 2 diabetes (T2D) and cardiovascular disease. This study aimed to investigate two dietary indices: Mediterranean Diet Score (MDS) and Dietary Inflammatory Index (DII^®), and their associations with direct measures of glucose metabolism and adiposity, and biochemical measures including lipids, cytokines and adipokines in overweight/obese adults. This cross-sectional study included 65 participants (males = 63%; age 31.3 ± 8.5 years). Dietary intake via 3-day food diaries was used to measure adherence to MDS (0–45 points); higher scores indicating adherence. Energy-adjusted DII (E-DII) scores were calculated with higher scores indicating a pro-inflammatory diet. IR was assessed using hyperinsulinemic euglycemic clamps, insulin secretion by intravenous glucose tolerance test, adiposity by dual-energy X-ray absorptiometry, and circulating cytokine and adipokine concentrations by multiplex assays. Higher MDS was associated with greater insulin sensitivity (β = 0.179; 95%CI: 0.39, 0.318) after adjusting for age, sex and % body fat, and lower NF-κB, higher adiponectin and adipsin in unadjusted and adjusted models. Higher E-DII score was associated with increased total cholesterol (β = 0.364; 95%CI: 0.066, 0.390) and LDL-cholesterol (β = 0.305; 95%CI: 0.019, 0.287) but not with adiposity, glucose metabolism, cytokines or adipokines. Greater MDS appears to be associated with decreased IR and inflammatory markers in overweight/obese adults.     

Truck drivers and heart disease in the United States, 1979-1990

BACKGROUND: Studies of truck drivers and cardiovascular disease (CVD), myocardial infarction, or ischemic heart disease (IHD) are limited, although studies of other professional drivers reported increased risk. METHODS: US mortality data from 1979 to 1990 for ages 15-90 were used to calculate proportional mortality ratios (PMRs) for heart disease and lung cancer for short and long haul truck drivers. Analysis was performed for Black (998 short haul and 13,241 long haul) truck drivers and White (4,929 short and 74,315 long haul) truck drivers separately. RESULTS: The highest significantly elevated proportionate heart disease (IHD, acute myocardial infarction (AMI), and other forms of heart disease) and lung cancer mortality was found for White and Black male long haul truck drivers age 15-54. Mortality was not significantly elevated for short haul truck drivers of either race or gender, nor for truck drivers who died after age 65, except for lung cancer among White males. An indirect adjustment suggested that smoking could explain the excess IHD mortality, but no direct data for smoking or the other known risk factors for heart disease were available and occupational exposures were not measured. CONCLUSIONS: The highest significant excess proportionate mortality for lung cancer, IHD and AMI was found for long haul truck drivers who were under age 55 at death. A cohort or longitudinal study of heart disease among long haul truck drivers, that obtains data for occupational exposures as well as lifestyle risk factors, could help explain inconsistencies between the findings of this and previous studies.     

Subclinical nutritional deficiency in treated coeliac disease and nutritional content of the gluten free diet

Patients with coeliac disease are started on a gluten free diet at the time of diagnosis, but after a varying period of follow-up are often discharged from outpatient and dietary follow-up. We have studied the nutritional status and dietary intake of 54 patients with treated coeliac disease diagnosed in adult life.
Each patient was paired with a healthy age and sex matched control. There was no difference in height in patients compared to controls, but a greater proportion of patients (15%) than controls (4%) had weight below the UK population lower 5th percentile ( x ² test P <0.05). Triceps skinfold thickness was 102% of age and sex matched mean reference values, but mid-arm circumference and arm muscle circumference were below reference mean values (93.1% and 91.5% of reference values, respectively). Haemoglobin, mean corpuscular volume, red cell folate and 25 hydroxyvitamin D were all in the normal range.
A strict gluten free diet was followed by 78% of patients; 22% had occasional gluten intake. Seventy-four per cent considered that they had reduced their intake of bread since commencing a gluten free diet. In 48% of patients, average daily intake of energy was less than the estimated average requirement, and in more than one-third of patients the intake of iron, copper, magnesium, retinol and folic acid was less than the relevant reference nutrient intake (RNI). In more than 10% of patients, average daily intake of calcium, zinc or vitamin B6 was less than the RNI. Vitamin D intake was lower than the RNI in four of five patients older than 65 years.     

Health behaviors, chronic disease prevalence and self-rated health of older Asian Indian immigrants in the U.S

The purpose of this study was to examine the correlates of healthy behaviors and self-rated health in middle-aged and older Asian Indian immigrants in the U.S. Asian Indian men (n = 162) and women (n = 64), 50 years of age or older completed a telephone survey which collected information regarding demographics, behavioral risk factors, acculturation, perceived control, quality of social support, depression, body mass index, chronic disease prevalence, and self-rated health. Participants average length of residence in the U.S. was 25 years, 52% were normal weight, 41% were vegetarians, 55% incorporated aerobic activity into daily lifestyle, and only 5% smoked. Hypertension and diabetes were most common chronic diseases (31 and 18%, respectively). Younger age, longer length of residence and a bicultural or more American ethnic identity were associated with greater participation in physical activity. Likewise, higher income, a bicultural or more American ethnic identity and depression were associated with higher fat intake. Poor self-rated health was associated with older age, female gender, BMI > 25, satisfaction with social support, and greater number of chronic disease conditions. A multitude of factors influence the practice of healthy behaviors and the perceived health of Asian Indian immigrants, which should be addressed when developing culturally appropriate health promotion interventions.     

The Benefits of Including Hummus and Hummus Ingredients into the American Diet to Promote Diet Quality and Health: A Comprehensive Review

Over the last decade, hummus has become an increasingly popular food. Given the ingredients (i.e., primarily chickpeas and tahini), nutrient composition, versatility, and acceptability, hummus can play a unique role when included in the American diet, to promote diet quality and improve health. The purpose of this paper is to provide a comprehensive review of the scientific evidence examining the effects of acute and long-term consumption of hummus and hummus ingredients on diet quality and risk factors related to type 2 diabetes, cardiovascular disease, and obesity. In addition, food pattern/menu modeling is included to illustrate the potential nutritional impact of consuming hummus to meet dietary guidelines. In general, the consumption of hummus and/or its respective ingredients has been shown to improve postprandial glycemic control, fasting lipids, appetite control, and daily food intake compared to other commonly consumed foods. The incorporation of hummus into the American diet can also improve diet quality by replacing foods higher in saturated fats, sodium, or added sugars. Collectively, these findings support the addition of hummus and/or hummus ingredients as an important component of a healthy dietary pattern.     

A New Evidence-Based Diet Score to Capture Associations of Food Consumption and Chronic Disease Risk

Previously, the attempt to compile German dietary guidelines into a diet score was predominantly not successful with regards to preventing chronic diseases in the EPIC-Potsdam study. Current guidelines were supplemented by the latest evidence from systematic reviews and expert papers published between 2010 and 2020 on the prevention potential of food groups on chronic diseases such as type 2 diabetes, cardiovascular diseases and cancer. A diet score was developed by scoring the food groups according to a recommended low, moderate or high intake. The relative validity and reliability of the diet score, assessed by a food frequency questionnaire, was investigated. The consideration of current evidence resulted in 10 key food groups being preventive of the chronic diseases of interest. They served as components in the diet score and were scored from 0 to 1 point, depending on their recommended intake, resulting in a maximum of 10 points. Both the reliability (r = 0.53) and relative validity (r = 0.43) were deemed sufficient to consider the diet score as a stable construct in future investigations. This new diet score can be a promising tool to investigate dietary intake in etiological research by concentrating on 10 key dietary determinants with evidence-based prevention potential for chronic diseases.     

Stories of meaning: lay perspectives on the origin and management of noninsulin dependent diabetes mellitus among older women in the United States

Researchers have sought to explain nonadherence to standard medical regimens by investigating a variety of sociodemographic variables, and, less often, by exploring variations between the health perspectives and life circumstances of the individual. While divergence between lay and professional perspectives on the etiology and treatment of chronic diseases, such as noninsulin dependent diabetes mellitus, may possibly account for the documented low rates of adherence to biomedical recommendations, health beliefs and activities are best understood as connected to an individual's personal history and circumstances. In order to evaluate the relationship between causal explanation of NIDDM and adherence, ethnographic interviews were conducted among 51 older (65+) women with diabetes and their physicians. We chose to investigate adherence to dietary recommendations because it represents one of the most challenging lifestyle modifications and is particularly important to maintaining glycemic control. The interviews involved ethnomedical and food frequency intake questionnaires and semi-structured interviews. Results reveal a stronger association between dietary adherence and etiological perspectives on diabetes than any sociodemographic factors, including ethnicity, education and income or other health belief factors. Informants suggested five categories that they believed were responsible for the onset of their NIDDM; poor past dietary practices (n = 22); familial tendency to have diabetes (n = 10); improper bodily functioning (n = 10); personal risk factors (n = 6); and currently being overweight (n = 3). Analyses indicated that those who implicate former dietary practices, currently being overweight, or having improper bodily functions were more likely to follow a standard recommended diet for individuals with diabetes. These findings also highlight the attempt by individuals with NIDDM to create 'stories' of meaning of their diabetes by linking their current management strategies for NIDDM with past practices and history. In addition, our results question the utility of the 'biomedical/alternative' labels.     

2型糖尿病人群中高尿酸血症与心血管病死亡风险的队列研究

目的 探讨2型糖尿病(type 2 diabetes mellitus,T2DM)队列人群中高尿酸血症与心血管病死亡风险的关系.方法 研究对象为江苏省常熟市的T2DM队列人群.应用Cox回归模型分析基线不同尿酸水平T2DM队列人群心血管病死亡的HR值和95％CI. 结果 10 246名T2DM队列人群中累积随访59 0...     

河北阜城县城乡中老年前列腺疾病认知及诊治情况调查

目的 了解贵州省黔南地区农村居民前列腺疾病患病现状及其危险因素,为采取相应的干预措施提供参考依据。 方法 于2016年10月 — 2018年9月,采用整群随机抽样方法抽取黔南地区99 887名 ≥ 30岁农村常住居民进行问卷调查、体格检查、直肠指检、实验室检查、经直肠超声检查、X线检查及穿刺活检,采用SAS 9.1软件进行统计学分析。 结果 贵州省黔南地区农村居民前列腺疾病患病49 367例,患病率为49.42 %,标化患病率为49.27 %。49 367例前列腺疾病患者中,前列腺增生18 387例（37.25 %）,前列腺钙化灶10 862例（22.00 %）,前列腺炎8 817例（17.86 %）,前列腺结石5 598例（11.34 %）,前列腺囊肿3 261例（6.61 %）,其他前列腺疾病2 442例（4.95 %）。多因素非条件logistic回归分析结果显示,年龄50～89岁、消瘦（OR = 2.018,95 % CI = 1.105～3.079）、超重（OR = 3.455,95 % CI = 1.207～4.261）和肥胖（OR = 4.026,95 % CI = 1.235～5.179）、喜辛辣食物（OR = 3.091,95 % CI = 1.121～4.329）、长期睡眠不足（OR = 3.137,95 % CI = 1.129～4.258）、长期手淫（OR = 3.732,95 % CI = 1.258～4.766）、长期骑马（OR = 3.187,95 % CI = 1.215～3.692）、长期骑自行车（OR = 3.225,95 % CI = 1.197～3.982）、长期便秘（OR = 3.104,95 % CI = 1.186～4.021）、长期憋尿（OR = 3.114,95 % CI = 1.201～4.425）、每日饮水量 < 1 L（OR = 3.538,95 % CI = 1.117～4.682）、长期久坐不动（OR = 3.883,95 % CI = 1.227～4.687）、高血压（OR = 2.856,95 % CI = 1.139～5.191）、高血脂（OR = 3.269,95 % CI = 1.212～4.968）、糖尿病（OR = 3.706,95 % CI = 1.325～4.857）和长期焦虑（OR = 3.316,95 % CI = 1.156～4.736）是贵州省黔南地区农村少数民族居民前列腺疾病患病的危险因素;规律性生活（OR = 0.456,95 % CI = 0.209～0.798）、不吸烟（OR = 0.765,95 % CI = 0.237～0.983）、不饮酒（OR = 0.815,95 % CI = 0.211～0.899）是贵州省黔南地区农村少数民族居民前列腺疾病患病的保护因素。 结论 贵州省黔南地区农村少数民族居民前列腺疾病患病率低于国内其他地区水平。     

慢性阻塞性肺疾病患者肺气肿改变对气道重塑与气流受限相关性的影响

  目的   了解慢性阻塞性肺疾病患者体力活动水平与并发症患病的关系,为减少慢性阻塞性肺疾病并发症提供参考依据。   方法   于2016年9月 — 2017年9月采用分层随机抽样方法在贵州省贵阳市公共卫生救治中心3个院区抽取330例住院慢性阻塞性肺疾病患者进行问卷调查,分析慢性阻塞性肺疾病患者体力活动水平与并发症患病的关系。   结果   本次最终有效调查的315例慢性阻塞性肺疾病患者中,低强度活动水平49例（15.56 %）,中强度活动水平178例（56.51 %）,高强度活动水平88例（27.94 %）;患有并发症者204例,并发症患病率为64.76 %,其中感染、心血管疾病、慢性肾衰竭、认知功能障碍、代谢综合征、骨质疏松、骨骼肌障碍和肺癌等并发症的患病率分别为28.25 %、11.75 %、11.11 %、11.11 %、11.11 %、7.30 %、6.03 %和3.49 %。204例患并发症慢性阻塞性肺疾病患者中,患1种并发症者56例（27.45 %）,患2种并发症者61例（29.90 %）,患 ≥ 3种并发症者87例（42.65 %）。在调整了性别、年龄、文化程度、婚姻状况、在职状况、居住地、吸烟情况、饮酒情况、病程、肺功能分级、是否疲劳、是否焦虑和是否抑郁等混杂因素后,多因素非条件logistic回归分析结果显示,中强度活动水平慢性阻塞性肺疾病患者并发症患病风险为低强度活动水平慢性阻塞性肺疾病患者的0.486倍（OR = 0.486,95 % CI = 0.243～0.973）,高强度活动水平慢性阻塞性肺疾病患者并发症患病风险为低强度活动水平慢性阻塞性肺疾病患者的0.368倍（OR = 0.368,95 % CI = 0.151～0.897）。   结论   慢性阻塞性肺疾病患者并发症患病类型多样,其中以感染和心血管疾病居多;体力活动强度越大的患者,其并发症患病风险越低。     

An update of the evidence relating to plant‐based diets and cardiovascular disease,type 2 diabetes and overweight

Recent findings from meta‐analyses, European cohorts and randomised controlled trials (RCTs) evaluating the relationship between plant‐based dietary regimes (i.e. those with an emphasis on plant foods, such as vegetarian, vegan, Mediterranean or combination diets), and the incidence of, or risk factors for, cardiovascular disease (CVD), type 2 diabetes (T2D) and obesity are considered in this review. Evidence from meta‐analyses of epidemiological studies indicates that those following plant‐based dietary regimes have around 20–25% lower risk of developing CVD and a similar reduced risk of developing T2D. Evidence from RCTs indicates that those following plant‐based dietary regimes have lower total cholesterol, low‐density lipoprotein‐cholesterol and blood pressure, and modest reductions in inflammatory and endothelial markers. Higher intake of plant foods has been associated with lower incidence of obesity, lower BMI and smaller waist circumference. For weight loss, it seems that following a plant‐based dietary regime results in weight loss comparable to that achieved on conventional reduced calorie diets, but with better overall weight management. The totality of evidence indicates there are benefits for cardiovascular health, risk of developing T2D and weight management from following a plant‐based dietary regime. From a nutritional perspective, plant‐based diets tend to be lower in saturated fatty acids, higher in unsaturated fatty acids and fibre, and lower in energy density than typical ‘Western’ diets. These qualities may be at the core of the health benefits reported and/or it may be simply a greater proportion of plant foods in the diet that is beneficial in its own right.     

Association between the Nutritional Quality of Household At-Home Food Purchases and Chronic Diseases and Risk Factors in the United States, 2015

Lower diet quality is a leading preventable risk factor for obesity and chronic diseases. This study assesses differences in the nutritional quality of at-home food purchases, using the Healthy Eating Index (HEI)-2015 and its components, among households with and without a member reporting type 2 diabetes (T2D), cardiovascular disease (CVD), obesity, and/or smoking. We use the 2015 IRI Consumer Network nationally representative household food purchase scanner data, combined with the IRI MedProfiler and the USDA’s Purchase-to-Plate Crosswalk datasets. For each/multiple condition(s), the difference in mean HEI score adjusted for covariates is tested for equivalence with the respective score against households without any member with the condition(s). The HEI score is higher for households without a member with reported T2D (2.4% higher), CVD (3.2%), obesity (3.3%), none of the three conditions (6.1%, vs. all three conditions), and smoking (10.5%) than for those with a member with the respective condition. Households with a member with T2D score better on the added sugar component than those with no member reporting T2D. We found that the average food purchase quality is lower than the recommended levels, especially for households with at least one member reporting a chronic condition(s).