Abstract TP423: A Fast Assessment of Diet in Stroke (FADS)

Objectives: To design and validate a questionnaire to identify stroke patients with an unhealthy diet. Hypothesis: A simple questionnaire can accurately identify patients with dietary patterns associated with increased risk for vascular disease. Methods: An expert panel identified the components of a healthy diet thought to be important for secondary stroke prevention and drafted ten candidate survey questions. A focus group of four stroke patients (2 men, 2 women) from Yale New Haven Hospital reviewed the questions to refine the wording. From this group, the investigator chose five questions to create the Fast Assessment of Diet in Stroke (FADS) score. To validate the score, among 20 patients with acute ischemic stroke, we compared FADS score to the score on an established “gold standard” measure of adherence to the Mediterranean-type diet, the Mediterranean Diet Score (MDS). The MDS has a range of 0 (lowest adherence to the diet) to 9 (highest adherence). We used ROC curve analysis to identify the FADS score with optimal performance. Based on population means in non-Mediterranean countries, we defined an unhealthy diet as an MDS score <4. Results and Conclusions: The mean MDS score in the population was 3.2 (range 2 to 5). 74% of participants were defined as having an unhealthy diet (MDS <4). The aROC was 0.77. A FADS score ≤3 had had the highest sum for sensitivity and specificity (sensitivity = 79%, specificity = 50%). However, for clinical purposes, a FADS score of <3 may be most effective in selecting patients who need dietary counseling (sensitivity = 46%, specificity = 100%). The FADS score takes less than 2 minutes to administer and accurately identifies stroke patients who need dietary counseling. The low sensitivity, however, indicates that further development is required and that testing against other established gold standards of dietary quality should be completed. This work is under way.

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Diet and cancer in Mediterranean countries: carbohydrates and fats

Public Health Nutrition ◽

10.1017/s1368980009990425 ◽

2009 ◽

Vol 12 (9A) ◽

pp. 1595-1600 ◽

Cited By ~ 39

Author(s):

Cristina Bosetti ◽

Claudio Pelucchi ◽

Carlo La Vecchia

Keyword(s):

Cancer Risk ◽

Olive Oil ◽

Digestive Tract ◽

Mediterranean Diet ◽

A Priori ◽

Glycaemic Index ◽

Case Control Studies ◽

Mediterranean Countries ◽

Increased Risk ◽

The Mediterranean

AbstractObjectiveSeveral aspects of the diet characteristic of the Mediterranean countries are considered favourable not only on cardiovascular disease, but also on cancer risk. We considered some aspects of the Mediterranean diet (including, in particular, the consumption of olive oil and carbohydrates) on cancer risk.Design, Setting and SubjectsData were derived from a series of case-control studies, conducted in Italy since the early 1990s, on over 10 000 cases of thirteen cancer sites and over 17 000 controls.ResultsOlive oil, and other mono- and unsaturated fats, appear to be favourable indicators of breast, ovarian, colorectal, but mostly of upper aero-digestive tract cancers. Whole grain foods are also related to reduced risk of upper aero-digestive tract and various other cancers. In contrast, refined grain intake and, consequently, glycaemic index and glycaemic load were associated to increased risk for several cancer sites. Fish, and hence a diet rich in n-3 polyunsaturated fatty acids, tended to be another favourable diet indicator, while frequent red meat intake was directly related to some common neoplasms. An a priori defined Mediterranean diet score was inversely related to upper digestive and respiratory tract cancers.ConclusionsThese data provide additional evidence that major characteristics of the Mediterranean diet favourably affect cancer risk.

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Homocysteine Levels Show Significant Differences among Mediterranean Dietary Quality Index Variables Compared to Folate and Vitamin B12 Status in Women

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000237 ◽

2015 ◽

Vol 85 (3-4) ◽

pp. 202-210 ◽

Cited By ~ 4

Author(s):

Ivona Višekruna ◽

Ivana Rumbak ◽

Ivana Rumora Samarin ◽

Irena Keser ◽

Jasmina Ranilović

Keyword(s):

Mediterranean Diet ◽

Diet Quality ◽

Quality Index ◽

Fruits And Vegetables ◽

Reproductive Age ◽

Dietary Quality ◽

Vitamin B ◽

Cross Sectional ◽

Poor Diet ◽

The Mediterranean

Abstract. Results of epidemiologic studies and clinical trials have shown that subjects following the Mediterranean diet had lower inflammatory markers such as homocysteine (Hcy). Therefore, the aim of this cross-sectional study was to assess female diet quality with the Mediterranean diet quality index (MDQI) and to determine the correlation between MDQI, homocysteine, folate and vitamin B12 levels in the blood. The study participants were 237 apparently healthy women (96 of reproductive age and 141 postmenopausal) between 25 and 93 years. For each participant, 24-hour dietary recalls for 3 days were collected, MDQI was calculated, and plasma Hcy, serum and erythrocyte folate and vitamin B12 levels were analysed. Total MDQI ranged from 8 to 10 points, which represented a medium-poor diet for the subjects. The strength of correlation using biomarkers, regardless of group type, age, gender and other measured parameters, was ranked from best (0.11) to worst (0.52) for olive oil, fish, fruits and vegetables, grains, and meat, in this order. Hcy levels showed the best response among all markers across all groups and food types. Our study shows significant differences between variables of the MDQI and Hcy levels compared to levels of folate and vitamin B12 in participants with medium-poor diet quality, as evaluated according to MDQI scores.

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Association between the Mediterranean lifestyle, metabolic syndrome and mortality: a whole-country cohort in Spain

Cardiovascular Diabetology ◽

10.1186/s12933-020-01195-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Mercedes Sotos-Prieto ◽

Rosario Ortolá ◽

Miguel Ruiz-Canela ◽

Esther Garcia-Esquinas ◽

David Martínez-Gómez ◽

...

Keyword(s):

Metabolic Syndrome ◽

Cardiovascular Mortality ◽

Cardiovascular Health ◽

Total Mortality ◽

Hdl Cholesterol ◽

Cardiometabolic Health ◽

The Metabolic Syndrome ◽

Mediterranean Countries ◽

Low Hdl ◽

The Mediterranean

Abstract Background Evidence is limited about the joint health effects of the Mediterranean lifestyle on cardiometabolic health and mortality. The aim of this study was to evaluate the association of the Mediterranean lifestyle with the frequency of the metabolic syndrome (MS) and the risk of all-cause and cardiovascular mortality in Spain. Methods Data were taken from ENRICA study, a prospective cohort of 11,090 individuals aged 18+ years, representative of the population of Spain, who were free of cardiovascular disease (CVD) and diabetes at 2008–2010 and were followed-up to 2017. The Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (with higher score representing better adherence). Results Compared to participants in the lowest quartile of MEDLIFE, those in the highest quartile had a multivariable-adjusted odds ratio 0.73 (95% confidence interval (CI) 0.5, 0.93) for MS, 0.63. (0.51, 0.80) for abdominal obesity, and 0.76 (0.63, 0.90) for low HDL-cholesterol. Similarly, a higher MELDIFE score was associated with lower HOMA-IR and highly-sensitivity C-reactive protein (P-trend < 0.001). During a mean follow-up of 8.7 years, 330 total deaths (74 CVD deaths) were ascertained. When comparing those in highest vs. lowest quartile of MEDLIFE, the multivariable-adjusted hazard ratio (95% CI) was 0.58 (0.37, 0.90) for total mortality and 0.33 (0.11, 1.02) for cardiovascular mortality. Conclusions The Mediterranean lifestyle was associated with lower frequency of MS and reduced all-cause mortality in Spain. Future studies should determine if this also applies to other Mediterranean countries, and also improve cardiovascular health outside the Mediterranean basin.

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Family Meals, Conviviality and the Mediterranean Diet among Families with Adolescents

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052499 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2499

Author(s):

Andrea de la Torre-Moral ◽

Sergi Fàbregues ◽

Anna Bach-Faig ◽

Albert Fornieles-Deu ◽

F. Xavier Medina ◽

...

Keyword(s):

Mediterranean Diet ◽

Eating Habits ◽

Family Meals ◽

Structured Interviews ◽

Family Meal ◽

Food Pattern ◽

Mediterranean Countries ◽

The Family ◽

The Mediterranean ◽

Meal Composition

Two aspects that characterize the Mediterranean diet (MD) are “what” and “how” we eat. Conviviality relates to “how” we eat and to the pleasure of sharing meals with significant people. The most studied concept is “family meals”, which includes conviviality, which involves “enjoying” family meals. Given the lack of research on convivial family meals in Mediterranean countries, the purpose of this qualitative study was to analyze the family meal representations and practices of families with 12- to 16-year-old adolescents to assess whether they responded to a pattern of conviviality, and to examine their association with MD adherence. Twelve semi-structured interviews were conducted and food frequency and family meal questionnaires were administered. A food pattern analysis was carried out and digital photos of meals were analyzed to examine eating habits and meal composition, respectively. The findings showed that parents believed family meals are a space for socialization and communication. Items relating to the conviviality of family meals identified in the study were meal frequency, meals at the table, lack of digital distractions, pleasant conversations, and time spent on family meals. Attention should be paid to conviviality in Mediterranean families when designing multi-approach strategies to promote healthy eating among adolescents.

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Nutrition as a Key Modifiable Factor for Periodontitis and Main Chronic Diseases

Journal of Clinical Medicine ◽

10.3390/jcm10020197 ◽

2021 ◽

Vol 10 (2) ◽

pp. 197

Author(s):

Prescilla Martinon ◽

Laurie Fraticelli ◽

Agnes Giboreau ◽

Claude Dussart ◽

Denis Bourgeois ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Chronic Diseases ◽

Periodontal Diseases ◽

Saturated Fat ◽

Warning Signal ◽

Dietary Quality ◽

Omega 3 ◽

Periodontal Health ◽

High Fiber ◽

Increased Risk

Nutrition is recognized as an essential component in the prevention of a number of chronic diseases, including periodontal disease. Based on these considerations, a better understanding is required regarding how the diet, and more particularly the intake of macronutrients and micronutrients, could impact the potential relationship between nutrition and periodontal diseases, periodontal diseases and chronic diseases, nutrition and chronic diseases. To overcome this complexity, an up-to-date literature review on the nutriments related to periodontal and chronic diseases was performed. High-sugar, high-saturated fat, low-polyols, low-fiber and low-polyunsaturated-fat intake causes an increased risk of periodontal diseases. This pattern of nutrients is classically found in the Western diet, which is considered as an ‘unhealthy’ diet that causes cardiovascular diseases, diabetes and cancers. Conversely, low-sugar, high-fiber and high-omega-6-to-omega-3 fatty acid ratio intake reduces the risk of periodontal diseases. The Mediterranean, DASH, vegetarian and Okinawa diets that correspond to these nutritional intakes are considered as ‘healthy’ diets, reducing this risk of cardiovascular diseases, diabetes and cancers. The role of micronutrients, such as vitamin D, E, K and magnesium, remains unclear, while others, such as vitamin A, B, C, calcium, zinc and polyphenols have been shown to prevent PDs. Some evidence suggests that probiotics and prebiotics could promote periodontal health. Periodontal and chronic diseases share, with a time delay, nutrition as a risk factor. Thus, any change in periodontal health should be considered as a warning signal to control the dietary quality of patients and thus reduce the risk of developing chronic diseases later on.

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Characteristics, Management, and Case-Fatality of Patients Hospitalized for Stroke with a Diagnosis of COVID-19 in France

Neuroepidemiology ◽

10.1159/000516670 ◽

2021 ◽

pp. 1-7

Author(s):

Amélie Gabet ◽

Clémence Grave ◽

Edouard Chatignoux ◽

Philippe Tuppin ◽

Yannick Béjot ◽

...

Keyword(s):

Case Fatality ◽

Cross Sectional Study ◽

Primary Diagnosis ◽

Index Hospitalization ◽

Sectional Study ◽

Stroke Patients ◽

National Hospital ◽

Cross Sectional ◽

Increased Risk ◽

Systèmes D’Information

Introduction: COVID-19 was found to be associated with an increased risk of stroke. This study aimed to compare characteristics, management, and outcomes of hospitalized stroke patients with or without a hospital diagnosis of COVID-19 at a nationwide scale. Methods: This is a cross-sectional study on all French hospitals covering the entire French population using the French national hospital discharge databases (Programme de Médicalisation des Systèmes d’Information, included in the Système National des Données de Santé). All patients hospitalized for stroke between 1 January and 14 June 2020 in France were selected. A diagnosis of COVID-19 was searched for during the index hospitalization for stroke or in a prior hospitalization that had occurred after 1 January 2020. Results: Among the 56,195 patients hospitalized for stroke, 800 (1.4%) had a concomitant COVID-19 diagnosis. Inhospital case-fatality rates were higher in stroke patients with COVID-19, particularly for patients with a primary diagnosis of COVID-19 (33.2%), as compared to patients hospitalized for stroke without COVID-19 diagnosis (14.1%). Similar findings were observed for 3-month case-fatality rates adjusted for age and sex that reached 41.7% in patients hospitalized for stroke with a concomitant primary diagnosis of COVID-19 versus 20.0% in strokes without COVID-19. Conclusion: Patients hospitalized for stroke with a concomitant COVID-19 diagnosis had a higher inhospital and 3 months case-fatality rates compared to patients hospitalized for stroke without a COVID-19 diagnosis. Further research is needed to better understand the excess of mortality related to these cases.

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Higher sRAGE Levels Predict Mortality in Frail Older Adults with Cardiovascular Disease

Gerontology ◽

10.1159/000512287 ◽

2021 ◽

pp. 1-9

Author(s):

Lee Butcher ◽

Jose Antonio Carnicero ◽

Karine Pérès ◽

Marco Colpo ◽

David Gomez Cabrero ◽

...

Keyword(s):

Older Adults ◽

Cox Regression ◽

Population Based ◽

Blood Levels ◽

Roc Curve Analysis ◽

Baseline Serum ◽

Frailty Status ◽

Risk Of Death ◽

Survival Difference ◽

Increased Risk

Introduction: The evidence that blood levels of the soluble receptor for advanced glycation end products (sRAGE) predict mortality in people with cardiovascular diseases (CVD) is inconsistent. To clarify this matter, we investigated if frailty status influences this association. Methods: We analysed data of 1,016 individuals (median age, 75 years) from 3 population-based European cohorts, enrolled in the FRAILOMIC project. Participants were stratified by history of CVD and frailty status. Mortality was recorded during 8 years of follow-up. Results: In adjusted Cox regression models, baseline serum sRAGE was positively associated with an increased risk of mortality in participants with CVD (HR 1.64, 95% CI 1.09–2.49, p = 0.019) but not in non-CVD. Within the CVD group, the risk of death was markedly enhanced in the frail subgroup (CVD-F, HR 1.97, 95% CI 1.18–3.29, p = 0.009), compared to the non-frail subgroup (CVD-NF, HR 1.50, 95% CI 0.71–3.15, p = 0.287). Kaplan-Meier analysis showed that the median survival time of CVD-F with high sRAGE (>1,554 pg/mL) was 2.9 years shorter than that of CVD-F with low sRAGE, whereas no survival difference was seen for CVD-NF. Area under the ROC curve analysis demonstrated that for CVD-F, addition of sRAGE to the prediction model increased its prognostic value. Conclusions: Frailty status influences the relationship between sRAGE and mortality in older adults with CVD. sRAGE could be used as a prognostic marker of mortality for these individuals, particularly if they are also frail.

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C-Reactive Protein and All-Cause Mortality in a Large Hospital-Based Cohort

Clinical Chemistry ◽

10.1373/clinchem.2007.091959 ◽

2008 ◽

Vol 54 (2) ◽

pp. 343-349 ◽

Cited By ~ 62

Author(s):

Claudia Marsik ◽

Lili Kazemi-Shirazi ◽

Thomas Schickbauer ◽

Stefan Winkler ◽

Christian Joukhadar ◽

...

Keyword(s):

Hospital Admission ◽

Acute Phase ◽

Cox Regression ◽

Disease Risk ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk ◽

All Cause Mortality ◽

Low Sensitivity

Abstract Background: C-reactive protein (CRP), an acute-phase protein, is a sensitive systemic marker of inflammation and acute-phase reactions. Testing CRP concentrations at hospital admission may provide information about disease risk and overall survival. Methods: All first-ever transmittals to the department of medical and chemical laboratory diagnostics for determination of low-sensitivity CRP (n = 274 515, 44.5% male, median age 51 years) between January 1991 and July 2003 were included [median follow-up time: 4.4 years (interquartile range, 2.3–7.4 years)]. The primary endpoint was all-cause mortality. Multivariate Cox regression adjusted for sex and age was applied for analysis. Results: Compared to individuals within the reference category (CRP <5 mg/L), hazard ratios (HR) for all-cause mortality increased from 1.4 (5–10 mg/L category) to 3.3 in the highest category (>80 mg/L, all P <0.001). CRP was associated with various causes of death. The relation of CRP to cancer death was stronger than to vascular death. Younger patients with increased CRP had relatively far worse outcome than older patients (maximal HR: ≤30 years: 6.7 vs >60 years: 1.7–3.7). Interestingly, both short- and long-term mortality were associated with increasing CRP concentrations (>80 mg/L: HR 22.8 vs 1.4). Conclusion: Measurement of low-sensitivity CRP at hospital admission allowed for the identification of patients at increased risk of unfavorable outcome. Our findings indicate that close attention should be paid to hospitalized patients with high CRP not only because of very substantial short-term risk, but also long-term excess risk, the basis for which needs to be determined.

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Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Cerebrovascular Diseases ◽

10.1159/000445299 ◽

2016 ◽

Vol 42 (1-2) ◽

pp. 81-89 ◽

Cited By ~ 28

Author(s):

Mohamed Al-Khaled ◽

Christine Matthis ◽

Andreas Binder ◽

Jonas Mudter ◽

Joern Schattschneider ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Case Fatality ◽

National Institutes Of Health ◽

Modified Rankin Scale ◽

Stroke Patients ◽

Stroke Outcomes ◽

Increased Risk ◽

Reduced Risk

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

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Water-Sediment Physicochemical Dynamics in a Large Reservoir in the Mediterranean Region under Multiple Stressors

Water ◽

10.3390/w13050707 ◽

2021 ◽

Vol 13 (5) ◽

pp. 707

Author(s):

Patrícia Palma ◽

Alexandra Marchã Penha ◽

Maria Helena Novais ◽

Sofia Fialho ◽

Ana Lima ◽

...

Keyword(s):

Land Use ◽

Land Cover ◽

Mediterranean Region ◽

Multiple Stressors ◽

Meteorological Conditions ◽

Severe Drought ◽

Potentially Toxic Metals ◽

Large Reservoir ◽

Increased Risk ◽

The Mediterranean

Nowadays, the Mediterranean freshwater systems face the threat of water scarcity, along with multiple other stressors (e.g., organic and inorganic contamination, geomorphological alterations, invasive species), leading to the impairment of their ecosystem services. All these stressors have been speeding up, due to climate variability and land cover/ land use changes, turning them into a big challenge for the water management plans. The present study analyses the physicochemical and phytoplankton biomass (chlorophyll-a) dynamics of a large reservoir, in the Mediterranean region (Alqueva reservoir, Southern Portugal), under diverse meteorological conditions and land cover/land use real scenarios (2017 and 2018). The most important stressors were identified and the necessary tools and information for a more effective management plan were provided. Changes in these parameters were further related to the observed variations in the meteorological conditions and in the land cover/land use. The increase in nutrients and ions in the water column, and of potentially toxic metals in the sediment, were more obvious in periods of severe drought. Further, the enhancement of nutrients concentrations, potentially caused by the intensification of agricultural activities, may indicate an increased risk of water eutrophication. The results highlight that a holistic approach is essential for a better water resources management strategy.

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