Perilunate Lesions – Clinical and Radiological Results with a Minimum of 2 Years of Follow-up

AbstractPerilunate injuries are complex and rare lesions with circumferential carpal bones, ligamentous and cartilage involvement. Despite optimal surgical treatment, poor prognosis is expected and usually gets worse over time. Our aim was to address clinical and radiological outcomes after 2 years of follow-up. Seven wrists were revised with average age of 35.59 ± 14.01 (range 21–56) years old and mean follow-up of 44.10 ± 14.24 (range 25.60–68.63) months. At the latest follow-up, mean postoperative VAS score for pain was 2.71 ± 3.40 and DASH score was 10.48 ± 10.54. Patients returned to work in 5.00 ± 3.15 months. Strength and Range of Motion (ROM) parameters were ∼80% of the contralateral side, with exception for extension (61%) and radial deviation (73%). After 2 years of follow-up, radiographic arthrosis was observed in 29% of the cases. One of these patients was symptomatic and was proposed for arthrodesis. Mean carpal height was 1.51 ± 0.81 and scapholunate angle was 41.58 ± 22.82°. A correlation was observed between arthritis found at final follow-up and grip (r = −0.8660; p < 0.001) and pinch strength (r = −0.8885; p < 0.001). In conclusion, despite characteristic guarded prognosis, efforts to perform a prompt and adequate treatment are helpful. Clinical and radiological outcomes may not be related. Thus, it is of main importance to understand patients' perception of their sequelae.

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Clinical results of the BoneWelding®Fiji® anchor for the treatment of Stener lesions of the thumb

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-020-03625-x ◽

2020 ◽

Author(s):

Tobias Kastenberger ◽

Peter Kaiser ◽

Gernot Schmidle ◽

Kerstin Stock ◽

Stefan Benedikt ◽

...

Keyword(s):

Surgical Treatment ◽

Range Of Motion ◽

Traumatic Event ◽

Ulnar Collateral Ligament ◽

Metacarpophalangeal Joint ◽

Contralateral Side ◽

Pinch Strength ◽

Dash Score ◽

Collateral Ligament

Abstract Introduction A new technology (Sportwelding®) was recently presented, which uses ultrasonic energy to meld a resorbable suture anchor at the interface with the host bone. A standardized clinical use was not investigated yet. This study prospectively evaluated the surgical and clinical outcomes of the Fiji Anchor® (Sportwelding®, Schlieren, Switzerland) in the repair of an ulnar collateral ligament lesion of the metacarpophalangeal joint of the thumb. Material and methods The range of motion, grip and pinch strength, disability of arm, shoulder and the hand (DASH) and patient rated evaluation (PRWE) score, pain, satisfaction, complications and adverse events were assessed in 24 patients after surgical treatment for an acute displaced rupture or avulsion of the ulnar collateral metacarpophalangeal ligament of the thumb using the Fiji Anchor® after 6, 12 and 52 weeks. Results At final follow up, the range of motion of the metacarpophalangeal joint reached almost the contralateral side (49.3° SD 11.7°). Thumb opposition showed a Kapandji score of 9.7 (SD 0.5; range 9–10). Grip strength, the lateral, tip and the three jaw pinch showed nearly similar values compared to the contralateral side (83–101%). Pain was low (0.2 SD 0.7 at rest and 0.6 SD 1.0 during load). The DASH score was 5.0 (SD 7.3) and the PRWE score was 4.1 (SD 9.0). 81% of patients were very satisfied at final follow-up. Two patients were rated unstable during the follow-up period due to a second traumatic event. Three cases experienced difficulties during anchor insertion, whereby incorrect anchor insertion resulted in damage to the suture material; however, this was resolved after additional training. Conclusion One advantage of this anchor appears to be its stable fixation in cancellous bone. The surgical treatment of an ulnar collateral ligament lesion of the thumb using the Fiji Anchor® can lead to an excellent clinical outcome with a minor complication rate; however, long-term dangers and the cost effectiveness of the procedure are not known yet.

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A Modified Suture Suspension Arthroplasty Technique for the Treatment of Basal Joint Arthritis: Short- to Intermediate-Term Outcomes

Hand ◽

10.1177/1558944719886669 ◽

2020 ◽

pp. 155894471988666 ◽

Cited By ~ 1

Author(s):

Ather Mirza ◽

Justin B. Mirza ◽

Laura Klingbeil ◽

Joseph F. Pavlik ◽

Jonathan Muratori ◽

...

Keyword(s):

Contralateral Side ◽

Pinch Strength ◽

Dash Score ◽

Radiographic Images ◽

Basal Joint ◽

Thumb Carpometacarpal ◽

Relationship Of ◽

Joint Arthritis ◽

Suture Suspension

Background: To present a retrospective study on the outcomes of a modified version of suture suspension arthroplasty with trapeziectomy on patients with thumb basal joint arthritis and to evaluate the relationship between the degree of subsidence and functional outcome. Methods: We performed a chart review on 67 patients (75 thumbs) who were surgically treated for thumb carpometacarpal osteoarthritis with trapeziectomy and suture suspension arthroplasty from May 2010 to May 2016. Outcome measures included Disabilities of the Arm, Shoulder and Hand (DASH), grip strength, lateral/precision pinch strength, range of motion, and return to work/resumption of usual activities. Radiographic images were used to measure first metacarpal subsidence into the trapezial space. Results: Clinical outcomes were satisfactory, showing an initial postoperative DASH score of 45.94, which decreased to 27.93 at 6 months postoperatively and to 19.69 at 1 year postoperatively. Radiographic images revealed a mean first metacarpal subsidence of 39% compared with the preoperative images. Grip and pinch strengths showed steady improvement from initial postoperative to final follow-up visits, resulting in 90% recovery of gross grasp, 77% recovery of lateral pinch, and 79% recovery of precision pinch compared with the contralateral side. Conclusions: Our study has found that suture suspension arthroplasty with trapeziectomy is an effective treatment for thumb basal joint arthritis. Suture suspension arthroplasty allows for short immobilization time, avoids tendon sacrifice, avoids anchor use, and leaves a cosmetically appealing scar. Furthermore, a relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear.

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A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415609656 ◽

2016 ◽

Vol 41 (7) ◽

pp. 710-718 ◽

Cited By ~ 2

Author(s):

M. Rubino ◽

L. Cavagnaro ◽

V. Sansone

Keyword(s):

Simple Technique ◽

Stage Iv ◽

Pinch Strength ◽

Dash Score ◽

Level Of Evidence ◽

First Ray ◽

Excision Arthroplasty ◽

Surgical Treatments ◽

New Surgical Technique

We describe a technique for treating Eaton stage IV osteoarthritis of the first ray, which is a development of our previously published technique for treating trapeziometacarpal arthritis. This simple technique is based on a limited resection arthroplasty of the first trapeziometacarpal and the scaphotrapezial joints, with the aim of inducing the formation of a narrow pseudoarthrosis at both sites. A total of 26 consecutive patients were treated for Eaton stage IV arthritis at a mean follow-up of 4.7 years (range 3.2–6.6). There were statistically significant improvements in all clinical parameters: mean appositional and oppositional pinch strength, mean DASH score (65 points pre-operatively to 8.7 points at final follow-up), and in mean visual analogue scale score (8.6 to 0.2 points). Although a larger cohort and a longer follow-up will be necessary to evaluate this new technique fully, these results encourage us to believe that the limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to the existing surgical treatments for stage IV thumb arthritis. Level of evidence: 4

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Partial Capitate Shortening Osteotomy and Its Impact on Lunate Revascularization: Mid-Term Results

Plastic Surgery ◽

10.1177/2292550319828787 ◽

2019 ◽

Vol 27 (2) ◽

pp. 141-146 ◽

Cited By ~ 2

Author(s):

Mesut Tahta ◽

Eyup C. Zengin ◽

Tahir Ozturk ◽

B. Dirim Mete ◽

İzge Gunal ◽

...

Keyword(s):

Contralateral Side ◽

Pinch Strength ◽

Success Rates ◽

Number Of Patients ◽

Shortening Osteotomy ◽

Kienböck Disease ◽

Vas Scores ◽

The Mean ◽

Clinical And Radiological Results ◽

Mid Term Results

Background: Treatment of Kienböck disease is still a clinical challenge. The treatment used in each instance is decided according to stage of the disease at presentation. Good clinical and radiological results could be obtained with partial capitate shortening osteotomy. However, mid-term results of this technique and its effect on lunate revascularization are not well known. Objectives: The aim of this study was to report our results of partial capitate shortening osteotomy in the treatment of stage II and IIIA Kienböck disease. Methods: Ten patients were enrolled in the study with a mean age of 37.7 years old (standard deviation [SD] = 9.6). Patients were evaluated clinically in terms of range of motion, DASH and VAS scores, satisfaction with the outcome, and grip/tip/palmar/key pinch strength compared to the contralateral side. Radiological evaluation consisted of Lichtman staging on plain radiographs and lunate revascularization on magnetic resonance imaging (MRI) at both preoperative and postoperative evaluations. Results: The mean duration of follow-up was 55.2 (SD = 24) months. The mean DASH and VAS scores were 14.3 (SD = 6.7) and 1.5 (SD = 1.3), respectively. For patient satisfaction, the mean score was 3.6 (SD = 0.6). The Lichtman stage of 7 patients remained unchanged. Lunate revascularization was detected with MRI in 6 patients. Conclusions: Although the number of patients in the study prevents more strict conclusions, our results are promising, and the technique presented offers minimally but observable lunate revascularization and high success rates in preventing the progression of the disease.

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Surgical treatment of the radial head is critical to the outcome of Monteggia-like lesions

The Bone & Joint Journal ◽

10.1302/0301-620x.101b12.bjj-2019-0547.r1 ◽

2019 ◽

Vol 101-B (12) ◽

pp. 1512-1519 ◽

Cited By ~ 3

Author(s):

Alexander Klug ◽

Felix Konrad ◽

Yves Gramlich ◽

Reinhard Hoffmann ◽

Kay Schmidt-Horlohé

Keyword(s):

Surgical Treatment ◽

Radial Head ◽

Type I ◽

Dash Score ◽

Type Ii ◽

Coronoid Fracture ◽

Radial Head Arthroplasty ◽

Type Iii ◽

Clinical And Radiological Results

Aims The aim of this study was to evaluate the outcome of Monteggia-like lesions at midterm follow-up and to determine whether the surgical treatment of the radial head influences the clinical and radiological results. Patients and Methods A total of 78 patients with a Monteggia-like lesion, including 44 women and 34 men with a mean age of 54.7 years (19 to 80), were available for assessment after a mean 4.6 years (2 to 9.2). The outcome was assessed using the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Mayo Modified Wrist Score (MMWS), and The Disabilities of the Arm, Shoulder and Hand (DASH) score. Radiographs were analyzed for all patients. A total of 12 Mason type I, 16 type II, and 36 type III fractures were included. Surgical treatment consisted of screw fixation for all type II and reconstructable type III fractures, while radial head arthroplasty (RHA) or excision was performed if reconstruction was not possible. Results The mean MEPS was 88.9 (40 to 100), mean OES was 40.1 (25 to 48), mean MMWS was 88.1 (50 to 100), mean DASH score was 14.7 (0 to 60.2), and mean movement was 114° (sd 27) in extension/flexion and 155° (sd 37) in pronation/supination. Mason III fractures, particularly those with an associated coronoid fracture treated with RHA, had a significantly poorer outcome. Suboptimal results were also identified in patients who had degenerative changes or heterotopic ossification on their latest radiograph. In contrast, all patients with successful radial head reconstruction or excision had a good outcome. Conclusion Good outcomes can be achieved in Monteggia-like lesions with Mason II and III fractures, when reconstruction is possible. Otherwise, RHA is a reliable option with satisfactory outcomes, especially in patients with ligamenteous instability. Whether the radial head should be excised remains debatable, although good results were achieved in patients with ligamentous stability and in those with complications after RHA. Cite this article: Bone Joint J 2019;101-B:1512–1519

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Partial capitate shortening for Kienböck’s disease

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414562355 ◽

2014 ◽

Vol 40 (9) ◽

pp. 957-960 ◽

Cited By ~ 18

Author(s):

A. Citlak ◽

U. Akgun ◽

T. Bulut ◽

M. Tahta ◽

B. Dirim Mete ◽

...

Keyword(s):

Magnetic Resonance ◽

Case Series ◽

Magnetic Resonance Images ◽

Stage Ii ◽

Pinch Strength ◽

Case Series Study ◽

The Mean ◽

Series Study ◽

Carpal Height

The purpose of this study was to report our experience of partial capitate shortening in seven patients with a median 38 months follow-up. Staging was made by the Lichtman classification system and stage II and III-A patients were included in the study. The mean age was 34 years (range 22–52). Patients were assessed for pain, range of motion, grip and pinch strength, and satisfaction was recorded using a scale between 0 and 4. All these parameters showed improvement after surgery. The Lichtman stage, lunate height index and carpal height index were determined radiographically. Magnetic resonance images of the wrist were studied for lunate revascularization at the final follow-up and occurred in all patients. According to our study, partial capitate shortening seems an effective treatment for Lichtman stage II and III-A patients. Level IV case series study.

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Treatment of Scaphoid Non-Unions of the Proximal third with Conventional Bone Grafting and Mini-Herbert Screws: an Analysis of Clinical and Radiological Results

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193408087030 ◽

2008 ◽

Vol 33 (2) ◽

pp. 179-185 ◽

Cited By ~ 22

Author(s):

KAI MEGERLE ◽

XAVIER KEUTGEN ◽

MIRIAM MÜLLER ◽

GÜNTER GERMANN ◽

MICHAEL SAUERBIER

Keyword(s):

Demographic Data ◽

Bone Grafts ◽

Bone Union ◽

Ct Scans ◽

Dash Score ◽

Dorsal Approach ◽

Carpal Collapse ◽

Non Union ◽

Clinical And Radiological Results ◽

Carpal Height

This study assessed the clinical and radiological outcomes after treatment of scaphoid non-union of the proximal third by non-vascularised bone grafts and stabilisation by Mini-Herbert Screws from a dorsal approach. Thirty-one patients, one woman and 30 men, were reviewed retrospectively at a mean of 42 (12–77) months. All patients received pre- and postoperative CT scans to assess bone union. In addition to demographic data, the range of motion, grip strength, DASH score, Krimmer score, Mayo wrist score and radiological parameters (carpal height, scapholunate and radiolunate angles) were recorded. Bone union was achieved in 21 patients. The average DASH score in patients with bone union was 12 and that in patients with persistent non-union it was 30. No progression into carpal collapse or increase of scapholunate angles was detected. Our study demonstrates that acceptable union rates can be achieved with non-vascularised bone grafts, and this technique compares favourably with other reports in the literature.

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Specific Guidelines Including Multidisciplinary Approach Is Critical of Management of Langerhans Cell Histiocytosis in Adults

Blood ◽

10.1182/blood-2019-129707 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 1041-1041

Author(s):

Lorenzo Rizzo ◽

Michelina Santopietro ◽

Gianluca Sfaciotti ◽

Marco Brunori ◽

Luisa Cardarelli ◽

...

Keyword(s):

Langerhans Cell Histiocytosis ◽

Multidisciplinary Approach ◽

Central Nervous System Involvement ◽

Langerhans Cell ◽

Age At Diagnosis ◽

Braf V600e ◽

Adequate Treatment ◽

Previously Treated ◽

Over Time

The knowledge of Langerhans Cell Histiocytosis (LCH) is based on pediatric studies. Adults with LCH are usually treated with pediatric protocols. In 2001, guidelines for adults with LCH (GIMEMA LCH 2001) were proposed, in order to standardize the diagnostic and therapeutic approaches for this category of patients. The aims of this retrospective study are: a) to evaluate the role of a multidisciplinary assessment in adults with LCH, according to the GIMEMA LCH 2001 guidelines, and b) to analyze the results obtained with the GIMEMA LCH 2001 guidelines and those obtained with pediatric protocols. Pts aged >18 years with a diagnosis of LCH (S-100+, CD1a+, CD207+) managed at our Institution since 1985 to 2018 were considered. As diagnostic and treatment approaches, two different strategies were used over time: the GIMEMA LCH 2001 guidelines and the pediatric protocols. The GIMEMA LCH 2001 guidelines included a multidisciplinary diagnostic work-up with complete odontostomatologic, pulmonary and endocrinologic assessments; treatment strategy consisted of: wait and see or local therapy in unifocal single system (SS), indomethacin in bone multifocal SS and vinblastine combined with low-dose prednisone (PDN) in multi-system (MS), PDN in pulmonary honey-combing disease (PHCD) and cladribine in central nervous system involvement. DAL-HX 83 and 90, LCH-I and LCH II were the pediatric protocols utilized over time. Response to treatment was defined as complete (CR) or intermediate (IR). Persistence of the symptoms and/or appearance of new lesions were defined no response (NR). Progression was considered the appearance of symptoms and/or new lesions after initial response. One-hundred-thirty-one LCH pts (females 72, males 59) with a median age at diagnosis of 36 years (range 18 - 71) were considered. Median follow up was 43 months (range 12 - 330). One-hundred-seven patients were managed according to the GIMEMA LCH 2001 guidelines, 16 of them previously treated with a pediatric protocol. Pulmonary and/or oral involvements were identified in 31/107 (29%) and 12/107 (11%) patients, respectively, 5/16 (31%) and 3/16 (19%), respectively, of previously treated asymptomatic patients. Ninety-one newly diagnosed patients (median age at diagnosis: 36 years) were treated according to the GIMEMA LCH 2001 guidelines and 40 (median age at diagnosis: 33 years) were managed with pediatric protocols. All patients treated with the GIMEMA LCH 2001 were evaluable for response. In particular, all patients with SS-LCH achieved a response (100%), that was complete in 20/26 (76.9%) unifocal-SS and in 10/14 (71.4%) multifocal-SS. All but one patient with MS-LCH reached a response that was complete in 22/45 (48.9%). Of 6 pts with PHCD, 5 had a IR and one a CR. No pt presented CNS involvement at initial diagnosis. Thirty-nine of 40 pts managed with pediatric protocols were evaluable for response. All 13 pts with SS-LCH had a response that was complete in 6 (46.1%). Among 26 patients with MS-LCH, 3 of them with organ risk involvement achieved a response, that was complete in 1, while among 23 patients without organ risk, 12 (52.2%), 8 (34.8%) and 3 (13%) had a CR, IR and NR, respectively. Overall, 12 patients were lost to follow-up. Disease progression was recorded in 47/95 pts (49.5%) after a median time of 19 months (range: 6-147 months). The progression-free survival at 43 months was significantly better for patients treated according to the GIMEMA LCH 2001 guidelines compared to those managed with pediatric protocols, 67% (IC95% 53.14 - 80.86%) vs 48% (IC95% 31.37 - 64.63%), respectively (p 0.005). Overall, 7 deaths were recorded, 5 in patients treated with the pediatric protocols. The overall survival at 43 months, was similar in patients managed with the GIMEMA LCH 2001 guidelines and in those treated with pediatric protocols (97.9%, CI 95%: 93.75% - 100% and 97.3%, (IC95% 91.96% - 100%). BRAF V600E mutation was found in 13/35 (37%) evaluable cases. No differences in response and outcome between BRAFV600E-mutated patients and those not-mutated were found. Our experience in a large cohort of LCH adults shows that a multidisciplinary approach is useful in identifying organ involvement in adults, including those asymptomatic. This is critical for an adequate treatment. Moreover, guidelines specific for adults with LCH proved efficacy in improving the outcome in this category of patients. Disclosures No relevant conflicts of interest to declare.

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Analysis of functional outcome of complex forearm injuries

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173087 ◽

2017 ◽

Vol 3 (5) ◽

pp. 904

Author(s):

Saranjeet Singh Jagdev ◽

Subodh Kumar Pathak ◽

Abhijeet Salunke ◽

Pritam Maheshwari ◽

Prahlad Ughareja

Keyword(s):

Grip Strength ◽

Bone Grafting ◽

Care Center ◽

Tertiary Care ◽

Skin Grafting ◽

Pinch Strength ◽

Dash Score ◽

Superficial Infection ◽

Forearm Injuries

Background: Complex forearm injuries are often associated with contamination, crushing, loss of tissues and patient arrives at odd hours when specialists are not available. These injuries can lead to complications like infective non-union, stiffness, disabilities and secondary amputations.Methods: 23 patients having complex forearm injuries treated primarily at tertiary care center by single surgeon were included in the study. Pinch strength, grip strength, residual deformity and DASH score was assessed at final follow-up. In 23 patients treated, 16 patients underwent primary internal fixation of both bone, primary external fixator was done in 4 patient, delayed fixations in 6patients, primary bone grafting in 3 patients and in 1 patient delayed bone grafting was done Skin grafting was performed in 6 cases, and flaps in 13 patients. Vascular repair was done in four patients.Results: All 23 patients came for follow-up. An average number of surgery performed per patient was 3.81 and mean hospital stay of 28.2 days. The mean duration of follow up was 47.2 months. The average DASH score was 10.24 with average key and tip pinch and grip strength of 62.24%, 58.48% and 54.75% respectively. 3 patients had superficial infection and two patient deep infections. Superficial infections were managed with IV antibiotics. The patients with nerve and vascular injuries had higher DASH score. Conclusions: Early wound coverage can improve functional outcomes. Training in plastic coverage of wounds using pedicle flaps and skin grafting, microsurgical nerve and vessel repairs for orthopedic surgeon can be of great help for the patients.

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Abstract MP56: Specific Nutrients Associate Better Than Dietary Approaches To Stop Hypertension Score With Adult Cardiovascular Risk Factors Over 25 Years: The Princeton Lipid Study

Circulation ◽

10.1161/circ.143.suppl_1.mp56 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Leah Beck ◽

Jessica G Woo

Keyword(s):

Cardiovascular Disease ◽

Diet Quality ◽

Dietary Habits ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Dietary Guidelines ◽

Dash Score ◽

Initial Visit ◽

Over Time

Introduction: Diet is a contributing factor to cardiovascular disease risk and is the basis for dietary guidelines such as the Dietary Approaches to Stop Hypertension (DASH) eating plan. However, little is known about how childhood dietary habits are maintained into adulthood or how child to adult, or adult to adult changes in diet may influence disease risk. Hypothesis: Our goal was to examine the relationship between diet quality, cardiovascular disease risk, and changes in diet quality over time. We hypothesized that diets lacking in nutrients for ideal cardiovascular health would be conserved from childhood to adulthood. This would be reflected as increased rates of hypertension, diabetes, dyslipidemia, and obesity. Methods: Diet data was analyzed from the Princeton Lipid Research study (24 hour recall in the 70’s; Block Food Frequency Questionnaire in 1998). Diet quality at each visit was assessed as a ranking of 15 different macro/micronutrients and by a modified DASH index based on 9 nutrient targets and adapted for children. Outcomes in both childhood and adulthood included: glucose intolerance/diabetes, high blood pressure/hypertension, dyslipidemia/hyperlipidemia, and obesity. Linear and logistic regression models were performed with adjustment for age, race, sex, BMI, occupation and education of self or head of household, and marital status. Results: Analysis included 221 total individuals in Generation 1 (parents at initial visit; 39% (86 of 221) male, mean age 38.9 ± 6.5 followed up at 66.6 ± 6.6 years) and 606 individuals in Generation 2 (45% (271 of 606) male, mean age 11.9 ± 3.23 at initial visit and 38.5 ± 3.6 years at follow up). Generation 1 increased in total DASH score from initial visit to follow-up (1.74 ± 0.95 → 2.11 ± 1.33) while Generation 2 decreased (1.91 ± 0.80 → 1.64 ± 1.13). Overall DASH score was not significantly associated with baseline or follow up outcomes in childhood or adulthood. However, in Generation 2 at follow-up, fiber, potassium, iron, niacin, and vitamin A were associated with hypertension; fiber and sugar with hyperlipidemia; cholesterol with obesity; and saturated fat with diabetes in Generation 1. Conclusions: Overall diet quality was poor in both generations and changed little over time. In conclusion, no relationship was detected between DASH diet accordance and disease outcomes, however certain nutrients are associated with higher cardiovascular disease risk.

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