Paleolithic nutrition improves plasma lipid concentrations of hypercholesterolemic adults to a greater extent than traditional heart-healthy dietary recommendations. Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. Beneficial effects of a Paleolithic diet on cardiovascular risk factors in type 2 diabetes: a randomized cross-over pilot study Paleolithic nutrition: twenty-five years later. Nutrition education in supermarkets: An unsuccessful attempt to influence knowledge and product sales Improving nutrition in Finland. What do review papers conclude about food and dietary patterns? Vitamin and Mineral Supplements: What Clinicians Need to Know. Substitution analysis in nutritional epidemiology: proceed with caution Tailored, iterative, printed dietary feedback is as effective as group education in improving dietary behaviours: results from a randomised control trial in middle-aged adults with cardiovascular risk factors A paleolithic diet is more satiating per calorie than a mediterranean-like diet in individuals with ischemic heart disease The key to life nutrition program: results from a community-based dietary sodium reduction trial. A Paleolithic Diet with and without Combined Aerobic and Resistance Exercise Increases Functional Brain Responses and Hippocampal Volume in Subjects with Type 2 Diabetes A long-term nutrition intervention experience: lipid responses and dietary adherence patterns in the Multiple Risk Factor Intervention Trial. National Institutes of Health State-of-the-Science Conference Statement: Multivitamin/Mineral Supplements and Chronic Disease Prevention Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Characteristics of the diet patterns tested in the optimal macronutrient intake trial to prevent heart disease (OmniHeart): options for a heart-healthy diet. Prudent diet and the risk of insulin resistance. Associations between dietary pattern and lifestyle, anthropometry and other health indicators in the elderly participants of the EPIC-Italy cohort. Development and Evaluation of a Nutritional Smartphone Application for Making Smart and Healthy Choices in Grocery Shopping Identification of a dietary pattern prospectively associated with bone mass in Australian young adults. DASH (Dietary Approaches to Stop Hypertension) Diet and Risk of Subsequent Kidney Disease. A prospective study of diet quality and mortality in women.
Recent research suggests that traditional grain-based heart-healthy diet recommendations , which replace dietary saturated fat with carbohydrate and reduce total fat intake , may result in unfavorable plasma lipid ratios , with reduced high-density lipoprotein ( HDL ) and an elevation of low-density lipoprotein ( LDL ) and triacylglycerols ( TG ) . The current study tested the hypothesis that a grain-free Paleolithic diet would induce weight loss and improve plasma total cholesterol , HDL , LDL , and TG concentrations in nondiabetic adults with hyperlipidemia to a greater extent than a grain-based heart-healthy diet , based on the recommendations of the American Heart Association . Twenty volunteers ( 10 male and 10 female ) aged 40 to 62 years were selected based on diagnosis of hypercholesterolemia . Volunteers were not taking any cholesterol-lowering medications and adhered to a traditional heart-healthy diet for 4 months , followed by a Paleolithic diet for 4 months . Regression analysis was used to determine whether change in body weight contributed to observed changes in plasma lipid concentrations . Differences in dietary intakes and plasma lipid measures were assessed using repeated- measures analysis of variance . Four months of Paleolithic nutrition significantly lowered ( P < .001 ) mean total cholesterol , LDL , and TG and increased ( P < .001 ) HDL , independent of changes in body weight , relative to both baseline and the traditional heart-healthy diet . Paleolithic nutrition offers promising potential for nutritional management of hyperlipidemia in adults whose lipid profiles have not improved after following more traditional heart-healthy dietary recommendations While the role of diet and nutrition in cognitive health and prevention of dementia  in older adults has attracted much attention , the efficacy of different dietary patterns remains uncertain . Previous review s have mainly focused on the Mediterranean diet , but either omitted other dietary patterns , lacked more recent studies , were based on cross-sectional studies , or combined older and younger population s. We followed PRISMA guidelines , and examined the efficacy of current research from r and omized controlled trials and cohort studies on the effects of different dietary patterns . We review ed the Mediterranean diet , Dietary Approach to Stop Hypertension ( DASH ) diet , the Mediterranean-DASH diet Intervention for Neurodegenerative Delay ( MIND ) diet , Anti-inflammatory diet , Healthy diet recommended by guidelines via dietary index , or Prudent healthy diets generated via statistical approaches , and their impact on cognitive health among older adults . Of 38 studies , the Mediterranean diet was the most investigated with evidence supporting protection against cognitive decline among older adults . Evidence from other dietary patterns such as the MIND , DASH , Anti-inflammatory , and Prudent healthy diets was more limited but showed promising results , especially for those at risk of cardiovascular disease . Overall , this review found positive effects of dietary patterns including the Mediterranean , DASH , MIND , and Anti-inflammatory diets on cognitive health outcomes in older adults . These dietary patterns are plant-based , rich in poly- and mono-unsaturated fatty acids with lower consumption of processed foods . Better underst and ing of the underlying mechanisms and effectiveness is needed to develop comprehensive and practical dietary recommendations against age-related cognitive decline among older adult Background Our aim was to compare the effects of a Paleolithic ( ' Old Stone Age ' ) diet and a diabetes diet as generally recommended on risk factors for cardiovascular disease in patients with type 2 diabetes not treated with insulin . Methods In a r and omized cross-over study , 13 patients with type 2 diabetes , 3 women and 10 men , were instructed to eat a Paleolithic diet based on lean meat , fish , fruits , vegetables , root vegetables , eggs and nuts ; and a Diabetes diet design ed in accordance with dietary guidelines during two consecutive 3-month periods . Outcome variables included changes in weight , waist circumference , serum lipids , C-reactive protein , blood pressure , glycated haemoglobin ( HbA1c ) , and areas under the curve for plasma glucose and plasma insulin  in the 75 g oral glucose tolerance test . Dietary intake was evaluated by use of 4-day weighed food records . Results Study participants had on average a diabetes duration of 9 years , a mean HbA1c of 6,6 % units by Mono-S st and ard and were usually treated with metformin alone ( 3 subjects ) or metformin in combination with a sulfonylurea ( 3 subjects ) or a thiazolidinedione ( 3 subjects ) . Mean average dose of metformin was 1031 mg per day . Compared to the diabetes diet , the Paleolithic diet result ed in lower mean values of HbA1c ( -0.4 % units , p = 0.01 ) , triacylglycerol ( -0.4 mmol/L , p = 0.003 ) , diastolic blood pressure ( -4 mmHg , p = 0.03 ) , weight ( -3 kg , p = 0.01 ) , BMI ( -1 kg/m2 , p = 0.04 ) and waist circumference ( -4 cm , p = 0.02 ) , and higher mean values of high density lipoprotein cholesterol ( + 0.08 mmol/L , p = 0.03 ) . The Paleolithic diet was mainly lower in cereals and dairy products , and higher in fruits , vegetables , meat and eggs , as compared with the Diabetes diet . Further , the Paleolithic diet was lower in total energy , energy density , carbohydrate , dietary glycemic load , saturated fatty acids and calcium , and higher in unsaturated fatty acids , dietary cholesterol and several vitamins . Dietary GI was slightly lower in the Paleolithic diet ( GI = 50 ) than in the Diabetic diet ( GI = 55 ) . Conclusion Over a 3-month study period , a Paleolithic diet improved glycemic control and several cardiovascular risk factors compared to a Diabetes diet in patients with type 2 diabetes . Trial registration Clinical Trials.gov NCT00435240 A quarter century has passed since the first publication of the evolutionary discordance hypothesis , according to which departures from the nutrition and activity patterns of our hunter-gatherer ancestors have contributed greatly and in specifically definable ways to the endemic chronic diseases of modern civilization . Refinements of the model have changed it in some respects , but anthropological evidence continues to indicate that ancestral human diets prevalent during our evolution were characterized by much lower levels of refined carbohydrates and sodium , much higher levels of fiber and protein , and comparable levels of fat ( primarily unsaturated fat ) and cholesterol . Physical activity levels were also much higher than current levels , result ing in higher energy throughput . We said at the outset that such evidence could only suggest testable hypotheses and that recommendations must ultimately rest on more conventional epidemiological , clinical , and laboratory studies . Such studies have multiplied and have supported many aspects of our model , to the extent that in some respects , official recommendations today have targets closer to those prevalent among hunter-gatherers than did comparable recommendations 25 years ago . Furthermore , doubts have been raised about the necessity for very low levels of protein , fat , and cholesterol intake common in official recommendations . Most impressively , r and omized controlled trials have begun to confirm the value of  hunter-gatherer diets  in some high-risk groups , even as compared with routinely recommended diets . Much more research needs to be done , but the past quarter century has proven the interest and heuristic value , if not yet the ultimate validity , of the model Although much evidence links dietary patterns with coronary heart disease , effective and economical methods for inducing dietary change in non clinical population s are needed to influence public health . This study was design ed as a preliminary investigation of the feasibility of conducting effective nutrition education campaigns in supermarket setting s. Eight supermarkets from a supermarket chain in the Twin Cities area participated . Four were assigned to an experimental condition in which educational material s consisting of posters , recipes , and brochures were placed in the dairy section during a 6-month period .  Four other stores were assigned to a control condition and received no educational material s. Shoppers in experimental and control stores completed a nutrition survey pre- and post-intervention . In addition , sales data for 25 dairy products were collected during a 10-month period . A significant increase in knowledge on the nutrition survey between pre- and posttests occurred among shoppers in all stores . There was no significant knowledge or product sales effect due to the education campaign . Study results suggest that , overall , shopper knowledge of food selection s for cardiovascular disease risk reduction is high and improving . Unfortunately , knowledge is often not reflected in food purchase patterns Finl and is a Northern European ( Nordic ) country with an economy traditionally based on agriculture , particularly milk production , and forestry . After the war , the country experienced rapid industrialisation . The interplay between a growing economy and traditional habits result ed in increased consumption of fatty dairy products , with unfavourable effects on lipid metabolism and risk of CVD . High serum cholesterol levels were found to be characteristic for lumberjacks in a health survey performed in the 1950s in Eastern Finl and . Subsequently , two cohorts of Finnish men were included in a prospect i ve cross-cultural study on CHD in seven countries . Men in the Eastern cohort showed the highest intake of SFA , the highest mean serum cholesterol levels and the highest mortality in CHD among the fifteen cohorts of the study . Men in the Southwestern cohort showed lower risk levels that were comparable to the levels in the Netherl and s and the Unites States . At the same time middle-aged Finnish men were found to have the highest CHD mortality in the world according to the WHO statistics . Awareness of the association between diet and the risk of CHD has prompted the development of surveys and the monitoring of risk factors and nutrition in the Finnish population . In this special issue , the subsequent development of nutrition in Finl and over the past 30 years is review ed , mainly on the basis of the activities of the National Public Health Institute , renamed after a reorganisation in 2009 , the National Institute for Health and Welfare . The diet of population sample s from different areas of the country was surveyed in 1967–1973 , and , starting in 1982 , the food habits of sub sample s from the FINRISK risk factor surveys have been studied at 5-year intervals . The model , originally tested in the North Karelia project in two Eastern provinces , was exp and ed first to cover an area in the Southwest and subsequently the capital area in the South , and the districts of Oulu and Lapl and in the North . The most recent FINDIET 2007 survey indicated a definite improvement in the dietary habits of adult Finns , particularly in the fatty acid composition and in salt intake . Mean serum cholesterol levels have declined by 20 % during the past 25 years , and changes in dietary fat composition explain 60–65 % of the decline . A decline in the initially high CHD mortality began in the late 1960s and has continued ever since . Between 1982 and 1997 the age-adjusted mortality declined by 63 % , and 37 % of this decline was estimated to result from serum cholesterol lowering . Several factors have been involved in the positive development observed in Finl and . Availability of reduced-fat dairy and meat products has been facilitated by the product developments of the food industry . Dietary fat modification has been promoted by domestic rapeseed crops and the production of rapeseed oil , which is now the principal vegetable oil and the main ingredient of soft fat spreads used in Finl and . The increased availability of imported fruit and vegetables has reduced the seasonal variation of intakes and explains the 3to 4-fold increase in average consumption . Dietary recommendations for the population were introduced in 1981 and have been revised regularly , during recent years in collaboration with the other Nordic countries . One of the major objectives of the recommendations is to act as guidelines for planning of diets in mass catering . In Finl and , findings reflecting the influence of the recommendations include healthier food choices by people who use the catering services of worksite canteens and children who consume school meals and the more balanced diet of pre-school children attending day care outside home compared with those cared for at home . Despite the decrease in classical cardiovascular risk factors and in cardiovascular mortality , obesity and the incidence of type 2 diabetes have continued to increase in Finl and . More than 10 % of the adult Finnish population are estimated to have type 2 diabetes , about one-half of them unaware that they have the disease . The possibilities of preventing the manifestation of type 2 diabetes in atrisk individuals were highlighted in the Finnish Diabetes Prevention Study , co-ordinated by the National Public Health Institute and conducted in the five university hospital districts of Finl and . The multi-factorial programme including modest weight reduction , reduction in intakes of total fat and SFA , increased intake of fibre and regular ( .30 min/d ) physical activity  reduced the incidence of diabetes by 58 % and prevented diabetes in all those subjects who were able to fulfil four or five of the five goals of the intervention programme . The lessons learned from the present study are being applied in projects on detection and prevention of diabetes in several hospital districts across the country . The Finnish government has been slow in establishing guidelines on nutrition and incorporating them in policy , but in June 2008 the current cabinet presented a resolution on guidelines for health-enhancing physical activity and nutrition that was accepted as part of a policy programme for health promotion . The resolution suggests that promotion of health-enhancing physical activity and healthy diets should take place by influencing culture , living environments , life circumstances , food Nutrients and other bioactive constituents of foods may interact with each other and the surrounding food matrix in complex ways . Therefore , associations between single nutrients and chronic disease may be difficult to identify and interpret , but when dietary patterns ( DPs ) are examined the combination of many food factors will be considered . An explorative literature search of published review articles was conducted to obtain a fuller underst and ing of current DPs in epidemiological research , to discuss pros and cons of DPs in nutrition research , and to identify results of studies linking DPs to chronic disease risk in adults . R and omized feeding trials providing the experimental diets to study participants have repeatedly demonstrated that diets based on current dietary recommendations are associated with important health benefits . Systematic review s of feeding trials and prospect i ve population studies of DPs and chronic disease risk reach similar conclusions regardless of the methodology used to construct DPs . However , to date only a few review articles of DP studies have followed a systematic process using independent review ers with strict inclusion , exclusion , and study quality criteria . Diets with plenty of plants foods , fish , and seafood that preferably include vegetable oils and low-fat dairy products are associated with a lower risk of most chronic diseases . In contrast , Western-type DPs with food products low in essential nutrients and high in energy , like sugar-sweetened beverages , sweets , refined cereals and solid fats ( e.g. butter ) , and high in red and processed meats , are associated with adverse health effects . An emphasis on high- quality original research , and systematic review s following a structured process to objective ly select and judge studies , is needed in order to enforce a strong future knowledge base regarding DPs and chronic disease Dietary supplementation is approximately a $ 30 billion industry in the United States , with more than 90 000 products on the market . In recent national surveys , 52 % of US adults reported use of at least 1 supplement product , and 10%reporteduseofatleast4suchproducts.1 Vitamins and minerals are among the most popular supplements and are taken by 48 % and 39 % of adults , respectively , typically to maintain health and prevent disease . Despite this enthusiasm , most r and omized clinical trials of vitamin and mineral supplements have not demonstrated clear benefits for primary or secondary prevention of chronic diseases not related to nutritional deficiency . Indeed , some trials suggest that micronutrient supplementation in amounts that exceed the recommended dietary allowance (RDA)—eg , high doses of beta carotene , folic acid , vitamin E , or selenium — may have harmful effects , including increased mortality , cancer , and hemorrhagic stroke.2 In this Viewpoint , we provide information to help clinicians address frequently asked questions about micronutrient supplements from patients , as well as promote appropriate use and curb inappropriate use of such supplements among generally healthy individuals . Importantly , clinicians should counsel their patients that such supplementation is not a substitute for a healthful and balanced diet and , in most cases , provides little if any benefit beyond that conferred by such a diet . Clinicians should also highlight the many advantages of obtaining vitamins and minerals from food instead of from supplements . Micronutrients in food are typically better absorbed by the body and are associated with fewer potential adverse effects.2,3 A healthful diet provides an array of nutritionally important substances in biologically optimal ratios as opposed to isolated compounds in highly concentrated form . Indeed , research shows that positive health outcomes are more strongly related to dietary patterns and specific food types than to individual micronutrient or nutrient intakes.3 Although routine micronutrient supplementation is not recommended for the general population , targeted supplementation may be warranted in high-risk groups for whom nutritional requirements may not be met through diet alone , including people at certain life stages and those with specific risk factors ( discussed in the next 3 sections and in the Box ) Substitution analysis has been increasingly used in nutritional epidemiologic research . It was originally used to compare the health effects of different macronutrients in an isocaloric setting [ 1 ] . This application is easy to underst and , since calories are considered relatively constrained for an individual . In essence , substitution analysis provides a statistical technique to mimic feeding studies that aim to identify the optimal diet by altering macronutrient composition while holding total caloric intake constant [ 2 ] . Using this approach , for instance , it has been established that replacing saturated fats and trans fats with monounsaturated and polyunsaturated fats ismore effective in preventing coronary heart disease than reducing overall fat intake by replacing it with the commonly consumed carbohydrate sources [ 3 ] . Beyond the health effects of macronutrient composition , an increasing number of studies have started using substitution analysis to compare the relative health associations of different food sources of certain macronutrients . For example , as a major source of carbohydrate in the US , potatoes and potato products have been compared with whole grains and refined grains for the influence on type 2 diabetes ( T2D ) [ 4 ] . Reciprocal substitution of major dietary protein sources , such as red meat , fish , poultry , dairy , and plants , have been studied in cardiovascular disease and mortality [ 5 , 6 ] . Exemplified as further expansion of the application , two studies in this issue of the Journal used substitution analysis to assess intake of different foods within a certain category in relation to disease risk . van den Br and t [ 7 ] compared the associations of two commonly consumed beverages , tea and coffee , with  mortality  in the Netherl and s Cohort Study and observed a sex-specific association pattern : while replacing coffee with tea was associated with lower mortality in men , a higher percentage of tea consumption of total coffee and tea was associated with increased mortality in women [ 7 ] . Laursen et al. [ 8 ] evaluated the associations for substitutions between subgroups of dairy products with the risk of stroke in the Danish Diet , Cancer and Health cohort , and found a beneficial association with ischemic stroke for substitution of whole-fat fermented milk for semi-skimmed fermented milk , cheese , buttermilk or milk of any fat content . Applying similar principles , Schwingshackl et al. [ 9 ] performed a network meta- analysis of 56 r and omized trials to assess the comparative efficacy of nine different dietary approaches on glycemic control in T2D patients . The findings suggest that , while all dietary approaches significantly reduce HbA1c and fasting glucose compared to a control diet , the Mediterranean diet seems most efficacious for improving glycemic control in T2D patients . These studies represent exp and ed applications of the substitution modeling approach from nutrient-based analysis to comparison of food groups or dietary patterns . These applications are particularly useful to inform dietary guidelines by either prioritizing foods within a certain group ( e.g. , beverage , dairy ) or identifying the optimal diet for better disease control and prevention . However , these applications pose new challenges , because compared to macronutrients , foods are far more complicated in several aspects . First , most food groups encompass more than three types of foods . For example , besides tea and coffee , there are other beverages such as water , juice and soda that may & Edward Giovannucci Background Tailored nutrition interventions have been shown to be more effective than non-tailored material s in changing dietary behaviours , particularly fat intake and fruit and vegetable intake . But further research examining efficacy of tailored nutrition education in comparison to other nutrition education methods and across a wider range of dietary behaviours is needed . The Stages to Healthy Eating Patterns Study ( STEPs ) was an intervention study , in middle-aged adults with cardiovascular risk factors , to examine the effectiveness of printed , tailored , iterative dietary feedback delivered by mail in improving short-term dietary behaviour in the areas of saturated fat , fruit , vegetable and grain and cereal intake . Methods STEPs was a 3-month r and omised controlled trial with a pre and post-test design . There were three experimental conditions : 1 ) tailored , iterative , printed dietary feedback ( TF ) with three instalments mail-delivered over a 3-month period that were re-tailored to most recent assessment of dietary intake , intention to change and assessment of self-adequacy of dietary intake . Tailoring for dietary intake was performed on data from a vali date d 63-item combination FFQ design ed for the purpose 2 ) small group nutrition education sessions ( GE ) : consisting of two 90-minute dietitian-led small group nutrition education sessions and 3 ) and a wait-listed control ( C ) group who completed the dietary measures and socio-demographic question naires at baseline and 3-months later . Dietary outcome measures in the areas of saturated fat intake ( g ) , and the intake of fruit ( serves ) , vegetables ( serves ) , grain and cereals as total and wholegrain ( serves ) were collected using 7-day estimated dietary records . Descriptive statistics , paired t-tests and general linear models adjusted for baseline dietary intake , age and gender were used to examine the effectiveness of different nutrition interventions . Results The TF group reported a significantly greater increase in fruit intake ( 0.3 serves/d P = 0.031 ) in comparison to GE and the C group . All three intervention groups showed a reduction in total saturated fat intake . GE also had a within-group increase in mean vegetable intake after 3 months , but this increase was not different from changes in the other groups . Conclusions In this study , printed , tailored , iterative dietary feedback was more effective than small group nutrition education in improving the short-term fruit intake behaviour , and as effective in improving saturated fat intake of middle-aged adults with cardiovascular risk factors . This showed that a low-level dietary intervention could achieve modest dietary behaviour changes that are of public health significance Background We found marked improvement of glucose tolerance and lower dietary  energy  intake in ischemic heart disease ( IHD ) patients after advice to follow a Paleolithic diet  , as compared to a Mediterranean-like diet . We now report findings on subjective ratings of satiety at meals and data on the satiety hormone leptin and the soluble leptin receptor from the same study . Methods Twenty-nine male IHD patients with impaired glucose tolerance or diabetes type 2 , and waist circumference > 94 cm , were r and omized to ad libitum consumption of a Paleolithic diet ( n = 14 ) based on lean meat , fish , fruit , vegetables , root vegetables , eggs , and nuts , or a Mediterranean-like diet ( n = 15 ) based on whole grains , low-fat dairy products , vegetables , fruit , fish , and oils and margarines during 12 weeks . In parallel with a four day weighed food record the participants recorded their subjective rating of satiety . Satiety Quotients were calculated , as the intra-meal quotient of change in satiety during meal and consumed energy or weight of food and drink for that specific meal . Leptin and leptin receptor was measured at baseline and after 6 and 12 weeks . Free leptin index was calculated as the ratio leptin/leptin receptor . Results The Paleolithic group were as satiated as the Mediterranean group but consumed less energy per day ( 5.8 MJ/day vs. 7.6 MJ/day , Paleolithic vs. Mediterranean , p = 0.04 ) . Consequently , the quotients of mean change in satiety during meal and mean consumed energy from food and drink were higher in the Paleolithic group ( p = 0.03 ) . Also , there was a strong trend for greater Satiety Quotient for energy in the Paleolithic group ( p = 0.057 ) . Leptin decreased by 31 % in the Paleolithic group and by 18 % in the Mediterranean group with a trend for greater relative decrease of leptin in the Paleolithic group . Relative changes in leptin and changes in weight and waist circumference correlated significantly in the Paleolithic group ( p < 0.001 ) but not in the Mediterranean group . Changes in leptin receptor and free leptin index were not significant . Conclusions A Paleolithic diet is more satiating per calorie than a Mediterranean-like diet . Trial registration Clinical Trials.gov OBJECTIVE Evaluation of a dietary Na reduction trial in a community setting . DESIGN Community-based r and omized trial . Ten-week nutrition intervention activities focused on lifestyle modification to decrease dietary Na intake , under the supervision of a registered dietitian . Twenty-four hour urine specimens were collected at baseline and follow-up visits to determine 24 h urinary Na excretion . SETTING The University of Pittsburgh Center for Healthy Aging , Key to Life Nutrition Program . SUBJECTS Hypertensive adults at least 65 years of age . RESULTS Mean age of participants was 75 years . Twenty-four hour mean urinary Na excretion at baseline was 3174 mg/d . This reduced to 2944 mg/d ( P = 0.30 ) and 2875 mg/d ( P < or= 0.03 ) at 6- and 12-month follow-ups , respectively . In a sub- sample ( urine volume of > or=1000 ml , baseline to 12 months ) , mean urinary Na excretion decreased from 3220 mg/d to 2875 mg/d ( P < or= 0.02 ) . CONCLUSIONS Significant reductions in mean 24 h urinary Na were reported , but results fell short of the recommended guidelines of 1500 mg/d for at-risk individuals . Our results reiterate the difficulty in implementing these guidelines in community-based programmes . More aggressive public health efforts , food industry support and health policy changes are needed to decrease Na levels in older adults to the recommended guidelines Type 2 diabetes is associated with impaired episodic memory functions and increased risk of different dementing disorders . Diet and exercise may potentially reverse these impairments . In this study , sedentary individuals with type 2 diabetes treated by lifestyle ± metformin were r and omized  to a Paleolithic diet ( PD , n = 12 ) with and without high intensity exercise ( PDEX , n = 12 ) for 12 weeks . Episodic memory function , associated functional brain responses and hippocampal gray matter volume was measured by magnetic resonance imaging . A matched , but not r and omized , non-interventional group was included as a reference ( n = 6 ) . The PD included a high intake of unsaturated fatty acids and protein , and excluded the intake of dairy products , grains , refined sugar and salt . The exercise intervention consisted of 180 min of supervised aerobic and resistance exercise per week . Both interventions induced a significant weight loss , improved insulin sensitivity and increased peak oxygen uptake without any significant group differences . Furthermore , both interventions were associated with increased functional brain responses within the right anterior hippocampus , right inferior occipital gyrus and increased volume of the right posterior hippocampus . There were no changes in memory performance . We conclude that life-style modification may improve neuronal plasticity in brain areas linked to cognitive function in type 2 diabetes . Putative long-term effects on cognitive functions including decreased risk of dementing disorders await further studies . Clinical trials registration number : Clinical trials . gov NCT01513798 Nutrition counselors in the Multiple Risk Factor Intervention Trial ( MRFIT ) were able to help middle-aged men who were at high risk for coronary heart disease change their dietary habits , maintain those changes over time , and decrease their serum cholesterol levels . Most of a 7.5 % mean serum cholesterol reduction achieved after 6 years of nutrition intervention occurred during the first year of the trial and was thereafter sustained . Total cholesterol and low-density lipoprotein cholesterol fraction decreases indicated improvement in terms of coronary heart disease risk . The food record rating , a numerical , semi- objective adherence technique that assesses a 3-day food record with respect to lipid-lowering potential , was used throughout the trial to measure adherence to recommended food patterns . Participants with lower food record rating scores , which indicate better adherence , demonstrated greater reductions in serum total cholesterol , plasma total cholesterol , and low-density lipoprotein fraction cholesterol determinations on a group basis . Subjective evaluations of the suitability of home and working environments , evidence of deviation from the MRFIT food patterns , and overall nutrition program motivation also showed that as ratings in each category became more favorable , lower food record rating scores and greater blood lipid reductions were consistently observed . The subgroup of participants who were non-smokers and not hypertensive demonstrated greater lipid responses and better dietary adherence . Continued smoking and antihypertensive medications appeared to adversely influence dietary adherence and /or lipid reductions . The MRFIT experience , however , demonstrated for the first time that dietary changes and blood lipid reductions can be achieved after the initial intervention effect , despite a continued emphasis on high blood pressure management and smoking cessation National Institutes of Health ( NIH ) consensus and state-of-the-science statements are prepared by independent panels of health professionals and public representatives on the basis of 1 ) the results of a systematic literature review prepared under contract with the Agency for Healthcare Research and Quality ( AHRQ ) , 2 ) presentations by investigators working in areas relevant to the conference questions during a 2-day public session , 3 ) questions and statements from conference attendees during open discussion periods that are part of the public session , and 4 ) closed deliberations by the panel during the remainder of the second day and the morning of the third . This statement is an independent report of the panel and is not a policy statement of the NIH or the federal government . The statement reflects the panel 's assessment of medical knowledge available at the time the statement was written . Thus , it provides a snapshot in time of the state of knowledge on the conference topic . When reading the statement , keep in mind that new knowledge is inevitably accumulating through medical research . At least half of American adults take a dietary supplement , the majority of which are multivitamin/multimineral ( MVM ) supplements . As more and more Americans seek strategies for maintaining good health and preventing disease , and as the marketplace offers an increasing number of products to fulfill that desire , it is important that consumers have the best possible information to make their choices . Assessing the available scientific evidence on the benefits of MVM supplement use for chronic disease prevention , identifying the gaps in the evidence , and recommending an appropriate research agenda to meet the shortfalls are subjects considered in this report . The word vitamine was coined in 1912 , as an abbreviated term meant to capture the notion of important factors in the diet , or vital amines . This was preceded more than 150 years earlier by British navy physician James Lind 's discoveryin the first recorded controlled trialthat citrus juice , a good source of what was found 2 centuries later to be vitamin C , could prevent scurvy in sailors . In 1913 , the first vitamin was isolated : thiamin , the deficiency of which caused beriberi . Thirteen vitamins and 15 essential minerals have now been identified as important to human nutrition . Large-scale fortification of diets began in the United States with the addition of iodine to table salt in 1924 to prevent goiter , followed by the addition of vitamin D to milk in 1933 to prevent rickets and the addition of thiamin , riboflavin , niacin , and iron to flour in 1941 . Multivitamin/multimineral products providing more than vitamins A and D became available in pharmacies and grocery stores in the mid-1930s . In the early 1940s , the first MVM tablet was introduced . Although clinical deficiency of vitamins or minerals , other than iron , is now uncommon in the United States , growth in supplement use has accelerated rapidly with marketing spurred by cl aims some based on scientific studies that chronic conditions could be prevented or treated by supplement use . Annual sales of supplements to Americans are now reported at about $ 23 billion , a substantial share of which is spent on vitamins and minerals . Because of such widespread use of MVM , increasing public and medical confusion over apparently contradictory results from studies , and reports of possible adverse effects from overuse in certain circumstances , the Office of Dietary Supplements and the Office of Medical Applications of Research of the NIH convened a State-of-the-Science Conference on Multivitamin/Mineral Supplements and Chronic Disease Prevention , held on 1517 May 2006 , in Bethesda , Maryl and . The goal of the conference was to assess the evidence available on MVM use and outcomes for chronic disease prevention in the generally healthy population of adults and to make recommendations for future research . The conference focused on vitamins and minerals and did not deal with botanicals , hormones , or other supplements . It also did not address the treatment of vitamin or mineral deficiencies . Except for considerations of safety , the conference also did not review issues of primary relevance to pregnant women or children . Specifically , the conference explored the following key questions : 1 ) What are the current patterns and prevalence of the public 's use of MVM supplements ? 2 ) What is known about the dietary nutrient intake of MVM users versus nonusers ? 3 ) What is the efficacy of single vitamin/mineral supplement use in chronic disease prevention ? 4 ) What is the efficacy of MVM  in chronic disease prevention in the general population of adults ? 5 ) What is known about the safety of MVM  for the generally healthy population ? and 6 ) What are the major knowledge gaps and research opportunities regarding MVM use ? During the first 2 days of the conference , experts presented information on each of the key questions . After weighing the scientific evidence , including the data presented by the speakers and a formal evidence report commissioned through AHRQ , an independent panel prepared and presented a draft of this state-of-the-science statement addressing the conference questions . The evidence report prepared for the conference is available at www.ahrq.gov/clinic/tp/multivittp.htm . For the purpose of this statement , the term MVM refers to any supplement containing 3 or more vitamins and minerals but no herbs , hormones , or drugs , with each component at a dose less than the tolerable upper level determined by the Food and Nutrition Boardthe maximum daily intake likely to pose no risk for adverse health effects . Our review also included studies of the relationship of single-nutrient supplements and 2-nutrient supplements to certain disease outcomes . The term primary prevention refers to preventing the development of disease in a person who does not have the disease in question . The chronic conditions assessed include cancer ; age-related sensory loss ; and cardiovascular , endocrine , neurologic , musculoskeletal , gastroenterologic , renal , and pulmonary diseases . A word is warranted about the nature of the evidence base considered by the panel . The range of vitamins and minerals of possible interest was so broad that the conference planning committee chose to focus the evidence report on nutrients for which the potential for impact had been most strongly suggested and on conditions for which supplements were thought to have the most potential influence . The planning committee also limited the scope of the evidence report to consideration of r and omized , controlled trials ( RCTs ) , which are generally considered the gold st and ard for evidence -based decision making . These are studies in which participants are allocated by chance alone to receive or not to receive 1 of 2 or more clinical interventions . For example , while folate supplementation was initially shown to decrease the risk for neural tube defects in animal studies , outcome data in nonhuman models were not considered sufficient evidence on which to base policy recommendations . At the next level of evidence , observational studies in humans suggested efficacy of folate supplementation to prevent such defects . However , these were criticized because they were not r and omized and were potentially subject to bias . Not until these findings were confirmed by RCTs in humans was public policy implemented , including fortification of cereal grains with folate . An observational study is one in which the exposure or treatment of interest is not assigned to the participant by the investigator . Such studies suggested that -carotene intake might protect against the development of some types of cancer . However , RCTs of -carotene supplementation not only showed no benefit , they also found an increased risk for lung cancer in persons who smoked cigarettes or who were exposed to asbestos . These examples illustrate both the risk of relying only on observational studies and the advantage of RCTs in identifying both benefits and risks of MVM supplementation . Limiting the focus of our statement to RCTs has some inherent limitations , given the potential of other types of studies to provide important insights . Observational studies , for example , are particularly useful for generating hypotheses , defining adverse effects , and documenting long-term treatment consequences . They are often essential precursors to the well-conducted RCTs important for policy formation . Our principal recommendations focus on the compelling research activities that must be supported to better inform the decisions that millions of Americans are making each day to use or not to use MVM supplements to prevent chronic disease . At the same time , mindful of the constraints of the available evidence base , we have also taken care not to make premature recommendations about whether generally healthy Americans should or should not take MVM supplements . Because of the need for more reliable information on MVMs , we have made strong recommendations for research and for increased U.S. Food and Drug Administration ( FDA ) oversight of the MVM industry . 1 . What Are the Current Patterns and Prevalence of the Public 's Use of MVM Supplements ? More than half of American adults take dietary supplements in the belief that they will make them feel better , give them greater energy , improve their health , and prevent and treat disease . The use of supplements has been steadily increasing , and growth appears likely to continue . Currently , users spend more than $ 23 billion per year on supplements , and among this supplement-using population , MVM is the major category of supplements , used by about one third of Americans . Uncertainty remains in estimating prevalence of use because of problems defining these products ; increasing complexity in the formulation of supplements , including more non-MVM components and specialized formulas ; and varying frequency of use . It appears that use is higher BACKGROUND Few studies have examined the long-term effect of habitual diet on risks of incident diabetes , coronary heart disease , and mortality . OBJECTIVE We analyzed the prospect i ve relation of dietary patterns with incident chronic disease and mortality during 15 y of follow-up in the Whitehall II study . DESIGN We conducted a prospect i ve analysis ( 106,633 person-years at risk ) among men and women ( n = 7731 ) with a mean age of 50 y at the time of dietary assessment ( 127-item food-frequency question naire ) .  Coronary death or nonfatal myocardial infa rct ion and incident diabetes were verified by record tracing and oral-glucose-tolerance tests . RESULTS Cluster analysis identified 4 dietary patterns at baseline . The patterns were termed unhealthy ( white bread , processed meat , fries , and full-cream milk ; n = 2665 ) , sweet ( white bread , biscuits , cakes , processed meat , and high-fat dairy products ; n = 1042 ) , Mediterranean-like ( fruit , vegetables , rice , pasta , and wine ; n = 1361 ) , and healthy ( fruit , vegetables , whole-meal bread , low-fat dairy , and little alcohol ; n = 2663 ) . Compared with the unhealthy pattern , the healthy pattern reduced the risk of coronary death or nonfatal myocardial infa rct ion and diabetes ; hazard ratios ( 95 % CI ) were 0.71 ( 0.51 , 0.98 ) and 0.74 ( 0.58 , 0.94 ) , respectively , after adjustment for age , sex , ethnicity , dietary energy misreporting , social position , smoking status , and leisure-time physical activity . Dietary pattern was not associated with all-cause mortality . Residual confounding by socioeconomic factors was unlikely to account for the observed dietary effects . CONCLUSIONS The healthy eating pattern reduced risks of diabetes and major coronary events . Such dietary patterns offer considerable health benefits to individuals and contribute to public health OBJECTIVE To describe the nutrient and food composition of the diets tested in the Optimal Macronutrient Intake Trial to Prevent Heart Disease ( OmniHeart ) . DESIGN Two center , r and omized , three-period crossover , controlled feeding trial that tested the effects of three healthful diet patterns on blood pressure , serum lipid levels , and estimated cardiovascular risk . SUBJECTS/ SETTING One hundred sixty-four participants with prehypertension and hypertension . During the 19 weeks of feeding , participants were required to consume only food prepared as part of the trial . INTERVENTION The OmniHeart trial studied three diet patterns that differed in macronutrient composition : a carbohydrate-rich diet similar to the Dietary Approaches to Stop Hypertension diet ( 58 % carbohydrate , 15 % protein , and 27 % fat ) , a higher protein diet that had 10 % more protein and 10 % less carbohydrate ( 48 % carbohydrate , 25 % protein , and 27 % fat ) , and a higher unsaturated fat diet that had 10 % more unsaturated fat and 10 % less carbohydrate ( 48 % carbohydrate , 15 % protein , and 37 % fat ) . Each diet contained 6 % saturated fat and 100 to 200 mg cholesterol . Sodium was 2,300 mg at the 2,100 kcal energy level and was indexed across energy levels . Calcium , magnesium , and potassium were consistent with recommendations for the Dietary Approaches to Stop Hypertension diet and also indexed to energy levels . Each diet pattern met the major nutrient recommendations set by the Dietary Guidelines for Americans 2005 . The 10 % protein increase in the higher protein diet emphasized plant protein ; however , meat and dairy food sources were also increased somewhat . Olive oil , canola oil , and olive oil spread were used liberally to achieve the unsaturated fat content of the higher unsaturated fat diet . The 10 % reduction in carbohydrate in the higher protein diet and the higher unsaturated fat diet was achieved by replacing some fruits with vegetables , reducing sweets , and using smaller portions of grain products . All three diets reduced blood pressure , total and low-density lipoprotein cholesterol levels , and estimated coronary heart disease risk . CONCLUSIONS The OmniHeart diet patterns offer substantial flexibility in macronutrient intake that should make it easier to eat a heart-healthy diet and reduce cardiovascular disease risk BACKGROUND AND AIM Diet is a potentially modifiable risk factor for diabetes .  Dietary patterns may exert greater effects on health than individual foods , nutrients or food groups . Data on associations between dietary patterns and the risk of insulin resistance and type  2 diabetes  are sparse . The aim of the study was to examine associations between dietary patterns and the risk of insulin resistance . METHODS AND RESULTS We performed a cross sectional study involving a group of 1018 men and women , sample d from 17 general practice lists in the South of Irel and , with a response rate of 69 % . Participants completed a detailed health and lifestyle question naire and provided fasting blood sample s for analysis of glucose , insulin and lipids . Dietary intake  was assessed using a food frequency question naire . The food frequency question naire was a modification of the UK arm of the European Prospect i ve Investigation into cancer , EPIC study , which was based on that used in the US Nurses ' Health Study . Dietary patterns were assessed by K cluster analysis . Insulin resistance was estimated on the basis of fasting glucose and insulin , using the glucose homeostasis model ( HOMA scores ) . Insulin resistance was defined as the upper quartile of the HOMA scores . Three dietary patterns were identified by cluster analysis ( traditional Irish diet , a prudent diet and an alcohol and convenience foods diet ) . Participants in clusters 1 ( traditional Irish diet ) and 3 ( high alcohol and convenience foods ) had a lower intake of more ' healthy ' food groups ( such as fruit , vegetables , low fat dairy products , poultry , fish and whole grain products ) and higher intake of foods richer in total and SFA content ( such as high fat dairy products , butter , meat and meat products ) . Cluster 2 ( prudent dietary pattern ) was characterized by a higher intake of food groups that are typically recommended in health promotion programs and a lower intake of meat ( read meat ) , meat products , sweets , high fat dairy and white bread ( white bread and unrefined cereal ) . The prudent diet had the lowest HOMA scores in analysis of covariance . The prevalence of insulin resistance in the prudent diet was lower than that in the traditional diet ( OR=0.53 ; 95%CI , 0.33 - 0.85 in fully adjusted analysis ) . CONCLUSION A prudent diet may be associated with enhanced insulin sensitivity and a lower risk of type 2 diabetes INTRODUCTION Epidemiological studies have shown that dietary behaviour is an important aetiological factor in various chronic diseases . We used principal component factor analysis to identify dietary patterns and to examine the associations of these patterns with health-related variables in a sample of elderly ( > or = 60 years ) Italians participating in the European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . METHODS AND RESULTS Exploratory factor analysis was applied to the intake of food groups as estimated by semi-quantitative food question naires . Individual participants were assigned factor scores , indicating the extent to which their diet conformed to each of the four dietary patterns identified : prudent ( cooked vegetables , pulses , cabbage , seed oil and fish ) ; pasta & meat ( pasta , tomato sauce , red meat , processed meat , bread and wine ) ; olive oil & salad ( raw vegetables , olive oil , soup and chicken ) ; and sweet & dairy ( sugar , cakes , ice cream , coffee and dairy ) . Highly educated people had high scores on prudent and low scores on pasta & meat . The pasta & meat and prudent patterns were strongly positively associated with body mass index ( BMI ) and waist-to-hip ratio ( WHR ) in men and women . Hyperlipidaemic men and women consumed more of the prudent and olive oil & salad patterns and less of the sweet & dairy pattern than those with normal lipids . The olive oil & salad was significantly higher and the pasta & meat and sweet & dairy patterns significantly lower in men and women who had dieted over the previous year , suggesting awareness of the health consequences of these patterns . CONCLUSIONS Dietary pattern analysis provides a characterization of recurrent dietary behaviour in elderly people , and can be used to provide tangible dietary advice to elderly people Objectives This study developed a smartphone nutritional application ( app ) for making smart and healthy choices when purchasing food in grocery stores and tested its feasibility , usability , satisfaction and acceptability . Methods “ MyNutriCart ” was developed following the ADDIE ( analysis , design , development , implementation , and evaluation ) model . The goals of the app were to improve food selection when purchasing foods in the grocery stores based on a pre-defined budget , to improve dietary patterns based on the Dietary Guidelines for Americans , and to improve weight status . It was evaluated within a pilot r and omized trial using a convenient sample of 26 overweight or obese adults aged 21–45 years for 8 weeks . Results The developed app provided a grocery list of healthy foods to meet the individual requirements of all family members within a budget following the recommendations of the Dietary Guidelines for Americans . The average use of the app was 75 % on each purchase and only 37 % of the recommended products were purchased . The main reasons for not purchasing the recommended items were that participants did not like these ( 28.5 % ) and that the item was unavailable in the supermarket ( 24.3 % ) . Over 50 % of participants considered the app as feasible , usable , satisfactory , and acceptable ( p < 0.05 ) . Conclusions “ MyNutriCart ” is the first available app for making smart and healthy choices when purchasing food in grocery stores . This app could be used as a tool to translate recommendations into a practical grocery list that meet the needs of a family within a budget BACKGROUND Relatively little is known about the relations between dietary patterns and bone health in adolescence , which is a period of substantial bone mass accrual . OBJECTIVES We derived dietary patterns that were hypothesized to be related to bone health on the basis of their protein , calcium , and potassium contents and investigated their prospect i ve associations with bone mineral density ( BMD ) , bone area , and bone mineral content ( BMC ) in a cohort of young adults . DESIGN The study included 1024 young adults born to mothers who were participating in the Western Australian Pregnancy Cohort ( Raine ) Study .  Dietary information was obtained from food-frequency question naires at 14 and 17 y of age . Dietary patterns were characterized according to protein , calcium , and potassium intakes with the use of reduced-rank regression . BMD , bone area , and BMC were estimated with the use of a total body dual-energy X-ray absorptiometry scan at 20 y of age . RESULTS We identified 2 major dietary patterns . The first pattern was positively correlated with intakes of protein , calcium , and potassium and had high factor loadings for low-fat dairy products , whole grains , and vegetables . The second pattern was positively correlated with protein intake but negatively correlated with intakes of calcium and potassium and had high factor loadings for meat , poultry , fish , and eggs . After adjustment for anthropometric , sociodemographic , and lifestyle factors , a higher z score for the first pattern at 14 y of age was positively associated with BMD and BMC at 20 y of age [ differences : 8.6 mg/cm(2 ) ( 95 % CI : 3.0 , 14.1 mg/cm(2 ) ) and 21.9 g ( 95 % CI : 6.5 , 37.3 g ) , respectively , per SD increase in z score ] . The z score for this same pattern at 17 y of age was not associated with bone outcomes at 20 y of age . The second pattern at 14 or 17 y of age was not associated with BMD , BMC , or bone area . CONCLUSIONS A dietary pattern characterized by high intakes of protein , calcium , and potassium in midadolescence was associated with higher BMD and BMC at 20 y of age . Our results indicate that high consumption of low-fat dairy products , whole grains , and vegetables in adolescence are associated with beneficial effects on bone development BACKGROUND There are established guidelines for recommended dietary intake for hypertension treatment and cardiovascular disease prevention . Evidence is lacking for effective dietary patterns for kidney disease prevention . STUDY DESIGN Prospect i ve cohort study . SETTING & PARTICIPANTS Atherosclerosis Risk in Communities ( ARIC ) Study participants with baseline estimated glomerular filtration rate ( eGFR ) ≥ 60mL/min/1.73m2 ( N=14,882 ) . PREDICTOR The Dietary Approaches to Stop Hypertension ( DASH ) diet score was calculated based on self-reported dietary intake of red and processed meat , sweetened beverages , sodium , fruits , vegetables , whole grains , nuts and legumes , and low-fat dairy products , averaged over 2 visits . OUTCOMES Cases were ascertained based on the development of eGFRs<60mL/min/1.73m2 accompanied by ≥25 % eGFR decline from baseline , an  International Classification of Diseases , Ninth/Tenth Revision code for a kidney disease-related hospitalization or death , or end-stage renal disease from baseline through 2012 . RESULTS 3,720 participants developed kidney disease  during a median follow-up of 23 years . Participants with a DASH diet score in the lowest tertile were 16 % more likely to develop kidney disease than those with the highest score tertile ( HR , 1.16 ; 95 % CI , 1.07 - 1.26 ; P for trend < 0.001 ) , after adjusting for sociodemographics , smoking status , physical activity , total caloric intake , baseline eGFR , overweight/obese status , diabetes status , hypertension status , systolic blood pressure , and antihypertensive medication use . Of the individual components of the DASH diet score , high red and processed meat intake was adversely associated with kidney disease and high nuts , legumes , and low-fat dairy products intake was associated with reduced risk for kidney disease . LIMITATIONS Potential measurement error due to self-reported dietary intake and lack of data for albuminuria . CONCLUSIONS Consuming a DASH-style diet was associated with lower risk for kidney disease independent of demographic characteristics , established kidney risk factors , and baseline kidney function . Healthful dietary patterns such as the DASH diet may be beneficial for kidney disease prevention CONTEXT Most studies of diet and health care have focused on the role of single nutrients , foods , or food groups in disease prevention or promotion . Few studies have addressed the health effects of dietary patterns , which include complex mixtures of foods containing multiple nutrients and nonnutrients . OBJECTIVE To examine the association of mortality with a multifactorial diet quality index . DESIGN AND SETTING Data from phase 2 ( 1987 - 1989 ) of a prospect i ve cohort study of breast cancer screening , the Breast Cancer Detection Demonstration Project , with a median follow-up of 5.6 years . PARTICIPANTS A total of 42,254 women ( mean age , 61.1 years ) who completed the food frequency question naire portion of the survey .  MAIN OUTCOME MEASURE All-cause mortality by quartile of Recommended Food Score ( RFS ; the sum of the number of foods recommended by current dietary guidelines [ fruits , vegetables , whole grains , low-fat dairy , and lean meats and poultry ] that were reported on the question naire to be consumed at least once a week , for a maximum score of 23 ) . RESULTS There were 2065 deaths due to all causes in the cohort . The RFS was inversely associated with all-cause mortality . Compared with those in the lowest quartile , subjects in the upper quartiles of the RFS had relative risks for all-cause mortality of 0.82 ( 95 % confidence interval [ CI ] , 0.73 - 0.92 ) for quartile 2 , 0.71 ( 95 % CI , 0.62 - 0.81 ) for quartile 3 , and 0.69 ( 95 % CI , 0.61 - 0.78 ) for quartile 4 adjusted for education , ethnicity , age , body mass index , smoking status , alcohol use , level of physical activity , menopausal hormone use , and history of disease ( chi2 for trend = 35.64 , P<.001 for trend ) . CONCLUSIONS These data suggest that a dietary pattern characterized by consumption of foods recommended in current dietary guidelines is associated with decreased risk of mortality in women
The home-delivery ( n = 1 ) and dietary recommendation ( n = 3 ) RCTs showed similar effects with the exception of greater improvements in triglycerides relative to the control with the home delivery .
None of the RCTs evaluated an improvement in quality of life .
The Paleolithic diet result ed in greater short-term improvements in metabolic syndrome components than did guideline -based control diets .
BACKGROUND Paleolithic nutrition , which has attracted substantial public attention lately because of its putative health benefits , differs radically from dietary patterns currently recommended in guidelines , particularly in terms of its recommendation to exclude grains , dairy , and nutritional products of industry .
OBJECTIVE We evaluated whether a Paleolithic nutritional pattern improves risk factors for chronic disease more than do other dietary interventions .