Relationship Between Diet Quality and Statin Use Among Adults With Metabolic Syndrome From the CARTaGENE Cohort.

Background: In metabolic syndrome (MetS), cardiovascular disease (CVD) risk reduction relies on the complementary use of diet and lipid-lowering medication. Evidence suggests that initiating such medication may impede diet quality. The objective of this study was to evaluate the relationship between diet quality and statin use among adults with MetS and free of CVD from the Province of Québec. Methods: This cross-sectional study included 2481 adults with MetS (40-69 years of age) from the CARTaGENE Québec population-based cohort, of whom 463 self-reported using statin monotherapy. Diet was assessed using the Canadian Dietary History Questionnaire II, a food- frequency questionnaire, and diet quality was assessed using the Alternative Healthy Eating Index (AHEI). Results: In multivariable-adjusted linear regression models, statin users had lower AHEI (%) compared with nonusers (users: 40.0; 95% confidence interval [CI], 38.9, 41.2 vs nonusers: 41.2; 95% CI, 40.4, 42.0; P = 0.03] because of a lower consumption of vegetables and whole grains. Stratified interaction analyses showed that the lower diet quality among statin users was mostly prevalent among men aged ≥ 50 years and women aged ≥ 60 years, among individuals with annual household incomes of < $50,000 and persons who self-reported history of high blood pressure. Conclusions: In this cohort of adults with MetS from Quebéc, the use of statin monotherapy in primary prevention of CVD was associated with a slightly lower diet quality. These data suggest suboptimal complementarity between diet quality and use of cholesterol-lowering medication in primary prevention of CVD in MetS.

Contexte: Dans le syndrome métabolique, la réduction du risque de maladie cardiovasculaire repose sur la complémentarité entre une saine alimentation et l'utilisation d'hypolipidémiants. Des évidences suggèrent que l'initiation d'un traitement médicamenteux hypolipémiant influencerait négativement la qualité de l'alimentation. Cette étude avait pour objectif de déterminer la relation entre la qualité de l'alimentation et l'utilisation de statines chez des adultes avec un syndrome métabolique, mais sans maladie cardiovasculaire, au Québec. Méthodologie: Cette étude transversale comptait 2481 adultes avec un syndrome métabolique (âgés de 40 à 69 ans) provenant de la cohorte CARTaGENE, représentative de la population du Québec, dont 463 sujets ayant autodéclaré qu'ils prenaient une statine en monothérapie. L'alimentation des sujets a été évaluée à l'aide du Canadian Dietary History Questionnaire II, un questionnaire de fréquence alimentaire, et la qualité de l'alimentation a été évaluée à l'aide de l'Alternative Healthy Eating Index (AHEI). Résultats: Dans des modèles de régression linéaire multivariée, les utilisateurs de statines ont présenté un indice AHEI (%) plus faible en comparaison aux non-utilisateurs (utilisateurs : 40,0; intervalle de confiance [IC] à 95 % : 38,9-41,2 vs non-utilisateurs : 41,2; IC à 95 % : 40,4-42,0; p = 0,03), en raison d'une plus faible consommation de légumes et de grains entiers. Selon des analyses d'interaction stratifiées, la plus faible qualité nutritionnelle chez les utilisateurs de statines était particulièrement prévalente chez les hommes de ≥ 50 ans et les femmes de ≥ 60 ans, chez les personnes dont le revenu annuel du ménage était < 50 000 dollars et chez les personnes ayant autodéclaré des antécédents d'hypertension. Conclusions: Dans cette cohorte d'adultes du Québec avec un syndrome métabolique, l'utilisation de statines en monothérapie dans la prévention des maladies cardiovasculaires était associée à une alimentation dont la qualité était légèrement plus faible. Ces données suggèrent une complémentarité sous-optimale entre la qualité de l'alimentation et l'utilisation d'hypocholestérolémiants en prévention des maladies cardiovasculaires chez les personnes avec un syndrome métabolique.

Relationship Between Diet Quality and Glucose-Lowering Medication Intensity Among Adults With Type 2 Diabetes: Results From the CARTaGENE Cohort.

Background: In real-world settings, whether diet and medication are used as complements for glycemic management in type 2 diabetes (T2D) remains unclear. This study assessed the relationship between diet quality and intensity of glucose-lowering medication among adults with T2D. Methods: This cross-sectional study included 352 adults with T2D from the CARTaGENE Québec population-based cohort. Diet quality was assessed using the Healthful Plant-Based Diet Index (hPDI). Glucose-lowering medication intensity was graded according to self-reported information on the type and number of drugs: no medication; oral monotherapy; oral polytherapy; and insulin with and without oral medication. In the subsample of 239 individuals who reported the medication dosages, intensity was also graded using the Medication Effect Score (MES). Results: In multivariable-adjusted models, we found no evidence of a relationship between the hPDI and medication intensity, assessed using the categorical approach (Pbetween-group = 0.25) or the MES (P = 0.43). However, the hPDI was inversely associated with the MES among men < 50 years of age and women < 60 years (ß1-point MES = -2.24 [95% confidence interval, -4.46, -0.02] hPDI points), but not among older individuals (ß = -0.03 [-1.28, 1.21] hPDI points). Evidence of a nonsignificant inverse relationship between the hPDI and HbA1c was observed (ß10-point hPDI = -0.23% [-0.63, 0.17]), whereas a positive and significant association between the MES and hemoglobin (Hb)A1c was found (ß1-point MES = 0.30% [0.10, 0.51]). Conclusions: In this cohort of adults with T2D, there was an overall lack of complementarity between diet quality and intensity of glucose-lowering medication. The issue was particularly important among younger adults for whom diet quality was inversely associated with intensity of medication.

Introduction: Il n'a jamais été étudié, en contexte réel, si la qualité de l'alimentation et la médication sont utilisées de façon complémentaire dans la gestion de la glycémie chez des personnes avec le diabète de type 2 (DT2). La présente a évalué la relation entre la qualité de l'alimentation et l'intensité de la médication hypoglycémiante chez des adultes avec DT2. Méthodes: Cette étude transversale portait sur 352 adultes avec DT2 participant à la cohorte populationnelle québécoise CARTaGENE. Nous avons évalué la qualité du régime à l'aide du Healthful Plant-based Diet Index (hPDI, soit l'indice d'un régime alimentaire à base de plantes). Nous avons évalué l'intensité des médicaments hypoglycémiants à partir des renseignements fournis sur le type et le nombre de médicaments : aucun médicament, monothérapie orale, polythérapie orale, insuline avec ou sans médicaments par voie orale. Dans le sous-échantillon de 239 individus qui ont mentionné les posologies de médicaments, nous avons aussi évalué l'intensité au moyen du Medication Effect Score (MES). Résultats: Dans les modèles multivariés, nous n'avons observé aucune évidence de relation entre le hPDI et l'intensité des médicaments au moyen de l'approche catégorielle (Pentre les groupes = 0,25) ou du MES (P = 0,43). Toutefois, le hPDI était inversement associé au MES chez les hommes < 50 ans et chez les femmes < 60 ans (ßMES 1 point = ­2,24 [intervalle de confiance à 95 %, ­4,46, ­0,02] points hPDI), mais non chez les personnes plus âgées (ß = ­0,03 [­1,28, 1,21] point hPDI). Nous avons observé une relation inverse non significative entre le hPDI et l'hémoglobine (Hb)A1c (ßhPDI 10 points = ­0,23 % [­0,63, 0,17]) et une association positive et significative entre le MES et l'HbA1c (ßMES 1 point = 0,30 % [0,10, 0,51]). Conclusions: Au sein de cette cohorte d'adultes avec DT2, nous avons constaté une absence globale de complémentarité entre la qualité de l'alimentation et l'intensité des médicaments hypoglycémiants. Cet enjeu était d'autant plus important chez les personnes plus jeunes pour lesquels la qualité du régime était inversement associée à l'intensité des médicaments.

Relationship Between Diet Quality and Antihypertensive Medication Intensity Among Adults With Metabolic Syndrome-Associated High Blood Pressure.

Background: Management of high blood pressure (BP), a key feature of the metabolic syndrome (MetS), relies on diet and medication. Whether these modalities are used as complements has never been evaluated in real-world settings. This study assessed the relationship between diet quality and antihypertensive medication intensity among adults with MetS-associated high BP. Methods: This cross-sectional study included 915 adults with MetS-associated high BP from the CARTaGENE cohort (Québec, Canada), of whom 677 reported using BP-lowering medication. Antihypertensive medication intensity was graded per the number of BP-lowering classes used simultaneously. Diet quality was assessed using the Dietary Approach to Stop Hypertension (DASH) score. Results: No evidence of a relationship between antihypertensive medication intensity and diet quality was found (ß for each additional antihypertensive = -0.05; 95% CI, -0.35; 0.26 DASH score points). However, among men aged < 50 years and women aged < 60 years, the DASH score was inversely associated with medication intensity (ß = -0.72; 95% CI, -1.24, -0.19), whereas this relationship tended to be positive among older participants (ß = 0.32; 95% CI, -0.05, 0.69). Among participants with low Framingham risk score, the DASH score was inversely associated with medication intensity (ß = -0.70; 95% CI, -1.31, -0.09), but no evidence of an association was found among individuals at moderate (ß = 0.00; 95% CI, -0.45, 0.45) or high (ß = 0.30, 95% CI, -0.24, 0.84) risk. Conclusions: In this cohort of adults with MetS-associated high BP, there was an overall lack of complementarity between diet quality and BP-lowering medication, especially among younger individuals and those with a lower risk for cardiovascular disease for whom diet quality was inversely associated with intensity of medication.

Introduction: La prise en charge de la pression artérielle (PA) élevée, l'une des caractéristiques principales du syndrome métabolique (SMet), repose sur une saine alimentation et l'usage de médicaments hypotenseurs. Il n'a jamais été évalué si ces modalités étaient utilisées de façon complémentaire en contexte réel. La présente étude portait sur la relation entre la qualité de l'alimentation et la médication antihypertensive au sein d'adultes ayant une PA élevée associée au SMet. Méthodes: Cette étude transversale regroupait 915 adultes de la cohorte CARTaGENE (Québec, Canada) ayant une PA élevée associée au SMet, dont 677 ont rapporté prendre des médicaments abaissant la PA. L'intensité de la médication antihypertensive a été évaluée par le nombre de classes de médicaments abaissant la PA utilisées simultanément. La qualité du régime alimentaire a été évaluée à l'aide du score Dietary Approache to Stop Hypertension (DASH). Résultats: Aucune évidence d'une relation entre l'intensité des médicaments antihypertenseurs et la qualité de l'alimentation n'a été observée (ß pour chaque antihypertenseur supplémentaire = ­0,05 ; intervalle de confiance [IC] à 95 %, ­0,35 ; 0,26 point au score DASH). Toutefois, chez les hommes âgés < 50 ans et chez les femmes âgées < 60 ans, le score DASH était inversement associé à l'intensité des médicaments (ß = ­0,72 ; IC à 95 %, ­1,24, ­0,19), alors que cette relation avait tendance à être positive chez les participants plus âgés (ß = 0,32 ; IC à 95 %, ­0,05, 0,69). Chez les participants qui avaient un score de risque de Framingham faible, le score DASH était inversement associé à l'intensité des médicaments (ß = ­0,70 ; IC à 95 %, ­1,31, ­0,09), mais aucune évidence d'une association n'a été observée chez les individus qui avaient un risque modéré (ß = 0,00 ; IC à 95 %, ­0,45, 0,45) ou élevé (ß = 0,30, IC à 95 %, ­0,24, 0,84). Conclusions: Au sein de cette cohorte d'adultes qui avaient une PA élevée associée au SMet, aucune évidence de complémentarité entre la qualité de l'alimentation et l'intensité de la médication antihypertensive n'a été observée, particulièrement chez les individus plus jeunes et chez ceux exposés à un risque plus faible de maladies cardiovasculaires pour qui la qualité du régime alimentaire était inversement associée à l'intensité des médicaments.

Clinical and organisational quality indicators for the optimal management of acute ischaemic stroke in the era of thrombectomy: a scoping review and expert consensus study.

OBJECTIVE: The purpose of this study is to identify clinical and organisational quality indicators conducive to the optimal interdisciplinary management of acute-phase ischaemic stroke. METHOD: A scoping review based on the six-step methodological framework of Arksey and O'Malley (2005) was conducted including a Delphi process with an experts committee. DATA SOURCES: MEDLINE, CINAHL, Academic search complete, Cochrane Library databases, in addition to Google Scholar and Google were searched through January 2015 to February 2023. ELIGIBILITY CRITERIA: French and English references, dealing with clinical and organisational indicators for the management and optimal care of adults with acute ischaemic stroke. DATA EXTRACTION AND SYNTHESIS: After duplicate removal, all publications were checked for title and abstract. The full text of articles meeting the inclusion criteria was reviewed. Two independent reviewers performed 10% of the study selection and data extraction. Data collected underwent descriptive statistics. RESULTS: Of the 4343 references identified, 31 were included in the scoping review. About 360 indicators were identified and preliminary screened by two stroke experts. Fifty-four indicators were evaluated for validity, relevance and feasibility by a committee of experts including a partner patient using a Delphi method. A total of 34 indicators were selected and classified based on dimensions of care performance such as accessibility of services, quality of care and resource optimisation. Safety accounted for about one-third of the indicators, while there were few indicators for sustainability, equity of access and responsiveness. CONCLUSION: This scoping review shows there are many clinical and organisational indicators in the literature that are relevant, valid and feasible for improving the quality of care in the acute phase of ischaemic stroke. Future research is essential to highlight clinical and organisational practices in the acute phase. REGISTRATION DETAILS: https://osf.io/qc4mk/.

Are Lipid-Lowering and Antihypertensive Medications Used as Complements to Heart-Healthy Diets? A Scoping Review.

In cardiovascular disease (CVD) prevention, whether antihypertensive and lipid-lowering medications are used as complements to heart-healthy diets has not been thoroughly assessed. This scoping review aimed to 1) analyze observational studies that assessed the relationship between diet and antihypertensive/lipid-lowering medication use and 2) evaluate whether medication was used as a complement to heart-healthy dietary intakes. We searched MEDLINE, Embase, Web of Science, and CINAHL through 14 January, 2023, for studies that assessed either 1) intraindividual changes in diet associated with lipid-lowering/antihypertensive medication initiation or use or 2) interindividual differences in diet between users and nonusers of these medications. A total of 17 studies were included. Of those, 3 prospectively assessed the intraindividual changes in diet associated with medication initiation or use, but none documented potential changes in diet prior to medication initiation. The 14 other studies compared dietary intakes of medication users and nonusers, most of which also relied on an incomplete assessment of the temporal dynamics between diet and medication use as they employed cross-sectional (n = 12) or repeated cross-sectional (n = 2) designs. Data from 8 studies, including 4 of the 5 studies from Europe, suggested that medication was used as a complement to heart-healthy diets, whereas data from the 9 other studies, including the 4 conducted in the United States, provided no such evidence, indicating potential between-country differences in this relationship. Finally, no studies investigated how the dynamics between diet and medication use influenced the long-term CVD risk. This scoping review suggests that the current literature on the relationship between lipid-lowering/antihypertensive medication use and diet provides an incomplete perspective on how medication may influence diet in CVD prevention. Prospective studies assessing intraindividual changes in diet associated with medication initiation and use and how these dynamics influence the CVD risk are thus needed.

Apparent Digestibility of Macronutrients and Fatty Acids from Microalgae (Schizochytrium sp.) Fed to Rainbow Trout (Oncorhynchus mykiss): A Potential Candidate for Fish Oil Substitution.

Aquaculture feed formulation has recently turned its focus to reduce the reliance on marine-derived resources and utilise alternative feedstuffs, as an approach to improve the environmental sustainability of the aquaculture sector. The fish oil market is highly volatile, and availability of this commodity is continuously decreasing for use in aquaculture. Currently, a growing number of commercial efforts producing microalgae are providing omega 3-rich oil for sustainable aquaculture feed. This study was focused to determine the nutrient digestibility of a marine microalga, Schizochytrium spp., which is rich in docosahexaenoic acid (DHA) and long-chain polyunsaturated fatty acids (LC-PUFA), as a novel dietary lipid source that could be utilized effectively by rainbow trout (Oncorhynchus mykiss). A whole-cell Schizochytrium spp. biomass was used in the digestibility experiment at two different temperatures, 8 °C and 15 °C. No significant differences were detected between the two temperatures for the apparent digestibility coefficients (ADCs) of the dry matter (94.3 ± 4.9%), total lipids (85.8 ± 0.0%), crude proteins (89.5 ± 1.8%), energy (83.1 ± 1.7%) and fatty acids (85.8 ± 7.5%). The ADCs of the nutrients, energy, DHA and other fatty acids showed that Schizochytrium spp. is a high-quality candidate for fish oil substitution and supplement of LC-PUFA in fish feed with vegetable oils.