Polyphenols, Inflammation, and Cardiovascular Disease

Polyphenols are compounds found in foods such as tea, coffee, cocoa, olive oil, and red wine and have been studied to determine if their intake may modify cardiovascular disease (CVD) risk. Historically, biologic actions of polyphenols have been attributed to antioxidant activities, but recent evidence suggests that immunomodulatory and vasodilatory properties of polyphenols may also contribute to CVD risk reduction. These properties will be discussed, and recent epidemiological evidence and intervention trials will be reviewed. Further identification of polyphenols in foods and accurate assessment of exposures through measurement of biomarkers (i.e., polyphenol metabolites) could provide the needed impetus to examine the impact of polyphenol-rich foods on CVD intermediate outcomes (especially those signifying chronic inflammation) and hard endpoints among high risk patients. Although we have mechanistic insight into how polyphenols may function in CVD risk reduction, further research is needed before definitive recommendations for consumption can be made

Evaluation of a dietary screener: The Mediterranean Eating Pattern for Americans tool

Background: Evidence exists for an association between accordance with a Mediterranean diet pattern and slower rates of cognitive decline. However, an ‘Americanized’ version of the Mediterranean diet screener is needed to assess accordance in the USA. Thus, the Mediterranean Eating Pattern for Americans (MEPA) tool was developed to assess accordance with a Mediterranean-like food pattern when time is limited. The present study aimed to determine whether the MEPA screener captured the key elements of the Mediterranean diet compared to the more comprehensive food frequency questionnaire (FFQ). Methods: The study comprised a cross-sectional study in which 70 women completed both the VioScreen™ FFQ (Viocare, Princeton, NJ, USA) electronically and the 16-item MEPA screener, either electronically or by telephone, aiming to evaluate the inter-method reliability of the proposed screener. The convenience sample included patients (n = 49) and healthcare providers (n = 21) recruited from a tertiary care medical center. Results: The overall score from the MEPA screener correlated with corresponding overall MEPA FFQ score (ρ = 0.365, P = 0.002). Agreement between screener items and FFQ items was moderate-to-good for berries (κ = 0.47, P \u3c 0.001), nuts (κ = 0.42, P \u3c 0.001), fish (κ = 0.62, P \u3c 0.001) and alcohol (κ = 0.64, P \u3c 0.001), whereas those for olive oil (κ = 0.33, P = 0.001) and green leafy vegetables (κ = 0.36, P = 0.0021) were fair. Usual intakes of potassium, magnesium, vitamin C, saturated fat, selected carotenoids, folate and fiber derived from the FFQ varied with MEPA screener scores in the anticipated directions. Conclusions: The MEPA screener captures several components of the Mediterranean style pattern, although further testing of the MEPA screener is indicated

Evaluation of a Brief Sodium Screener in Two Samples

The Sodium Screener© (SS©), as developed by NutritionQuest (Berkeley, CA, USA), was designed to reduce the burden of repeated dietary or urinary sodium measurements, but the accuracy of daily sodium intake estimates has not been reported. Associations were examined between sodium intakes derived from the SS© scores and repeated 24-h recalls (24DR) in two studies with different administration modes. In one study, 102 registered dietitians (RD) completed three Automated Self-Administered 24DRs (ASA24©), version 2014, followed by the SS©; both were self-administered and web-based. In the second sample, (the Study of Household Purchasing Patterns, Eating, and Recreation or SHoPPER), trained dietitians conducted 24DR interviews with 69 community-dwelling adults in their homes; all the community adults then completed a paper-based SS© at the final visit. In the RD study, SS©-predicted sodium intakes were 2604 ± 990 (mean ± Standard deviation (SD)), and ASA24© sodium intakes were 3193 ± 907 mg/day. In the SHoPPER sample, corresponding values were 3338 ± 1310 mg/day and 2939 ± 1231 mg/day, respectively. SS© -predicted and recall sodium estimates were correlated in the RD study (r = 0.381, p = 0.0001) and in the SHoPPER (r = 0.430, p = 0.0002). Agreement between the SS© and 24-h recalls was poor when classifying individuals as meeting the dietary sodium guidelines of 2300 mg/day or not (RD study: kappa = 0.080, p = 0.32; SHoPPER: kappa = 0.207, p = 0.08). Based on repeated 24DR either in person or self-reported online as the criterion for estimating daily sodium intakes, the SS© may require additional modifications

The Big Opportunity: Advancing a Culture of Interprofessionalism

Historically, education has been siloed by disciplines leaving little room for interprofessional education to take place. Culture within an academic organization determines the strategies, modes of operation, goals, values, and terminal student learning outcomes. Using Kotter’s accelerated change management model, as a worksheet for educational cultural change, is an effective method to break complacency, generate ideas, align people, and overcome resistance to change

Change in Knowledge of and Adherence to the Low-Sodium Diet in Patients with Heart Failure after Nutrition Education by a Registered Dietitian Nutritionist

Nutrition intervention by a registered dietitian nutritionist (RDN) is effective in improving patients’ knowledge or adherence to low-sodium diet (LSD, <2,000 mg/d); however, changes in knowledge and adherence in heart failure (HF) patients.   have not been simultaneously assessed in the same study Therefore, the objective of the present study was to identify both HF patient sodium knowledge and adherence to the LSD before and after an education session with an RDN. A quasi-experimental study with a one-group, pre-test post-test design was conducted. An RDN conducted a 15-minute individualized nutrition education regarding the LSD at the initial visit. Sodium knowledge was measured by the Parkland Sodium Knowledge Test, and sodium intake was measured by a 29-item sodium-specific food frequency questionnaire created by NutritionQuest© at both the initial and follow-up visits. A total of 71 patients were educated on the LSD and assessed for changes in sodium knowledge and intake at their next visit. Most patients were middle aged, obese, male, and non-Hispanic Black with an education level of greater than 12 years. At the initial visit, the majority of patients were considered knowledgeable but not accordant to the LSD. Following RDN education, sodium knowledge significantly improved and sodium intake significantly decreased. RDNs should be included as members of the HF multidisciplinary team to increase sodium knowledge and reduce sodium intake through individualized nutrition education

MIND diet associated with reduced incidence of Alzheimer's disease

INTRODUCTION: In a previous study, higher concordance to the MIND diet, a hybrid Mediterranean-Dietary Approaches to Stop Hypertension diet, was associated with slower cognitive decline. In this study we related these three dietary patterns to incident Alzheimer's disease (AD). METHODS: We investigated the diet-AD relations in a prospective study of 923 participants, ages 58 to 98 years, followed on average 4.5 years. Diet was assessed by a semiquantitative food frequency questionnaire. RESULTS: In adjusted proportional hazards models, the second (hazards ratio or HR = 0.65, 95% confidence interval or CI 0.44, 0.98) and highest tertiles (HR = 0.47, 95% CI 0.26, 0.76) of MIND diet scores had lower rates of AD versus tertile 1, whereas only the third tertiles of the DASH (HR = 0.61, 95% CI 0.38, 0.97) and Mediterranean (HR = 0.46, 95% CI 0.26, 0.79) diets were associated with lower AD rates. DISCUSSION: High adherence to all three diets may reduce AD risk. Moderate adherence to the MIND diet may also decrease AD risk

MIND diet slows cognitive decline with aging

INTRODUCTION: The Mediterranean and dash diets have been shown to slow cognitive decline; however, neither diet is specific to the nutrition literature on dementia prevention. METHODS: We devised the Mediterranean-Dietary Approach to Systolic Hypertension (DASH) diet intervention for neurodegenerative delay (MIND) diet score that specifically captures dietary components shown to be neuroprotective and related it to change in cognition over an average 4.7 years among 960 participants of the Memory and Aging Project. RESULTS: In adjusted mixed models, the MIND score was positively associated with slower decline in global cognitive score (β = 0.0092; P < .0001) and with each of five cognitive domains. The difference in decline rates for being in the top tertile of MIND diet scores versus the lowest was equivalent to being 7.5 years younger in age. DISCUSSION: The study findings suggest that the MIND diet substantially slows cognitive decline with age. Replication of these findings in a dietary intervention trial would be required to verify its relevance to brain health

MIND food and speed of processing training in older adults with low education, the MINDSpeed Alzheimer's disease prevention pilot trial

Background Multiple national organizations and leaders have called for increased attention to dementia prevention in those most vulnerable, for example persons with limited formal education. Prevention recommendations have included calls for multicomponent interventions that have the potential to improve both underlying neurobiological health and the ability to function despite neurobiological pathology, or what has been termed cognitive reserve. Objectives Test feasibility, treatment modifier, mechanism, and cognitive function effects of a multicomponent intervention consisting of foods high in polyphenols (i.e., MIND foods) to target neurobiological health, and speed of processing training to enhance cognitive reserve. We refer to this multicomponent intervention as MINDSpeed. Design MINDSpeed is being evaluated in a 2 × 2 randomized factorial design with 180 participants residing independently in a large Midwestern city. Qualifying participants are 60 years of age or older with no evidence of dementia, and who have completed 12 years or less of education. All participants receive a study-issued iPad to access the custom study application that enables participants, depending on randomization, to select either control or MIND food, and to play online cognitive games, either speed of processing or control games. Methods All participants complete informed consent and baseline assessment, including urine and blood samples. Additionally, up to 90 participants will complete neuroimaging. Assessments are repeated immediately following 12 weeks of active intervention, and at 24 weeks post-randomization. The primary outcome is an executive cognitive composite score. Secondary outcomes include oxidative stress, pro-inflammatory cytokines, and neuroimaging-captured structural and functional metrics of the hippocampus and cortical brain regions. Summary MINDSpeed is the first study to evaluate the multicomponent intervention of high polyphenol intake and speed of processing training. It is also one of the first dementia prevention trials to target older adults with low education. The results of the study will guide future dementia prevention efforts and trials in high risk populations

Nutrition state of science and dementia prevention: Recommendations of the Nutrition for Dementia Prevention Working Group

Observational studies suggest that nutritional factors have a potential cognitive benefit. However, systematic reviews of randomised trials of dietary and nutritional supplements have reported largely null effects on cognitive outcomes and have highlighted study inconsistencies and other limitations. In this Personal View, the Nutrition for Dementia Prevention Working Group presents what we consider to be limitations in the existing nutrition clinical trials for dementia prevention. On the basis of this evidence, we propose recommendations for incorporating dietary patterns and the use of genetic, and nutrition assessment tools, biomarkers, and novel clinical trial designs to guide future trial developments. Nutrition-based research has unique challenges that could require testing both more personalised interventions in targeted risk subgroups, identified by nutritional and other biomarkers, and large-scale and pragmatic study designs for more generalisable public health interventions across diverse populations

Polyphenols, Inflammation, and Cardiovascular Disease

Polyphenols are compounds found in foods such as tea, coffee, cocoa, olive oil, and red wine and have been studied to determine if their intake may modify cardiovascular disease (CVD) risk. Historically, biologic actions of polyphenols have been attributed to antioxidant activities, but recent evidence suggests that immunomodulatory and vasodilatory properties of polyphenols may also contribute to CVD risk reduction. These properties will be discussed, and recent epidemiological evidence and intervention trials will be reviewed. Further identification of polyphenols in foods and accurate assessment of exposures through measurement of biomarkers (i.e., polyphenol metabolites) could provide the needed impetus to examine the impact of polyphenol-rich foods on CVD intermediate outcomes (especially those signifying chronic inflammation) and hard endpoints among high risk patients. Although we have mechanistic insight into how polyphenols may function in CVD risk reduction, further research is needed before definitive recommendations for consumption can be made