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Nelia P. Steyn - One of the best experts on this subject based on the ideXlab platform.
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13. “If you drink alcohol, drink sensibly.” Is this Guideline still appropriate?
The South African journal of clinical nutrition, 2013Co-Authors: Liezille Jacobs, Nelia P. SteynAbstract:Background: Alcohol abuse remains one of the most serious substance abuse disorders in South African society, resulting in inordinately large social, economic and health problems at all levels of society. Alcohol consumers in South Africa are estimated to drink 16.6 l per annum, with a per capita consumption of 7.1 l. South Africa has one of the highest rates of deaths attributable to crime, violence, traffic accidents and HIV/AIDS in the world. These rates relate directly to the high prevalence of alcohol abuse and risky drinking patterns. A food-based Dietary Guideline that appears to encourage alcohol consumption is not in the nation’s best interest. Method: A search was conducted of websites supported by the World Health Organization to find published literature on substance abuse in South Africa. The website of the Medical Research Council of South Africa for studies on the social impact of alcohol abuse on humans was also reviewed. The search terms “alcohol Guidelines”, “alcohol abuse”, “noncommunicable diseases”, “health benefits of alcohol”, “moderate drinking”, “alcohol” and “intake patterns” were used. Studies published between 2002 and the present were reviewed. Results: Based on evidence of the past two decades, messages that convey the positive health benefits of moderate alcohol consumption (e.g. increased levels of high-density cholesterol) should be promoted and even encouraged in moderate drinkers (i.e. one alcoholic drink per day for women and a maximum of two drinks per day for men). Moderate drinking is not encouraged in those who do not consume alcohol at all. Nutrition educators should emphasise the negative consequences of alcohol abuse. Conclusion: The current food-based Dietary Guideline “If you drink alcohol, drink sensibly”, issued by the South African Department of Health, should not remain as is.
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11. Sugar and health: a food-based Dietary Guideline for South Africa
The South African journal of clinical nutrition, 2013Co-Authors: Norman J. Temple, Nelia P. SteynAbstract:The intake of added sugar appears to be increasing steadily across the South African population. Children typically consume approximately 40-60 g/day, possibly rising to as much as 100 g/day in adolescents. This represents roughly 5-10% of Dietary energy, but could be as much as 20% in many individuals. This paper briefly reviews current knowledge on the relationship between sugar intake and health. There is strong evidence that sugar makes a major contribution to the development of dental caries. The intake of sugar displaces foods that are rich in micronutrients. Therefore, diets that are rich in sugar may be poorer in micronutrients. Over the past decade, a considerable body of solid evidence has appeared, particularly from large prospective studies, that strongly indicates that Dietary sugar increases the risk of the development of obesity and type 2 diabetes, and probably cardiovascular disease too. These findings point to an especially strong causal relationship for the consumption of sugar-sweetened beverages (SSBs). We propose that an intake of added sugar of 10% of Dietary energy is an acceptable upper limit. However, an intake of < 6% energy is preferable, especially in those at risk of the harmful effects of sugar, e.g. people who are overweight, have prediabetes, or who do not habitually consume fluoride (from drinking fluoridated water or using fluoridated toothpaste). This translates to a maximum intake of one serving (approximately 355 ml) of SSBs per day, if no other foods with added sugar are eaten. Beverages with added sugar should not be given to infants or to young children, especially in a feeding bottle. The current food-based Dietary Guideline is: “Use foods and drinks containing sugar sparingly, and not between meals”. This should remain unchanged. An excessive intake of sugar should be seen as a public health challenge that requires many approaches to be managed, including new policies and appropriate Dietary advice.
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2. “Enjoy a variety of foods”: as a food-based Dietary Guideline for South Africa
The South African journal of clinical nutrition, 2013Co-Authors: Nelia P. Steyn, R OchseAbstract:Eating a diverse diet is an internationally accepted recommendation for a healthy diet. The food-based Dietary Guideline (FBDG) “Enjoy a variety of foods” aims to encourage people to consume mixed meals, to increase variety by eating different foods from various food groups, and to alter food preparation methods. This position paper suggests ways of measuring Dietary variety, addresses the consequences of poor Dietary variety in South Africa, and provides results pertaining to Dietary variety in South African children and adults. The literature reveals that Dietary diversity is best calculated by means of different food groups, which are based on the traditional eating patterns of the population under investigation. Ideally, the recall period should be three days. Two national surveys in South Africa have provided data on Dietary diversity scores (DDS) in adults and children, of 4.02 and 3.6 respectively. It was shown that in children, DDS positively relates to weight-for-height z-scores, with a z-score above zero being achieved when DDS is > 4. However, an energy-dense diet is cheaper and lower in micronutrients and also positively associated with increased body mass index in women. Hence, Dietary variety is essential in improving the micronutrient intake of the diet, and is also important in preventing obesity. Household food insecurity in South Africa remains a constraint on the implementation of this Guideline. This FBDG should be used in conjunction with the other South African FBDGs, to ensure the sufficient intake of food that contains protective factors and the limited intake of food that is known to increase the risk of noncommunicable diseases.
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2 enjoy a variety of foods as a food based Dietary Guideline for south africa
The South African journal of clinical nutrition, 2013Co-Authors: Nelia P. Steyn, R OchseAbstract:Eating a diverse diet is an internationally accepted recommendation for a healthy diet. The food-based Dietary Guideline (FBDG) “Enjoy a variety of foods” aims to encourage people to consume mixed meals, to increase variety by eating different foods from various food groups, and to alter food preparation methods. This position paper suggests ways of measuring Dietary variety, addresses the consequences of poor Dietary variety in South Africa, and provides results pertaining to Dietary variety in South African children and adults. The literature reveals that Dietary diversity is best calculated by means of different food groups, which are based on the traditional eating patterns of the population under investigation. Ideally, the recall period should be three days. Two national surveys in South Africa have provided data on Dietary diversity scores (DDS) in adults and children, of 4.02 and 3.6 respectively. It was shown that in children, DDS positively relates to weight-for-height z-scores, with a z-score above zero being achieved when DDS is > 4. However, an energy-dense diet is cheaper and lower in micronutrients and also positively associated with increased body mass index in women. Hence, Dietary variety is essential in improving the micronutrient intake of the diet, and is also important in preventing obesity. Household food insecurity in South Africa remains a constraint on the implementation of this Guideline. This FBDG should be used in conjunction with the other South African FBDGs, to ensure the sufficient intake of food that contains protective factors and the limited intake of food that is known to increase the risk of noncommunicable diseases.
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Commentary: if you drink alcohol, drink sensibly: is this Guideline still appropriate?
Ethnicity & disease, 2013Co-Authors: Liezille Jacobs, Nelia P. SteynAbstract:OBJECTIVE: Alcohol abuse remains one of the most serious substance abuse disorders in South African society, resulting in inordinately large social, economic and health problems at all levels of society. Alcohol consumers in South Africa are estimated to drink 16.6L per annum with a per capita consumption of 7.1L. South Africa has one of the highest rates of death attributable to crime, violence, traffic accidents, and HIV/AIDS in the world. These rates have been directly related to the high prevalence of alcohol abuse and risky drinking patterns. A food-based Dietary Guideline that encourages alcohol consumption would appear to be not in the nation's best interest. METHODS: We conducted a search of websites supported by the World Health Organization to find published literature on substance abuse in South Africa and also reviewed the website of the Medical Research Council of South Africa for studies on the social impact of alcohol abuse in humans. We used the search terms alcohol Guidelines, alcohol abuse, non-communicable diseases, health benefits of alcohol, moderate drinking, alcohol, and intake patterns and reviewed studies that hade been published between 2002 and the current time. RESULTS: Based on evidence over the past two decades, messages that convey the positive health benefits of moderate alcohol consumption (eg, the increased levels of HDL cholesterol) should be raised and even encouraged for those who are very moderate drinkers (ie, one alcoholic drink/ day for women and a maximum of 2 drinks/day for men). For those who do not consume alcohol at all, even moderate drinking is not encouraged. Nutrition educators should emphasize the negative consequences of alcohol abuse. CONCLUSION: The current food-based Dietary Guideline, "If you drink alcohol, drink sensibly," from the South African Department of Health should not remain as is. Ethn Dis. 2013;23[1]:110–115
Norman J. Temple - One of the best experts on this subject based on the ideXlab platform.
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11. Sugar and health: a food-based Dietary Guideline for South Africa
The South African journal of clinical nutrition, 2013Co-Authors: Norman J. Temple, Nelia P. SteynAbstract:The intake of added sugar appears to be increasing steadily across the South African population. Children typically consume approximately 40-60 g/day, possibly rising to as much as 100 g/day in adolescents. This represents roughly 5-10% of Dietary energy, but could be as much as 20% in many individuals. This paper briefly reviews current knowledge on the relationship between sugar intake and health. There is strong evidence that sugar makes a major contribution to the development of dental caries. The intake of sugar displaces foods that are rich in micronutrients. Therefore, diets that are rich in sugar may be poorer in micronutrients. Over the past decade, a considerable body of solid evidence has appeared, particularly from large prospective studies, that strongly indicates that Dietary sugar increases the risk of the development of obesity and type 2 diabetes, and probably cardiovascular disease too. These findings point to an especially strong causal relationship for the consumption of sugar-sweetened beverages (SSBs). We propose that an intake of added sugar of 10% of Dietary energy is an acceptable upper limit. However, an intake of < 6% energy is preferable, especially in those at risk of the harmful effects of sugar, e.g. people who are overweight, have prediabetes, or who do not habitually consume fluoride (from drinking fluoridated water or using fluoridated toothpaste). This translates to a maximum intake of one serving (approximately 355 ml) of SSBs per day, if no other foods with added sugar are eaten. Beverages with added sugar should not be given to infants or to young children, especially in a feeding bottle. The current food-based Dietary Guideline is: “Use foods and drinks containing sugar sparingly, and not between meals”. This should remain unchanged. An excessive intake of sugar should be seen as a public health challenge that requires many approaches to be managed, including new policies and appropriate Dietary advice.
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Evidence to support a food-based Dietary Guideline on sugar consumption in South Africa
BMC Public Health, 2012Co-Authors: Nelia P. Steyn, Norman J. TempleAbstract:BackgroundTo review studies undertaken in South Africa (SA) which included sugar intake associated with dental caries, non-communicable diseases, diabetes, obesity and/or micronutrient dilution, since the food-based Dietary Guideline: “Use foods and drinks that contain sugar sparingly and not between meals” was promulgated by the Department of Health (DOH) in 2002.MethodsThree databases (PubMed, Cochrane Library, and ScienceDirect), and SA Journal of Clinical Nutrition (SAJCN), DOH and SA Medical Research Council (SAMRC) websites were searched for SA studies on sugar intake published between 2000 and January 2012. Studies were included in the review if they evaluated the following: sugar intake and dental caries; sugar intake and non-communicable diseases; sugar and diabetes; sugar and obesity and/or sugar and micronutrient dilution.ResultsThe initial search led to 12 articles in PubMed, 0 in Cochrane, 35 in ScienceDirect, 5 in the SAJCN and 3 reports from DOH/SAMRC. However, after reading the abstracts only 7 articles from PubMed, 4 from SAJCN and 3 reports were retained for use as being relevant to the current review. Hand searching of reference lists of SAJCN articles produced two more articles. Intake of sugar appears to be increasing steadily across the South African (SA) population. Children typically consume about 50 g per day, rising to as much as 100 g per day in adolescents. This represents about 10% of Dietary energy, possibly as much as 20%. It has been firmly established that sugar plays a major role in development of dental caries. Furthermore, a few studies have shown that sugar has a diluting effect on the micronutrient content of the diet which lowers the intake of micronutrients. Data from numerous systematic reviews have shown that Dietary sugar increases the risk for development of both obesity and type 2 diabetes. Risk for development of these conditions appears to be especially strong when sugar is consumed as sugar-sweetened beverages.ConclusionBased on the evidence provided the current DOH food-based Dietary Guideline on sugar intake should remain as is.
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Evidence to support a food-based Dietary Guideline on sugar consumption in South Africa.
BMC public health, 2012Co-Authors: Nelia P. Steyn, Norman J. TempleAbstract:To review studies undertaken in South Africa (SA) which included sugar intake associated with dental caries, non-communicable diseases, diabetes, obesity and/or micronutrient dilution, since the food-based Dietary Guideline: “Use foods and drinks that contain sugar sparingly and not between meals” was promulgated by the Department of Health (DOH) in 2002. Three databases (PubMed, Cochrane Library, and ScienceDirect), and SA Journal of Clinical Nutrition (SAJCN), DOH and SA Medical Research Council (SAMRC) websites were searched for SA studies on sugar intake published between 2000 and January 2012. Studies were included in the review if they evaluated the following: sugar intake and dental caries; sugar intake and non-communicable diseases; sugar and diabetes; sugar and obesity and/or sugar and micronutrient dilution. The initial search led to 12 articles in PubMed, 0 in Cochrane, 35 in ScienceDirect, 5 in the SAJCN and 3 reports from DOH/SAMRC. However, after reading the abstracts only 7 articles from PubMed, 4 from SAJCN and 3 reports were retained for use as being relevant to the current review. Hand searching of reference lists of SAJCN articles produced two more articles. Intake of sugar appears to be increasing steadily across the South African (SA) population. Children typically consume about 50 g per day, rising to as much as 100 g per day in adolescents. This represents about 10% of Dietary energy, possibly as much as 20%. It has been firmly established that sugar plays a major role in development of dental caries. Furthermore, a few studies have shown that sugar has a diluting effect on the micronutrient content of the diet which lowers the intake of micronutrients. Data from numerous systematic reviews have shown that Dietary sugar increases the risk for development of both obesity and type 2 diabetes. Risk for development of these conditions appears to be especially strong when sugar is consumed as sugar-sweetened beverages. Based on the evidence provided the current DOH food-based Dietary Guideline on sugar intake should remain as is.
Gavin Turrell - One of the best experts on this subject based on the ideXlab platform.
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the contribution of three components of nutrition knowledge to socio economic differences in food purchasing choices
Public Health Nutrition, 2014Co-Authors: Loretta Mckinnon, Katrina Giskes, Gavin TurrellAbstract:Objectives To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) Dietary Guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices. Design The cross-sectional study considered household food purchasing, nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size. Setting Brisbane, Australia in 2000. Subjects Main household food shoppers ( n 1003, response rate 66·4 %), located in fifty small areas (Census Collectors Districts). Results Shoppers in households of low SEP made food purchasing choices that were less consistent with Dietary Guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing. Conclusions Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with Dietary Guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.
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the contribution of three components of nutrition knowledge to socio economic differences in food purchasing choices
Centre for Health Research; Faculty of Health; Institute of Health and Biomedical Innovation, 2014Co-Authors: Loretta Mckinnon, Katrina Giskes, Gavin TurrellAbstract:Free to read Objectives: To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) Dietary Guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices. Design: The cross-sectional study considered household food purchasing,nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size. Setting: Brisbane, Australia in 2000. Subjects: Main household food shoppers (n 1003, response rate 66?4 %), located in fifty small areas (Census Collectors Districts). Results: Shoppers in households of low SEP made food purchasing choices that were less consistent with Dietary Guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing. Conclusions: Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with Dietary Guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.
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DETERMINANTS OF GENDER DIFFERENCES IN Dietary BEHAVIOR
Nutrition Research, 1997Co-Authors: Gavin TurrellAbstract:Abstract Population-based food and nutrition studies consistently demonstrate that women are significantly more likely than men to comply with Dietary Guideline recommendations. To date however, the precise reasons for this difference are not clear. This paper examines this issue using data collected from a representative sample of men and women (n=330) living in Brisbane City (Australia). A general linear modelling analysis shows that women's greater compliance with Dietary Guideline food behaviors is due in part to their greater liking for the taste of healthy foods, they were more likely to believe that Dietary Guideline food was better for their health, and they were more knowledgeable about food and nutrition. Women were also more likely to report a heightened concern about their physical and personal appearance, although this factor made no independent contribution to Dietary Guideline compliance. The model developed in this study explained approximately 30 percent of the variation in food behavior. At the study's completion, men and women still differed significantly in their food behaviors, indicating that other important explanatory factors remain to be identified. © 1997 Elsevier Science Inc.
Gabriele Berg-beckhoff - One of the best experts on this subject based on the ideXlab platform.
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Nutritional correlates of perceived stress among university students in Egypt
International journal of environmental research and public health, 2015Co-Authors: Walid El Ansari, Gabriele Berg-beckhoffAbstract:Food intake choice and amount might change with stress. However, this has not been examined among Egyptian students. We examined students' stress levels, its correlation with their consumption of a range of food groups, and adherence to Dietary Guidelines. A cross sectional survey (N = 2810 undergraduates at 11 faculties at Assiut University, Egypt) assessed two composite food intake pattern scores (one unhealthy: sweets, cakes, snacks; and a healthy one: fruits and vegetables), and two indicators of healthy eating (subjective importance of healthy eating; and Dietary Guideline adherence index). Multiple linear regression tested the associations of stress with two food intake pattern scores and two indicators of healthy eating, controlling for six potential confounders for the sample and separately for males and females. Higher perceived stress score was significantly associated with less frequent food intake of fruit and vegetables in males and females. The association was more pronounced among males than in females. No significant association was observed between the sweets cakes and snacks score and stress. Of the two indicators of healthy eating, the Dietary Guideline adherence index was not associated with stress, while the subjective judgment of healthy eating was consistently negatively associated with stress. Stress related decreased-eating was present. Recent studies suggest that stress could be associated with either decreased or increased eating depending on the study population, food group, and type of stressor. Further research is necessary to understand stress related over- and undereating.
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Is Healthier Nutrition Behaviour Associated with Better Self-Reported Health and Less Health Complaints? Evidence from Turku, Finland.
Nutrients, 2015Co-Authors: Walid El Ansari, Sakari Suominen, Gabriele Berg-beckhoffAbstract:We examined nutrition behaviour, self-reported health and 20 health complaints of undergraduates in Finland. Students at the University of Turku in Finland participated in a cross-sectional online survey (N = 1189). For nutrition behaviour, we computed two composite food intake pattern scores (sweets, cakes and snacks; and fruits and vegetables), a Dietary Guideline adherence index and the subjective importance of healthy eating. Multinomial logistic regression assessed the association of students’ nutrition behaviour with three levels of self-reported health, controlling for many potential confounders (age, sex, living with partner, economic situation, moderate physical activity, Faculty and BMI). Factor analysis of the 20 health complaints revealed three components (psychological, pains/aches and circulatory/breathing symptoms). Multiple linear regression tested the association of students’ eating habits with the three components of health complaints, controlling for the same confounders. Fruits and raw and cooked vegetable consumption, Dietary Guideline adherence index and subjective importance of healthy eating were highest among students with excellent/very good self-reported health, exhibiting a decreasing trend for those individuals with poor/fair self-reported health. High levels of psychological symptoms were associated with decreased consumption of fruits and vegetables, less Dietary Guideline adherence and less subjective importance of healthy eating. Pain/aches symptoms were associated with a higher consumption of sweets, cookies and snacks and a lower adherence to Dietary Guidelines. More healthy nutrition behaviour was consistently associated with better self-reported health and less health complaints. Of the four nutrition behaviour indicators we employed, the Dietary Guideline adherence index was the best indicator and exhibited the most consistent associations with self-reported health and health complaints.
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Mood and food at the University of Turku in Finland: nutritional correlates of perceived stress are most pronounced among overweight students
International journal of public health, 2015Co-Authors: Walid El Ansari, Sakari Suominen, Gabriele Berg-beckhoffAbstract:We examined perceived stress and food intake at University of Turku, Finland. This study was conducted as an online survey (1189 students). We computed two composite food intake pattern scores (sweets, cakes and snacks; fruits and vegetables), a Dietary Guideline adherence index, and the subjective importance of healthy eating. We assessed the correlations between perceived stress, and two food intake pattern scores, Dietary Guideline adherence index and subjective importance of healthy eating. We tested the associations between stress and the same variables, controlling for potential confounders for the whole sample, by gender, and by Body Mass Index (BMI). Fruits and vegetables intake and Dietary Guideline adherence were both negatively associated with stress. These negative associations were more pronounced in overweight and less pronounced in underweight compared to healthy weight students. Sweets, cookies and snacks consumption were not associated with stress. Stress was associated with lower subjective importance of healthy eating, independent of gender and BMI. Perceived stress might have relationships of different magnitudes in overweight vs. normal BMI or underweight persons. BMI could be an effect modifier of the stress–food habits association.
John Chalmers - One of the best experts on this subject based on the ideXlab platform.
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The effects of a lifestyle-focused text-messaging intervention on adherence to Dietary Guideline recommendations in patients with coronary heart disease: an analysis of the TEXT ME study.
The international journal of behavioral nutrition and physical activity, 2018Co-Authors: Karla Santo, Karice Hyun, Laura De Keizer, Aravinda Thiagalingam, Graham S. Hillis, John Chalmers, Julie Redfern, Clara K. ChowAbstract:A healthy diet is an important component of secondary prevention of coronary heart disease (CHD). The TEXT ME study was a randomised clinical trial of people with CHD that were randomised into standard care or a text-message programme in addition to standard care. This analysis aimed to: 1) assess the effects of the intervention onadherence to the Dietary Guideline recommendations; 2) assess the consistency of effect across sub-groups; and 3) assess whether adherence to the Dietary Guideline recommendations mediated the improvements in objective clinical outcomes. Dietary data were collected using a self-report questionnaire to evaluate adherence to eight Dietary Guideline recommendations in Australia, including consumption of vegetables, fruits, fish, type of fat used for cooking and in spreads, takeaway food, salt and standard alcohol drinks. The primary outcome of this analysis was the proportion of patients adhering to ≥ 4 Dietary Guideline recommendations concomitantly and each recommendation was assessed individually as secondary outcomes. Data were analysed using log-binomial regression for categorical variables and analysis of covariance for continuous variables. Among 710 patients, 54% were adhering to ≥ 4 Dietary Guideline recommendations (intervention 53% vs control 56%, p = 0.376) at baseline. At six months, the intervention group had a significantly higher proportion of patients adhering to ≥ 4 recommendations (314, 93%) compared to the control group (264, 75%, RR 1.23, 95% CI 1.15–1.31, p
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the effects of a lifestyle focused text messaging intervention on adherence to Dietary Guideline recommendations in patients with coronary heart disease an analysis of the text me study
International Journal of Behavioral Nutrition and Physical Activity, 2018Co-Authors: Karla Santo, Karice Hyun, Laura De Keizer, Aravinda Thiagalingam, Graham S. Hillis, John ChalmersAbstract:A healthy diet is an important component of secondary prevention of coronary heart disease (CHD). The TEXT ME study was a randomised clinical trial of people with CHD that were randomised into standard care or a text-message programme in addition to standard care. This analysis aimed to: 1) assess the effects of the intervention onadherence to the Dietary Guideline recommendations; 2) assess the consistency of effect across sub-groups; and 3) assess whether adherence to the Dietary Guideline recommendations mediated the improvements in objective clinical outcomes. Dietary data were collected using a self-report questionnaire to evaluate adherence to eight Dietary Guideline recommendations in Australia, including consumption of vegetables, fruits, fish, type of fat used for cooking and in spreads, takeaway food, salt and standard alcohol drinks. The primary outcome of this analysis was the proportion of patients adhering to ≥ 4 Dietary Guideline recommendations concomitantly and each recommendation was assessed individually as secondary outcomes. Data were analysed using log-binomial regression for categorical variables and analysis of covariance for continuous variables. Among 710 patients, 54% were adhering to ≥ 4 Dietary Guideline recommendations (intervention 53% vs control 56%, p = 0.376) at baseline. At six months, the intervention group had a significantly higher proportion of patients adhering to ≥ 4 recommendations (314, 93%) compared to the control group (264, 75%, RR 1.23, 95% CI 1.15–1.31, p < 0.001). In addition, the intervention patients reported consuming higher amounts of vegetables, fruits, and fish per week; less takeaway foods per week; and greater salt intake control. The intervention had a similar effect in all sub-groups tested. There were significant mediational effects of the increase in adherence to the recommendations for the association between the intervention and LDL-cholesterol (p < 0.001) and body mass index (BMI) at six months follow-up (p = 0.005). A lifestyle-focused text-message programme improved adherence to the Dietary Guideline recommendations, and specifically improved self-reported consumption of vegetables, fruits, fish, takeaway foods and salt intake. Importantly, these improvements partially mediated improvements in LDL-cholesterol and BMI. This simple and scalable text-messaging intervention could be used as a strategy to improve diet in people with CHD. Australia and New Zealand Clinical Trials Registry ACTRN12611000161921 . Registered on 10 February 2011.