The Effectiveness of Dietary Approaches to Stop Hypertension (DASH) Mobile Applications in Supporting a Healthy Diet and Controlling Hypertension in Adults: Systematic Review (Preprint)

BACKGROUND Uncontrolled hypertension is a public health issue, with increasing prevalence worldwide. The Dietary Approach to Stop Hypertension (DASH) diet is one of the most effective dietary approaches for lowering blood pressure (BP). Dietary mobile applications (apps) have gained popularity and are being used to support DASH diet self-management, aiming to improve DASH diet adherence and thus lower BP OBJECTIVE This systematic review aimed to assess the effectiveness of smartphone apps that support self-management to improve DASH diet adherence and, consequently, reduce BP. A secondary aim was to assess user engagement, satisfaction and acceptance, and usability related to DASH mobile app use. METHODS EMBASE (OVID), Cochrane Library, CINAHL, Web of Science, Scopus, and Google Scholar electronic databases were used to conduct systematic searches for studies conducted between 2008 and 2021 that used DASH smartphone apps to support self-management. The included articles’ reference lists were also checked. RESULTS Five studies (three RCTs and two pre-post studies) including 334 participants altogether examined DASH mobile apps. All studies found a positive trend related to the use of DASH smartphone apps, but the three RCTs had a high risk of bias. One pre-post study had a high risk of bias, the other had a low risk. As a consequence, no firm conclusions can be drawn regarding DASH smartphone apps’ effectiveness in increasing DASH diet adherence and lowering blood pressure. All the apps appeared to be accepted and easy to use. CONCLUSIONS There is weak emerging evidence of a positive effect of using DASH smartphone apps supporting self-management to improve DASH diet adherence and, consequently, lower BP. Further research is needed to provide high-quality evidence that can determine the effectiveness of DASH smartphone apps. CLINICALTRIAL Review article

Mediterranean Diet Adherence in People With Parkinson's Disease Reduces Constipation Symptoms and Changes Fecal Microbiota After a 5-Week Single-Arm Pilot Study

Introduction: Non-motor symptoms of Parkinson's disease (PD) such as gastrointestinal (GI) dysfunction are common, yet little is known about how modifying dietary intake impacts PD symptoms. The aim of this study in individuals with PD was to determine whether a Mediterranean diet intervention is feasible and affects GI function, intestinal permeability and fecal microbial communities.Methods: A single-arm, 5-week Mediterranean diet intervention study was conducted in eight people with PD. Daily and weekly questionnaires were administered to determine changes in GI symptoms. Urine and stool samples were collected at baseline and after 5 weeks to assess intestinal permeability and fecal microbial communities. Additionally, live-in partners of the participants with PD were matched as controls (n = 8) for baseline urine and stool samples.Results: Participants with PD increased intake of Mediterranean diet based on adherence scores from baseline to week 5 (4.4 ± 0.6 vs. 11.9 ± 0.7; P < 0.01 with >10 representing good adherence), which was linked with weight loss (77.4 kg vs. 74.9 kg, P = 0.01). Constipation syndrome scores decreased after 5 weeks (2.3 ± 0.5 vs. 1.5 ± 0.3; P = 0.04). Bilophila, was higher at baseline in PD (0.6 ± 0.1% vs. 0.2 ± 0.1% P = 0.02) and slightly decreased after the diet intervention (0.5 ± 0.1%; P = 0.01). Interestingly, the proportion of Roseburia was significantly lower in PD compared to controls (0.6 ± 0.2% vs. 1.6 ± 0.3%; P = 0.02) and increased at week 5 (0.9 ± 0.2%; P < 0.01). No differences were observed for markers of intestinal permeability between the control and PD groups or post-intervention.Conclusions: Short-term Mediterranean diet adherence is feasible in participants with PD; correlated with weight loss, improved constipation, and modified gut microbiota.Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT03851861.

A Generation Shift in Mediterranean Diet Adherence and Its Association with Biological Markers and Health in Dalmatia, Croatia

Previous studies have confirmed the beneficial effect of a Mediterranean diet in mitigating health issues related to cardiovascular disease, diabetes and obesity. However, rapid changes in the traditional way of life and the “westernization” of the diet in Mediterranean populations, especially in younger generations, has led to progressive abandonment of healthy dietary patterns. In order to investigate the generation shift in dietary patterns and lifestyle habits in the Mediterranean part of Croatia, we compared two cohorts of 610 women (266 pregnant and 344 non-pregnant) from the same region, but from different age groups. The MDSS score was derived from food frequency questionnaires. The results showed that the young, reproductively active generation (pregnant women) in Dalmatia, Croatia, although having a higher education and socioeconomic status, exhibits a more adverse eating behaviour (lower adherence to the Mediterranean diet) and lifestyle (excessive smoking in pregnancy) than the older population from the same region. Lower MDSS scores across aggregated age groups in both cohorts showed significant association with higher blood lipid levels and higher smoking frequency. In conclusion, Mediterranean diet adherence is associated with biological markers (age, lipid profile) and lifestyle (smoking) in our study, with a more adverse trend observed in the younger generation.

Prospective Association of the Portfolio Diet with All-Cause and Cause-Specific Mortality Risk in the Mr. OS and Ms. OS Study

The Portfolio Diet has demonstrated its cardiovascular benefit from interventions, but the association between Portfolio Diet adherence and the risk of all-cause and cause-specific mortality has not been examined in Chinese population. The present study has collected Portfolio Diet adherence (assessed by food frequency questionnaire), lifestyle factors and mortality status of 3991 participants in the Mr. Osteoporosis (OS) and Ms. OS Study. Cox regression models were used to examine the association between the Portfolio Diet adherence and mortality risk (all-cause, cardiovascular disease or cancer). The highest quartile of the Portfolio Diet score was associated with a 28% lower risk of all-cause (hazard ratio, HR: 0.72) and cancer (HR: 0.72) mortality, respectively. The association between Portfolio Diet adherence and cardiovascular disease mortality did not reach statistical significance (HR: 0.90, 95% CI = 0.64, 1.26). Among male participants, the highest adherence to the Portfolio Diet was also associated with a lower risk of all-cause (HR: 0.63) and cancer mortality (HR: 0.59), and there was an inverse association between food sources of plant protein and the risk of cardiovascular mortality (HR: 0.50). However, most associations between the Portfolio Diet and mortality were not significant among females. The protection for cancer mortality risk might reach the plateau at the highest adherence to the Portfolio Diet for females. To conclude, greater adherence to the Portfolio Diet was significantly associated with a lower risk of mortality in Hong Kong older adults, and the associations appeared stronger among males.

Improving the Compliance of Fluid Diet of Patients with Chronic Kidney Failure with Family Support-Based Health Education

Background: Failure of kidney function can lead to complications of other health problems, one of which is the condition of excess fluid volume caused by non-compliance with fluid dietary restrictions so that it triggers hypervolemia and results in excessive circulation burden, edema, cardiovascular disorders, impaired cognitive function and can lead to cause death. It is expected that patients with chronic renal failure undergoing hemodialysis therapy can comply with the prescribed fluid diet restrictions. Therefore, in increasing compliance, strong support is needed regarding the importance of fluid diet restriction management. Objective: The purpose of this study was to analyze the Effect of Family Support-Based Health Education on Fluid Diet Compliance in Chronic Kidney Failure Patients. Methods: The design of this study was a quasi-experimental with a pre and post design approach. The population of all patients with chronic kidney failure at Islamic Hospital Of Surabaya A. Yani was 82 patients. The sample size is 48 respondents. The sampling technique used simple random sampling. Patients are given family support-based health education in an effort to increase health knowledge in improving the health status of patients with chronic kidney failure with a family support approach to improve adherence to the fluid intake diet. The analysis used the Wilcoxon Signed Ranks test with p value < 0.05. Results: The results of this study indicate p = 0.000 which means that there is a significant effect of Fluid Diet Adherence before and after Family Support-Based Health Education. Conclusion: Family Support-Based Health Education is effective in improving Fluid Diet Adherence in patients with chronic renal failure and is highly recommended for patients undergoing hemodialysis therapy.

Sudomotor dysfunction in patients with gluten neuropathy

Background and aim Gluten neuropathy (GN) is a common neurological manifestation of gluten sensitivity (GS), characterized by serological evidence of GS, while other risk factors for developing neuropathy are absent. The degree of small fiber dysfunction in GN has not been studied in depth to date. Small fiber involvement may lead to pain, thermal perception abnormalities, and sweat gland dysfunction. Sudomotor innervation refers to the cholinergic innervation of the sympathetic nervous system through small fibers in the sweat glands. The aim of our study was to assess the sudomotor function of GN patients. Methods Patients with GN were recruited. Clinical and neurophysiological data were obtained. HLA-DQ genotyping was performed. The skin electrochemical conductance (ESC) was measured with SUDOSCANTM. Results Thirty-two patients (25 males, mean age 69.5±10.2 years) were recruited. Thirteen patients (40.6%) had abnormal sudomotor function of the hands. Sixteen patients (50%) had abnormal sudomotor function of the feet. Twenty-one patients (65.6%) had abnormal sudomotor function of either the hands or feet. Sudomotor dysfunction did not correlate with the type of neuropathy (length-dependent neuropathy or sensory ganglionopathy), gluten-free diet adherence, severity of neuropathy, and duration of disease or HLA-DQ genotype. No differences in the ESC were found between patients with painful and patients with painless GN. Conclusion Sudomotor dysfunction affects two-thirds of patients with GN. The lack of correlation between pain and sudomotor dysfunction suggests different patterns of small fiber involvement in patients with GN.

Body Composition Assessment and Mediterranean Diet Adherence in U12 Spanish Male Professional Soccer Players: Cross-Sectional Study

Soccer is the most practiced team sport in the world. Due to the importance of nutrition in soccer performance, controlling the body composition and dietary guidelines of players takes place starting from lower categories. The objective of this study was to evaluate body composition and adherence to the Mediterranean diet of U12 players from a professional soccer team and to identify their dietary weak points. Seventy-one U12 male soccer players participated in the study. Weight, height, percentiles, skinfolds, and body fat were measured by a certified anthropometrist following the procedures recommended by the International Society for the Advancement of Kinanthropometry. The Mediterranean diet adherence test (KIDMED) was the questionnaire used to evaluate eating habits. In addition, a comparison was made among field positions. The results showed percentiles and body fat percentages appropriate for their age. Furthermore, the average score on the KIDMED test showed that the players generally adhered well to the Mediterranean diet, although they should improve their consumption of fruits and vegetables, as well as avoid skipping breakfast. Moreover, goalkeepers and defenders had a higher percentile BMI and percentage of fat than midfielders and forwards. In addition, these players had lower KIDMED values than midfielders and forwards. Although U12 soccer players have an appropriate body composition and adherence to the Mediterranean diet, there are differences between the different field positions that should be assessed by coaches, doctors, and nutritionists/dietitians.

Diet Adherence among Adults with Type 2 Diabetes Mellitus: A Concept Analysis

Aim: To analyze the concept of diet adherence in type 2 diabetes mellitus (T2DM). Background: Different healthcare providers widely use the concept of adherence. In the 1970s, the term compliance was commonly used as the patients' views on treatment decisions were neglected. With consideration of patients' perspectives in treatment choices and treatment management, the concept of "compliance" has been increasingly replaced by "adherence." Adhering to a healthy diet is very challenging among patients with T2DM, and empirical studies show a low adherence rate to a healthy diet. Methods: The Walker and Avant (2011) method of concept analysis was implemented. Scientific databases were probed for research articles in the English language published between 2010-2020 using the search terms: compliance, adherence, treatment adherence, diet adherence, T2DM, and concept analysis. Results: Diet adherence as a concept includes, following diet recommendations, self-monitoring, maintenance, and relapse prevention. Antecedents include motivation, understanding of diet recommendations, health beliefs, self-efficacy, goal setting, and social support. Consequences include overall health promotion, health-related quality of life, and improved disease-specific parameters such as lower body mass index, HbA1c, a better level of triglycerides, LDL-cholesterol, non-HDL-cholesterol, and lower diastolic blood pressure. Diet adherence is frequently measured using the Perceived Dietary Adherence Questionnaire, Patient Diet Adherence in Diabetes Scale, the Compliance Praxis Survey-Diet, multiday food diaries, 24-hour recalls, and food frequency questionnaires. Conclusion: Adherence to a healthy diet for patients with T2DM is a primary determinant of management, but diet adherence is frequently inadequate. Poor diet adherence attenuates optimum expected outcomes; hence more research is needed to promote diet adherence.