Delivering a dietetic intervention to cardiovascular patients in the Covid era

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Department of Health Introduction Healthy diet and body composition are core components of cardiac rehabilitation. Following the COVID outbreak in March 2020, our face-to-face cardiac rehabilitation programme (Our Hearts Our Minds) was suspended. The programme was then quickly moved to a virtual platform to continue to deliver the programme. Purpose Here we describe how the OHOM programme adapted our service to deliver the dietetic assessment and intervention on a virtual platform. Methods Pre-Covid the dietary component of OHOM consisted of a face-to-face Initial Assessment (IA) with a dietitian, group education sessions and an End of Programme assessment (EOP). Anthropometric measures and dietary habits were assessed including adherence to the Mediterranean diet via the Mediterranean Diet Score (MDS) toolkit. Using behaviour change techniques, tailored dietary advice was provided and goals agreed to educate on healthier food choices, increase adherence to Mediterranean diet and (if appropriate) promote weight loss and reduce central obesity. The assessment and intervention is now delivered virtually via telephone or video. Anthropometrics are self-reported with tape-measures supplied to assess waist circumference and advice provided on home-weighing. MDS is still assessed. The programme includes fortnightly coaching telephone consultations to review and reset goals, the option to attend a dietitian-led virtual group education session, access to a filmed educational video and submission of food diaries via the Fitbit app. Results From April to November 2020, 114 patients completed the virtual programme (65 telephone, 39 video). Dietetic outcomes are outlined in Table 1 with inclusion of data for a similar period one year previously (face-to-face) for comparison. Reductions in anthropometric measures and increased adherence to a cardio-protective diet were noted and the results for the two time periods are remarkably similar. Conclusion Delivery of a virtual dietetic component in cardiac rehabilitation is feasible, acceptable and just as effective as face-to-face based on preliminary data. Table 1: Dietary outcomes at IA and EOP Face-to-face assessments (April - March 2019) Virtual assessments (April - November 2020) IA EOP Change IA EOP Change Mean weight (in those with BMI >25kg/m2) 86.5 85.2 -1.3 91.4 88.6 -2.8 Waist circumference (cm) 104.3 103 -1.3 107 102 -5 Mean MDS (Range 1-14) 4.4 7.5 +3.1 4.8 7.8 +3 % Consuming oily fish once per week 20 57 +37 25 68 +43 Achieving fruit and vegetable target 16 61 +45 21 57 +36 Abstract Figure. Dietitian waist circumference tutorial

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Early results on the efficacy and acceptability of a cardiac rehabilitation programme that transitioned to a fully virtual platform with adoption of wearable technology for covid era

European Heart Journal ◽

10.1093/eurheartj/ehab724.2688 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S B Connolly ◽

J L Jones ◽

C Jennings ◽

L Neubeck ◽

D A Wood

Keyword(s):

Blood Pressure ◽

Cardiac Rehabilitation ◽

Patient Reported Outcomes ◽

Smoking Habit ◽

Wearable Technology ◽

Rehabilitation Programme ◽

Cardiac Rehabilitation Programme ◽

Face To Face ◽

Patient Reported ◽

Virtual Platform

Abstract Background/Introduction Cardiaovascular prevention/rehabilitation programmes continue to reduce cardiovascular mortality even with contemporary treatment. During covid the majority of face-to-face programmes were suspended but these services have never been more crucial as control of cardiovascular risk factors can mitigate the morbidity/mortality risk from covid. Programmes must now however be delivered in a way that reduces patient exposure. Here we describe how we rapidly transitioned our previously fully face to face cardiovascular prevention/programme to a completely virtual platform adopting Fitbit as wearable technology. Methods The previously face-to-face initial assessment (IA) conducted by the multidisciplinary team (MDT) – nurse, dietician and physiotherapist is now delivered via video/phone as per patient preference. Patients are provided with equipment kits (tape measures, blood pressure monitors (BP), Fitbit smartwatches and Fibricheck app as required. The virtual IA includes assessment of: Smoking habit, blood pressure (BP), heart rate, lipid profile and HbA1c (taken in community phlebotomy hub), cardioprotective medications, weight, BMI, waist circumference, Mediterranean Diet Score, functional capacity via the Duke Activity Status Index, habitual activity levels, risk stratification for exercise, hospital anxiety and depression scores (HADS) and quality of life (QOL). Patients receive education and tailored advice with SMART goals as well as a written care plan. The subsequent 12 programme is comprised of Results Between April and November 2020 n=262 had a virtual IA (94% of those offered and n=114 (95% of those offered) attended an end of programme assessment. 64% were male and the mean age was 64.1 years. Acceptance of the Fitbit device was 72% of those offered. Table 1 below shows the main clinical and patient-reported outcomes in those attending both an IA and EOP with the data for the same 6 months the year prior (face to face programme) also for comparison. Programme satisfaction ratings were high with 85% rating the programme as excellent or very good. Conclusions Transitioning a previously fully face to face cardiac rehabilitation programme to a wholly virtual platform was feasible and acceptable to patients. Early data analysis would suggest that the virtual programme achieves similar clinical and patient reported outcomes. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Funded under Transformation Funding Programme, Department of Health, Northern Ireland Table 1

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The Mediterranean diet protects against waist circumference enlargement in 12Ala carriers for the PPARγ gene: 2 years' follow-up of 774 subjects at high cardiovascular risk

British Journal Of Nutrition ◽

10.1017/s0007114509289008 ◽

2009 ◽

Vol 102 (5) ◽

pp. 672-679 ◽

Cited By ~ 28

Author(s):

Cristina Razquin ◽

J. Alfredo Martinez ◽

Miguel A. Martinez-Gonzalez ◽

Dolores Corella ◽

José Manuel Santos ◽

...

Keyword(s):

Cardiovascular Risk ◽

Waist Circumference ◽

Mediterranean Diet ◽

Nutritional Intervention ◽

Control Group ◽

Diabetic Patients ◽

High Cardiovascular Risk ◽

Pro12ala Polymorphism ◽

The Mediterranean ◽

Pparγ Gene

The PPARγ gene regulates insulin sensitivity and adipogenesis. The Pro12Ala polymorphism of this gene has been related to fat accumulation. Our aim was to analyse the effects of a 2-year nutritional intervention with Mediterranean-style diets on adiposity in high-cardiovascular risk patients depending on the Pro12Ala polymorphism of the PPARγ gene. The population consisted of a substudy (774 high-risk subjects aged 55–80 years) of the Prevención con Dieta Mediterránea (PREDIMED) randomised trial aimed at assessing the effect of the Mediterranean diet for CVD prevention. There were three nutritional intervention groups: two of them of a Mediterranean-style diet and the third was a control group advised to follow a conventional low-fat diet. All the participants were genotyped by PCR-restriction fragment length polymorphism (RFLP). The results showed that carriers of the 12Ala allele allocated to the control group had a statistically significant higher change in waist circumference (adjusted difference coefficient = 2·37 cm; P = 0·014) compared with wild-type subjects after 2 years of nutritional intervention. This adverse effect was not observed among 12Ala carriers allocated to both Mediterranean diet groups. In diabetic patients a statistically significant interaction between Mediterranean diet and the 12Ala allele regarding waist circumference change was observed ( − 5·85 cm; P = 0·003). In conclusion, the Mediterranean diet seems to be able to reduce waist circumference in a high-cardiovascular risk population, reversing the negative effect that the 12Ala allele carriers of the PPARγ gene appeared to have. The beneficial effect of this dietary pattern seems to be higher among type 2 diabetic subjects.

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The Relationship Between Adherence to the Mediterranean Diet and Body Composition in Nutrition and Dietetic Students

Proceedings of The Nutrition Society ◽

10.1017/s0029665120002876 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Servet Madencioğlu ◽

Sevinç Yücecan

Keyword(s):

Physical Activity ◽

Body Composition ◽

Waist Circumference ◽

Mediterranean Diet ◽

Near East ◽

Female Students ◽

Significant Difference ◽

The Mediterranean ◽

Nutrition And Dietetics ◽

The Relationship

AbstractIntroductionThe determination of level of adherence to the Mediterranean diet (MD) in young adults has been investigated in countries situated near the Mediterranean region generally. The main purpose of this study were to determine differences in body composition by gender and level of adherence to the MD and to determine the relationship between body composition and level of adherence to the MD in Nutrition and Dietetics students at Near East University in Cyprus.Materials and MethodsThe study was conducted on 126 Nutrition and Dietetics students, aged 18 to 32 years. MDS was calculated, and then classified into three groups: good (36–55 points), moderate (21–35 points), and poor (0–20 points). Body composition was assessed using bioelectrical impedance (BIA). Anthropometrical measurements; height (H), body weight (BW), waist circumference (WC) and hip circumference (HC) were assessed according to standardized procedures and physical activity (PA) was assessed by using International Physical Activity Questionnaire (IPAQ-short form). The study protocol was approved by the Ethics Committee at Near East University.ResultsAccording to study results 31.0% of students were found out to low adherence, while 69.0% of students had moderate adherence to the MD. There is no student had high adherence to the MD. There was no significant difference (p = 0.877) between the male and female students in terms of adherence to Mediterranean diet. The findings indicate that the eating habits of the Nutrition and Dietetics students, even those studying nutrition, are in need of improvement. The results show that 78.6% of students were normal and 21.4% of students were overweight and obese. Male students’ BW (p = 0.000), WC (p = 0.000) and HC (p = 0.015) were higher than females’, while female students’ fat mass (FM) (p = 0.000) was higher than males’. However, there is no significant difference between BW (p = 0.724), FM (p = 0.896), BMI (p = 0.691), WC (p = 0.632) and HC (p = 0.982) neither low adherence nor moderate adherence to the MD. Most of students minimal active according to IPAQ scores (41.2%) and there is no significant difference IPAQ score and adherence to the MD (p = 0.923).DiscussionOne of the healthiest diets worldwide is the traditional MD. Several studies have shown, that higher adherence to the MD is inversely related with BMI, waist circumference (WC) and waist-to-height ratio (WHR). Little is known of how adherence to the MD is related to body composition, especially in university students. Further large-scale studies are required to clarify the relationship between adherence to the MD and body composition

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Validation of a self-administered version of the Mediterranean diet scale (MDS) for cardiac rehabilitation patients in Canada

International Journal of Food Sciences and Nutrition ◽

10.1080/09637486.2018.1486392 ◽

2018 ◽

Vol 70 (2) ◽

pp. 202-211 ◽

Cited By ~ 3

Author(s):

Gabriela Lima de Melo Ghisi ◽

Anisha Mahajan ◽

Gabriela Suéllen da Silva Chaves ◽

Veronica Rouse ◽

Margaret Brum ◽

...

Keyword(s):

Cardiac Rehabilitation ◽

Mediterranean Diet ◽

The Mediterranean

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Nutrition information, Mediterranean diet, and weight: A structural equation approach

Agricultural Economics (Zemědělská ekonomika) ◽

10.17221/25/2019-agricecon ◽

2020 ◽

Vol 66 (No. 1) ◽

pp. 10-18

Author(s):

Alessia Cavaliere ◽

Elena Siletti ◽

Alessandro Banterle

Keyword(s):

Mediterranean Diet ◽

Structural Equation ◽

Weight Status ◽

Equation Model ◽

Healthy Weight ◽

Food Label ◽

Nutritional Knowledge ◽

Face To Face ◽

Related Information ◽

The Mediterranean

This paper studies the relationships between adherence to the Mediterranean diet, food-related information, and possible effects they could jointly exert on weight status. The empirical analysis was conducted via a consumer survey using face-to-face interviews, and a structural equation model was implemented to the data analysis. This model choice was led by its ability to simultaneously evaluate multiple constructs. The results outline the central role played by adherence to the Mediterranean diet and food-related information, both in terms of nutritional knowledge and expert recommendations, which seem to be the key drivers affecting healthy weight. Moreover, food label use increases the nutritional knowledge of consumers, which in turn favours a healthy diet.

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Assessment of the knowledge and application of the Mediterranean diet among students of dietetics

Progress in Health Sciences ◽

10.5604/01.3001.0012.8320 ◽

2018 ◽

Vol 8 (2) ◽

pp. 40-45

Author(s):

P. Nikołajuk ◽

Ka. Zujko ◽

Ki. Zujko ◽

M.E. Zujko

Keyword(s):

Fatty Acids ◽

Waist Circumference ◽

Mediterranean Diet ◽

Nutritional Value ◽

Vitamin B1 ◽

General Information ◽

Daily Diet ◽

High Knowledge ◽

The Mediterranean ◽

Diet Score

Purpose: To assess the knowledge of young adults (students of dietetics) of the health benefits of the Mediterranean diet (MedDiet) and the practical application of the principles of this diet. Materials and methods: The study was performed on 97 women, students of dietetics. Research on general information about the respondents and knowledge about the MedDiet was carried out using a questionnaire with 29 questions. To assess the nutritional value of the diet, a 3-day nutritional diary and computer programme Diet 5.0 were used. Adherence to the MedDiet was appraised according to the 9-point scale of aMED (alternate Mediterranean Diet Score). Results: The most students responded that they have high knowledge of the MedDiet, but do not use the MedDiet recommendations in their daily nutrition. Better adherence to MedDiet was significantly associated with the lower waist circumference of the women, higher intake of mono- and polyunsaturated fatty acids, omega3 fatty acids, fiber, vitamin C, folate, vitamin B1, vitamin E and magnesium, and the knowledge of participants of the diet and nutritional value of foods. Conclusions: The adherence to the MedDiet is significantly associated with the participants' knowledge about the diet, the higher nutritional value of the daily diet and lower waist circumference

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Validation of the Telephone-Administered Version of the Mediterranean Diet Adherence Screener (MEDAS) Questionnaire

Nutrients ◽

10.3390/nu12051511 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1511 ◽

Cited By ~ 4

Author(s):

Maria João Gregório ◽

Ana M. Rodrigues ◽

Clara Salvador ◽

Sara S. Dias ◽

Rute D. de Sousa ◽

...

Keyword(s):

Mediterranean Diet ◽

Large Population ◽

Population Based ◽

Validity And Reliability ◽

Face To Face ◽

Portuguese Version ◽

Diet Adherence ◽

Mediterranean Diet Adherence ◽

The Face ◽

The Mediterranean

A 14-Item Mediterranean Diet Adherence Screener (MEDAS) questionnaire was developed and validated in face-to-face interviews, but not via telephone. The aims of this study were to evaluate the validity and reliability of a telephone-administered version of the MEDAS as well as to validate the Portuguese version of the MEDAS questionnaire. A convenience community-based sample of adults (n = 224) participated in a three-stage survey. First, trained researchers administered MEDAS via a telephone. Second, the Portuguese version of Food Frequency Questionnaire (FFQ), and MEDAS were administered in a semi-structured face-to-face interview. Finally, MEDAS was again administered via telephone. The telephone-administered MEDAS questionnaire was compared with the face-to-face-version using several metrics. The telephone-administered MEDAS was significantly correlated with the face-to-face-administered MEDAS [r = 0.805, p < 0.001; interclass correlation coefficient (ICC) = 0.803, p < 0.001] and showed strong agreement (k = 0.60). The MEDAS scores that were obtained in the first and second telephone interviews were significantly correlated (r = 0.661, p < 0.001; ICC = 0.639, p < 0.001). The overall agreement between the Portuguese version of MEDAS and the FFQ-derived Mediterranean diet adherence score had a Cohen’s k = 0.39. The telephone-administered version of MEDAS is a valid tool for assessing the adherence to the Mediterranean diet and acquiring data for large population-based studies.

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Mediterranean Diet Adherence Modulates Anthropometric Measures by TCF7L2 Genotypes among Puerto Rican Adults

Journal of Nutrition ◽

10.1093/jn/nxz210 ◽

2019 ◽

Vol 150 (1) ◽

pp. 167-175 ◽

Cited By ~ 2

Author(s):

Mercedes Sotos-Prieto ◽

Caren E Smith ◽

Chao-Qiang Lai ◽

Katherine L Tucker ◽

José M Ordovas ◽

...

Keyword(s):

Waist Circumference ◽

Puerto Rican ◽

Mediterranean Diet ◽

Population Based ◽

Dietary Factors ◽

Health Study ◽

Anthropometric Measures ◽

Cross Sectional ◽

Sectional Analysis ◽

Tcf7l2 Rs7903146

ABSTRACT Background Transcription factor 7–like 2 (TCF7L2) genetic variants that predispose individuals to type 2 diabetes (T2D) show inconsistent associations with anthropometric traits. Interaction between TCF7L2 genotypes and dietary factors may help explain these observations. Objective We aimed to examine the potential modulation of TCF7L2-rs7903146 and rs12255372 on anthropometric markers by a Mediterranean diet (MedDiet). Methods Cross-sectional analysis was conducted in 1120 participants (aged 45–75 y) of the Boston Puerto Rican Health Study. Anthropometric variables were measured, and polymorphisms were genotyped using standardized protocols. Diet was assessed using a validated FFQ. The MedDiet was defined based on adherence to 9 food and nutrient components using sex-specific population-based median cut-offs; high adherence was defined as meeting ≥4 components. Haplotypes were tested for association with obesity traits, independently and via interaction with the MedDiet. Results TCF7L2-rs7903146 showed significant interaction with the MedDiet influencing BMI, weight, and waist circumference. The T risk-allele carriers (CT + TT) with a high MedDiet score had lower weight (77.3 ± 1.0 compared with CC 80.9 ± 1.0 kg; P = 0.013) and waist circumference (99.2 ± 0.9 compared with CC 102.2 ± 0.9 cm; P = 0.021), when compared with CC participants. A low MedDiet score resulted in no significant differences between genotypes. For TCF7L2-rs12255372, we found significant interactions with the MedDiet for weight (P-interaction = 0.034) and BMI (P-interaction = 0.036). The T allele carriers with a higher MedDiet score showed a trend of lower but no significant differences when compared with CC participants for BMI (P = 0.19), weight (P = 0.09), and waist circumference (P = 0.11). We found significant interactions between the 2 risk-carrying haplotypes and the MedDiet compared with the common haplotype (GC), with lower BMI (β ± SE, TT: −1.53 ± 0.68; P-interaction = 0.024), weight (TT: −4.16 ± 1.77; P-interaction = 0.019), and waist circumference (GT: −5.07 ± 2.50; P-interaction = 0.042) at a high MedDiet score. Conclusion Puerto Ricans with the TCF7L2-rs7903146 and rs12255372 T2D risk genotypes, although still high, had better anthropometric profiles when adhering to a MedDiet, suggesting that this diet may offset unfavorable genetic predisposition.

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Impact of Mediterranean diet education versus posted leaflet on dietary habits and serum cholesterol in a high risk population for cardiovascular disease

Public Health Nutrition ◽

10.1017/s1368980000000318 ◽

2000 ◽

Vol 3 (3) ◽

pp. 273-283 ◽

Cited By ~ 34

Author(s):

Wanda JE Bemelmans ◽

Jan Broer ◽

Jeanne HM de Vries ◽

Karin Fam Hulshof ◽

Jo F May ◽

...

Keyword(s):

Mediterranean Diet ◽

Dietary Habits ◽

Intervention Group ◽

Saturated Fat ◽

Control Group ◽

Fat Intake ◽

Group Education ◽

The Mediterranean ◽

Intensive Group ◽

Saturated Fat Intake

AbstractObjectiveTo investigate the impact of intensive group education on the Mediterranean diet on dietary intake and serum total cholesterol after 16 and 52 weeks, compared to a posted leaflet with the Dutch nutritional guidelines, in the context of primary prevention of cardiovascular disease (CVD).DesignControlled comparison study of an intervention group given intensive group education about the Mediterranean diet and a control group of hypercholesterolaemic persons given usual care by general practitioners (GPs).SettingA socioeconomically deprived area in the Netherlands with an elevated coronary heart disease (CHD) mortality ratio.SubjectsTwo hundred and sixty-six hypercholesterolaemic persons with at least two other CVD risk factors.ResultsAfter 52 weeks, the intervention group decreased total and saturated fat intake more than the control group (net differences were 1.8 en% (95%CI 0.2–3.4) and 1.1 en% (95%CI 0.4–1.9), respectively). According to the Mediterranean diet guidelines the intake of fish, fruit, poultry and bread increased in the intervention group, more than in the control group. Within the intervention group, intake of fish (+100%), poultry (+28%) and bread (+6%) was significantly increased after 1 year (P< 0.05). The intensive programme on dietary education did not significantly lower serum cholesterol level more (−3%) than the posted leaflet (−2%) (net difference 0.06 mmol l−1, 95%CI −0.10 to 0.22). Initially, the body mass index (BMI) decreased more in the intervention group, but after 1 year the intervention and control group gained weight equally (+1%).ConclusionsDespite beneficial changes in dietary habits in the intervention group compared with the control group, after 1 year BMI increased and total fat and saturated fat intake were still too high.

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Association between Adherence to the Mediterranean Diet and Physical Fitness with Body Composition Parameters in 1717 European Adolescents: The AdolesHealth Study

Nutrients ◽

10.3390/nu12010077 ◽

2019 ◽

Vol 12 (1) ◽

pp. 77 ◽

Cited By ~ 4

Author(s):

Pablo Galan-Lopez ◽

Antonio J. Sanchez-Oliver ◽

Maret Pihu ◽

Thórdís Gísladóttír ◽

Raúl Domínguez ◽

...

Keyword(s):

Body Composition ◽

Waist Circumference ◽

Physical Fitness ◽

Mediterranean Diet ◽

Body Mass ◽

Body Fat ◽

Dietary Habits ◽

Fat Percentage ◽

Chi Square ◽

The Mediterranean

Obesity, low levels of physical fitness, and unhealthy eating patterns are responsible for part of the health problems of adolescents today. The current study aimed at examining the association between the adherence to the Mediterranean diet (MD), through each answer to the items of the Adherence to the MD Questionnaire (KIDMED), and physical fitness with body composition parameters (body mass index (BMI), percentage of body fat, and waist circumference) in 1717 European adolescents (N = 900 boys, N = 817 girls). Data of body composition, physical fitness results, and the answers to KIDMED were analyzed by the Student’s t-test. Additionally, the effect size (ES) was calculated and a Chi-square test analyzed the proportion of participants with and without over waist circumference, overfat, and overweight in each KIDMED question. The relative risk of suffering over waist circumference, overfat and overweight in relation to the responses was calculated by Odd-Ratio. Adherence to the MD did not influence the condition of over waist circumference, overfat and overweight, although certain dietary habits were identified as risk factors for their development. Over waist circumference, overfat, and overweight boys and girls presented higher levels of body mass, waist circumference, body fat percentage, and BMI (p < 0.001; ES = 1.73–3.38), as well as lower levels of all the parameters of the physical fitness analyzed (p < 0.001; ES = 0.45–1.08), except the handgrip test. A direct relationship between fitness and over waist circumference, overfat, and overweight was found.

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