Abstract: There is growing evidence that healthy dietary patterns including Mediterranean, prudent, traditional and plant- food based dietary patterns could have favorable effects in breast cancer prevention but there are inconsistencies in this regard. In the current study we reviewed the current evidences in relation to healthy dietary patterns and the risk of breast cancer. Both positive and negative association between Mediterranean dietary pattern and scores as well as prudent and traditional diet and breast cancer risk were observed in case-control and cohort studies. These conflicting findings might be explained by several issue including different dietary assessment methods, different definitions of Mediterranean dietary pattern and score, measurement errors, race differences, and potential confounding variables adjusted in the models. The healthy dietary patterns with high loading of fruits, vegetables, whole grains and legumes had been mainly accompanied with a considerable reduced risk of breast cancer in different races. It should be noted that menopausal and tumor's hormone receptor status, as well as body mass index of women had determinant role in the association of healthy dietary patterns and breast cancer risk. Protective effects of healthy dietary patterns against breast cancer were mainly observed in women with normal body weight (BMI<25 kg/m 2 ). Further studies are required to clear the associations of dietary patterns and breast cancer risk.
Background: Despite the dietary guidelines for healthy eating (HE) and daily recommended food servings to promote healthy dietary patterns among the population in Saudi Arabia, the incidence of unhealthy eating has increased. Methods: We used the Theory of Planned Behavior (TPB) as a conceptual framework to explain and understand important factors affecting HE among Saudi adults. Six hundred forty-seven Saudi adults were recruited for an on- line survey. Results: The mean age of the subjects was 26.74 ± 8.21 years; the majority of subjects (74.1%) were young adults and were primarily female (60.1%). The correlation analysis indicated a positive correlation between all the TPB components and HE. The present study shows that positive attitudes and perceived behavioral control are the strongest predictors of HE intuition. The path analysis showed a good overall model fit (RMSEA = 0.034; CFI = 0.975; NFI = 974; GFI = 0.975) (χ 2 = 4.1964, df = 3, p = 0.45). Conclusion:
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Since this is a prospective study recall bias is unlikely. However, accurate measurement of food intake is important for studies of dietary pattern. The FFQ used in this cohort has been validated against biomarkers(Spence et al. 2002) and follows recommendations for good design(Cade et al. 2002). The dietary patterns described reflect existing predefined scores and may not necessarily be those which are optimal for breast cancer prevention. The UKWCS has a health conscious outlook with relatively low smoking rates and low body mass index(Cade et al. 2004). It is possible that less healthy dietary patterns were under- represented in our cohort. A further weakness of this study was that we did not have information on hormone receptor status of the tumour. Other studies have shown a possible link between dietary pattern and hormone receptor status although findings are not consistent(Cottet et al. 2009; Fung et al. 2005).
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In ﬂ ammation also is plays an important role in the patho- genesis of depression. 6 An in ﬂ ammatory diet has been found to be associated with the depression. 7,8 Among various fac- tors that contribute to the setting of an in ﬂ ammatory milieu in the context of depression, dietary intakes could play a vital role. 9 Over the past few years ’ evidence has emerged about the interplay between nutrition and in ﬂ ammation with mental disorders such as depression. 6,10 Diet directly affects neuro- transmitters, hormones, gut microbiota population, and in ﬂ ammation, which have a critical role in signal pathways related to sleep, mood, and behavior. 7,11 Present clinical evidence also supports the view that dietary supplements with anti-in ﬂ ammatory properties such as omega-3 fatty acids, zinc, and vitamin D can attenuate the depression symptoms. 12–14 Nowadays, there is suf ﬁ cient knowledge of the relationship between individual dietary components and depressive disorders. However, this approach does not take into account many aspects of diet such as the interaction and cumulative effects of nutrients or foods ingested together. 9,15 The main challenge in understanding the role of diet in the etiology of depression, is the description of this complex exposure. One method is the identi ﬁ cation of dietary patterns through statistical modeling such as factor analysis. Recent reviews have shown that healthy dietary patterns are asso- ciated with a decreased risk of depression or, 16 but these are not general ﬁ ndings. 17,18,19
The essential role of diabetes in the development of long-term complications such as retinopathy, nephropathy, neuropathy, cardiovascular disease (CVD) has been confirmed in several studies (3, 4). CVD, as the leading cause of death in more than 70% of diabetic patients, occurs at least two to four times more in diabetics compared to none- diabetics (5). Diabetes and its micro and macrovascular complications impose a heavy burden on the society and result in reduced quali- ty of life, disability and mortality in diabetic pa- tients (3, 4). However, several studies have under- lined the importance of blood glucose control in preventing the complications in diabetic patients (4, 6). The role of nutrients and dietary modifica- tions in glycemic control and improving diabetes complications risk factors have been investigated in several studies (7, 8). Recently, dietary pattern analysis has been introduced as an alternative and complementary approach that allows the evalua- tion of cumulative effects of nutrients and their interactions (9). Taking into account the cultural and ethnic preferences, food availability and indi- vidual circumstances can be considered as other advantages of this method (10). The approach provides more effective and understandable rec- ommendations than studies in which the focus is more on the role, amount and distribution of some nutrients and food items (10). Studies showed higher risk of diabetes in western (11, 12) dietary pattern compared to prudent and healthy dietary patterns (12, 13). A systematic review and meta-analysis of 15 cohort studies indicated that risk of type 2 diabetes increased by adopting un- healthy dietary patterns (RR: 1.44, 95% CI :1.33– 1.57, P< 0.005) and on the contrary adherence to healthy dietary patterns reduced the risk (RR: 0.79, 95% CI: 0.74–0.86, P< 0.005) (14). Follow- ing the Mediterranean dietary pattern, caused at- tenuation of fasting glucose and insulin levels and subsequently insulin resistance in both norm gly- cemic (15, 16) and metabolic syndrome subjects
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The failure to identify a positive relationship between overweight and unheal- thy foods in cross-sectional studies is partly explained by changes in dietary ha- bits and food restrictions due to childhood weight gain  . It is not known whether this is a general phenomenon or a phenomenon is dependent on other characteristics. Several studies have linked healthy dietary patterns among child- ren with high parental education levels  , female sex , and increased physical activity .
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To the best of our knowledge, this is the ﬁ rst study to assess relationships of dietary sodium intake with a wide range of robust measurements of adiposity. We found that the average dietary so- dium consumed by our white and African American adolescents was as high as that of adults and more than twice the AHA recommendation. Higher sodium intake was positively associ- ated with adiposity independent of intakes of energy and sweetened soft drinks. In addition, high sodium intake was positively and independently as- sociated with leptin and TNF- a . The AHA recommends that all Ameri- cans reduce the amount of sodium in their diet to , 1500 mg a day. Ninety- seven percent (741 of 766) of our adolescents exceeded the AHA recom- mendation for sodium intake. More than 80% (615 of 766) exceeded the
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In summary our study showed that dietary habits of Slovenian soldiers markedly deviated from healthy dietary habits and reflected dietary hab- its of adult Slovenian population. 51,2 % of Slovenian professional sol- diers were overweight or obese. Their knowledge about the nutrition was poor. In the view of socioeconomic status, we found that healthier dietary habits prevailed among older, single and among higher educated soldiers. In contrary normal BMI prevailed among less educated, as well as among married soldiers. Nevertheless it must be emphasized that our study of- fers the basic information about dietary behaviours, nutritional knowledge and BMI of Slovenian professional soldiers, which all need to be im- proved. Changing the traditional lifestyle is one of the most important ele- ments in health but extremely difficult, and a process of very long dura- tion, tightly bound to the economy and politics of a country . The results of the present study clearly show the need for a greater emphasis of the benefits of regular and adequate nutritional education early in mili- tary training to encourage soldiers to adopt healthier behaviours. Inter- vention programs should be targeted at younger and less educated sol- diers and physical activity (especially among overweight and obese soldiers and officers) encouraged. Based on our research findings, the Ministry of Defence of the Republic Slovenia will be able to form suitable and focused preventive programmes with the aim for improving dietary behaviours and nutritional knowledge of Slovenian professional soldiers and in particular to promote physical activity between them. Further de- tailed investigations of health status, anthropometric measures, dietary habits as well as physical activities of representative sample of Slovenian soldiers should be performed in the future. The investigations should be performed periodically (i. e. every 4 years) in order to follow the trends in dietary habits as well as to follow the efficacy of the education process.
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and nuts [26-28]. The Nicoya Peninsula region in Costa Rica has been reported to be an exceptional longevity area where healthy centenarians live surrounded by a solid support network of friends and family . Although the possible role played by the dietary regimen in Nicoya region in relation to extreme longevity has not yet been investigated, the diet includes garden vegetables, an abundance of fruit (orange, mango, papaya), squash, beans, rice and corn. The water is also particularly high in minerals such as magnesium and calcium . This area has also reported one of the lowest middle-age mor- tality rates in the world. A 60-year -old has more than a fourfold better chance of making it to the age of 90 years than a 60-year-old in North America . Finally, it was reported that people in Ikaria Island, Greece, have also one of the highest life expectancies in the world. Ikarians are three times more likely to reach the age of 90 years than in the U.S. . In this community, scientific evi- dence shows protective health benefits from long-term adherence to the Mediterranean food culture revealing that this diet has a cardioprotective effect and is able to reduce the prevalence of hyperuricaemia in elderly indivi- duals . The above mentioned regions have been labeled as ‘ Blue Zones ’ and while scientists try to validate the veracity and variety of associated causes of this exceptional longevity, it is advisable to follow a diet rich in fruits, vegetables, legumes and whole grains but reduced in saturated fat.
. Eating is an important habit for optimal health. Healthy dietary habits refer to avoiding eating fat and eating more fruits and vegetables. A healthy diet emphasizes having the appropriate portions of fruits, vegetables, whole grains and low-fat or fat-free milk products and should include lean meats, poultry, fish, eggs, beans and nuts. Fats and sugars should be limited. People experiencing mental health problems in particular should aim for a diet low in refined sugar as research has sh own that a diet high in refined sugar is associated with worsening symptoms. Human nature, according to the Bhagwad Gita, is controlled by three qualities: Sattva, rajas and tamas signifying goodness, passion and illusion. The soul, which is invisible and incomprehensible to materials nature, apparently manifests through these qualities. By nature, a saatvik person is active, a rajasik person is good and tamasic is an ignorant person. Ancient Indian literature has discussed in detail the type of food according to the gunas. There is Sattvic food, Rajasic food and the Tamasic food. So also, there are three kinds of company, three kinds of actions, three kinds of rituals, etc. The kinds of environment are greatly affecting the origin and the modification of the motives which ultimately are instrumental in shaping the personality (Gita 8). The factors associated with poor eating habits among college students include a high perception of stress (Cartwright, Wardle, Steggles, Simon, Croker, & Jarvis, 2003)  and low self-esteem (Hustinger & Luecken, 2004) . Studies by Oliver, Wardle, and Gibson (2000)  and Zucker (2000)  indicated the relationship between high stress levels and lower self-esteem and unhealthy eating behaviours. Exercise
The dietary patterns observed in this study are incompatible with a consump- tion pattern that ensures adequate nutrition during the first year of life. The fre- quent replacement of breast milk by cow’s milk during the second semester of life was observed. In addition, the “family food” pattern had lower explanatory power among the observed patterns of dietary consumption, even at twelve months of age, when it is expected that the child consumes the family food. These conditions contribute to an inadequate supply of nutrients during a criti- cal period of development in which damage can be difficult to reverse.
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The mean age of participants was 42.1 ± 7.3 years. We identified 2916 incident cases of hypertension and three dietary patterns. The cumulative incidence of hyperten- sion was 4.6% over 1.7 ± 1.1 years. Factor-loading ma- trixes for these patterns are shown in Fig. 1, positive loadings indicate a positive association with the compo- nent, while negative loadings indicate an inverse associ- ation with it. The first component was loaded positively with other vegetables, green vegetables, tomatoes, car- rots and fruits, while pastries loaded negatively; the sec- ond component was loaded positively with processed meats, fast foods, and red meat, and negatively with fruit and corn tortilla; and finally the third component was loaded positively with corn tortillas, hot peppers and sodas, and negatively on whole grains, dairy and fruits. The first component explained 8.6% of the total vari- ance, while the second and third component explained 5.9% and 5.1% of the total variance, respectively. We named the component as Fruits & Vegetables, Western, Table 1 Thirty-seven food groups derived from the 140-item
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The present study had some limitations. First, was its cross-sectional design, wich does not permit to examine the causal link between dietary patterns and MetS risk, because the temporal relation of these events could not be clearly established. Second, the findings from this study could be specific to southeastern Brazilian adults, and did not represent national findings. Finally ,the sample size and the use of only one 24h dietary recall could underestimated the individual variability of food intakes which implicates that the dietary patterns identified by principal were plausible but they did not reveal all possible patterns.
reported that distinct dietary patterns already existed among infants and toddlers, suggesting disparities in eating behaviors begin at a very young age. It is very likely that infant dietary patterns from other countries cannot be generalized to US infants, given the considerable differences in culture, food availability, and parental feeding practices. Little is known on the role of infant dietary patterns in child growth and development. In the UK study men- tioned previously, infants who had a high score on the “ infant guidelines ” dietary pattern (fruit, vegetables, and home-prepared foods) at 6 months gained body weight more rapidly from age 6 to 12 months, whereas infants who had high consumption of “ adult foods ” (bread, savory snacks, biscuits, and chips) gained weight less rapidly. 17
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The aim of this work was to relate the nut consumption to three commonly used methods to determine dietary patterns, namely Healthy Eating Index, Mediterranean Diet Score and Healthy Dietary Pattern. For the three methods, the highest nut consumption was related with the highest quintile. Moreover, and despite the higher fat content of nuts, a high consumption was associated with a dietary pattern with the lowest intake of total, saturated and unsaturated fat. The subjects in the healthiest quin- tiles for the three methods have macronutrient intake close to the official guidelines, which are respectively for proteins, fat and carbohydrates 15, 30 and 55 energy- percent of total intake. Mean intake for the highest quin- tiles of Healthy Eating Index, Mediterranean Diet Score and Healthy Dietary Pattern ranged between 17 to 18 energy-percent for proteins, 29 to 34 energy-percent for fat and 45 to 50 energy-percent for carbohydrates. For the subjects of the lower quintiles, there was a great dis- crepancy between intake and official guidelines.
Separate mixed linear models were used to assess the time– treatment interaction for the parameters carbohydrate and fibre intake, dietary GI and GL, and urinary C-peptide. The subjects individually subject numbers were included as random factors to account for heterogeneity between sub- jects. The analyses were based on the 77 subjects (LGI/LP: n = 20, LGI/HP: n = 15, HGI/LP: n = 21 and HGI/HP: n = 21) who completed the 24-h urine collections at baseline and after 1, 3 and 6 month. Post hoc pair-wise comparisons of treatments were made using t tests with Tukey–Kramer adjustment of the P values to maintain the pre-specified significance level and thus to minimise the risk of false positive findings. In case the interaction of time and treatment was significant, only the treatment differences for the final time were reported. It was tested whether gender, BMI, PABA, total urine volume, time, diet group and dietary components had a significant effect on the total urinary C-peptide excretion. Where appropriate, variables that significantly affected urinary C-peptide excretion were included as covariates in the analyses. Statistical analyses were performed with SAS (Statistical Analysis Package version 9.1 for Windows (SAS institute Inc, Cary, NC)), in particular the MIXED procedure. The significance level used was 0.05.
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The types of dietary supplements reported to be used by the respondents included single minerals (35.1%), single vitamin supplements (14.9%), multivitamin supplements (12.8%), multiple mineral supplements (18.1) and other unspecified supplements (19.1%). Notably, single mineral supplements were the most used supplements among the reported supplements. Surprisingly, about 19% of the respondents could not specifically mention the name or even accurately state the type of supplement they were taking but were only aware of the fact that they took something else apart from their prescribed drugs and their daily meals to boost their health statuses (Table 1).
Articles were obtained and included in this review if they (1) examined the whole diet and included measurements of all dietary components by using a 24-h dietary recall, food record, food frequency questionnaire (FFQ), or similar instruments; (2) included hs-CRP measures; and (3) enrolled adults. Articles were excluded if they (1) examined only individual nutrients or did not examine all dietary components; (2) did not report hs-CRP data in a format that can be extracted; (3) comprised study samples that were not population- based or only focused on a subgroup of individuals with nutritional needs that are different from the general population; (4) were non-human studies; (5) were reviews, case reports, conference papers, and letters; (6) were studies focused on pregnant or lactating women; (7) were non–English language papers; (8) were studies conducted on infants, children, and adolescents; (9) did not report serum concentrations of CRP; (10) did not assess dietary intakes using FFQ, 24-h recall, or 3-day recall; (11) were abstracts with no more information ; (12) were dissertations.
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Participants consumed their usual diet. They were instructed to fill a 147-item food-frequency questionnaire (FFQ) that was validated previously . The questionnaire was completed in the presence of a trained dietitian. Data were recorded in household measures and serving sizes and then converted into grams and milliliters. Dietary intake data were analyzed using the Nutritionist IV (First DataBank, San Bruno, CA) food analyzer. First, based on the similarity of nutrients, food items were grouped into 25 predefined categories [24,25]. Then, adjusted means for energy were calculated for each category through analysis of residuals. In the next step, to determine the suitability of the model, the KMO and Bartlett’s test was used. Dietary patterns were identified using factor analysis. To this end, principal components analysis with varimax rotation was applied to energy-adjusted food categories. The extracted factors were checked on the basis of eigenvalues for the energy-adjusted food categories, and factors having an eigenvalue of greater than 1.5 were considered major dietary patterns. The designation of patterns was based on the interpretation of food items in each factor, which together accounted for 26.97% of the total variance on the basis of the scree plot and varimax rotation on 25 food groups . It should be noted that other food patterns were identified but were not considered as their contribution to the total variance was too small. Then, we categorized the subjects according to the tertiles of the dietary pattern scores. The naming of the major dietary patterns was done on the basis of previous knowledge.
We acknowledge that our study had several limitations. The case-control nature of the study, as well as the multifactorial character of infertility, may have led to misclassification of our participants. Although dietary pattern approach provides a comprehensive analysis by using food items or nutrients which are limited by biological interactions, several challenges in factor analysis include making decision on putting food items into food groups, the number of factors to be extracted, and the labeling of the components [62, 66]. We assessed dietary patterns by using a self-reported FFQ, which is susceptible to measurement errors and the misreporting of habitual energy intake. This study was a hospital-based case-control study. Therefore, the results cannot be generalized to the whole population. Moreover, these findings cannot be generalized to all Iranian population because infertile couples have different social, cultural, and educational backgrounds. It is worth mentioning that this is the first study conducted in relation to dietary patterns and infertility among the Iranian population.
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