High blood pressure is a common problem around the world. Although many trials attest to the value of reducing blood pressure with medication and lifestyle changes, current prevalence studies of high blood pressure show a substantial portion of the adult population with uncontrolled high blood pressure. Treatment nonadherence is part of the challenge to achieving blood pressure control and newer approaches to high blood pressure treatment, whether device based, or using agents such as silencing ribonucleic acids, have shown high levels of treatment efficacy and since they are administered in the health care setting, adherence is less of an issue. In this introduction to a special issue of the American Journal of Cardiology we will review the history of hypertension treatment and some current epidemiology highlighting the public health importance of improving blood pressure control to reap the well described benefits of lower blood pressure upon the target organs of hypertension. Subsequent sections of this special issue will focus on aspects of renal denervation, including patient selection, efficacy in blood pressure lowering, measuring success of denervation and procedural guidance for this emerging therapy in the management of uncontrolled hypertension.

This study examined the relationship between the Dietary Inflammatory Index (DII) and Alzheimer's disease (AD) mortality in US adults.

Data from 45,093 participants in the 1988-2014 National Health and Nutrition Examination Survey (NHANES) were analyzed, with mortality follow-up through December 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for AD mortality. Restricted cubic spline analysis explored the non-linear association of DII with AD mortality, and stratified analyses identified higher-risk subgroups.

Over a median follow-up of 14.3 years, 455 AD-related deaths occurred. Participants in the highest DII quartile (>2.41) had a 1.50-fold increased risk of AD mortality (95 % CI: 1.12-2.01) compared to the lowest quartile (≤-0.44). Pro-inflammatory diets (DII > 0) were associated with a 44 % higher risk of AD mortality (HR: 1.44, 95 % CI: 1.14-1.81). A dose-response relationship was observed, with increased risks across quartiles, and findings were consistent across demographic and clinical subgroups.

Higher DII levels were significantly associated with elevated AD mortality risk, highlighting the potential role of pro-inflammatory diets in AD-related outcomes.

Randomised controlled trials in nutrition (RCTN) face unique challenges, including the considerable influence of the background diet and the challenge of assuring intervention adherence by participants. The impact of these factors on the outcome of RCTNs has been difficult to quantify, but nutritional biomarkers represent a valuable tool to address these challenges. Using flavanols as a model dietary intervention and a set of recently validated flavanol biomarkers, we here investigated the impact of background diet and adherence on the outcomes of a subcohort of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS, NCT02422745). We found that 20% of participants in the placebo and cocoa-extract intervention arms had a flavanol background intake as high as the intervention, and only 5% did not consume any flavanols. Approximately 33% of participants in the intervention group did not achieve expected biomarker levels from the assigned intervention - more than the 15% estimated with pill-taking questionnaires usually implemented in RCTN. Taking these factors into account resulted in a larger effect size for all observed endpoints (HR (95% CI)) estimated using intention-to-treat vs. per-protocol vs. biomarker-based analyses: total cardiovascular disease (CVD) events 0.83 (0.65; 1.07); 0.79 (0.59; 1.05); 0.65 (0.47; 0.89) - CVD mortality 0.53 (0.29; 0.96); 0.51 (0.23; 1.14); 0.44 (0.20; 0.97) - all-cause mortality 0.81 (0.61; 1.08); 0.69 (0.45; 1.05); 0.54 (0.37; 0.80) -- major CVD events 0.75 (0.55; 1.02); 0.62 (0.43; 0.91); 0.48 (0.31; 0.74). These results highlight the importance of taking background diet and adherence into consideration in RCTN to obtain more reliable estimates of outcomes through nutritional biomarker-based analyses.

Pentadecanoic acid (C15:0) and heptadecanoic acid (C17:0) are considered to have protective effects on cardiovascular health. However, research on the relationship between C15:0 and C17:0 levels and hypertension remains limited. This cross-sectional study aims to investigate the association between serum levels of odd-chain fatty acids (C15:0 and C17:0) and prevalent hypertension.

Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) were used for this study. Multiple logistic regression models, restricted cubic spline (RCS) analysis, saturation threshold effect analysis, and interaction effect tests were employed to analyze the relationship between serum C15:0 and C17:0 levels and prevalent hypertension.

A total of 4,775 participants (C15:0 analysis group) and 4,718 participants (C17:0 analysis group) were included in this study. The prevalence of hypertension in the two groups is 46.99% and 46.82%, respectively. To improve the distribution and comparability of the data, the primary analysis used the per mille of total fatty acids (C15:0‰ and C17:0‰). After adjusting for multiple confounders, both C15:0‰ and C17:0‰ levels were significantly inversely associated with the odds of prevalent hypertension. In the fully adjusted model, an increase in C15:0‰ and C17:0‰ levels was associated with a lower odds of prevalent hypertension (C15:0‰: OR = 0.78, 95% CI: 0.66-0.93, P = 0.0063; C17:0‰: OR = 0.77, 95% CI: 0.64-0.93, P = 0.0074). Further restricted cubic splines analysis showed a significant nonlinear relationship between C15:0‰ level and prevalent hypertension. Saturation threshold effect analysis revealed that when C15:0‰ level was below 1.5‰, the inverse association with the odds of prevalent hypertension was stronger (OR = 0.42, 95% CI: 0.23-0.77, P = 0.0052), while the relationship weakened when C15:0‰ level was above 1.5‰ (OR = 0.89, 95% CI: 0.74-1.07, P = 0.2158). Interaction effect tests indicated that, in the subgroup with C15:0‰ level ≥ 1.5‰, age modified the relationship between C15:0‰ level and prevalent hypertension. In the population aged ≥ 65 years, C15:0‰ level was inversely associated with the odds of prevalent hypertension (OR = 0.54, 95% CI: 0.36-0.79, P = 0.0384), while no significant association was observed in the population aged < 65 years (OR = 0.83, 95% CI: 0.68-1.02, P = 0.1032).

Serum C15:0 and C17:0 levels are significantly inversely associated with the odds of prevalent hypertension, suggesting that serum C15:0 and C17:0 levels may serve as potential biomarkers for hypertension monitoring.

We aimed to understand data-driven dietary patterns in Canadian preschoolers and their impact on obesity development among male and female individuals.

In the prospective, population-based Canadian pregnancy cohort, the CHILD Cohort Study (N = 2219), dietary intake was assessed at age 3 years using a previously developed 112-item food frequency questionnaire. At age 5 years, we measured height, weight, and waist circumference and calculated BMI and waist circumference z scores. Obesity was defined as BMI z score > 2. We used principal components analysis to derive dietary patterns and multivariable-adjusted regression analyses to determine dietary patterns' associations with BMI and waist circumference z scores, as well as obesity status.

Among Canadian preschoolers, we identified three dietary patterns: "Prudent" (high in vegetables, fruits, legumes, and fish); "Western-like" (high in fast foods, red/processed meats, and carbonated drinks); and "Refined Grain-Snack" (high in refined grains, dairy, and salty snacks). At age 5 years, 4.7% of the children were living with obesity (3.1% male individuals and 1.6% female individuals). Females adhering to the Refined Grain-Snack pattern had higher waist circumference z scores (β = 0.14; 95% CI: 0.03-0.25) and 2.74-fold odds of living with obesity (95% CI: 1.29-5.85). No significant associations were observed among male individuals or with other dietary patterns and obesity outcomes among female individuals.

Preschool dietary patterns are associated with sex-biased obesity development, highlighting the need for further research to explore these differences and inform targeted obesity prevention strategies during this important developmental period.

Adolescence and early adulthood is an important period for the development of health behaviours and diet quality, which may persist through adult life. Socioeconomic position (SEP) during early adulthood shows associations with inequalities in diet quality and cardiometabolic health later in adulthood, yet little is known about how dietary inequalities develop during adolescence and early adulthood. This study aimed to identify distinct diet quality trajectories observed across adolescence and early adulthood; and explore the association between parental and individual SEP and these trajectories.

The Raine Study is a large multigenerational cohort (n=1984) based in Western Australia. Dietary data was self-reported at five time points from ages 14 to 27 years. Growth mixture modelling was used to identify distinct diet quality trajectories based on Dietary Approaches to Stop Hypertension (DASH) diet scores. Multinomial logistic regression was used to determine the associations of parental SEP (maternal education level; and household income at age 14) and individual SEP (school leaving age) with diet quality trajectory membership.

Three diet quality trajectories were identified: consistently low quality (41%), low-to-high quality (42%), and consistently high quality (16%). The 'low-to-high' diet quality trajectory showed a steep increase in diet quality from ages 14 to 20 years. Higher parental SEP was associated with a higher diet quality trajectory. After adjusting for parental SEP, leaving school before year 11 remained strongly associated with the low diet quality trajectory.

Our study demonstrates the development of dietary inequalities across adolescence and early adulthood, highlighting the importance of emerging individual SEP, in addition to parental SEP in shaping this. Interventions to improve diet quality in early adulthood are particularly needed among those who leave education at a young age.

Poor diet quality is a leading risk factor for cardiometabolic disease (ie, diabetes and diseases associated with metabolism and inflammation), which is present in about half of American adults. Support has grown for incorporating the provision of healthy food as a complement to or a component of clinical care. Such "Food Is Medicine" programs provide free or subsidized healthy food directly to patients in close coordination with the health care system. In this review, we systematically examined published randomized controlled trials examining Food Is Medicine programs in the United States, categorizing them into different stages of development using the National Institutes of Health Model for Behavioral Intervention Development. This review identified a total of 14 randomized controlled trials of Food Is Medicine interventions in the United States with noncommunicable disease outcomes, more than one-third of which were early-stage smaller-scale trials (stage 1 randomized controlled trials). Broad variations in populations enrolled; intervention design, duration, and intensity; and outcomes precluded many direct comparisons between studies. Randomized controlled trial data were generally consistent with findings in the observational literature, indicating that common Food Is Medicine approaches often positively influence diet quality and food security, which are theorized to be key mediators for clinical outcomes. However, the impact on clinical outcomes was inconsistent and often failed to reach statistical significance. These observations highlight the need for larger, higher-quality Food Is Medicine studies focusing on the measurement of clinical outcomes within well-designed programs and the need for additional randomized controlled trials that more systematically map out the relationship between participation in different types of Food Is Medicine programs and health outcomes.

Exercise-induced bronchoconstriction (EIB) describes an acute narrowing of the airways that develops following vigorous physical activity. Clinical responses to current asthma therapy, such as leukotriene antagonists and corticosteroids, are heterogeneous, even with optimal treatment. Epidemiological studies indicate an increasing use of complementary and alternative medicine therapy in asthma patients due to the lack of efficacy of conventional treatment, concerns about potentially harmful side effects of pharmacological treatment, cost barriers to asthma care, and the accessibility of complementary and alternative medicine therapy. Plausible physiological mechanisms now exist for many nutrients as potential modifiers of EIB severity, primarily because of their role in inflammatory processes, airway smooth muscle function, and modulation of lung microvascular volume and pressure. Dietary supplementation as a treatment for EIB has generally shown evidence of significant yet incomplete inhibition of EIB with low-salt diets, omega-3 fatty acids, and vitamin C when supplemented for up to 3 weeks. However, larger, randomized, placebo-controlled, double-blinded trials are needed to clarify the effectiveness of nutritional intervention in individuals with EIB. Additionally, many studies have focused on nonathletes with EIB, and therefore, more studies are required to evaluate the efficacy of nutritional intervention on EIB in elite athletes. In conclusion, if dietary supplementation or restriction is prescribed, it should be seen as an option to lessen the reliance on pharmaceutical interventions and not as an alternative to established pharmacotherapies.

The Dietary Approaches to Stop Hypertension (DASH) diet lowers estimated 10-year ASCVD (atherosclerotic cardiovascular disease) risk. The effects of dietary sodium reduction on ASCVD risk are uncertain. This study aims to evaluate the impact of sodium reduction, alone and combined with the DASH diet, on 10-year ASCVD risk scores.

The DASH-Sodium trial randomized adults with elevated blood pressure (average systolic blood pressure of 120 to 159 mm Hg and average diastolic blood pressure of 80 to 95 mm Hg) to the DASH diet or typical American diet. Within each arm, individuals consumed 3 different levels of sodium in random order: low, medium, and high. Each period lasted 30 days. Pooled cohort equation-estimated 10-year ASCVD risk scores were calculated at baseline and at the end of each feeding period. The primary outcomes of interest were the absolute and relative differences in 10-year ASCVD risk scores from baseline.

Among the 412 participants (mean age 48 ± 10 years; 57 % female, 57 % Black), sodium reduction decreased ASCVD risk scores in both dietary arms. Compared to high sodium intake, low sodium intake changed ASCVD risk by -9.4 % (95 % CI -11.7, -7.0). When compared to a typical American diet, the DASH diet changed 10-year ASCVD by -5.3 % (95 % CI -9.3, -1.2). Compared to a high sodium-control diet, the combination of both low sodium intake with DASH changed ASCVD risk by -14.1 % (95 % CI -18.6, -9.3).

Sodium reduction and the DASH diet both independently reduced 10-year ASCVD risk scores. Moreover, the combined impact was additive. These findings support dietary sodium reduction in addition to the DASH diet for ASCVD prevention.

Background: Adherence to the Mediterranean diet (MedDiet) offers multiple metabolic benefits. However, its relationship with maximal fat oxidation (MFO) and cardiorespiratory fitness (VO2max), alongside the potential mediating role of leptin, remains underexplored in young adults. Objective: The objective was to investigate the associations between MedDiet adherence and the body mass index (BMI), MFO, and VO2max and to evaluate whether leptin mediates these relationships. Methods: Sixty-five young adults (n = 23 women), aged 18-38, were assessed for body composition, MedDiet adherence (14-Item Mediterranean Diet Adherence Screener), MFO, and VO2max through indirect calorimetry. Plasma leptin concentrations were measured in fasting conditions. Multiple linear regression models were performed, adjusting for sex, age, and both. Mediation analyses were conducted. Results: Higher MedDiet adherence was significantly associated with lower BMI (β = -0.339, p = 0.006) and leptin values (β = 0.284, p = 0.022) and higher absolute MFO (β = 0.338, p = 0.006) and VO2max values (β = 0.462, p < 0.001). These associations remained significant in all models except BMI and leptin when adjusted for sex and sex and age. Leptin was positively associated with the BMI (β = 0.550, p < 0.001) and inversely associated with absolute MFO (β = -0.650, p < 0.001) in all models. There was a trend in the association between leptin and VO2max (β = -0.233, p = 0.061) only in the unadjusted model. Mediation analysis revealed that the leptin levels significantly mediated the associations between MedDiet adherence and BMI (β = -0.358, 95% CI [-0.677, -0.077]) and VO2max (β = 1.043, 95% CI [0.280, 1.833]). Conclusions: MedDiet adherence is associated with a lower BMI and higher MFO and VO2max in young adults. Our findings further suggest that leptin plays a mediating role in how MedDiet adherence influences the BMI and VO2max.

Obesity and cardiometabolic diseases are leading causes of morbidity and mortality among adults worldwide. These conditions significantly contribute to and exacerbate other major causes of illness and death, including cancer, neurodegenerative diseases, and chronic kidney disease. The growing burden of these diseases has increased the interest of modern medicine in understanding metabolic processes and health, with diet emerging as a pivotal modifiable factor, alongside physical inactivity and smoking. In this review, we discuss the pathophysiological and evolutionary foundations of metabolic processes that may link "unhealthy" nutrition to obesity and cardiometabolic diseases and review the current literature to assess the effects of various diet interventions and patterns on cardiometabolic parameters. Special emphasis is placed on summarizing the latest, albeit partially contradictory, evidence to offer balanced dietary recommendations with the ultimate aim to improve cardiometabolic health.

Chronic kidney disease (CKD) is a widespread condition with significant cardiovascular risks and a progression to end-stage kidney failure. In recent years, increasing attention has been paid to the role of dietary interventions as a factor capable of influencing disease trajectory. This review summarizes the current observational and interventional evidence on various dietary approaches in patients with CKD and kidney transplants (KTs), including Mediterranean, plant-based, and low-protein diets. A balanced Mediterranean diet, rich in fruits, vegetables, whole grains, fish, and unsaturated fats, shows promises in improving the prognosis for CKD patients. Plant-based diets, which emphasize legumes, vegetables, and grains while minimizing animal protein, improve blood pressure and the glycemic and lipid control. Low-protein diets (LPDs), typically providing less than 0.6 g/kg/day of protein, may reduce the CKD progression and nitrogen burden, further delaying the initiation of dialysis. In conclusion, diets represent a valuable and underutilized therapeutic strategy in the management of CKD and KTs, influencing disease progression and patient outcomes.

The association between the dietary approach to stop hypertension (DASH) and sleep status is well-documented. Nevertheless, a consistent relationship with employees population has yet to be known. Thus, we aimed to investigate the relationship between the DASH diet and sleep quantity/quality among Iranian employees of both genders.

We enrolled 337 persons whose Sleep status was assessed through the Pittsburgh Sleep Quality Index. A validated Food Frequency Questionnaire was used to measure the DASH diet score. Analysis of variance and covariance, chi-square, and multinomial logistic regression tests were used as appropriate.

Our findings demonstrated that, even after adjusting for multiple potential confounders the odds of poor sleep quality were not significantly related to the higher DASH diet adherence (OR = 0.69, 95% CI: 0.38-1.27). However, participants in the highest tertiles of DASH had lower chances of experiencing short sleep duration compared to those in the lowest one (OR = 0.53; 95% CI: 0.30-0.96).

The present study indicated that Iranian employees with a higher adherence to the DASH diet had considerably lower odds of having short sleep; however DASH adherence has no significant effect on sleep quality. More prospective and controlled investigations are required to confirm these findings.

Lifestyle and dietary modifications are unanimously suggested as the initial step to treat hypertension in the general population and in patients with chronic kidney disease (CKD). Limiting sodium intake constitutes the cornerstone of dietary interventions, but augmenting dietary potassium intake has also been associated with a significant blood pressure (BP)-lowering effect. Although there may be a consensus about restraining the daily sodium intake to <2 g per day, the target for optimal potassium intake is vague. In hypertensive patients with CKD, the desired amount of potassium in the diet remains a controversial issue, as evidence from studies concerning the effect on CKD progression is contradictory. Hence, medical societies and food authorities worldwide do not share a joint recommendation. Other dietary components, including calcium, magnesium, protein, phosphorus, zinc, and alcohol intake may play a role in BP control, but the evidence in the CKD population so far is inconclusive. Further studies are needed to establish solid evidence about the safety and efficacy of dietary interventions, particularly in CKD patients, the majority of whom suffer from hypertension. The purpose of this review is to summarize the existing recommendations and evidence concerning dietary interventions in hypertensives with CKD, with a primary focus on sodium and potassium intake. Additionally, we briefly address other dietary components that may play a role in BP regulation or kidney function.

The dietary sodium/potassium ratio is positively correlated with blood pressure, and understanding this relationship is crucial for improving hypertension treatment. Moreover, few studies have examined these effects in both sexes. In this study, we aimed to investigate how supplementing (1.41% K+; HK) or depleting (DK) dietary potassium affects the development of salt-sensitive (SS) hypertension in male and female Dahl SS rats. Potassium supplementation attenuated blood pressure during 5 weeks of high-salt (4% NaCl) diet in male but not in female rats. In contrast, a potassium-deficient diet prevented the development of salt-induced hypertension in both sexes, though this effect is unlikely to be protective. Both males and females on the DK diet were hypokalemic and had diminished heart rates and reduced weight gain; furthermore, females experienced high mortality. RNA-Seq of kidney cortical tissue revealed a number of genes that may underlie the sex-specific differences in phenotype. Male rats supplemented with potassium exhibited a decreased number and size of WNK4 puncta, whereas in potassium-supplemented females, there was no difference in puncta count and there was an increase in puncta size. Our data indicate there are sex-dependent differences in response to dietary potassium in hypertension and that the distal nephron compensates for severe potassium deficiency.

The beneficial effects of the Dietary Approaches to Stop Hypertension (DASH) to reduce blood pressure among adults are well established. However, whether this dietary pattern is also relevant for the control of blood pressure in children remains unknown. Therefore, this study aimed to evaluate adherence to the DASH dietary pattern and examine its association with blood pressure among Australian primary schoolchildren.

Cross-sectional data from 658 Australian children aged 8-12 years participating in the Salt and Other Nutrients In Children (SONIC) study were analyzed. One 24-hour diet recall was used to assess dietary intake. Systolic and diastolic blood pressure were measured with a digital automatic blood pressure machine. To assess adherence to the DASH dietary pattern a total DASH score (0-90) was created based on nine nutrient targets (protein, saturated fat, total fat, cholesterol, total fiber, sodium, potassium, magnesium, calcium). Multiple linear regression models were used to examine the association between the DASH score and blood pressure.

The mean total DASH score was 53.1 (SD 10.4) and was significantly different between boys (52.3) and girls (54.0) (p = 0.013). After controlling for covariates, no association between total DASH score and systolic or diastolic blood pressure was found.

Adherence to the DASH dietary pattern was moderate and there was no association between the DASH dietary pattern and blood pressure among Australian children aged 8-12 years.

The Dietary Approaches to Stop Hypertension (DASH) diet is designed to lower blood pressure and improve cardiovascular health by reducing sodium and unhealthy fats while increasing nutrients, including potassium, calcium, magnesium, and fibre. While evidence supports its benefits for managing cardiovascular risk factors, gaps remain in understanding its long-term impact on preventing cardiovascular disease (CVD), particularly in terms of hard clinical outcomes such as myocardial infarction and stroke.

To assess the effects of the DASH diet for the primary and secondary prevention of cardiovascular diseases.

We used standard extensive Cochrane search methods. The latest search date was in May 2024.

We included randomised controlled trials (RCTs) comparing a DASH diet intervention to no intervention (including usual care), minimal intervention, or other dietary interventions. In the context of this review, 'minimal intervention' includes brief dietary advice or informational leaflets provided during a medical consultation, without a structured dietary intervention. 'Other dietary interventions' include any other dietary programme besides the DASH diet. Participants were adults with or without CVD. The minimum duration of eligible interventions was eight weeks and the minimum follow-up was three months.

We used standard Cochrane methods. Primary outcomes were myocardial infarction, heart failure, and stroke. Secondary outcomes were the need for coronary revascularisation, carotid revascularisation, peripheral revascularisation, all-cause mortality, cardiovascular mortality, changes in blood pressure, blood lipids, the occurrence of type 2 diabetes, health-related quality of life, and adverse effects. We used GRADE to assess the certainty of evidence for each outcome.

Five RCTs involving 1397 participants met our inclusion criteria and were included in this review. All five trials contributed at least one intervention arm to one or more of the three prespecified comparisons. In total, 1075 participants across eligible arms were included in the meta-analyses. The difference reflects trial arms that did not meet our prespecified intervention and comparison definitions, and were therefore not analysed, though all participants were randomised within eligible trials and are accounted for in the review total. The trials assessed the DASH diet in a primary prevention setting; none evaluated its effects in secondary prevention. Participants were generally healthy adults aged 18 years or older, without diagnosed cardiovascular disease. The intervention duration ranged from 16 weeks to 12 months, with follow-up periods between 16 weeks and 18 months (medium- and long-term). The trials were conducted in the USA and Poland, with funding from public institutions, including the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the Institute of Cardiology in Poland. DASH diet versus no intervention (including usual care) Myocardial infarction: one trial (144 participants) reported no myocardial infarctions in either group over a one-year follow-up. The GRADE certainty rating was low due to the high risk of performance bias and imprecision. Stroke: one trial (144 participants) reported no strokes in either group over the same follow-up period. The GRADE rating was low for similar reasons. All-cause mortality: one trial (90 participants) reported no deaths over a six-month follow-up. The GRADE rating was very low due to unclear risk of selection bias, high risk of performance bias, and imprecision. No data were available for heart failure or revascularisation needs (coronary, carotid, or peripheral) in this comparison. DASH diet versus minimal intervention Myocardial infarction: two trials (902 participants in total; 629 participants were in trial arms eligible for this comparison, based on our prespecified intervention and comparison definitions) reported limited events, with no clear differences between groups over one year (risk ratio (RR) 2.99, 95% confidence interval (CI) 0.12 to 73.04). The GRADE rating was low due to high risk of performance bias and imprecision. Stroke: two trials (reporting on the same 629 participants) reported no strokes in either group over follow-up periods ranging from six months to one year. The GRADE rating was low due to similar concerns. No data were available for heart failure, revascularisation needs (coronary, carotid, or peripheral), or all-cause mortality in this comparison. DASH diet versus another dietary intervention All-cause mortality: one trial (261 participants) reported no clear difference between the groups over one year (RR 2.98, 95% CI 0.12 to 72.42). The GRADE rating was very low due to multiple risks of bias and imprecision. No data were available for myocardial infarction, stroke, heart failure, or revascularisation needs in this comparison.

The effect of the DASH diet on major cardiovascular outcomes - including myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality - remains inconclusive due to a lack of robust long-term evidence. Additionally, no trials have assessed its impact on heart failure or the need for revascularisation procedures, such as coronary, carotid, or peripheral interventions. While the DASH diet may reduce blood pressure, total cholesterol, and triglyceride levels while increasing high-density lipoprotein (HDL) cholesterol compared to no intervention or usual care, it appears to have little to no effect on low-density lipoprotein (LDL) cholesterol. Evidence comparing the DASH diet to a minimal intervention or alternative dietary approaches remains limited. Although the DASH diet has minimal reported adverse effects, the absence of long-term safety data prevents definitive conclusions on its use in individuals with or without cardiovascular disease. The certainty of evidence is low to very low, primarily due to design limitations such as high risk of bias, small sample sizes, and short follow-up periods in the included trials. Most studies focused on cardiovascular risk factors rather than long-term clinical outcomes, and all eligible trials assessed primary prevention, with no data on secondary prevention. Given these uncertainties, well-designed, long-term randomised controlled trials are needed to evaluate the DASH diet's impact on major cardiovascular events, its effectiveness in secondary prevention, and its long-term safety.

Children's diets affect multiple health outcomes. Dietary indices are a useful tool for quantifying the quality of the overall diet, but their performance may differ among children of different ages and in understudied populations.

This analysis aimed to validate 2 dietary indices and examine their associations with physical body measures among 2-8-y-old children of the United States-Affiliated Pacific region.

Data were collected on children (n = 2359) from 5 jurisdictions of the children's healthy living randomized control trial in independent cross-sectional cluster samples over 3-time points. Anthropometric measurements were taken, and dietary intakes were ascertained from 2 d of dietary records completed by caregivers. The Healthy Eating Index (HEI)-2020 and dietary approaches to stop hypertension (DASH) scores were calculated using a simple scoring algorithm, their construct validity and performance were evaluated, and associations with nutrient intake, body measures, and obesity status were examined using covariate-adjusted means and unconditional logistic regression.

We observed a wide range of variation in DASH (9-38 points) and HEI-2020 (10-94.7 points), clear separation of mean component scores by quintile of the total score, and multiple dimensions for each index. Significant trends in polyunsaturated and saturated fat were observed from the lowest to the highest quintile of HEI-2020 (12% higher and 21% reduction, respectively) but not for DASH. Significant differences by quintile of DASH and HEI-2020 were found for mean body mass index z-score among 6-8-y-olds and for waist circumference among boys and 6-8-y-olds. The odds of obesity exhibited statistically significant downward trends across quintiles of HEI-2020 among all participants and in all sexes and age groups, and across quintiles of DASH among all participants, boys and 6-8-y-olds.

We found that HEI-2020 is a better measure of dietary intake than DASH in this population of 2-8-y-old children of the United States-Affiliated Pacific region.

Whether cardiovascular health (CVH) contributes to a reduced risk of cancer incidence and improves cancer prognosis remains unclear. This study aimed to evaluate the associations between CVH and risks of incident cancer and its subsequent CVD development and mortality.

Prospective cohort study.

This study obtained data from the UK Biobank study. CVH was assessed based on Life's Essential 8 (LE8) metrics. The primary outcome was incident cancer, which was defined using ICD-10 code C00-C97, excluding nonmelanoma skin cancer. The hazard ratio and 95 % confidence intervals between CVH and risk of incident cancer and risk of CVD and death after diagnosis of cancer were assessed using multistate Markov and Cox proportional hazards regression models. CVD includes coronary heart disease, atrial fibrillation, heart failure and stroke. The median follow-up period was 12.7 years, and follow-up ended on December 1, 2022.

In total, 218,587 participants were eligible for analysis. During the follow-up, 27,603 (12.6 %) participants experienced incident cancer, 26,630 (12.2 %) experienced incident CVD and 12,399 (5.7 %) died. In fully-adjusted multi-state models, increased CVH scores were significantly associated with a reduced risk of incident cancer (HR per 10-point increment of CVH scores: 0.98, 95 % CI: 0.96-0.99), incident CVD (0.90, 0.89-0.91), and death (0.84, 0.81-0.87). Higher CVH scores were also associated with lower risks of incident CVD (0.90, 0.86-0.94) and death (0.89, 0.87-0.92) among cancer survivors. Notably, participants with a high Townsend deprivation index demonstrated the strongest associations of CVH with cancer and its prognosis, compared to those with low or intermediate levels of the index (P-for-interaction <0.05).

CVH is notably associated with the reduced risk of cancer and its subsequent development of CVD and death, which is more evident among participants with lower socioeconomic status. Our results highlight the potential of promoting LE8 adherence for primary and secondary prevention of cancer.

Studies demonstrate that consuming plant-based diets has beneficial effects on several health outcomes. However, the evaluation of the healthiness of plant-based diets and the incidence of hypertension has still been little explored in the literature.

Thus, this study aimed to evaluate the association between plant-based diet indices and the incidence of hypertension in Brazilian adults and test whether the interaction between hPDI, sociodemographic, and lifestyle variables modifies this association.

This longitudinal study included 3192 (F = 2125, average age 34 years) participants from the Cohort of Universities of Minas Gerais (CUME Study, Brazil, 2016-2022). Dietary intakes were assessed using a validated food frequency questionnaire. We measured three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). Participants were classified as new cases of hypertension if they were free of this disease at baseline, had a systolic blood pressure ≥ 140 mmHg, a diastolic blood pressure ≥90 mmHg, were using antihypertensive medications, or had a diagnosis of hypertension by a physician in at least one of the follow-ups. Crude and adjusted Cox regression models were used to evaluate the relationship between plant-based diet indices and hypertension incidence and a multiplicative interaction was tested.

The incidence of hypertension was 19,8/1000 person-years total. The mean follow-up time was 3.36 years. There was an inverse association between the highest quintiles of hPDI (HR = 0.56, 95% CI = 0.37-0.86; HR = 0.55, 95% CI = 0.35-0.88) and hypertension. In subgroup analysis, inverse associations between hPDI and hypertension risk were stronger in participants who were insufficiently active and overweight (p-interaction < 0.05).

Greater consumption of healthful plant foods, reduced consumption of animal-source foods, and less consumption of unhealthful plant foods are important for hypertension prevention in the Brazilian population.

We examined the association between dairy intake and all-cause, cancer, and cardiovascular disease mortality in a cohort of the general population followed up for 12 years across Japan.

We conducted a longitudinal cohort study of 79,715 participants from the Japan Multi-Institutional Collaborative Cohort study (57.2% women, mean age 54.7 years old). The amount of dairy (milk and yogurt) intake was determined using a validated short-food frequency questionnaire. The hazard ratio for mortality according to sex-specific tertile of dairy intake was calculated using Cox proportional hazards regression models with adjustment for potential confounding factors and dietary factors by sex.

During the follow-up period (932,738 person-years), 3,723 participants died, including 2,088 cancer and 530 cardiovascular disease deaths. The highest tertile of total dairy intake (versus the lowest tertile) was associated with a 19% lower all-cause mortality risk (hazard ratio=0.81, 95% confidence interval: 0.70-0.92; P for trend=0.001) in women. Similarly, we observed inverse associations between milk intake and all-cause and cancer mortality risk in women, yogurt intake and cardiovascular disease risk in women, and yogurt intake and all-cause mortality risk in both sexes.

A higher total dairy and milk intakes in women and yogurt intake in both sexes were associated with a reduced risk of all-cause mortality in the general population across Japan during the 12-year follow-up period.

Approximately 9 to 10 million adults (4%) have experienced a stroke in the United States. While stroke incidence has generally declined, progress has been less pronounced among young individuals, and such trends have underlined the importance of focusing on the primary prevention of stroke. In 2024, the American Heart Association and American Stroke Association released new guidelines for the primary prevention of stroke. Here, we review major updates in 7 domains: dietary modification, glucagon-like peptide-1 receptor agonists, blood pressure targets, lipid-lowering medications, antithrombotic agents, colchicine therapy, and sex-specific preventive risk assessment. Through this process, we review important randomized controlled trial evidence contributing to guideline updates and provide key perspectives on the incorporation of lifestyle and pharmacotherapy for personalized stroke prevention.

Age-related cognitive decline is an important global challenge. Substantial evidence suggests that diet may prevent or delay cognitive aging. This narrative review examines recent literature on how dietary factors influence cognitive function, with a focus on subjective cognitive decline (SCD).

Higher intakes of flavonoids, carotenoids, and plant-based protein were associated with lower odds of SCD. Berries, citrus fruits and juices, carotenoid-rich and green leafy vegetables, and beans/legumes were among the foods with the strongest inverse associations with SCD. Healthy dietary patterns, such as the Mediterranean and MIND diet, may be beneficial for maintaining subjective cognitive function. Healthy choice of diet may play a role in lowering the risk of late-life SCD.

Obesity is a major nutritional disease that increases the risk of developing serious health conditions like dyslipidemia. Plant-based diets, like DASH (dietary approaches to stop hypertension), can help lower the risk of dyslipidemia. However, evidence on the effect of DASH diet on lipid profile in populations with overweight/obesity is inconsistent. This meta-analysis of controlled trials investigated the effects of the DASH diet on lipid profile in individuals with overweight/obesity.

A search for relevant studies was conducted in databases like PubMed, Web of Science, and Scopus until January 2024. The calculation of weighted-mean differences (WMDs) and 95 % confidence intervals (CIs) was performed based on the random-effects model. Sensitivity, meta-regression and publication bias analyses were also conducted. 22 eligible studies with 26 arms and 3562 participants were included. DASH diet significantly reduced total cholesterol (TC) (WMD: 5.05 mg/dl, 95 % CI: 8.78, -1.31, p = 0.008), low-density lipoprotein cholesterol (LDL-C) (WMD: 5.33 mg/dl, 95 % CI: 8.54, -2.11, p = 0.001) and very low-density lipoprotein cholesterol (VLDL-C) (WMD: 3.26, 95 % CI: 6.19, -0.34, p = 0.029) levels. Greater reductions were observed in studies with durations ≤8 weeks. All of the included studies were classified as high quality except two, which were classified as moderate quality. LDL-C and VLDL-C were categorized as high-grade evidence, while others were categorized as moderate.

DASH diet could improve the lipid profile of individuals with overweight/obesity by decreasing TC, LDL-C and VLDL-C levels. However, it doesn't have significant effects on high-density lipoprotein cholesterol and triglyceride levels.

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly among older adults. Identifying modifiable dietary factors associated with CVD prevalence is essential for prevention. This cross-sectional study analyzed 7,341 adults aged ≥ 65 years from NHANES 2007-2018. CVD was defined based on self-reported physician-diagnosed conditions, including coronary heart disease, heart failure, angina, heart attack, or stroke. A nutrient-wide association study (NWAS) evaluated associations between 56 dietary nutrients and CVD prevalence using multivariable logistic regression. Dose-response relationships were assessed using restricted cubic spline (RCS) models. Model discrimination was evaluated using receiver operating characteristic (ROC) analysis. Eight nutrients were significantly associated with CVD prevalence after adjusting for confounders and correcting for multiple comparisons: PUFAs 20:4 (OR 0.88, 95% CI 0.80-0.97, P = 0.024), 22:5 (OR 0.72, 95% CI 0.56-0.92, P = 0.019), and 22:6 (OR 0.92, 95% CI 0.87-0.99, P = 0.032); total choline (OR 0.96, 95% CI 0.93-0.99, P = 0.024); cholesterol (OR 0.89, 95% CI 0.82-0.96, P = 0.037); protein (OR 0.82, 95% CI 0.76-0.89, P = 0.040); vitamin A (OR 0.95, 95% CI 0.91-0.99, P = 0.045); and total sugars (OR 0.97, 95% CI 0.96-0.98, P = 0.049). Clustering analysis identified protective effects of fat-soluble vitamins and unsaturated fatty acids. The inclusion of these nutrients significantly improved model discrimination (P < 0.05). This study identified key dietary nutrients and clusters associated with CVD prevalence and characterized their dose-response relationships. Integrating these nutrients into predictive models enhances CVD risk discrimination, providing actionable dietary targets for prevention strategies in older adults.

Plant-based diets are associated with a lower risk of cardiovascular disease (CVD). Proteomics may improve our understanding of the biological pathways underlying these associations.

Using large-scale proteomics, we aimed to examine if plant-based diet-related proteins, which have been previously identified, are associated with incident CVD and subtypes of CVD in the Atherosclerosis Risk in Communities (ARIC) Study and Framingham Heart Study (FHS) Offspring cohort.

Discovery analyses were based on 9078 participants free of CVD at ARIC visit 3 (1993-1995). Cox proportional hazards regression was used to evaluate the associations between plant-based diet-related proteins and incident CVD, coronary artery disease, heart failure, and stroke. Replication analyses were based on 1279 participants without CVD in the FHS Offspring cohort.

In the ARIC study, over a median follow-up of 21 y, there were 3167 CVD events. At a false discovery rate <0.05, 26 of 73 plant-based diet-related proteins were significantly associated with incident CVD, after adjusting for important confounders. Eighteen, 1, and 0 proteins were associated with heart failure, stroke, and coronary artery disease, respectively. Three and 2 additional proteins were associated with CVD and heart failure risk in the FHS Offspring cohort at the nominal threshold (P < 0.05). In the ARIC Study and FHS Offspring cohort, soluble advanced glycosylation end product-specific receptor was inversely associated with incident CVD whereas thrombospondin-2 (THBS2) and N-terminal pro-BNP was positively associated with incident CVD. THBS2 was positively associated with incident heart failure, whereas neuronal growth factor regulator 1 and insulin-like growth factor-binding protein 1 was inversely associated.

These proteins highlight several pathways that could explain plant-based diets-CVD associations.

The increasing prevalence of metabolic syndrome (MetS) and its associated risk factors highlights the critical need to understand dietary patterns that influence health outcomes, particularly among overweight and obese individuals. Identifying dietary networks provides valuable insights into the complex interactions between food groups within typical dietary patterns. This study aimed to derive dietary networks using Gaussian graphical models (GGM) and evaluate their associations with the risk of MetS components in a sample of the Iranian population.

This cross-sectional study involved 647 participants who were overweight or obese. The study included assessments of body composition and anthropometric measurements. Dietary fatty acid consumption was evaluated using a validated Food Frequency Questionnaire (FFQ) containing 168 items. Additionally, biochemical parameters, including serum total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), and insulin levels, were measured using enzymatic methods. GGM was utilized to explore the networks of participants' dietary intake, and the association between these networks and risk factors related to MetS was assessed using logistic regression.

GGM analysis identified six major networks of dietary intake, where 28 food items were allocated into six dietary networks of vegetable, grain, fruit, snack, fish/dairy, and fat/oil dietary networks, with raw vegetables, grain, fresh fruit, snack, margarine, and red meat were central to the networks respectively. In the vegetable network, TC was significantly lower in the higher tertiles of this network, and HDL was higher in the third tertile compared with the first tertile in sex, age, and fully adjusted models. In the grain network, lower SBP, DBP, TG, LDL, and higher HDL were shown in the higher tertile (P < 0.05).

This study showed that vegetables and grains are associated with decreased risk of MetS components, including reduced blood pressure and cholesterol. Therefore, these results emphasize that dietary networks can be valuable for analyzing nutritional habits and consumption trends.

Atherosclerotic cardiovascular disease (ASCVD) continues to be a growing global health concern with ischemic heart disease and stroke as leading causes of years of life lost. While aging is a major ASCVD risk factor, recent trends show a concerning rise in its incidence among younger adults driven, in part, by increased rates of risk factors such as hypertension and diabetes. These individuals with ASCVD are at elevated risk of recurrence years following their initial event, further underscoring the need for aggressive implementation of secondary prevention strategies to reduce morbidity and mortality. This case-based review discusses evidence-based pharmacological approaches to ASCVD secondary prevention-focusing on the roles of antiplatelets, lipid lowering therapies, antihypertensive medications, and glucose lowering treatments, in practical clinical settings.

The Dietary Approaches to Stop Hypertension (DASH) diet is recommended for adults with diabetes. However, the effects of the DASH diet on glucose control and variability have not been thoroughly investigated.

To study the effects of a modified DASH diet on glycemic control and glucose variability assessed by continuous glucose monitoring (CGM) in individuals with hypertension and type 2 diabetes.

We conducted an ancillary study to add CGM to the Dietary Approaches to Stop Hypertension for Diabetes (DASH4D) Trial. The DASH4D Trial was designed to determine the effects, alone and combined, of a modified DASH diet (vs a diet typical of what Americans with diabetes eat) and lower (vs higher) sodium intake on systolic blood pressure among people with type 2 diabetes and elevated blood pressure. Participants were fed each of the 4 study diets for 5 weeks in a random order. We invited all participants enrolling in the DASH4D Trial to wear a masked CGM sensor for up to 14 days during screening and during each of the four 5-week feeding periods. The DASH4D-CGM Study primarily aimed to evaluate the effects of the modified DASH diet (vs comparison diet) on glycemic control (mean glucose and time-in-range) and glucose variability (coefficient of variation).

Combining CGM technology and a controlled feeding design, the DASH4D-CGM Study will generate robust data on the effects of diet on glycemic control and variability. These findings will inform dietary recommendations for adults with type 2 diabetes.

This study explored how adherence to the DASH diet relates to electrophysiological measures in individuals at varying Alzheimer's disease (AD) risk due to family history (FH). There were 179 dementia-free subjects. DASH index was calculated, and participants were classified into different DASH adherence groups. Tertiles of relative alpha power in default mode network (DMN) regions were calculated. Multivariate logistic regression models were used to examine the association. Lower DASH adherence was associated with decreased odds of higher relative alpha power in the DMN, observed across the entire sample and specifically among those without a FH of AD. Logistic regression models indicated that participants with poorer DASH adherence had a reduced likelihood of elevated DMN alpha power, potentially influenced by vascular and amyloid-beta mechanisms. These findings underscore the dietary pattern's potential role in neural activity modulation, particularly in individuals not genetically predisposed to AD.

Brazilian Cohort Study of Preeclampsia: latent risks after pregnancy (PERLA-Brazil) are a retrospective cohort study including women with and without preeclampsia history, 6-15 years after pregnancy, aiming to evaluate lipid profile, clinical parameters and the frequency of metabolic syndrome. A total of 188 women from Belo Horizonte (Brazil), who became pregnant between 2008 and 2017, were included: 86 with PE history and 102 with normotensive pregnancy. The participants underwent an interview and had blood samples collected between 2022 and 2023. The following data were collected, using standard equipment and techniques: blood pressure, body weight, height, body fat percentage, waist and hip circumference and lipid profile. For variable comparisons, T-test, Mann-Whitney, and chi-square test were used. A linear regression model assessed the isolated effect of a positive history of PE on cardiovascular risk indicators. PE group had higher body mass index compared to normotensive pregnancy, as well as fat percentage, systolic blood pressure, diastolic blood and low-density lipoprotein. Finally, a higher frequency of metabolic syndrome was detected in PE history group. These results suggested that women who had PE showed a combination of cardiovascular risk markers and increased frequency of metabolic syndrome. To mitigate the risk of subsequent chronic diseases, lifestyle modifications are recommended, along with more frequent follow-ups with a health-care team.

Hypertension is a major global health issue that contributes significantly to cardiovascular morbidity and mortality. The management and prevention of hypertension often involve nutritional and dietary modifications, which are considered effective non-pharmacological strategies. In 2023, the Hypertension Research published several papers highlighting nutrition and hypertension. In addition, multiple studies published in leading journals explored the relationship between salt intake and blood pressure (BP) in 2023. In this mini-review, we summarize the key findings of nutritional studies published in the Hypertension Research in 2023. This mini-review also highlights significant findings from the latest research on salt intake and its impact on BP. The new findings from nutritional studies will provide deeper insights on planning dietary strategies for the management of hypertension.

The Mediterranean (MED) dietary pattern improves cardiovascular disease (CVD) risk factors. Increased central systolic blood pressure and arterial stiffness are independent predictors of CVD. The effect of a MED diet on these measures of vascular health has not been investigated.

The aim was to evaluate the effects of a MED diet incorporating 0.5 oz./d (MED0.5), 2.5 oz./d (MED2.5) and 5.5 oz./d (MED5.5) of lean beef compared with an Average American diet (AAD) on vascular health [brachial and central blood pressure, pulse wave velocity (PWV), and augmentation index].

A multicenter, 4-period randomized, crossover, controlled-feeding study was conducted at Penn State University and USDA, Beltsville. In random sequence order, participants consumed each test diet for 4 wk. Vascular outcomes were assessed at baseline and the end of each diet period. Linear mixed models were used for analyses.

Between-diet differences were observed for peripheral and central blood pressure as well as PWV (P < 0.05). PWV was lower following MED0.5 [-0.24 m/s; 95% confidence interval (CI): -0.44, -0.04] and MED2.5 (-0.27 m/s; 95% CI: -0.47, -0.07) compared with the AAD; PWV was nominally lower after the MED5.5 compared with the AAD (-0.20 m/s; 95% CI: -0.40, 0.003; P = 0.055). Central systolic blood pressure was lower following the MED0.5 (-3.24 mmHg; 95% CI: -5.22, -1.27) and MED2.5 (-2.93 mmHg; 95% CI: -4.91, -0.96) compared with the AAD. A similar pattern was observed for central diastolic pressure. Brachial systolic and diastolic pressure were lower following all 3 MED diets compared with the AAD (P < 0.05).

Compared with an AAD, MED diets containing 0.5 and 2.5 oz./d of lean beef improved brachial and central systolic and diastolic blood pressure and arterial stiffness. Our findings suggest that a MED diet with ≤5.5 oz./d of lean beef does not adversely affect vascular function.This trial was registered at clinicaltrials.gov as NCT02723617.

Participating in co-creation processes can improve the knowledge, satisfaction and healthcare outcomes of volunteers. However, this methodology is still underused in nutritional clinical studies.

This study aimed to use participatory research as an innovative approach to co-creating nutritional and physical activity (PA) recommendations for the FOOP-Sarc project and to assess their usability and volunteers' satisfaction and engagement experience (SEE) during the co-creation process.

The co-creation process was based on four stages: (s1) co-ideation, (s2) co-design, (s3) co-implementation and (s4) co-evaluation (Ref.: NCT05485402).

Thirteen volunteers with sarcopenia were included (stages 1-2 [n = 7], stage 3 [n = 3 intervention, n = 3 control] and stage 4 [n = 13]).

The co-ideation (s1) and co-design (s2) stages focused on designing recommendations adapted to the volunteers' preferences; the co-implementation (s3) stage included the implementation and comparison of the co-created or standard recommendations for 3 weeks to test the recommendations' acceptance; and the co-evaluation (s4) stage focused on usability, SEE, and adherence.

The volunteers co-created recommendations for improving sarcopenia according to the barriers identified related to diet and PA. The recommendations' usability and the SEE of volunteers were high in all cases.

The participatory research approach used in this nutritional intervention study, demonstrates a high usability of the co-created recommendations for sarcopenia and high SEE of the volunteers, particularly in the volunteers who participated in co-ideation (s1) and co-design (s2), the most key stages of the co-creation process.

The volunteers in this study participated in the co-creation of nutritional and PA recommendations to improve sarcopenia, which they must subsequently follow.

ClinicalTrials.gov identifier: NCT05485402.

The dominant public health narrative equates excess weight with poor health, and previous research has demonstrated that people judge adults with higher body weights as being in poor health, even when they engage in healthy lifestyles. The present study investigated whether the same pattern of beliefs holds for perceptions of children's health. Participants (n = 445) viewed the health profile of a female child that varied in terms of weight status (normal weight, obese), health behaviors (good, poor), and age (younger, older), and then rated the child's overall health and indicated their agreement with suggested behavior recommendations. For older children, targets with obesity were perceived as less healthy and were recommended to engage in more healthy and weight control behaviors than were the targets with normal weight. Health behaviors did influence perceptions of health and behavioral recommendations, but much less so for the target with obesity than for the target with normal weight. For younger children, participants placed a greater emphasis on health behaviors than on weight in their perceptions of the target's health and healthy behavior recommendations, but the target's weight did play a greater role in weight-control behavior recommendations. Overall, perceptions of older children reflect the mainstream weight-centric health beliefs that are perpetuated in public health messaging, whereas perceptions of younger children seem to be more aligned with the scientific evidence supporting the importance of health behaviors to overall health. Public health messaging, particularly messaging targeting parents, should be reframed to focus on the importance of engagement with health behaviors without reference to weight.

BackgroundNutrition and dietary trials are often prone to bias, leading to inaccurate or questionable estimates of intervention efficacy. However, reports on quality management practices of well-controlled dietary trials are scarce. This study aims to introduce the quality management system of the Diet, ExerCIse and CarDiovascular hEalth-Diet Study and report its performance in ensuring study quality.MethodsThe quality management system consisted of a study coordinating center, trial governance, and quality control measures covering study design, conduct, and data analysis and reporting. Metrics for evaluating the performance of the system were collected throughout the whole trial development and conducted from September 2016 to June 2021, covering major activities at the coordinating center, study sites, and central laboratories, with a focus on the protocol amendments, protocol deviations (eligibility, fidelity, confounders management, loss to follow-up and outside-of-window visits, and blindness success), and measurement accuracy.ResultsThree amendments to the study protocol enhanced feasibility. All participants (265) met the eligibility criteria. Among them, only 3% were lost to the primary outcome follow-up measurement. More than 95% of participants completed the study, they consumed more than 96% of the study meals, and more than 94% of participants consumed more than 18 meals per week, with no between-group differences. Online monitoring of nutrient targets for the intervention diet showed that all targets were achieved except for the fiber intake, which was 4.3 g less on average. Only 3% experienced a body weight change greater than 2.0 kg, and 3% had medication changes which were not allowed by the study. James' blinding index at the end of the study was 0.68. The end digits of both systolic and diastolic blood pressure readings were distributed equally. For laboratory measures, 100% of standard samples, 97% of blood-split samples, and 87% of urine-split samples had test results within the acceptable range. Only 1.4% of data items required queries, for which only 30% needed corrections.DiscussionThe Diet, ExerCIse and CarDiovascular hEalth-Diet Study quality management system provides a framework for conducting a high-quality dietary intervention clinical trial.

Depression and diet are both common modifiable factors related to mortality rates among individuals with cancer, but their combined effects remained underexplored. We aimed to comprehensively evaluate the independent and joint association of depressive symptoms and dietary patterns with mortality among cancer survivors.

A cohort of US cancer survivors (3,011 eligible participants, representing 20 million cancer patients) were collected from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-9). Based on dietary data from 24-hour recall, several well-developed dietary pattern indices were calculated, including Healthy Eating Index-2020 (HEI-2020), Alternative Healthy Eating Index (AHEI), Alternate Mediterranean Diet Score (aMED), MED Index in serving sizes from the PREDIMED trial (MEDI), Dietary Approaches to Stop Hypertension Index (DASH), DASH Index in serving sizes from the DASH trial (DASHI), Dietary Inflammation Index (DII), and DII excluding alcohol (DII [No EtOH]). Kaplan-Meier curves and multivariable Cox proportional hazards regression models were conducted to investigate the relationships of independent and combined prognostic effects of PHQ-9 score and dietary pattern indices with survival among cancer survivors.

In joint analysis, combinations of lower PHQ-9 score with higher HEI-2020, AHEI, aMED or DASH were favorably linked to lower risks of overall and noncancer mortality. Representatively, cancer survivors with no to minimal depressive symptoms (PHQ-9 score: 0-4) and high adherence to the HEI-2020 had lower risk of all-cause (HR = 0.43, 95% CI: 0.24-0.75) and noncancer (HR = 0.29, 95% CI: 0.15-0.55) mortality, when compared to those with PHQ-9 score ≥ 10 and low adherence to the HEI-2020. Additionally, a combination of higher adherence to the MEDI and lower PHQ-9 scores was linked to a reduced risk of noncancer mortality.

The joints of depressive symptoms and certain dietary patterns were associated with risks of all-cause, cancer-specific, and noncancer mortality among cancer survivors. Early psychological counseling and individualized dietary strategies are crucial to reduce mortality risk and improve quality of life for this population.

Aging increases the risk of neurodegenerative diseases (NDs) like Alzheimer's (AD) and Parkinson's (PD), characterized by neuronal loss and cognitive decline. Potential preventive/therapeutic interventions also include lifestyle changes like nutrition & diet, exercise, leisure and social engagement. Here, we discuss several lifestyle interventions for healthy brain aging, and in older adults with NDs. Balanced diets like the Mediterranean and MIND diets can reduce cognitive decline during aging. Long-term use of specific nutrient combinations in medical food may also exert benefits on memory. Metabolic interventions like calorie restriction (CR) and intermittent fasting (IF) have shown potential benefits in aging. However, their effects on cognitive function in older adults were modestly explored and remain unclear. Clinical trials are ongoing to test the cognitive and health outcomes of CR/IF variants in older adults with AD or PD (associated or not with metabolic disorders). We also highlight the role of cognitive reserve (CoR) in delaying dementia symptoms. Engaging in diverse leisure activities like music and bilingualism may enhance CoR and reduce AD risk. Finally, we outline future directions for promoting healthy brain aging through lifestyle interventions (e.g., personalized diets, precision nutrition, synergistic lifestyle approaches, AI-based technologies to monitor the effectiveness of lifestyle practices).