Dietary Quality 1 Year after Diagnosis of Coronary Heart Disease

Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Journal of the American Dietetic Association (Impact Factor: 3.92). 03/2008; 108(2):240-6; discussion 246-7. DOI: 10.1016/j.jada.2007.10.047
Source: PubMed


The purpose of this ancillary study is to determine the quality of diets in patients with documented coronary heart disease (CHD).
Dietary data were originally collected using a 24-hour dietary recall in 555 patients with CHD, 1 year after a diagnostic coronary angiography. Data used for this investigation were collected between March 2001 and November 2003.
Patients were participants in a clinical trial to improve adherence to lipid-lowering medications. The Alternate Healthy Eating Index, an instrument designed to evaluate the degree to which a diet has the potential to prevent cardiovascular disease, measured dietary quality.
Linear regression models were used to assess the association of dietary quality with patients' sociodemographic and clinical characteristics.
Mean age of participants was 61 years, with an average body mass index of 30 (calculated as kg/m(2)). Sixty percent were men. Average daily caloric intake was 1,775 kcal, with 50% of calories derived from carbohydrates, 18% from protein, and 32% from total fat. Average Alternate Healthy Eating Index score was 30.8 out of a possible maximum score of 80. Only 12.4% of subjects met the recommended consumption of vegetables, 7.8% for fruit, 8% for cereal fiber, and 5.2% for trans-fat intake. Lower dietary quality was associated with lower total caloric intake, as well as with smoking, obesity, and lower educational level.
A high proportion of patients reported poor dietary quality 1 year after experiencing a coronary event. Our data support continued efforts to enhance healthful dietary changes over time for secondary prevention of CHD. Dietary change should be emphasized with CHD patients who are less educated, smokers, or obese.

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Available from: Barbara C Olendzki
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    • "With attention to the role of diet or medical nutritional therapy on chronic disease, the dietary pattern approach, which involves diet quality indices, has been suggested as a powerful tool because of the complexity of diets [1-3]. In recent decades, several indices have been developed and validated, including the Diet Quality Index (DQI), Healthy Eating Index (HEI), Mediterranean Diet Score, Healthy Diet Indicator (HDI; based on the World Health Organization dietary guidelines), Alternate HEI (AHEI; including American dietary guidelines), and DQI-International (DQI-I; developed for worldwide national dietary guidelines) [4]. "
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    ABSTRACT: The present study was performed to evaluate the relationship between dietary quality indices including the Diet Quality Index-International (DQI-I), Alternate Healthy Eating Index (AHEI), and Healthy Diet Indicator (HDI) and glycemic status in Korean patients with type 2 diabetes. A total of 110 consecutive outpatients with type 2 diabetes who visited 2 university hospitals in Seoul and Seongnam from April 2004 to November 2006 were enrolled as subjects. At the time of enrollment, anthropometric parameters, dietary habits, experience of exercise, and metabolic parameters were obtained. Experienced registered dietitians collected one-day dietary intake using the 24-hour recall method. The mean scores for DQI-I, AHEI, and HDI were 68.9 ± 8.2, 39.4 ± 8.9, and 5.0 ± 1.3, respectively. After adjustment for age, body mass index, and energy intake, DQI-I and HDI were found to have a significant correlation with hemoglobin A1c (HbA1c) (r = -0.21, p < 0.05; r = -0.28, p < 0.05), fasting plasma glucose (r = -0.21, p < 0.05; r = -0.23, p < 0.05), and postprandial 2-h glucose (r = -0.30, p < 0.05; r = -0.26, p < 0.05, respectively). However, AHEI did not have a significant correlation with HbA1c. In conclusion, the DQI-I and HDI may be useful tools in assessing diet quality and adherence to dietary recommendations in Korean patients with type 2 diabetes. Future research is required to determine whether the dietary quality indices have predictive validity for dietary and glycemic changes following diet education in a clinical setting.
    Full-text · Article · Jul 2013
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    • "The Pharmacist Assisted Compliance Trial (PACT, Identifier: NCT00848224) was a randomized controlled trial testing a pharmacist-delivered program to improve adherence to lipid-lowering pharmacologic therapy in patients with known CHD [19]. The objective of this study was to compare intervention and usual care conditions for LDL-C goal attainment and proportion of prescribed lipid-lowering medication taken by subjects over a one-year period. "
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    ABSTRACT: A randomized trial of a pharmacist-delivered intervention (PI) versus usual care (UC) was conducted; 689 subjects with known coronary heart disease were recruited from cardiac catheterization laboratories. Participants in the PI condition received 5 pharmacist-delivered telephone counseling calls post-hospital discharge. At one year, 65% in the PI condition and 60% in the UC condition achieved an LDL-C level <100 mg/dL (P = .29); mean statin adherence was 0.88 in the PI, and 0.90 in the UC (P = .51). The highest percentage of those who reached the LDL-C goal were participants who used statins as opposed to those who did not use statins (67% versus 58%, P = .05). However, only 53% and 56% of the patients in the UC and PI conditions, respectively, were using statins. We conclude that a pharmacist-delivered intervention aimed only at improving patient adherence is unlikely to positively affect outcomes. Efforts must be oriented towards influencing physicians to increase statin prescription rates.
    Full-text · Article · Aug 2010 · Cholesterol
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    ABSTRACT: BackgroundDietary quality may impact heart failure outcomes. However, the current status of the dietary quality of persons with heart failure has not been previously reported. ObjectiveTo describe sodium intake, patient factors associated with sodium intake and overall dietary quality in a national sample of persons with heart failure. DesignAnalysis of repeated cross-sectional probability sample surveys using data from National Health and Nutrition Examination Surveys (NHANES) of 1999–2000, 2001–2002, 2003–2004 and 2005–2006. ParticipantsThe study sample consisted of 574 persons with self-reported heart failure (mean age = 70years; 52% women). MeasurementsDiet of each survey participant was assessed using single 24 hour recall. Dietary nutrients of interest included sodium, the mainstay of heart failure dietary recommendations, and additionally potassium, calcium, magnesium, fish oils, saturated fat and fiber. Specific dietary goals were based on established guidelines. ResultsMean sodium intake was 2,719mg, with 34% consuming less than 2,000mg per day. Patient factors associated with greater sodium intake included male gender, lower education, lower income and no reported diagnosis of hypertension. Mean potassium intake was 2,367mg/day, with no differences by type of diuretic used or renal disease status. Adherence rates to established guidelines for other nutrients were 13% for calcium, 10% for magnesium, 2% for fish oils, 13% for saturated fat and 4% for fiber. ConclusionsDietary quality of persons with self-reported heart failure was poor. Public health approaches and clinical dietary interventions are needed for persons with this increasingly prevalent clinical syndrome. KEY WORDSdietary quality-heart failure-clinical dietary interventions-sodium intake
    Full-text · Article · Feb 2009 · Journal of General Internal Medicine
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