Search Results (17)

Introduction: The sodium-to-potassium (Na:K) ratio in the diet is a critical biomarker for cardiovascular and metabolic health, yet global adherence to recommended levels remains poor. Objectives: The objective of this study was to identify dietary determinants of the dietary Na:K ratio and its associations with micronutrient intake and diet quality. Methods: An observational cross-sectional survey was conducted in a representative sample of manufacturing workers through a combined stratified proportional and two-stage probability sampling plan, with strata defined by company size and industrial sector from the state of Rio Grande do Norte, Brazil. Dietary intake was assessed using 24 h recalls via the Multiple Pass Method, with Na:K ratios calculated from quantified food composition data. Diet quality was assessed with the Diet Quality Index-International (DQI-I). Multiple linear regression was used to analyze associations of Na:K ratio with the study variables. Results: The survey was conducted in the state of Rio Grande do Norte, Brazil, in 921 randomly selected manufacturing workers. The sample mean age was 38.2 ± 10.7 years, 55.9% males, mean BMI 27.2 ± 4.80 kg/m². The mean Na:K ratio was 1.97 ± 0.86, with only 0.54% of participants meeting the WHO recommended target (<0.57). Fast food (+3.29 mg/mg per serving, p < 0.001), rice, bread, and red meat significantly increased the ratio, while fruits (−0.16 mg/mg), dairy, white meat, and coffee were protective. Higher Na:K ratios were associated with lower intake of calcium, magnesium, phosphorus, and vitamins C, D, and E, as well as poorer diet quality (DQI-I score: −0.026 per 1 mg/mg increase, p < 0.001). Conclusions: These findings highlight the critical role of processed foods in elevating Na:K ratios and the potential for dietary modifications to improve both electrolyte balance and micronutrient adequacy in industrial workers. The study underscores the need for workplace interventions that simultaneously address sodium reduction, potassium enhancement, and overall diet quality improvement tailored to socioeconomic and cultural contexts, a triple approach not previously tested in intervention studies. Future studies should further investigate nutritional consequences of imbalanced Na:K intake. Full article

Background/Objectives: The adherence to a healthy lifestyle is important for supporting healthy cognitive function as aging progresses. This study aimed to assess the association between a healthy lifestyle, specifically diet quality, physical activity, and smoking, and cognitive function in middle-aged and older adults. Methods: A cross-sectional study was conducted among participants aged 45 and older with normal cognition. Participants’ cognitive performance was assessed by the Montreal Cognitive Assessment (MoCA). Dietary intake was assessed using a 24 h dietary recall, and diet quality was assessed using the Diet Quality Index-International (DQI-I). Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Participants were categorized as unhealthy (score ≤ 1), average (score 2), and healthy (score 3). Results: In this study, a total of 176 participants were recruited, 46% of them were classified as unhealthy, 40% was average, and 14% as healthy. Participants in the unhealthy group had lower performance in the naming cognitive domain compared to the other groups (p = 0.01). Participants in the average group scored significantly lower than the other groups in the orientation domain (p = 0.02). Performing moderate and high physical activity levels were significantly associated with higher scores of MoCA (p = 0.04) and in the naming domain (p = 0.02). Conclusions: Adopting a healthy lifestyle is associated with maintaining cognitive health among middle-aged and older adults, supporting the relevance of multidomain lifestyle interventions. Further longitudinal research is warranted to evaluate the long-term feasibility and effectiveness of lifestyle interventions in this population. Full article

Background/Objectives: With the rise of artificial intelligence (AI) in nutrition and healthcare, AI-driven chatbots are increasingly recognised as potential tools for generating personalised diet plans. This study aimed to evaluate the capabilities of three popular chatbots—Gemini, Microsoft Copilot, and ChatGPT 4.0—in designing weight-loss diet plans across varying caloric levels and genders. Methods: This comparative study assessed the diet quality of meal plans generated by the chatbots across a calorie range of 1400–1800 kcal, using identical prompts tailored to male and female profiles. The Diet Quality Index-International (DQI-I) was used to evaluate the plans across dimensions of variety, adequacy, moderation, and balance. Caloric accuracy was analysed by calculating percentage deviations from requested targets and categorising discrepancies into defined ranges. Results: All chatbots achieved high total DQI-I scores (DQI-I > 70), demonstrating satisfactory overall diet quality. However, balance sub-scores related to macronutrient and fatty acid distributions were consistently the lowest, showing a critical limitation in AI algorithms. ChatGPT 4.0 exhibited the highest precision in caloric adherence, while Gemini showed greater variability, with over 50% of its diet plans deviating from the target by more than 20%. Conclusions: AI-driven chatbots show significant promise in generating nutritionally adequate and diverse weight-loss diet plans. Nevertheless, gaps in achieving optimal macronutrient and fatty acid distributions emphasise the need for algorithmic refinement. While these tools have the potential to revolutionise personalised nutrition by offering precise and inclusive dietary solutions, they should enhance rather than replace the expertise of dietetic professionals. Full article

Background and objectives: Increasing evidence suggests that complex measures of exposure accounting for the relative presence of healthy and unhealthy food outlets are more strongly associated with dietary pattern that absolute measures of the food environment, although evidence is limited by the cross-sectional design of existing studies. This study examined the long-term associations between absolute and relative measures of neighbourhood food environment and diet quality in Luxembourg. Methods: We used data of 566 adults participating in both waves of the population-based ORISCAV-LUX study (Wave 1: 2007–2009, Wave 2: 2016–2017). Diet quality was estimated in both waves using the Diet Quality Index-International (DQI-I), assessed with a 174-item food frequency questionnaire. Exposure to healthy and less healthy food outlets was computed within a 1000 m street network buffer around the participants’ home address using both absolute (density, spatial access) and relative (proportion) GIS-based measurements. We used linear mixed models adjusted on individual-level covariates and neighbourhood socioeconomic status to estimate associations between cumulative exposure and change in local retail food environment and DQI-I, and tested modification by neighbourhood socioeconomic status. Results: There was a significant decrease in DQI over 10 years from 62.4 to 60.9 (p < 0.0001). Less healthy food outlets increased by +56% over the 10-year. The results showed a 56% increase in less-healthy food outlets over the period. In an adjusted mixed-effects linear regression, high (vs. low) cumulative exposure to less-healthy food outlets is associated with lower DQI-I, when examining spatial access (β = −1.25, 95% CI: −2.29, −0.22) and proportions (β = −1.24, 95% CI: −2.15, −0.33). Stratification shows these associations to be significant only among urban residents. There was no association between change in exposure to less-healthy food outlets and DQI-I. Among rural residents, increased exposure to healthy food outlets over time was associated with worsened DQI-I when examining absolute measurements (density and spatial access). This unexpected result brings into question the ability of absolute measurements to fully capture the healthiness of food environments. Neighborhood socioeconomic status did not moderate the above associations. Discussion: Our results suggest that the relative contribution of unhealthy food outlets in the neighbourhood may play a role in the deterioration of the quality of the population’s diet over time, and should be given special attention by public authorities. Full article

The association between diet quality and all-cause mortality in Chinese population is unclear. We aimed to study the associations of three a priori diet quality indices—including the Diet Quality Index-International (DQI-I), Chinese Healthy Eating Index (CHEI), and energy-adjusted Dietary Inflammatory Index (E-DII)—and their included components with all-cause mortality. We used baseline data from the 2004, 2006, 2009, and 2011 waves of the China Health and Nutrition Survey (CHNS). We used a multivariable-adjusted Cox model to examine the associations between DQI-I, CHEI, and E-DII with all-cause mortality. During a mean of 7 years of follow-up, a total of 461 deaths occurred among 12,914 participants. For DQI-I, there were significant inverse associations with mortality for the variety score (HR_Q4 vs. _Q1 = 0.69, 95%CI = 0.52–0.92) and overall balance score (HR_>0 vs. ₀ = 0.81, 95%CI = 0.66–0.91). The adequacy score of CHEI was associated with 40% less risk of all-cause mortality (HR_{Q4 vs}. _Q1 = 0.60, 95%CI = 0.43–0.84). E-DII was not associated with mortality. An estimated 20.1%, 13.9%, and 31.3% of total mortality would be averted if the DQI-I variety score, DQI-I overall balance score, and CHEI adequacy score improved from the bottom to the top quartile, respectively. Improving diet quality, especially improving diet variety and adequacy, and having a more balanced diet may reduce all-cause mortality in Chinese adults. Full article

This study aimed to identify sociodemographic and health indicators of diet quality in pre-frail community-dwelling older adults. Pre-frail older adults are those at risk of progression to clinical manifestations of frailty and are targets for preventative intervention. We previously reported that pre-frail older adults have reasonably good overall diet quality. However, further analyses found a low intake of energy, protein and several micronutrients. Methods: We collected detailed dietary intake from pre-frail (FRAIL scale 1–2) older adults using NZ Intake24, an online version of 24 h multiple pass dietary recall. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). We used regression generalized linear models to determine predictors of diet quality as well as classification and regression tree (CART) analysis to examine the complex relationships between predictors and identified profiles of sub-groups of older adults that predict diet quality. Results: The median age in this sample (n = 468) was 80.0 years (77.0–84.0). Living with others, a high deprivation index and a higher BMI were independent predictors of poorer diet quality. With CART analysis, we found that those with a BMI > 29 kg/m², living with others and younger than 80 years were likely to have a lower diet quality. Conclusions: We found that BMI, living arrangement and socioeconomic status were independent predictors of diet quality in pre-frail older adults, with BMI being the most important variable in this sample when the interaction of these variables was considered. Future research is needed to determine the similarities and/or differences in the profile of subgroups of older adults with poorer diet quality. Full article

The acquisition of healthy dietary and exercise habits during childhood is essential for maintaining these behaviors during adulthood. In early childhood, parents have a profound influence on a child’s lifestyle pursuits, serving as both role models and decision-makers. The present study examines family factors as potential contributors to healthy lifestyle habits and their child’s overall diet quality among a sample of primary school children. A secondary aim is to evaluate several aspects of diet quality using the Mediterranean adaptation of the Diet Quality Index-International (DQI-I). This cross-sectional study involved 106 children enrolled in a primary school located in Imola, Italy. Data were collected from October to December 2019 using an interactive tool used to assess parent characteristics, children’s lifestyle, food frequency (ZOOM-8 questionnaire), and actigraph accelerometers to capture children’s physical activity and sedentary behavior. Adherence to the Mediterranean Diet (expressed by KIDMED Index) was positively associated with fathers’ educational level, parental sport participation, and the parent’s overall nutritional knowledge. Higher mothers’ educational level was inversely associated with children’s leisure screen time. Parents’ nutritional knowledge was positively related to children’s average daily minutes of organized sport activities. The better score for DQI-I was for consumption adequacy, followed by variety and moderation. The lowest score was for overall balance. The present study reinforces the importance of family factors in young children’s lifestyle choices, particularly their dietary, leisure time, and exercise habits. Full article

The quality of diet can be measured using diet quality indices, based on knowledge of associations between diet and health. The objective of this work was to evaluate whether the International Diet Quality Index is suitable for use as a diet quality index in populations of Mexican university girls. A cross-sectional nutritional survey was conducted at the University of Chihuahua (Mexico), collecting semi-quantitative nutritional information and socio-economic and lifestyle data from a representative sample of 400 women. Mean (Standard Deviation (SD)) age was 21.43 years (SD: 3.72); 59.1% were normal weight, 26.6% overweight, 15.3% obesity. The Diet Quality Index-International (DQI-I) was developed according to the method of Kim et al. (2003) and focused on major aspects of a high-quality diet (variety, adequacy, moderation and overall balance). The total score of Diet Quality Index-International reached 53.86% (SD: 11.43), indicating that the general diet of Mexican women a poor-quality diet. Adequacy scored highest, followed by moderation and variety. Overall balance scored the lowest. Variety: 26.3 % consumed less than 4 food groups daily, only 12.8% take more than 1 serving from each food group, and 50.6% consumed only one source of protein daily. Regarding adequacy, a large proportion of the population reported an intake of proteins, vitamin C, calcium, iron, and fruit greater than 50% of recommendation; the vegetables, fiber and grain groups were less 50%. Poor scores were obtained for total fat and SFA consumption (moderation). No statistically significant differences are observed for any of the variables under study and score of the Diet Quality Index-International: body mass index, weight, physical activity level, education level of father and mother, location of lunch, breakfast considered important, knowledge of nutrition, which allows us to consider a relatively uniform population in its eating habits. These people are close to a Westernized diet, and an intervention in nutritional education would be advisable to improve the intake of unprocessed foods, consume a greater variety of protein sources and significantly reduce consumption of sugary foods and soft drinks. Due to different methodological and cultural factors, the proposed Diet Quality Index-International dietary assessment method does not seem to be useful in the assessment of diet quality in the Mexican university population, so further research is needed to develop a diet quality index adapted to the Mexican population. Full article

(1) Background: Nutrition is a key determinant of sarcopenia in later life. (2) Methods: A systematic review of prospective cohort studies examining association of diet quality with muscle mass (MM), muscle strength (MS) or physical performance (PP) among older adults was conducted. A total of 22,885 results were obtained from a literature search in MEDLINE via PubMed and EMBASE up to November 2020. Inclusion criteria included diet quality assessment via dietary indices or statistical approaches, a sample of adults aged 45 years and over at baseline in a longitudinal study design. (3) Results: Of the 22,885 cohort studies, 14 studies were eligible. Meaningful results were obtained for the Mediterranean diet and Nordic diet regarding the decrease of sarcopenia risk, however results from non-European countries were inconsistent. In addition, due to the insufficient number of studies on Japanese Food Guide Spinning Top (JFG-ST), dietary variety score (DVS), and dietary quality index-international (DQI-I), effectiveness was difficult to prove. Studies using factor analysis to examine dietary patterns suggested that the risk of sarcopenia is increased with a high in saturated fat diet such as westernized pattern etc. (4) Conclusion: In this systematic review it was found that various diet qualities are meaningful to a decreased risk of sarcopenia. Full article

This study aimed to describe the diet quality of pre-frail community-dwelling older adults to extend the evidence of nutrition in frailty prevention. Pre-frailty, the transition state between a robust state and frailty, was ascertained using the FRAIL scale. Socio-demographic, health status, and 24-h dietary recalls were collected from 465 community-dwelling adults aged 75+ (60 years for Māori and Pacific people) across New Zealand. Diet quality was ascertained with the Diet Quality Index-International (DQI-I). Participants (median (IQR) age 80 (77–84), 59% female) had a moderately healthful diet, DQI-I score: 60.3 (54.0–64.7). Women scored slightly higher than men (p = 0.042). DQI-I components identified better dietary variety in men (p = 0.044), and dietary moderation in women (p = 0.002); both sexes performed equally well in dietary adequacy and poorly in dietary balance scores (73% and 47% of maximum scores, respectively). Low energy 20.3 (15.4–25.3) kcal/kg body weight (BW) and protein intakes 0.8 (0.6–1.0) g/kg BW were coupled with a high prevalence of mineral inadequacies: calcium (86%), magnesium (68%), selenium (79%), and zinc (men 82%). In conclusion, the diet quality of pre-frail older adults was moderately high in variety and adequacy but poor in moderation and balance. Our findings support targeted dietary interventions to ameliorate frailty. Full article

Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45–75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions’ effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45–75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = −0.09 (95% CI: −0.29–0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: −0.32–0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01–0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64–1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55–1.73), no smoking OR = 0.61 (95% CI: 0.54–1.06), EVA adjusted mean difference = −1.26 (95% CI: −4.98–2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control. Full article

Dietary pattern analyses allow assessment of the diet as a whole. Limited studies include both a priori and a posteriori dietary pattern analyses. This study aimed to explore the diet of pregnant women in urban South Africa through both a priori and a posteriori dietary pattern analyses and associated maternal and household factors. Dietary data were collected during early pregnancy using a quantified food frequency questionnaire from 250 pregnant women enrolled in the Nutrition During Pregnancy and Early Development (NuPED) cohort. A priori dietary patterns were determined using the Diet Quality Index-International (DQI-I), and a posteriori nutrient patterns using exploratory factor analysis. Based on the DQI-I, the study population followed a borderline low-quality diet. Three a posteriori nutrient patterns were identified: Pattern 1 “plant protein, iron, thiamine, and folic acid”; pattern 2 “animal protein, copper, vitamin A, and vitamin B₁₂”; pattern 3 “fatty acids and sodium”. Pattern 1 was associated with higher dietary quality (p < 0.001), lower maternal educational level (p = 0.03) and socioeconomic status (p < 0.001). Pattern 3 was significantly associated with lower dietary quality. The low dietary quality among pregnant women residing in urban South Africa should be addressed to ensure optimal maternal and offspring health outcomes. Full article

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. Full article

During the last decades the gut microbiota has been identified as a key mediator in the diet-health interaction. However, our understanding on the impact of general diet upon microbiota is still limited. Dietary indices represent an essential approach for addressing the link between diet and health from a holistic point of view. Our aim was to test the predictive potential of seven dietary ratings on biomarkers of inflammation, oxidative stress and on the composition and metabolic activity of the intestinal microbiota. A cross-sectional descriptive study was conducted on a sample of 73 subjects aged >50 years with non-declared pathologies. Dietary inflammatory index (DII), Empirical Dietary Inflammatory Index (EDII), Healthy Eating Index (HEI), Alternative Healthy Eating Index (AHEI), Mediterranean adapted Diet Quality Index-International (DQI-I), Modified Mediterranean Diet Score (MMDS) and relative Mediterranean Diet Score (rMED) were calculated based on a Food Frequency Questionnaire. Major phylogenetic types of the intestinal microbiota were determined by real time polymerase chain reaction (qPCR) and fecal short chain fatty acids (SCFAs) by gas chromatography. While DII, HEI, DQI-I and MMDS were identified as predictors of Faecalibacterium prausnitzii levels, AHEI and MMDS were negatively associated with Lactobacillus group. HEI, AHEI and MMDS were positively associated with fecal SCFAs. In addition, DII and EDII explained lipoperoxidation level and Mediterranean scores the serum IL-8 concentrations. The lower detection of IL-8 in individuals with higher scores on Mediterranean indices may be partially explained by the increased levels of the anti-inflammatory bacterium F. prausnitzii in such individuals. Full article

Background: Current scientific literature suggests healthy dietary patterns may have less environmental impact than current consumption patterns, but most of the studies rely on theoretical modeling. The aim of this study was to assess the impact on resources (land, water, and energy) use and greenhouse gas (GHG) emissions of healthy dietary patterns in a sample of Italian adults. Methods: Participants (n = 1806) were recruited through random sampling in the city of Catania, southern Italy. Dietary consumption was assessed through a validated food frequency questionnaire (FFQ); dietary patterns were calculated through dietary scores. The specific environmental footprints of food item production/processing were obtained from various available life-cycle assessments; a sustainability score was created based on the impact of the four environmental components calculated. Results: The contribution of major food groups to the environmental footprint showed that animal products (dairy, egg, meat, and fish) represented more than half of the impact on GHG emissions and energy requirements; meat products were the stronger contributors to GHG emissions and water use, while dairy products to energy use, and cereals to land use. All patterns investigated, with the exception of the Dietary Approach to Stop Hypertension (DASH), were linearly associated with the sustainability score. Among the components, higher adherence to the Mediterranean diet and Alternate Diet Quality Index (AHEI) was associated with lower GHG emissions, dietary quality index-international (DQI-I) with land use, while Nordic diet with land and water use. Conclusions: In conclusion, the adoption of healthy dietary patterns involves less use of natural resources and GHG emissions, representing eco-friendlier options in Italian adults. Full article