Nutrition & Food Science
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Item Healthy eating index versus alternate healthy index in relation to diabetes status and health markers in U.S. adults: NHANES 2007–2010(Springer Nature, 2019-04-17) Al-Ibrahim, Afnan A.; Jackson, Robert T.It remains to be determined whether the Alternate Healthy Eating Index 2010 (AHEI-2010) or the Healthy Eating Index 2010 (HEI-2010) is preferably recommended as means to assess dietary quality in people with type 2 diabetes (T2DM).Item Flavonoids, Cardiovascular Disease, and Diabetes(2019) Gahche, Jaime; Sahyoun, Nadine R; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Flavonoids have been shown to have anti-inflammatory, antioxidant, and vasodilatory properties; mechanisms that may lead to cardio-protective benefits. Results from observational studies assessing the associations between flavonoid intake and cardiovascular disease (CVD) and type 2 diabetes mellitus have been largely equivocal. Earlier studies were limited due to lack of complete flavonoid composition databases. With the development of more complete databases, total flavonoid intake can be more accurately estimated, but the associations between them and CVD and diabetes have not been assessed in a nationally representative sample of the U.S. population. Aims: The objective of this study was to assess the relationship between dietary intake of flavonoids and risk of: 1) CVD outcomes, and 2) diabetes. Methods: Baseline data from the Third National Health and Nutrition Examination Survey (NHANES III) were collected from participants in 1988-1994 and linked with administrative records to identify CVD and diabetes outcomes. The National Death Index was used for mortality and CMS Medicare Claims and Medicare enrollment data to identify initial events. Flavonoid intake was assessed with up to four 24-hour dietary recalls and the USDA’s flavonoid databases were used to assign flavonoid values to reported food and beverage consumption. Usual intakes of flavonoids and flavonoid sub-classes were estimated using the NCI method. Hazard ratios and 95% confidence intervals were estimated using Cox proportional hazards regression modeling. Results: In this nationally representative sample of adults, from a 1988-1994 constructed cohort and followed passively for over 20 years, significant inverse associations between total flavonoids or sub-classes and CVD outcomes or diabetes were not evident. However, there was a marginal association between flavanones and CVD mortality, for males only (HR =0.93, 95 % CI 0.87, 1.00, p-value<0.04). Conclusions: In this population-based sample of individuals, associations between intakes of flavonoid and CVD mortality (with the exception of flavanone intake for men only), CVD morbidity or diabetes were not evident after 20 years of follow-up. This may be due to their low levels of usual intake, to errors in measurement of flavonoid intake, or misclassification over time of flavonoid intakes, or relatively small sample sizes.Item ASSOCIATIONS OF HEALTH MARKERS, PERCEPTIONS, AND LIFESTYLE BEHAVIORS WITH DIET QUALITY INDICES AND TYPE 2 DIABETES STATUS IN U.S. ADULTS(2018) Al-Ibrahim, Afnan Abdul Hamid; Jackson, Robert T; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)There is growing evidence that adherence to healthful dietary patterns reduces the risk of type 2 diabetes (T2DM). The Healthy Eating Index 2010 (HEI-2010) and the Alternate Healthy Eating Index 2010 (AHEI-2010) are recognized as assessment tools for measuring dietary quality. This research had three main objectives: 1) Determine whether the AHEI-2010 provides a more accurate assessment of dietary quality than the HEI-2010 in relation to diabetes status; 2) Examine the relationship between diabetes status and discrepancies between perceived diet quality (PDQ) and measured diet quality (MDQ) (using total HEI-2010 and AHEI-2010 scores, respectively); 3) Examine the relationships between selected lifestyle behaviors independently, and in combination with other lifestyle behaviors, and dietary quality (using total HEI-2010 and AHEI-2010 scores) by diabetes status. Data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 were used to analyze participants age 20 years and older (n = 4097). Overall, the total HEI-2010 and AHEI-2010 scores for the sample indicate that U.S. adults need dietary improvement (mean total HEI-2010 score = 47.3 ± 0.4; mean total AHEI-2010 score = 38.2 ± 0.4). Diabetics had higher total HEI-2010 and AHEI-2010 scores compared to prediabetics and non diabetics, but did not have better health markers. Results indicate no predictive value of total HEI-2010 and AHEI-2010 scores (OR = 1.00, p > 0.05) in relation to diabetes status. In addition, the associations between diabetes status and discrepancy scores (for both HEI-2010 and AHEI-2010) were not significant after adjusting for perceived health status (p > 0.05). However, there were significant associations between individual lifestyle behaviors and total HEI-2010 and AHEI-2010 scores by diabetes status (p < 0.05). In addition, the combined Lifestyle Behaviors score was a significant predictor of total HEI-2010 and AHEI-2010 scores (p < 0.05) by diabetes status. In conclusion, these findings suggest that dietary quality, measured with HEI-2010 or AHEI-2010 is associated with health markers, perceptions, and lifestyle behaviors, all of which can influence the development of T2DM. Findings of this research have implications for developing more successful strategies to improve compliance with dietary guidelines and evidence-based recommendations for disease management and prevention.Item Folate intake and biomarkers and risk of chronic disease(2014) Hu, Jing; Sahyoun, Nadine R; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Background: Folate status of the U.S. population significantly improved after folic acid fortification of enriched cereal-grain products in 1998. Recent evidence suggests that the increased folate levels may have impacts on the risk of chronic disease. The kidneys are known to be highly involved in folate metabolism. Reduced renal function may affect folate metabolism and play a role in the associations between folate and chronic disease. Objectives: The purpose of this study was to review key events regulating folate homeostasis along folate metabolic pathway. In addition, we examined the associations between folate intake and biomarker levels and the incidence of cancer, stroke and cardiovascular disease (CVD) and between folate biomarker levels and renal function among older adults in post-fortification years. Design: The Key Events Dose-Response Framework was used to review key steps of folate metabolism. Data of adult participants of the National Health and Nutrition Examination Survey 1999-2002 were used as the baseline data. Incidence of cancer, stroke and CVD were obtained from the linked Medicare and mortality files. The associations between folate intake and biomarker levels and incidence of cancer, stroke and CVD, and the associations between estimated glomerular filtration rate (eGFR) and folate biomarkers, serum unmetabolized folic acid (UMFA) and plasma homocysteine levels were assessed using Cox proportional hazards regression models and multivariable regression models, respectively. Results: The saturation of dihydrofolate reductase in the liver is the determining point regulating the release of UMFA in circulation. Lower red blood cell (RBC) folate levels and intake of dietary folate equivalents were associated with a higher cancer incidence. Lower RBC folate and serum folate levels were associated with a higher stroke incidence. No significant associations between folate and CVD were observed. In addition, reduced renal function was associated with higher RBC folate and plasma homocysteine levels among men and women, and higher prevalence of UMFA in blood among women. Conclusion: High intake of folate may disturb folate metabolism by overwhelming folate regulation mechanisms. Folate may play a protective role against cancer and stroke even at high levels in post-fortification years. Reduced renal function may be implicated in the increased blood folate concentrations.Item Appropriate Waist Circumference Cutoff Values for the Diagnosis of Metabolic Syndrome in Mexican American Adults(2009) Sarafrazi, Neda; Jackson, Robert T; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Metabolic syndrome increases the risk of cardiovascular disease and diabetes. The International Diabetes Federation (IDF) recently proposed new criteria for the diagnosis of metabolic syndrome, which requires the presence of central obesity as measured by ethnic specific waist circumference (WC) cutoff values. Currently, no specific WC thresholds for diagnosis of central obesity in Hispanics are available. The objectives were to determine the appropriate gender specific WC thresholds for diagnosis of central obesity in Mexican American adults and to estimate the prevalence of metabolic syndrome using IDF definition with and without the modified WC in this population. Data from 3265 Mexican American adults aged 20-80 years who participated in the National Health and Nutrition Examination Survey 1999-2006 were used. The prevalence of metabolic syndrome was compared using IDF criteria with and without the modified waist circumference. Receiver operating characteristic curve analysis suggested that yielding at least 80% sensitivity, the WC value of 90 cm in both genders was more appropriate in predicting the presence of two or more metabolic syndrome risk factors in this population. Based on this cutoff, there was 34% reduction in the prevalence of central obesity in women (82.5% to 54.2%). The age adjusted prevalence of metabolic syndrome decreased from 58.4 to 48.2%. The metabolic syndrome was more common among Mexican American men than women (55.8% in men versus 37.8% in women, P =0.0003). Our findings provided a practical guidance in the assessment and screening of central obesity and metabolic syndrome in Mexican Americans.Item Relationship between fish intake, omega-3 fatty acids, mercury, and risk markers of coronary heart disease (NHANES 1999-2002)(2006-07-24) Smith, Kimberly Michele; Sahyoun, Nadine; Nutrition; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)