'Between foods and medicines': A qualitative interview study of patient experiences of the meaning and usage of oral nutritional supplements.

The aim of this study was to deepen the understanding of what oral nutritional supplements mean to patients and how this meaning connects to supplement usage, by exploring patient experiences of such supplements. Qualitative interviews were conducted in June 2019-March 2020 with ten patients with malnutrition or at nutritional risk, prescribed oral nutritional supplements by dietitians. Data were thematically analysed using systematic text condensation. Two final categories were identified: 'Oral nutritional supplements are a one-dimensional remedy' and 'Everyday oral nutritional supplement usage is regulated autonomously'. The patients described the meaning of oral nutritional supplements as nutrition. While the supplements could compensate for nutrients not eaten or be part of a helpful compensation strategy, they could not lessen the burden of altered eating. Supplement usage was described as dependent on the acceptance of taste and the priority given to nutrition in everyday life. Usage was greater when nutrients were perceived as needed, such as when striving for higher bodyweight or disease recovery. Usage was lower when a patient's own goals were not increased nutrient intake or bodyweight or when other activities were perceived as more important. Patient experiences indicated that oral nutritional supplements could serve as a remedy for malnutrition, but not for a situation of altered eating. Supplement usage was described as being regulated autonomously based on patient views on the importance of nutrition. Those views were diverse, highlighting the importance of supplement prescribers discussing treatment goals with each patient. A deeper understanding of the meaning of oral nutritional supplements and reasons for their usage from a patient perspective is crucial in order for healthcare to provide appropriate, effective nutrition therapy for malnutrition.

Setting goals with patients at risk of malnutrition: A focus group study with clinical dietitians.

OBJECTIVE: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition. METHODS: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes. RESULTS: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal-setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically-oriented goals and patients' personal goals. CONCLUSION: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. PRACTICE IMPLICATIONS: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.

Discrepancy in the evaluation of explicit and implicit nutrition care outcomes for patients at risk of malnutrition: A qualitative study.

BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.

A Proposed Theoretical Model for Sustainable and Safe Commensality among Older Adults.

Eating together at the same table, i.e., commensality, is an old phenomenon among humans. Today, there is a relatively high number of people living in single households eating most meals on their own. Among adults aged 65+ years, both malnutrition and non-communicable diseases are common. These circumstances, as well as foodborne illnesses, cause health problems for the individual, as well as high societal costs. In older adults, several external factors might impact on commensality, such as living arrangements, health status, and cooking competence. Improved knowledge regarding healthy eating and food handling may improve attitudes and behaviors in relation to food safety and dietary intake. Further, commensality has been shown to influence dietary intake in multiple ways. Community-organized activities, e.g., Food Classes for Older Adults (FCOA), may lead to sustainable commensality. Participating in health-promoting activities can contribute to improved health outcomes and improved social interaction among older adults. The objective of this study was to propose a theoretical model to inspire and create networks for sustainable commensality among older adults. The model could serve as a conceptual framework when implementing FCOA in communities and research. Outcomes could be measured by investigating the frequency of commensality, health effects, and well-being.

A qualitative exploration of dietitians' experiences of prescribing oral nutritional supplements to patients with malnutrition: A focus on shared tailoring and behaviour change support.

BACKGROUND: Oral nutritional supplements (ONS) are commonly prescribed to patients with malnutrition. Dietitians have been suggested as preferred prescribers but generally lack ONS prescribing rights. How dietitians with prescribing rights experience their professional practice of prescribing ONS remains understudied. Thus, by exploring dietitians' experiences of prescribing ONS, the present study aimed to obtain a deeper understanding of specific aspects that are of importance for dietitians when providing a nutrition therapy including ONS. METHODS: Qualitative individual interviews were conducted with 13 dietitians prescribing ONS to free-living adult outpatients with malnutrition or at nutritional risk in the hospital or primary care setting. Systematic text condensation was used for data analysis. RESULTS: Two main categories signifying important aspects were identified and labelled: 'Shared tailoring of the ONS prescription' and 'Supporting and facilitating ONS use'. First, the dietitians described tailoring the ONS prescription together with the patient, having their acceptance as a prerequisite, and being flexible regarding products and amounts prescribed. Second, they described performing different communication strategies and organising of practical issues (e.g., ONS delivery and support from others) to support and facilitate patients' ONS usage. CONCLUSIONS: The present study identifies patient involvement and the role of dietitians as behaviour change facilitators as two important aspects when dietitians prescribe ONS. These findings allow for dietitians' ideals and strategies on how to prescribe ONS to be made more visible, which can inform both clinical practice and clinical trials for future improvements in nutrition therapy to address malnutrition.

Adherence to a regulation that aims to prevent and treat malnutrition-The case of Swedish elderly care.

Malnutrition constitutes a serious and challenging problem in elderly care. In 2015, a Swedish regulation that aims to prevent and treat malnutrition came into effect. This study set out to explore associations between level of adoption of the regulation reported as: no, started, yes, in a previous survey, and registrations in a national quality registry. Registry data on screening and actions extracted from the first trimester in 2014 (n=18967), 2016 (n=20318) and 2017 (n= 25669) represented 209, 197 and 199 of 290 Swedish municipalities respectively. A repeated measures ANOVA showed that there was no effect on screened nutritional status, Pearson's chi-square that there were minor differences in types of actions, and regression analysis that the number of actions increased on average by 0.3 due to a higher level of adoption of the regulation. Over the years studied, five actions were prominent regardless of level of adoption or screened nutritional status. Hence, to date, no firm conclusions regarding effects of the regulation can be drawn. Despite the regulatory nature, it appear as if the regulation and the level of adoption reported so far is routine in theory, although not yet leveraged to an implemented practice visible in the quality registry but instead decoupled from practice.

High Adherence to Oral Nutrition Supplements Prescribed by Dietitians: A Cross-Sectional Study on Hospital Outpatients.

BACKGROUND: This study aimed to assess adherence to oral nutrition supplements (ONS) among hospital outpatients and to assess patient characteristics, experiences of ONS, and the characteristics of ONS prescriptions in clinical practice. METHODS: Hospital outpatients aged ≥18 years and prescribed ONS by a dietitian at a Swedish hospital were referred to the study from September 2016 to February 2017. Data were collected from structured telephone interviews, medical records, and a register of ONS delivered. Adherence to ONS was measured by dividing self-reported intake of ONS (frequency question and 24-hour recall question) by the amount prescribed and using the medication possession ratio (MPR). RESULTS: Of the 96 patients included (mean age 67 ± 13 years), 52% were male. The 2 most frequent medical diagnoses were malignancy and digestive system disease. Mean adherence to ONS was 93% measured by the frequency question, 87% measured by the 24-hour recall question, and 76% according to MPR. The majority of the patients (83%) were prescribed 1-3 bottles of ONS/day. The average number of flavors of ONS delivered was 4.2. Before prescription, 69% of the patients had been allowed to taste the ONS and 92% had chosen the flavors to be prescribed. Over 75% liked the taste of the ONS and considered them to be good for their health. CONCLUSIONS: Adherence to ONS was high in this population, which might be explained by the individual tailoring of ONS prescriptions by a dietitian, positive experiences of ONS, and the relatively young mean age of the participants.

Effect of exercise and nutritional supplementation on health-related quality of life and mood in older adults: the VIVE2 randomized controlled trial.

BACKGROUND: Health-related quality of life (HRQoL) and absence of depressive symptoms are of great importance for older people, which may be achieved through lifestyle interventions, e.g., exercise and nutrition interventions. The aim of this investigation was to analyze the effects of a physical activity program in combination with protein supplementation on HRQoL and depressive symptoms in community-dwelling, mobility-limited older adults. METHODS: In the Vitality, Independence, and Vigor 2 Study (VIVE2), community-dwelling men and women with an average age of 77.5 ± 5.4 years, some mobility limitations and low serum vitamin D levels (25(OH)Vit D 22.5-60 nmol/l) from two study sites (Stockholm, Sweden and Boston, USA) were randomized to receive a nutritional supplement or a placebo for 6 months. All took part in a physical activity program 2-3 times/ week. The primary outcome examined in VIVE2 was 400 M walk capacity. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Health Survey (SF36), consisting of the Physical Component Summary (PCS) and Mental Component Summary (MCS), and depressive symptoms were measured using The Centre for Epidemiologic Studies Depression Scale (CES-D). In the sensitivity analyses, the sample was divided into sub-groups based on body measures and function (body mass index (BMI), appendicular lean mass index (ALMI), handgrip strength and gait speed). RESULTS: For the whole sample, there was a significant improvement in both MCS, mean (95% CI) 2.68 (0.5, 4.9) (p 0.02), and CES-D -2.7 (- 4.5, - 0.9) (p 0.003) during the intervention, but no difference was detected between those who received the nutritional supplement and those who received the placebo. The results revealed no significant change in PCS or variation in effects across the sub-categories. CONCLUSIONS: This study demonstrates that a six-month intervention using a physical activity program had positive effects on mental status. No additional effects from nutritional supplementation were detected. TRIAL REGISTRATION: Registered at ClinicalTrials.gov, March 2 2012, NCT01542892 .

National survey in elderly care on the process of adopting a new regulation aiming to prevent and treat malnutrition in Sweden.

Guided by the i-PARIHS framework, this study investigates perceived facilitators in the process of adopting a new regulation launched in 2015 which aims to prevent and treat malnutrition. In May 2016, a national web-based questionnaire was emailed to chief medical nurses in elderly care in all Swedish municipalities (n = 290). The response rate in this cross-sectional study was 75% (n = 217). Fifty per cent of the municipalities had adopted new routines, 42% had started and 8% had not. One third of the respondents considered malnutrition to be a major problem in elderly care and about half considered the new national regulation to have strengthened local work. A logistic regression showed that the odds for having adopted new routines were higher for CMNs with long experience in elderly care and who had previously worked to prevent malnutrition, and for those who considered the new national regulation helpful. To extract underlying factors in the adoption process, two principal component analyses were performed for key actors and support. For key actors, the analysis yielded four factors, explaining 67% of the total variance; (a) first line team, (b) expert team, (c) management team and (d) surrounding resources. For support, the analysis yielded three factors, which explained 65% of the total variance; (a) agile teamwork, (b) management and leadership and (c) acceptance. The slow adoption rate of the regulation raises questions about its impact; this might be an effect of the general trend of decentralisation in the Swedish welfare sector, and in elderly care in particular, making it hard to attain change that is steered centrally. However, malnutrition is a pronounced problem in elderly care and the mandatory nature of the new regulation therefore warrants further investigation of whether its launch has contributed to a reduction of malnutrition by investigating outcomes and preventive actions carried out in practice.

Reforming foodservice in elderly care: National actions and local outcomes.

AIM: The aim was to explore the outcome, on a local level, of steering, organisation and practices of elderly care foodservice by Swedish municipalities, and changes relative to national actions. METHODS: A survey using a web-based questionnaire about elderly care foodservice targeting all Swedish municipalities (n = 290) was conducted in 2006 and 2013/2014. The questionnaire included the topics: organisation of foodservice, its practice in elderly care and steering devices such as guidelines and policies. Based on the share of a rural population, municipalities were divided into groups: rural (≥50%), urban (<50%) and city (≤20%). RESULTS: The response rate from municipalities was 80% in 2006 and 56% in 2013/2014; 45% participated in both surveys. The results showed increased use of local food policies (P = 0.03) and meal choice (P < 0.001), while access to clinical/community dietitians declined (P = 0.01) between the surveys. In home-help services, daily delivered cook-serve meals declined (P < 0.001) and chilled meals delivered three times a week increased (P = 0.002) between the surveys. City municipalities used private foodservice organisations the most (P < 0.001), and reported reduced use of cook-serve systems in favour of chilled. In rural municipalities, the use of public providers (98%) and a cook-serve system (94%) were firmly established. Urban municipalities were placed between the other groups. CONCLUSIONS: National actions such as soft governance and benchmarking appear largely to determine local level outcomes. However, conditions for adapting these measures vary between municipality groups. While efficiency enhancing trends were prominent, questions remain whether national actions should be expanded beyond performance to also examine their consequences.

Consumers' health-related perceptions of bread - Implications for labeling and health communication.

There is a wide variety of commercial bread types and the present study identifies potential pitfalls in consumer evaluations of bread from a health perspective. The aim is to describe consumers' health-related perceptions of bread by exploring which health-related quality attributes consumers associate with bread and whether there are differences with regard to age, gender and education level. A postal and web-based sequential mixed-mode survey (n = 1134, 62% responded online and 38% by paper) with open-ended questions and an elicitation task with pictures of commercial breads were used. Responses were content analyzed and inductively categorized. Three fourths (n = 844) knew of breads they considered healthy; these were most commonly described using terms such as "coarse," "whole grain," "fiber rich," "sourdough," "crisp," "less sugar," "dark," "rye," "seeds," "a commercial brand," "homemade" and "kernels." The breads were perceived as healthy mainly because they "contain fiber," are "good for the stomach," have good "satiation" and beneficial "glycemic properties." The frequency of several elicited attributes and health effects differed as a function of age group (18-44 vs. 45-80 years), gender and education level group (up to secondary education vs. university). Difficulties identifying healthy bread were perceived as a barrier for consumption especially among consumers with a lower education level. Several of the health effects important to consumers cannot be communicated on food packages and consumers must therefore use their own cues to identify these properties. This may lead to consumers being misled especially if a bread is labeled e.g., as a sourdough bread or a rye bread, despite a low content.

The Vitality, Independence, and Vigor in the Elderly 2 Study (VIVE2): Design and methods.

BACKGROUND: Nutritional supplementation may potentiate the increase in skeletal muscle protein synthesis following exercise in healthy older individuals. Whether exercise and nutrition act synergistically to produce sustained changes in physical functioning and body composition has not been well studied, particularly in mobility-limited older adults. METHODS: The VIVE2 study was a multi-center, randomized controlled trial, conducted in the United States and Sweden. This study was designed to compare the effects of a 6-month intervention with a once daily, experimental, 4 fl.oz. liquid nutritional supplement providing 150 kcal, whey protein (20 g), and vitamin D (800 IU) (Nestlé Health Science, Vevey, Switzerland), to a low calorie placebo drink (30 kcal, non-nutritive; identical format) when combined with group-based exercise in 150 community-dwelling, mobility-limited older adults. All participants participated in a structured exercise program (3 sessions/week for 6 months), which included aerobic, strength, flexibility, and balance exercises. RESULTS: The primary outcome was 6-month change in 400 m walk performance (m/s) between supplement and placebo groups. Secondary outcomes included 6 month change in: body composition, muscle cross-sectional area, leg strength, grip strength, stair climb time, quality of life, physical performance, mood/depressive symptoms and nutritional status. These outcomes were selected based on their applicability to the health and well-being of older adults. CONCLUSIONS: The results of this study will further define the role of nutritional supplementation on physical functioning and restoration of skeletal muscle mass in older adults. Additionally, these results will help refine the current physical activity and nutritional recommendations for mobility-limited older adults.

Bread consumption patterns in a Swedish national dietary survey focusing particularly on whole-grain and rye bread.

BACKGROUND: Bread types with high contents of whole grains and rye are associated with beneficial health effects. Consumer characteristics of different bread consumption patterns are however not well known. OBJECTIVE: To compare bread consumption patterns among Swedish adults in relation to selected socio-demographic, geographic, and lifestyle-related factors. For selected consumer groups, the further aim is to investigate the intake of whole grains and the context of bread consumption, that is, where and when it is consumed. DESIGN: Secondary analysis was performed on bread consumption data from a national dietary survey (n=1,435). Respondents were segmented into consumer groups according to the type and amount of bread consumed. Multiple logistic regressions were performed to study how selected socio-demographic, geographic, and lifestyle-related factors were associated with the consumer groups. Selected consumption groups were compared in terms of whole-grain intake and consumption context. Consumption in different age groups was analysed more in detail. RESULTS: One-third of the respondents consumed mainly white bread. Socio-demographic, geographic, and healthy-lifestyle-related factors were associated with the bread type consumed. White bread consumption was associated with younger age groups, less education, children in the family, eating less fruit and vegetables, and more candy and snacks; the opposite was seen for mainly whole-grain bread consumers. Older age groups more often reported eating dry crisp bread, whole-grain bread, and whole-grain rye bread with sourdough whereas younger respondents reported eating bread outside the home, something that also mainly white bread eaters did. Low consumers of bread also consumed less whole grain in total. CONCLUSIONS: Traditional bread consumption structures were observed, as was a transition among young consumers who more often consumed fast food bread and bread outside the home, as well as less rye and whole-grain bread. Target groups for communication strategies and product development of more sensorily attractive rye or whole-grain-rich bread should be younger age groups (18-30 years), families with children, and groups with lower educational levels.

Laypeople blog about fruit and vegetables for self-expression and dietary influence.

Private health information websites run by laypeople are more often visited than websites of official agencies. Understanding the role of weblogs in dietetic communication-i.e., sharing personal perceptions on healthy eating-is still lacking. This study aims to describe the nature of noncommercial Swedish blogs with fruits and vegetables (F&V)-related content and to identify different blogger types. A qualitative content analysis with abduction was performed on 50 weblogs. Most bloggers presented themselves as women. Only one-third reported their age (range 17 to over 50 years). The bloggers had either an active or passive influential purpose, and they approached F&V through either lived or mediated experiences. From these two dimensions, four F&V blogger ideal types were identified: the Persuader, the Authority, the Exhibitionist, and the Mediator. Particularly women wrote about their lived experiences close to the personal level, whereas men were more equally distributed across the different ideal types. Self-expression (typical for the Exhibitionist) and purpose to influence others' diets (typical for the Persuader and the Authority) were frequently expressed in these weblogs. The current findings on blogging purposes, approaches, and F&V blogger types may help to improve online dietetic communication, which sets new challenges for media strategies of health and nutritional professionals.

Pregnancy planning in Sweden--a pilot study among 270 women attending antenatal clinics.

OBJECTIVE: Health status and lifestyle before and at the time of conception could affect the health of both mother and child, but there is a lack of knowledge about the degree to which pregnancies are planned. The aim of this pilot study was to investigate whether and how women plan their pregnancies. MATERIAL AND METHODS: The main outcome measures were use of timetables, ovulation tests and lifestyle changes. Women (n= 322) visiting four antenatal clinics were asked to fill out a questionnaire (participation rate = 83.9%, n= 270). RESULTS: Three of four pregnancies (n= 202) were very or rather well planned, whereas 4.4% (n= 12) were totally unplanned. During the planning period, 37.1% (n= 100) made up a timetable for getting pregnant, 23% (n= 62) used ovulation tests, 20.7% (n= 56) took folic acid and 10.4% (n= 28) changed alcohol consumption. CONCLUSION: Although a majority of these women had planned pregnancies, only one in five had taken folic acid during the planning period.

Comparison between optical readable and open-ended weighed food records.

BACKGROUND: A simplified optically readable food record (ORFR) was developed and compared with an open-ended weighed record (WR). OBJECTIVE: To compare intake of nutrients and foods using a seven-day ORFR with intake estimated using a seven-day WR. The results from each method were validated against 24-h urinary nitrogen excretion and energy intake (EI)/estimated basal metabolic rate (BMR) cut-off values. DESIGN: The study comprised 73 free-living, healthy 70-year-old Swedish men. Dietary data were collected during seven consecutive days, starting either with WR or ORFR. RESULTS: Average intakes of energy and several nutrients were significantly lower when estimated using ORFR than when using WR. However, when adjusted for nutrient density, only a few nutrients were still lower with ORFR. Spearman correlation coefficients between the two methods regarding intakes of energy and energy-yielding nutrients were moderate to high, i.e. 0.4-0.6, while figures for most micro-nutrients were in the range 0.3-0.5. A large proportion of subjects under-reported their EIs, a higher proportion doing so when using ORFR. Protein intake obtained using ORFR was 31% lower than the values calculated from the 24-h urine nitrogen excretion, and 22% lower than those obtained from WR. Average intakes of milk, cheese and other milk products as well as coffee, tea and alcohol were significantly higher when estimated using ORFR than when using WR, while intakes of vegetables, meat and meat products, fish, bread and cereal products as well as number of sweet foods were significantly lower with ORFR. CONCLUSIONS: Based on these results, adjustments of some portion sizes in ORFR are suggested. In view of the advantages of ORFR with respect to lower response burden and rapid processing of data, such adjustments would make ORFR a suitable dietary assessment tool for use in dietary surveys, including larger resource-demanding epidemiological investigations.

Fruit and vegetable consumption close to recommendations. A partly web-based nationwide dietary survey in Swedish adults.

BACKGROUND: Fruit and vegetables (F&V) are strongly associated with health. The latest Swedish national dietary survey from a decade ago showed that consumption of F&V was below recommended levels. However, current consumption in different subgroups is not well known. OBJECTIVE: To investigate the consumption of various F&V types in Swedish adults grouped according to sociodemographic factors and self-reported physical activity (PA). DESIGN: A cross-sectional survey using a quantitative pen-and-paper or web-based questionnaire in a population-based random sample of adults 18-84 years (final n=1,304; 51%). A self-administered 24-h recall and a food frequency questionnaire (FFQ) were used to measure F&V consumption. Data on gender, age, education level, country of birth, and PA (hours/week) were included as grouping variables. Besides descriptive data, two-sample t-tests and non-parametric tests were performed. A P-value <0.01 was regarded as significant. RESULTS: Mean F&V consumption based on the self-administered 24-h recall was close to the recommended five portions/day: 5.4 (99% CI 5.1-5.6) portions/day among women and 4.7 (4.4-5.0) portions/day among men (P<0.001). Also the FFQ showed that women generally consumed more F&V than men did. Consumption was lowest among respondents with

Long-term monounsaturated fatty acid diets reduce platelet aggregation in healthy young subjects.

The aim of the present study was to compare the response of a range of atherogenic and thrombogenic risk markers to two dietary levels of saturated fatty acid (SFA) substitution with monounsaturated fatty acids (MUFA) in students living in a university hall of residence. Although the benefits of such diets have been reported for plasma lipoproteins in high-risk groups, more needs to be known about effects of more modest SFA-MUFA substitutions over the long term and in young healthy adults. In a parallel design over 16 weeks, fifty-one healthy young subjects were randomised to one of two diets: (1) a moderate-MUFA diet in which 16 g dietary SFA/100 g total fatty acids were substituted with MUFA (n 25); (2) a high-MUFA diet in which 33 g dietary SFA/100 g total fatty acids were substituted with MUFA (n 26). All subjects followed an 8-week run-in diet (reference diet), with a fatty acid composition close to the UK average values. There were no differences in plasma lipid responses between the two diets over 16 weeks of the study with similar reductions in total cholesterol (P<0.001) and LDL-cholesterol (P<0.01) in both groups; a small but significant reduction in HDL-cholesterol was also observed in both groups (P<0.01). Platelet responses to ADP (P<0.01) and arachidonic acid (P<0.05) differed with time on the two diets; at 16 weeks, platelet aggregatory response to ADP was significantly lower on the high-MUFA than the moderate-MUFA (P<0.01) diet; ADP responses were also significantly lower within this group at 8 (P<0.05) and 16 (P<0.01) weeks compared with baseline. There were no differences in fasting factor VII activity (factors VIIc and VIIag), fibrinogen concentration or tissue-type plasminogen activator activity between the diets. There were no differences in postprandial factor VIIc responses to a standard meal (area under the curve) between the diets after 16 weeks, but postprandial factor VIIc response was lower than on the high-MUFA diet compared with baseline (P<0.01). In conclusion, a high-MUFA diet sustains potentially beneficial effects on platelet aggregation and postprandial activation of factor VII. Moderate or high substitution of MUFA for SFA achieves similar reductions in fasting blood lipids in young healthy subjects.