Abstract：
BACKGROUND: Emerging evidence suggests that poor dietary quality is an important risk factor for disability. However, few studies have compared adherence to dietary patterns and disability, and none among Puerto Rican adults.
OBJECTIVE: This study was designed to examine relationships between three dietary patterns, including DASH, Mediterranean (MeDS), and Healthy Eating Index (HEI-2010), and ∼6-y incidence of activities of daily living (ADL) and instrumental ADL (IADL) disability, and to assess potential mediation by handgrip strength.
METHODS: Data are from the Boston Puerto Rican Health Study (BPRHS), a longitudinal cohort of Puerto Rican adults aged 45-75 y (n=1502). Adherence to dietary pattern variables were derived from food frequency questionnaire (FFQ) data averaged at baseline and ∼2-y. Handgrip strength was assessed at baseline. Cox proportional hazards models were used to assess longitudinal associations between DASH, MeDS, HEI-2010, and incident ∼6-y ADL (and subscales) and IADL disability. Mediation by handgrip strength was also tested.
RESULTS: Participants with higher adherence DASH had lower risk of ADL, ADL mobility, and ADL manual dexterity disabilities (HR = 0.96, 95%CI: 0.91, 0.98; HR = 0.96, 95%CI: 0.92, 0.99; HR = 0.95, 95%CI: 0.92, 0.98, respectively).Higher adherence to MeDS was associated with lower risk of ADL and ADL mobility disabilities (HR = 0.89, 95%CI: 0.81, 0.98; HR = 0.90, 95%CI: 0.82, 1.00), and higher adherence to HEI with lower risk of ADL manual dexterity (HR = 0.98, 95%CI: 0.97, 0.99) in fully adjusted models. Only DASH tended to be associated with IADL (HR = 0.97, 95%CI: 0.94, 1.00). Baseline handgrip strength was a mediator between HEI and ADL manual dexterity (23.7% of the indirect effect was explained through handgrip strength).
CONCLUSIONS: Higher adherence to a healthy diet pattern may decrease risk of disability and may be an important prevention strategy for ADL and IADL disability associated with aging.
OBJECTIVE: This study was designed to examine relationships between three dietary patterns, including DASH, Mediterranean (MeDS), and Healthy Eating Index (HEI-2010), and ∼6-y incidence of activities of daily living (ADL) and instrumental ADL (IADL) disability, and to assess potential mediation by handgrip strength.
METHODS: Data are from the Boston Puerto Rican Health Study (BPRHS), a longitudinal cohort of Puerto Rican adults aged 45-75 y (n=1502). Adherence to dietary pattern variables were derived from food frequency questionnaire (FFQ) data averaged at baseline and ∼2-y. Handgrip strength was assessed at baseline. Cox proportional hazards models were used to assess longitudinal associations between DASH, MeDS, HEI-2010, and incident ∼6-y ADL (and subscales) and IADL disability. Mediation by handgrip strength was also tested.
RESULTS: Participants with higher adherence DASH had lower risk of ADL, ADL mobility, and ADL manual dexterity disabilities (HR = 0.96, 95%CI: 0.91, 0.98; HR = 0.96, 95%CI: 0.92, 0.99; HR = 0.95, 95%CI: 0.92, 0.98, respectively).Higher adherence to MeDS was associated with lower risk of ADL and ADL mobility disabilities (HR = 0.89, 95%CI: 0.81, 0.98; HR = 0.90, 95%CI: 0.82, 1.00), and higher adherence to HEI with lower risk of ADL manual dexterity (HR = 0.98, 95%CI: 0.97, 0.99) in fully adjusted models. Only DASH tended to be associated with IADL (HR = 0.97, 95%CI: 0.94, 1.00). Baseline handgrip strength was a mediator between HEI and ADL manual dexterity (23.7% of the indirect effect was explained through handgrip strength).
CONCLUSIONS: Higher adherence to a healthy diet pattern may decrease risk of disability and may be an important prevention strategy for ADL and IADL disability associated with aging.
摘要：
背景：新的证据表明，饮食质量差是导致残疾的重要危险因素。然而,很少有研究将坚持饮食模式和残疾进行比较，波多黎各成年人中没有。
目的：本研究旨在研究三种膳食模式之间的关系，包括DASH,地中海(MeDS),和健康饮食指数(HEI-2010)，日常生活活动(ADL)和工具性ADL(IADL)残疾的发病率，并通过握力评估潜在的调解。
方法：数据来自波士顿波多黎各人健康研究（BPRHS），波多黎各成年人45-75岁的纵向队列(n=1502)。对膳食模式变量的依从性来自基线和~2-y时平均的食物频率问卷(FFQ)数据。在基线处评估握力。Cox比例风险模型用于评估DASH之间的纵向关联，MEDS,HEI-2010，以及事件~6-yADL(和分量表)和IADL残疾。还测试了通过握力进行的调解。
结果：DASH依从性较高的参与者ADL风险较低，ADL移动性,和ADL手动灵活性障碍（分别为HR=0.96，95CI：0.91，0.98；HR=0.96，95CI：0.92，0.99；HR=0.95，95CI：0.92，0.98）。较高的MeDS依从性与ADL和ADL行动不便的风险较低相关（HR=0.89，95CI：0.81，0.98；HR=0.90，95CI：0.82，1.00），在完全调整的模型中，对HEI的依从性更高，ADL手动灵活性的风险较低（HR=0.98，95CI：0.97，0.99）。只有DASH倾向于与IADL相关(HR=0.97,95CI:0.94,1.00)。基线握力是HEI和ADL手动灵活性之间的中介（通过握力解释了23.7％的间接影响）。
结论：更坚持健康饮食模式可能会降低残疾风险，并且可能是与衰老相关的ADL和IADL残疾的重要预防策略。
目的：本研究旨在研究三种膳食模式之间的关系，包括DASH,地中海(MeDS),和健康饮食指数(HEI-2010)，日常生活活动(ADL)和工具性ADL(IADL)残疾的发病率，并通过握力评估潜在的调解。
方法：数据来自波士顿波多黎各人健康研究（BPRHS），波多黎各成年人45-75岁的纵向队列(n=1502)。对膳食模式变量的依从性来自基线和~2-y时平均的食物频率问卷(FFQ)数据。在基线处评估握力。Cox比例风险模型用于评估DASH之间的纵向关联，MEDS,HEI-2010，以及事件~6-yADL(和分量表)和IADL残疾。还测试了通过握力进行的调解。
结果：DASH依从性较高的参与者ADL风险较低，ADL移动性,和ADL手动灵活性障碍（分别为HR=0.96，95CI：0.91，0.98；HR=0.96，95CI：0.92，0.99；HR=0.95，95CI：0.92，0.98）。较高的MeDS依从性与ADL和ADL行动不便的风险较低相关（HR=0.89，95CI：0.81，0.98；HR=0.90，95CI：0.82，1.00），在完全调整的模型中，对HEI的依从性更高，ADL手动灵活性的风险较低（HR=0.98，95CI：0.97，0.99）。只有DASH倾向于与IADL相关(HR=0.97,95CI:0.94,1.00)。基线握力是HEI和ADL手动灵活性之间的中介（通过握力解释了23.7％的间接影响）。
结论：更坚持健康饮食模式可能会降低残疾风险，并且可能是与衰老相关的ADL和IADL残疾的重要预防策略。
