Normally, EHEC Stx delivery is mediated by Tir/intimin adherence, so the unusual combination of an alternate adhesion system (EAEC) with Stx2 could account for the enhanced virulence.
Through regular support and the training diaries, we know that the participants did perform varying amounts of training (i.e., weeks with good adherence alternated with weeks with low adherence).
In addition to exploring alternate methods for assessing adherence, such as electronic monitoring, further research should explore methods of improving persistence and adherence.
Mayonnaise is not part of the traditional Lebanese cuisine and its consumption could reflect adherence to alternate patterns.
Each of the other lifestyle factors before pregnancy (total moderate/vigorous physical activity, smoking status, adherence to Alternate Healthy Eating Index-2010 diet) was also significantly associated with risk of gestational diabetes.
The combination of three low risk factors (non-smoker, ≥150 minutes a week of moderate to vigorous physical activity, and healthy eating (top two fifths of Alternate Healthy Eating Index-2010 adherence score)) was associated with a 41% lower risk of gestational diabetes compared with all other pregnancies (relative risk 0.59, 95% confidence interval 0.48 to 0.71).
We chose the last year as a comparator, rather than a single test result or a shorter time interval, to avoid the possibility that patients would "game" the incentive by deliberately alternating periods of poorer adherence with periods of better adherence.
Katon and colleagues [ 11] recommend increasing the frequency of patients' visits with their healthcare providers, with visits focusing on monitoring their treatment adherence, and alternating visits between patients' PCPs and psychiatrists.
To our knowledge our findings represent the first demonstration examining the relationship between adherence to the alternate Mediterranean diet and a direct assessment of total and regional body fat distribution as measured by DXA.
Based on the food frequency questionnaire, we derived a score of the alternate healthy eating index, an indicator of adherence to healthy eating behavior, described in detail elsewhere.
