Mediterranean Diet and Cardiovascular Disease: A Critical Evaluation of A Priori Dietary Indexes

The aim of this paper is to analyze the a priori dietary indexes used in the studies that have evaluated the role of the Mediterranean Diet in influencing the risk of developing cardiovascular disease. All the studies show that this dietary pattern protects against cardiovascular disease, but studies show quite different effects on specific conditions such as coronary heart disease or cerebrovascular disease. A priori dietary indexes used to measure dietary exposure imply quantitative and/or qualitative divergences from the traditional Mediterranean Diet of the early 1960s, and, therefore, it is very difficult to compare the results of different studies. Based on real cultural heritage and traditions, we believe that the a priori indexes used to evaluate adherence to the Mediterranean Diet should consider classifying whole grains and refined grains, olive oil and monounsaturated fats, and wine and alcohol differently.     

A Revised Australian Dietary Guideline Index and Its Association with Key Sociodemographic Factors,Health Behaviors and Body Mass Index in Peri-Retirement Aged Adults

The Dietary Guideline Index, a measure of diet quality, was updated to reflect the 2013 Australian Dietary Guidelines. This paper describes the revision of the index (DGI-2013) and examines its use in older adults. The DGI-2013 consists of 13 components reflecting food-based daily intake recommendations of the Australian Dietary Guidelines. In this cross-sectional study, the DGI-2013 score was calculated using dietary data collected via an 111-item food frequency questionnaire and additional food-related behaviour questions. The DGI-2013 score was examined in Australian adults (aged 55–65 years; n = 1667 men; 1801 women) according to sociodemographics, health-related behaviours and BMI. Women scored higher than men on the total DGI-2013 and all components except for dairy. Those who were from a rural area (men only), working full-time (men only), with lower education, smoked, did not meet physical activity guidelines, and who had a higher BMI, scored lower on the DGI-2013, highlighting a group of older adults at risk of poor health. The DGI-2013 is a tool for assessing compliance with the Australian Dietary Guidelines. We demonstrated associations between diet quality and a range of participant characteristics, consistent with previous literature. This suggests that the DGI-2013 continues to demonstrate convergent validity, consistent with the original Dietary Guideline Index.     

Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy

Although the positive association between pre-pregnancy overweight and obesity with excessive gestational weight gain is well known, it is not clear how pre-pregnancy weight status is associated with gestational weight gain through maternal diet during pregnancy. This study aimed to examine the relationship between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Our study included 795 U.S. pregnant women from the National Health and Nutrition Examination Survey, 2003–2012. Pre-pregnancy body mass index (BMI) was calculated based on self-reported pre-pregnancy weight and height. The cutoff points of <18.5 (underweight), 18.5–24.9 (normal), 25.0–29.9 (overweight), and 30 kg/m² (obese) were used to categorize pregnant women’s weight status. Diet quality during pregnancy was assessed by the Healthy Eating Index (HEI)-2010 based on a 24-h recall. Multivariable logistic regressions were used to estimate the odds ratios (OR) and 95% confidence intervals (CI). For all pregnant women included in this study, the mean HEI-2010 (±standard error of the mean (SEM)) was 50.7 (±0.9). Women with obese pre-pregnancy BMI demonstrated significantly lower HEI-2010 compared to those with underweight and normal pre-pregnancy BMI, respectively. In an unadjusted model, women with pre-pregnancy obesity BMI had increased odds for being in the lowest tertile of HEI-2010 (33.4 ± 0.5) compared to those with underweight pre-pregnancy BMI (OR 5.0; 95% CI 2.2–11.4). The inverse association between pre-pregnancy overweight and obesity status and diet quality during pregnancy persisted even after we controlled for physical activity levels (adjusted OR (AOR) 3.8; 95% CI 1.2–11.7, AOR 5.4; 95% CI 2.0–14.5, respectively). Serum folate concentration (ng/mL) was significantly higher in underweight women compared to overweight women (23.4 ± 1.7 vs. 17.0 ± 0.8, p < 0.05). Serum iron concentration (ng/dL) was significantly higher in normal weight women compared to overweight women (86.2 ± 5.0 vs. 68.9 ± 3.0, p < 0.05). An inverse association was found between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Poor diet quality as measured by HEI-2010 was shown among overweight and obese women. Nutrition education and interventions need to be targeted to those women entering pregnancy as overweight and obese.     

A Comparison of Diet Quality in a Sample of Rural and Urban Australian Adults

The diet quality of rural Australians is under researched. Characterising disparities in diet quality between rural and urban populations may inform targeted interventions in at- risk groups. A cross-sectional study aimed to determine the relationship between diet quality, rurality and sociodemographic characteristics in a sample of Australian adults. Participants were recruited at rural and regional events between 2017 and 2020, in New South Wales, Australia. Diet quality was measured using the Healthy Eating Quiz or Australian Eating Survey to generate an Australian Recommended Food Score (ARFS). ARFS was compared by rurality and sociodemographic characteristics using multivariate regression. Participants (n = 247; 53% female) had a mean ± SD ARFS of 34.5 ± 9.0. There was no significant effect of rurality on ARFS (β-coefficient = −0.4; 95%CI −3.0, 2.3). Compared to participants aged 18–30 years, higher ARFS was evident for those aged 31–50 (β = 5.4; 95%CI 0.3, 10.4), 51–70 (β = 4.4; 95%CI 0.3, 8.5) and >71 years (β = 6.5; 95% CI 1.6–11.4). Compared to those living alone, participants living with a partner (β = 5.2; 95%CI 2.0, 8.4) and families with children (β = 5.6; 95%CI 1.4, 9.8) had significantly higher ARFS. ARFS was significantly lower with each additional self-reported chronic health condition (β = −1.4; 95%CI −2.3, −0.4). Our results indicate that diet quality as defined by the ARFS was classified as ‘getting there’ and that age, living arrangements and chronic health conditions, but not rurality, influenced diet quality in a sample of Australian adults.     

An Ultra-Processed Food Dietary Pattern Is Associated with Lower Diet Quality in Portuguese Adults and the Elderly: The UPPER Project

This study aimed to identify dietary patterns (DPs) and their associations with sociodemographic factors and diet quality in Portuguese adults and the elderly. Cross-sectional data were obtained from the National Food, Nutrition and Physical Activity Survey (2015–2016), with two non-consecutive dietary 24 h recalls. Food items were classified according to the NOVA system and its proportion (in grams) in the total daily diet was considered to identify DPs by latent class analysis, using age and sex as concomitant variables. Multinomial logistic and linear regressions were performed to test associations of DPs with sociodemographic characteristics and diet quality, respectively. Three DPs were identified: “Traditional” (higher vegetables, fish, olive oil, breads, beer and wine intake), “Unhealthy” (higher pasta, sugar-sweetened beverages, confectionery and sausages intake) and “Diet concerns” (lower intake of cereals, red meat, sugar-sweetened and alcoholic beverages). “Unhealthy” was associated with being younger and lower intake of dietary fiber and vitamins and the highest free sugars and ultra-processed foods (UPF). “Diet concerns” was associated with being female and a more favorable nutrient profile, but both DPs presented a higher contribution of UPF than the “Traditional” DP. These findings should be considered for the design of food-based interventions and public policies for these age groups in Portugal.     

Low Protein Intakes and Poor Diet Quality Associate with Functional Limitations in US Adults with Diabetes: A 2005–2016 NHANES Analysis

Type 2 diabetes is associated with an increased risk for sarcopenia. Moreover, sarcopenia correlates with increased risk for falls, fractures, and mortality. This study aimed to explore relationships among nutrient intakes, diet quality, and functional limitations in a sample of adults across levels of glycemic control. Data were examined from 23,487 non-institutionalized adults, 31 years and older, from the 2005–2016 National Health and Nutrition Examination Survey. Hemoglobin A1c (%) was used to classify level of glycemic control: non-diabetes (<5.7%); pre-diabetes (5.7–6.4%); diabetes (≥6.5%). Dietary data were collected from a single 24-h dietary recall. Participants were categorized as meeting or below the protein recommendation of 0.8 g/kg of body weight. Physical functioning was assessed across 19-discrete physical tasks. Adults below the protein recommendation consumed significantly more carbohydrate and had lower diet quality across all glycemic groups compared to those who met the protein recommendation (p < 0.001). Adults with diabetes who did not meet protein recommendations had significantly poorer diet quality and significantly higher mean number of functional limitations. A greater percent of adults with diabetes who did not meet the protein recommendation reported being physically limited for most activities, with more than half (52%) reporting limitations for stooping, crouching, and kneeling. This study underscores the potential for physical limitations associated with low protein intakes, especially in adults with diabetes. In the longer term, low protein intakes may result in increased risk of muscle loss, as protein intake is a critical nutritional factor for prevention of sarcopenia, functional limitations, and falls.     

Plant-Based Diets and Lipid,Lipoprotein, and Inflammatory Biomarkers of Cardiovascular Disease: A Review of Observational and Interventional Studies

Plant-based diets (PBDs) are becoming increasingly popular. Thus far, the literature has focused on their association with lipid profiles, with less investigation of lipoprotein and inflammatory profiles. Because pro-atherogenic lipid, lipoprotein, and inflammatory processes may facilitate the development of atherosclerosis, understanding the relation between PBDs and these processes is important to inform risk mitigation strategies. Therefore, the objective of this paper was to review the literature on PBDs and lipid, lipoprotein, and inflammatory biomarkers of cardiovascular disease (CVD). A structured literature search was performed, retrieving 752 records, of which 43 articles were included. Plant-based diets generally associated with favourable lipid and lipoprotein profiles, characterised by decreased total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B concentrations, and less low-grade inflammation, characterised by decreased C-reactive protein concentrations. Effect sizes from PBD interventions were greatest compared to habitual dietary patterns, and for non-low-fat vegan and tightly controlled dietary interventions. Associations between PBD indices and the reviewed biomarkers were less consistent. Findings are discussed with reference to the literature on PBDs and PBD indices and CVD risk, the associations between specific plant food groups and CVD outcomes and the reviewed biomarker outcomes, and the potential mechanisms underpinning associations between PBDs and reduced CVD risk.     

Modeling the Impact of Adding a Serving of Dairy Foods to the Healthy Mediterranean-Style Eating Pattern Recommended by the 2015–2020 Dietary Guidelines for Americans

Objective: The Healthy Mediterranean-Style Eating Pattern (HMEP) in the 2015 Dietary Guidelines for Americans (DGA) recommends that adults eating less than 2400?kcal a day consume only two daily servings (or cup-equivalents) of low-fat or fat-free dairy foods like milk, cheese, and yogurt, which does not provide enough calcium, potassium, and vitamin D to meet dietary reference intakes (DRIs). Our objective was to assess the impact of additional servings of dairy foods on the nutrient adequacy of the 1600, 2000, and 2400?kcal HMEP in the 2015 DGA.

Methods: Using the same food pattern modeling procedures as the 2015 DGA, we assessed the nutrient composition of three alternative models of the 1600, 2000, and 2400?kcal HMEP. For Model 1, we increased servings of dairy foods (77?kcal/serving). For Model 2, we added one serving of dairy foods and removed one serving of refined grains (85?kcal/serving), and for Model 3 (2400?kcal HMEP only), we added one-half serving of dairy foods and removed one-half serving of refined grains. We then assessed these models for nutrient adequacy and compared them to the Healthy U.S.-Style Eating Pattern and the HMEP.

Results: The changes to the HMEP with these models increased the amounts of several nutrients to encourage, including calcium, vitamin D, potassium, vitamin A, phosphorus, riboflavin, vitamin B12, zinc, and magnesium. For instance, Model 1 increased the calcium (by 295?mg), vitamin D (by 59.3?IU), potassium (by 235?mg), vitamin A (by 98?mcg), and phosphorus (by 232?mg) content of the original HMEP, and Model 3 increased the amounts of these nutrients by half of those amounts. Model 2 increased the calcium content by 266?mg, vitamin D by 58?IU, potassium by 202?mg, vitamin A by 88?mcg, and phosphorus by 193?mg. Notably, Models 1 and 2 increased the vitamin D content of the HMEP to about 62% of the DRI (average across all calorie levels) and the potassium content to 78% of the DRI (average across all calorie levels), from 52% and 73%, respectively, in the original HMEP. Most of our models increased the saturated fat (0.5?g in Model 1 and 0.2?g in Model 2) and sodium (202?mg in Model 1 and 101?mg in Model 2) content as well. The amounts of these nutrients to limit remained within the ranges recommended in the 2015 DGA.

Conclusions: The addition of a dairy food serving to the 1600, 2000, and 2400?kcal HMEP brings their nutrient profiles closer to the DRIs for several nutrients to encourage, including calcium, vitamin D, and potassium.     

Influence of Dietary Habits and Mediterranean Diet Adherence on Sleep Quality during Pregnancy. The GESTAFIT Project

We examined the association of the dietary habits and the Mediterranean diet (MD) adherence with sleep quality during pregnancy. A food frequency questionnaire and the Mediterranean Food Pattern were employed to assess dietary habits and MD adherence, respectively. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) global score (n = 150; mean age 32.9 ± 4.6 years). A higher consumption of fruits was associated with better sleep quality at the 16th gestational week (g.w.; p < 0.05). A greater olive oil consumption and a higher MD adherence were associated with better sleep quality at the 16th and 34th g.w. (all, p < 0.05). Contrarily, a higher red meat and subproducts consumption was associated with worse sleep quality at the 34th g.w. (p < 0.05). The group with the highest adherence to the MD (Tertile 3) showed better sleep quality than the group with the lowest adherence (Tertile 1) at the 16th and 34th g.w. (both, p < 0.05). A higher adherence to the MD, a greater intake of fruits and olive oil and a lower intake of red meat and subproducts were associated with better sleep quality along the pregnancy course, especially among sedentary women.     

Use of Dietary Supplements Improved Diet Quality But Not Cardiovascular and Nutritional Biomarkers in Socioeconomically Diverse African American and White Adults

Knowledge of the contribution of supplements to overall nutritional health is limited. The research objectives were to describe motivations for use of dietary supplements by African Americans and Whites examined in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study and to determine if supplements provided beneficial effects to micronutrient diet quality and nutritional and cardiovascular biomarkers. The majority of the HANDLS study population were smokers, overweight or obese, and self-reported their health as poor to good. The top two reasons for their supplement use were to supplement the diet and to improve overall health. Micronutrient intake was calculated from two 24-hour recalls and a supplement questionnaire. Diet quality was assessed by the Mean Adequacy Ratio (MAR) [Maximum score?=?100] derived from the Nutrient Adequacy Ratio (NAR) for 17 micronutrients. The MAR score for nonusers was 73.12, for supplement users based on diet alone was 74.89, and for food and supplements was 86.61. Dietary supplements significantly increased each NAR score and MAR score. However, there were no significant differences between the population proportions with inadequate or excessive blood levels for any biomarkers examined. Nutrition education programs and intervention strategies addressing dietary supplement intake might lead to healthier food choices and may improve the health of this population.     

Assessment of Dietary Habits Using the Diet Quality Index—International in Cerebrovascular and Cardiovascular Disease Patients

Improvement of dietary habits is recommended for the management of cerebrovascular and cardiovascular diseases (CCVD). This study aimed to evaluate the dietary habits of CCVD patients and compare them with the general population by using the Diet Quality Index—International (DQI-I). Data from the Korean National Health and Nutrition Examination Surveys (2013–2016) were used. Cardiovascular diseases included myocardial infarction, angina pectoris, and heart failure; and cerebrovascular diseases included stroke, cerebral infarction, and hemorrhage. In total, 12,683 subjects over 20 years old were included, comprising 718 CCVD patients and 11,965 non-CCVD subjects. Survey-weighted multiple linear regression analyses with adjustment for covariates were used to compare DQI-I scores. The mean total DQI-I scores for the CCVD and non-CCVD groups were 66.7 ± 9.2 and 67.8 ± 9.2, respectively. After adjusting for covariates, the CCVD group had DQI-I scores significantly lower than the non-CCVD group (coefficient −1.13, p-value = 0.011). In the analysis of each DQI-I component, the CCVD group had lower scores for variety (coefficient −0.54, p-value = 0.004) and adequacy (coefficient −0.86, p-value = 0.001). In this study, using nationally representative data, dietary habits of CCVD patients were shown to be lower in quality than non-CCVD subjects. Therefore, evaluation and education of adequate dietary habits are needed in the management of CCVD patients.     

Comparison of Nutritional Quality of the Vegan,Vegetarian, Semi-Vegetarian,Pesco-Vegetarian and Omnivorous Diet

The number of studies comparing nutritional quality of restrictive diets is limited. Data on vegan subjects are especially lacking. It was the aim of the present study to compare the quality and the contributing components of vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diets. Dietary intake was estimated using a cross-sectional online survey with a 52-items food frequency questionnaire (FFQ). Healthy Eating Index 2010 (HEI-2010) and the Mediterranean Diet Score (MDS) were calculated as indicators for diet quality. After analysis of the diet questionnaire and the FFQ, 1475 participants were classified as vegans (n = 104), vegetarians (n = 573), semi-vegetarians (n = 498), pesco-vegetarians (n = 145), and omnivores (n = 155). The most restricted diet, i.e., the vegan diet, had the lowest total energy intake, better fat intake profile, lowest protein and highest dietary fiber intake in contrast to the omnivorous diet. Calcium intake was lowest for the vegans and below national dietary recommendations. The vegan diet received the highest index values and the omnivorous the lowest for HEI-2010 and MDS. Typical aspects of a vegan diet (high fruit and vegetable intake, low sodium intake, and low intake of saturated fat) contributed substantially to the total score, independent of the indexing system used. The score for the more prudent diets (vegetarians, semi-vegetarians and pesco-vegetarians) differed as a function of the used indexing system but they were mostly better in terms of nutrient quality than the omnivores.     

Cooking Frequency and Perception of Diet among US Adults Are Associated with US Healthy and Healthy Mediterranean-Style Dietary Related Classes: A Latent Class Profile Analysis

Background: Meal habits are associated with overall dietary quality and favorable dietary patterns determined by the Healthy Eating Index (HEI). However, within dietary patterns, complexities of food combinations that are not apparent through composite score determination may occur. Also, explorations of these food combinations with cooking and perceived diet quality (PDQ) remain unknown. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2007–2010 were utilized to determine the frequency of cooking at home and PDQ, along with sociodemographic variables. Latent class profile analysis was performed to determine person-centered data-driven analysis using the dietary index, HEI-2010, at both the daily and dinner meal-time levels. Multinomial logistic regression analysis was utilized to evaluate the association of dietary patterns with all covariates. Results: For daily HEI, five distinct dietary classes were identified. For dinner HEI, six classes were identified. In comparison to the standard American diet classes, home cooking was positively associated with daily (p < 0.05) and dinner (p < 0.001) dietary classes that had the highest amounts of total vegetable and greens/beans intake. PDQ was positively associated with these classes at the daily level (p < 0.001), but negatively associated with healthier classes at the dinner level (p < 0.001). Conclusion: The use of latent class profile analysis at the daily and dinner meal-time levels identified that food choices coalesce into diverse intakes, as shown by identified dietary classes. Home cooking frequency could be considered a positive factor associated with higher vegetable intake, particularly greens/beans, at the daily and dinner levels. At the same time, the perception of diet quality has a positive association only with daily choices.     

Identification of Dish-Based Dietary Patterns for Breakfast,Lunch, and Dinner and Their Diet Quality in Japanese Adults

We identified dish-based dietary patterns for breakfast, lunch, and dinner and assessed the diet quality of each pattern. Dietary data were obtained from 392 Japanese adults aged 20–69 years in 2013, using a 4 d dietary record. K-means cluster analysis was conducted based on the amount of each dish group, separately for breakfasts (n = 1462), lunches (n = 1504), and dinners (n = 1500). The diet quality of each dietary pattern was assessed using the Healthy Eating Index 2015 (HEI-2015) and Nutrient-Rich Food Index 9.3 (NRF9.3). The extracted dietary patterns were as follows: ‘bread-based’ and ‘rice-based’ for breakfast; ‘bread’, ‘rice-based’, ‘ramen’, ‘udon/soba’, and ‘sushi/rice bowl dishes’ for lunch; and ‘miscellaneous’, ‘meat dish and beer’, and ‘hot pot dishes’ for dinner. For breakfast, the HEI-2015 and NRF9.3 total scores were higher in the ‘rice-based’ pattern than the ‘bread-based’ pattern. For lunch, the HEI-2015 and NRF9.3 total scores were relatively high in the ‘rice-based’ pattern and low in the ‘ramen’ pattern. For dinner, the HEI-2015 total score was the highest in the ‘meat dish and beer’ pattern, and the NRF9.3 total score was higher in the ‘hot pot dishes’ than the ‘miscellaneous’ pattern. These results suggested that breakfast, lunch, and dinner have distinctive dietary patterns with different diet qualities.     

The Association of Dietary Intake,Oral Health,and Blood Pressure in Older Adults: A Cross-Sectional Observational Study

Hypertension is related to impaired mastication that causes malnutrition, declining the general health of older adults. This study assessed the role of dietary intake in the relationship between oral health and blood pressure. Eight hundred ninety-four adults aged ≥65 years who independently lived in rural regions of Japan participated in this study. Hypertension was classified according to the guidelines of the Japanese Society of Hypertension. The oral condition was evaluated by analyzing the remaining teeth, occlusal force, posterior occlusal support, masticatory performance, oral moisture, and oral bacterial level. Dietary intake was assessed using a brief self-administered dietary history questionnaire. Mann-Whitney U, chi-square, Kruskal-Wallis tests, and logistic regression analyses were used to elucidate the factors related to hypertension. Normotensive, hypertensive, and history of hypertension were observed in 30.9%, 23.8%, and 45.3% of the participants, respectively. The factors significantly associated with the hypertension were age, body mass index, posterior occlusal support condition, and sodium-to-potassium ratio related to salt intake and/or vegetable intake. Participants without posterior occlusion significantly had higher risk of hypertension (odds ratio = 1.72). This study suggested that there was an association between oral health and hypertension, while the loss of occlusal support may influence nutritional intake conditions.     

Dietary Pattern and Dietary Energy from Fat Associated with Sarcopenia in Community-Dwelling Older Chinese People: A Cross-Sectional Study in Three Regions of China

Associations between dietary patterns (DPs) and sarcopenia remain controversial, and fewer studies have mentioned the relationship between dietary energy composition and sarcopenia. The present cross-sectional study was conducted in three regions of China, to detect the associations between DPs and sarcopenia, and to identify the influencing nutrients. Exploratory factor analysis was conducted for DP identification. Logistic regressions were performed to explore the associations between DPs and sarcopenia. Dietary nutrients and dietary energy composition were calculated and compared among different DPs. Three DPs were identified from 861 community-dwelling older people. The “mushrooms–fruits–milk” pattern was negatively associated with sarcopenia (OR = 0.33, 95% CI = 0.14~0.77, p-trend = 0.009). Subjects in the highest quartile of the “mushrooms–fruits–milk” pattern showed more abundant intake (1.7 g/kg/d) of dietary protein, and lower percentage (31%) of energy from fat (PEF) than the other two DPs. Further analyses indicated that lower PEF (<30%) was negatively associated with sarcopenia. In conclusion, the “mushrooms–fruits–milk” pattern was negatively associated with sarcopenia in community-dwelling older Chinese people. This pattern showed abundant protein intake and low PEF, which may partially contribute to its protective effect on sarcopenia. Therefore, besides protein, dietary fat and PEF may also be considered in the prevention and management of sarcopenia.     

Data-Driven Dietary Patterns and Diet Quality Scores: Reproducibility and Consistency in Sex and Age Subgroups of Poles Aged 15–65 Years

This study aimed to assess: (i) the test–retest reproducibility of identification of data-driven dietary patterns (DPs) derived using a Principal Component Analysis (PCA) and hypothesis-driven DPs (diet quality scores); (ii) the consistency of data-driven DPs with diet quality scores in sex and age subgroups of Poles aged 15–65 years. The study involved 504 subjects (55.6% of females). Data on food consumption frequency (33 food items) were collected twice with a two-week interval using the Dietary Habits and Nutrition Beliefs Questionnaire (KomPAN^®) in a self-administered version (test and retest). Two major data-driven DPs (‘Prudent’ and ‘Western’) were identified in the total sample, sex groups and four age groups separately from test and retest data. Two diet quality scores were analysed: Pro-Healthy-Diet-Index-10 (pHDI-10) and Non-Healthy-Diet-Index-14 (nHDI-14). Tucker’s congruence coefficient indicated fair-to-good similarity of data-driven DPs between test and retest for all study subgroups, except for males. Across study subgroups, the intraclass correlation coefficient (ICC) between the test and retest ranged from 0.56 to 0.86 for ‘Prudent’ DP and 0.57 to 0.82 for ‘Western’ DP, with the lowest values in males. The ICC (test vs. retest) ranged from 0.84 to 0.88 for pHDI-10 and 0.75 to 0.88 for nHDI-14. Comparing the data-driven DPs and diet quality scores, the Spearman’s correlations ranged from 0.63 to 0.93 between ‘Prudent’ DP and pHDI-10, and from 0.60 to 0.81 between ‘Western’ DP and nHDI-14. The test–retest reproducibility of data-driven DPs and diet quality scores and their consistency were acceptable in most of the study subgroups, with a tendency to be higher for pro-health than unhealthy DPs. Data-driven DPs were more reproducible in females than males. The reproducibility of diet quality scores tended to be better in males than females and was the highest in 25–44-year-olds. The KomPAN^® questionnaire can be recommended to use data-driven DPs and diet quality scores to describe the habitual diet in people aged 15–65 years.     

Ketogenic Diet: A Dietary Intervention via Gut Microbiome Modulation for the Treatment of Neurological and Nutritional Disorders (a Narrative Review)

The ketogenic diet (KD) has been important in treating epilepsy since the 1920s. The benefits of KD further expanded to other neurological diseases, including Alzheimer’s diseases, autism spectrum disorder, and nutritional disorder (obesity). Although the therapeutic efficacy of KD has been generally accepted, there is limited knowledge about its underlying mechanism of action, particularly its effect on our gut microbiome. Gut dysbiosis has been proposed to be involved in those diseases, and KD can promote gut microbiota remodeling that may assist in recovery. This review explores the therapeutic applications of KD, the roles of the gut microbiome in neurological diseases and obesity, as well as the effect of KD on the gut microbiome. The present information suggests that KD has significant roles in altering the gut microbiome to improve disease symptoms, mainly by incrementing Bacteroidetes to Firmicutes (B/F) ratio and reducing Proteobacteria in certain cases. However, current gaps call for continued research to understand better the gut microbiota profile altered by KD.     

Dietary Fats and Blood Pressure: A Critical Review of the Evidence

Comparisons of blood pressure patterns among populations suggest that low-fat diets or consumption of unsaturated fatty acids decrease blood pressure. However, in most single populations dietary fatty acids and total fat, as determined by diet history, are not significantly correlated with blood pressure. Dietary fatty acids, quantitated by levels in adipose tissue or plasma lipoproteins, had no consistent association with blood pressure. Dietary fatty acids and total fat were not predictive of the development of hypertension over four years in a large cohort of nurses in the United States. Although several dietary trials lacking randomized controls suggested effects of dietary fats on blood pressure, 11 of 12 controlled trials showed no significant effects. All seven double-blind trials, and the two trials of longest duration (one and five years), showed no effect of either varying the content of total fat or of exchanging polyunsaturated for saturated fatty acids. In summary, there is little convincing evidence that the amount or type of dietary fat, varied within customary dietary patterns, affects blood pressure levels in persons with normal or mildly elevated blood pressure.