The association between adherence to Alternative Healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache among women: A cross-sectional study

The association between adherence to Alternative Healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache among women: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The association between adherence to Alternative Healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache among women: A cross-sectional study Pardis Khalili, Atieh Mirzababaei, Faezeh Abaj, Asma Rajabi Harsini, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2561598/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Aug, 2023 Read the published version in Nutrition Journal → Version 1 posted 7 You are reading this latest preprint version Abstract Background Migraine is a common brain disorder with pain characteristics that can be defined by moderate to severe unilateral throbbing pain, worsening in physical activity, and can be associated with nausea. Migraine headaches can be caused by numerous factors, including diet. This study aimed to assess the association of adherence to Alternative Healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache. Methods In this cross-sectional study, 266 women (18 to 50 years old) who suffered with migraines, who visited the brain and neurology clinics of Khatam al-Anbia and Sina hospitals and the professional headache clinic in Tehran, were selected. Anthropometric measurements and demographic information were collected. Dietary intake in the past year was assessed using a semi-quantitative, 147-item, food frequency questionnaire (FFQ). AHEI was calculated based on FFQ, and episodic migraine was diagnosed by a neurologist. The Migraine Disability Assessments (MIDAS) questionnaire was used to evaluate migraine disability and migraine severity, visual Analog Scale (VAS) questionnaire was used to measure pain, and duration and frequency were ascertained via questionnaire. Results People with high adherence to AHEI, compared with low adherence, had a 43% reduction in headache duration in the crude model (OR = 0.57; 95% CI 0.34, 0.97; P = 0.03), which remained significant after adjusting for potential confounders (OR = 0.56; 95% CI 0.31, 0.99; P = 0.04). However, other variables, VAS, MIDAS and frequency of headache in month, were not significant. Conclusion Regarding the association between migraine headache and AHEI, the results of our study showed that people with high adherence of AHEI had a reduction in duration of migraine. Further studies are suggested to better evaluate and understand this association. Alternative Healthy Diet Index severity of migraine duration of migraine frequency of migraine Introduction Migraine is a common brain disorder characterized by recurrent seizures lasting between 4 and 72 hours. Its pain characteristics can be attributed to moderate to severe unilateral throbbing pain, that worsen in physical activity, and can be concomitantly associated with nausea [1]. Approximately 12% of the world's population has migraines [2], it is the third most common disease in adults worldwide, and the third leading cause of disability in people under 50y with a prevalence of 11.6% [3, 4]. Moreover, its prevalence in women (More than 20%) is twofold more than men (more than 10%) [5]. Migraine headaches are caused by various factors, such as diet, hunger, time of day, hormonal changes, family history, depression, stress ,and irregular sleep patterns [6]. There are several factors involved in the pathogenesis of migraine, but the underlying cause is still unknown. Some studies have suggested the role of nerve damage in the brain, as well as the density and pressure of the nervous system, in causing migraines. Also, the role of food in engendering migraine should not be ignored, indeed, food may elicit pain through the effect of vasoconstriction and expansion on the nervous system [6]. Pickled fermented products, salty, monosodium glutamate in fast food, caffeine in coffee and chocolate, nitrate in food containing protein, aspartame, seafood, dairy, and foods containing tyramine, including red wine and alcohol, caffeine, smoked fish, old cheese, beans, onions, fruits such as figs, citrus fruits, avocados, and bananas are among the highest migraine-stimulating foods. It has also been shown that alpha-lipoic acid and eicosapentaenoic acid may play a role in reducing the severity and frequency of migraines [7]. The other factors include vitamin D deficiency, production of inflammatory agents and prostaglandins, production of serotonin from platelets, stimulation of norepinephrine production, and increased sensitivity to nitric oxide and hyperhomocysteine [8, 9]. People with migraines are more likely to develop cardiovascular disease and death [10], and therefore, control and management of this disorder is very important [11]. Drug regimen are used extensively, however, have major side effects [12], and so, identifying alternative treatment approaches is important. Some studies have shown that a variety of diets, including high-folate, low-fat, omega-3 and low-omega-6 fats, ketogenic, atkins, and low-sodium diets, may be a promising approach in managing migraines and reducing the severity of seizures [13]. A nutritious diet is an important factor that is relatively easily modifiable. Indeed, it has been reported that consuming more vegetables, fruits, and legumes is associated with a reduction in headache duration and intensity [14]. Additionally, nutrients are usually not consumed alone, where food groups consisting of several foods are consumed, which is assumed to be a factor for the existence of synergistic effects of complex food combinations [6]. The AHEI is a measure of diet quality and adherence to healthy dietary patterns, suggesting better recommendations for healthy diets to improve health observation to factors, as well as greater predictive power for chronic diseases. AHEI includes healthy foods, such as fruits, vegetables, whole grains, nuts and legumes, n-3 chain fatty acids, polyunsaturated fatty acids, fruit juice and sugar-sweetened beverages, red and processed meat, trans fatty acids, sodium, and alcohol [15]. Previous studies have shown that migraine is associated with inflammation and oxidative stress [16], and since high fiber, whole grains, vegetables, fruits, magnesium, which are known to improve systemic inflammation, as well as suppress the inflammatory process, and these foods are components of AHEI. Although there have been studies on the effect of diet on migraines, to our knowledge, no study has investigated the impact of AHEI on migraines. In the present study, we sought to investigate the association between adherence to Alternative Healthy Diet Index (AHEI) and severity, duration, and frequency of migraine headaches among women. Materials And Methods Study population In this cross-sectional study, 266 women (18 to 50 years old) who suffered with migraines, who visited the brain and neurology clinics of Khatam al-Anbia and Sina hospitals and the professional headache clinic in Tehran, were selected. Migraine was clinically diagnosed by a neurologist. Participants were included in the study based on the following inclusion and exclusion criteria. Entry criteria: Body Mass Index (BMI) 18.5–30 kg/m 2 , visiting the headache clinic for the first time, and the diagnosis of migraine by a neurologist based on the International Classification of Headache Disorders 3 (ICHD3) criteria. If subjects in the study had a history of Cardiovascular Disease (CVD), cancer, diabetes, liver or kidney disease, and other neurological disorders because of possible disease-related changes in diet, along with subjects taking medications that affect serum lipoprotein concentrations (e.g. lovastatin, atorvastatin) a or those consuming less than 800 kcal/day (3347 kJ/day) or more than 4200 kcal/day (17573 kJ/day) were excluded from the study (28). All participants signed written informed consent forms prior to participation. The study protocol was approved by the local ethics committee: IR. TUMS.VCR.REC.1395.1597 Anthropometric Measurements Anthropometric measurements were taken from all study participants. Weight was measured while subjects were minimally clothed (i.e., no jacket, jacket or belt and shoes) using a digital scale, to an accuracy of 100 grams. Height was measured using a stadiometer while the participant was standing, without shoes, with heels touching the wall, feet together and head facing forward. BMI was calculated from height and weight data using the equation "weight (kg)/height 2 (square meter)". Waist Circumference (WC) was measured halfway between the lower part of the xiphoid process and the umbilicus, and Hip Circumference (HC) was taken at the greatest anterior projection. Waist and hip circumferences were measured using a flexible plastic tape with an accuracy of 0.5 cm. The ratio between Waist and Hip Ratio (WHR) was also calculated. Assessment of dietary intake Dietary intake over the past year was assessed using a semi-quantitative food frequency questionnaire (FFQ). This questionnaire includes a list of 147 food items, along with the standard serving size for each nutrient [17]. The reliability and validity of this questionnaire has been confirmed in Iran [18]. Foods commonly consumed at home were reported and converted to grams of food per day using the IV nutrition software [19]. Nutrient intake was calculated using Nutritionist IV software modified for Iranian foods based on the United States Food Composition Table of the Department of Agriculture (USDA). At baseline, scores of intensity (from 0 to 10 on a Visual Analogue Scale (VAS)), and duration were recorded after each migraine attack, regardless of the time of day. Instructions for completing this form were provided by a neurologist. If the participants had a problem completing their diaries, a staff member was available to assist. At the time of recruitment, participants were asked to complete their headache diaries over the proceeding month [20]. Physical activity levels (PAL) were measured using the International Physical Activity Questionnaire (IPAQ) and according to the time spent on light, moderate, high, and very intense activities. PAL was expressed as metabolic equivalent hours per week (METs hours per week). Calculation of AHEI score AHEI includes 11 components: fruits, vegetables, whole grains, nuts and legumes, n-3 chain fatty acids, polyunsaturated fatty acids, fruit juice and sugar-sweetened beverages, red and processed meat, trans fatty acids, sodium, and alcohol. Alcohol consumption was not assessed in this study due to lack of data. Scores for consumption of fruits, vegetables, whole grains, nuts and legumes, long-chain n-3 fatty acids and polyunsaturated fatty acids were considered as '10' and '0', respectively, for the highest and lowest amount. For fruit juice and drinks sweetened with sugar, red and processed meat, trans fatty acids and sodium, respectively, the AHEI score for each component ranged from 0 to 10 for nonadherence to full adherence, respectively, and then participants were categorized into three groups based on their AHEI scores (1, 2, and 3) [15]. Migraine Diagnosis Based on ICHD3 criteria, episodic migraine was diagnosed by a neurologist. Episodic migraine diagnosis criteria include two types of migraine, with aura and without aura. A diagnosis of migraine without aura, according to the International Headache Society (IHS), can include five or more attacks lasting 4 to 72 hours. The headache must have two or more of the following features: unilateral, throbbing, moderate or severe pain, worsening or avoidance of usual Physical Activity (PA), as well as one or more of the following: nausea and/or vomiting, sensitivity to light (photophobia) and sound (ova phobia), feature of migraine with normal aura (with or without headache), Migraine with Brainstem Aura (MBA), hemiplegic, and retinal involvement. MBA is a type of migraine headache with aura, which is accompanied by pain in the back of the head. An aura is a group of warning signs known as a bad headache coming on. Auras may include symptoms such as vertigo, slurred speech, ataxia, tinnitus, visual changes, and/or loss of balance, as diagnosed by a neurologist [21]. MIDAS and VAS handbook Migraine Disability Assessments (MIDAS) questionnaire was used to evaluate migraine disability and migraine severity [22]. This questionnaire consists of five questions that evaluate the severity of headache in the last three months. The first to fifth questions of the questionnaire evaluate the decrease in performance caused by migraine. Based on the total score of these five questions, participants are placed into one of four groups: 0–5 (MIDAS grade I, little or no disability), 6–10 (MIDAS grade II, mild disability), 11–20 (MIDAS grade III, moderate disability), 21+ (MIDAS grade IV, severe disability). This questionnaire was previously validated in Iranian populations [23]. Also, visual Analog Scale (VAS) was used to measure pain. The VAS consists of a 10 cm long horizontal line fixed by word descriptors at each end. The patient marks a point on the line that they feel represents an understanding of their current situation. The VAS score is determined by measuring the centimeter from the end of the left line to the point marked by the patient. Cut points include: mild pain (1–3), moderate pain (4–7), and severe pain (8–10) [17]. Evaluation of Other Variables Age, marital status, education, and job were collected by the researchers through a demographic questionnaire. Physical activity levels (PAL) were measured using the International Physical Activity Questionnaire (IPAQ) and evaluated according to the time spent on light, moderate, high and very intense activities. PAL was expressed as metabolic equivalent hours per week (METs hours per week). Statistical analysis Chi-square test were used to examine the association between AHEI and qualitative variables. Also, independent T-Tests were used to investigate the association between AHEI and quantitative variables (such as dietary intake, age, weight, body mass index, waist circumference, etc.). Mild pain in VAS variable, no disability in MIDAS variable, low adherence of AHEI variable were considered as reference group. P < 0.05 was considered statistically significant, and SPSS version 24 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. Results Participant characteristics The mean (± SD) age, height, weight, BMI, and physical activity of participants were 34.29 (7.95) years, 1.61 (0.05) m, 67.71 (13.04) kg, 25.88 (4.74) kg/m 2 , 380.03 (599.63) MET/min/week, respectively. Except for duration (less than and more than 10 hours of migraine), there was no significant association between high adherence AHDI compared with low adherence. However, people with higher adherence to the AHEI compared to lower adherence had better scores for VAS, disability, and headache frequency. Participant characteristics among intake of AHEI The mean intake of AHEI was significantly different among those with higher adherence to AHEI, Table 2. Individuals with higher AHEI adherence had higher energy, total fat, cholesterol, saturated fatty acid, trans, Mono Unsaturated Fatty Acid (MUFA), Poly Unsaturated Fatty Acid (PUFA), oleic acid, linoleic acid, linolenic acid, Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA), total fiber, riboflavin (B2), pyridoxine (B6), cobalamin (B12), vitamins K, E, D, C, biotin, retinol, lutein, lycopene, sodium, potassium, calcium, iron, phosphor, magnesium, and copper (p-value < 0.001) intakes compared to individuals with lower adherence. The association between AHEI and severity, duration, and frequency of migraine headache Multivariable-adjusted OR and 95% CI for AHEI and migraine VAS, MIDAS, frequency, and duration migraine are shown in Table 3 . A significant positive association was found between adherence to the AHEI and headache duration. People with high adherence of AHEI, compared with low adherence, had 43% reduction of headache duration (OR = 0.57; 95% CI 0.34, 0.97; P = 0.03) in the crude model; this association remained significant in the adjusted model (OR = 0.56; 95% CI 0.31, 0.99; P = 0.04). Frequency of migraine in crude and adjusted models did not show any significant association. High adherence of AHEI compared to low adherence for people with severe headaches (OR = 0.72; 95% CI 0.31, 1.67; P = 0.45) compared to people with moderate (OR = 0.69; 95% CI 0.31, 1.51; P = 0.36), despite a decrease in OR, was not significant. Similarly, people with moderate disability (OR = 0.76; 95% CI 0.28, 2.07; P = 0.60) compared to people with mild disability (OR = 1.28; 95% CI 0.53, 3.12; P = 0.57), despite a decrease in OR, was not significant. Furthermore, in people with severe disability (OR = 0.76; 95% CI 0.31, 1.88; P = 0.76) compared to mild disability (OR = 0.76; 95% CI 0.28, 2.07; P = 0.60), despite reductions, statistical significance was not found. Characteristics Low adherence of AHEI High adherence of AHEI Table 1 Characteristics of study population based on adherence of AHEI. Quantitative variables Mean ± SD Mean ± SD P-value Age (year) 34.29 ± 7.95 34.34 ± 7.77 0.95 Height (m) 1.61 ± 0.05 1.62 ± 0.05 0.56 Weight (kg) 67.71 ± 13.04 71.44 ± 12.89 0.02 BMI (kg/m 2 ) 25.88 ± 4.74 27.23 ± 5.01 0.02 HC (cm) 103.94 ± 11.39 103.91 ± 13.14 0.98 WC (cm) 85.55 ± 12.44 87.45 ± 13.02 0.22 WHR (cm) 0.82 ± 0.06 0.94 ± 0.86 0.13 Physical activity (MET/h/week) 380.03 ± 599.63 437.18 ± 406.03 0.37 Qualitative variables N (%) N (%) P-value Marital situation Single 44 (59.5) 30 (40.5) 0.55 Married 98 (52.1) 90 (47.9) Divorced 2 (50) 2 (50) Education Undergraduate 66 (51.57) 60 (48.42) 0.31 Bachelor 37 (46.8) 42 (53.2) Master or higher 40 (56.16) 20(43.83) Job Employed 50 (50) 47 (66.36) 0.81 Unemployed 95 (60.13) 75 (39.86) Migraine severity VAS Mild 25 (58.1) 18 (41.9) 0.84 Moderate 61 (53.5) 53 (46.5) Severe 58 (53.2) 51 (46.8) MIDAS Without or low disability 19 (54.3) 16 (45.7) 0.35 Mild disability 42 (63.6) 24 (36.4) Moderate disability 23 (50) 23 (50) Severe disability 60 (50.8) 58 (49.2) Headache duration ≤ 10 h 89 (49.7) 90 (50.3) 0.03 > 10 h 55 (63.2) 32 (36.8) Headache frequency > 15 days/month 95 (57.6) 70 (42.4) 0.15 ≥ 15 days month 49 (48.5) 52 (51.5) BMI: body mass index, WC: waist circumference, HC: hip circumference, WHR: weight to hip ratio, VAS: visual analog scale, MIDAS: migraine disability assessment, AHEI: alternate healthy eating index. Quantitative variables calculated by T-test and presented as mean ± SD. Qualitative variables calculated by chi-square test and presented as N (%). P-value < 0.05 was considered significant. Table 2. Dietary intake based on adherence of AHEI. Variables Low adherence of AHEI (n = 144) High adherence of AHEI (n = 122) P-value Mean ± SD Mean ± SD Macronutrients Energy(kcal/d) 2363.62 ± 490.91 2074.48 ± 510.97 < 0.001 Carbohydrates(gr/ day) 296.38 ± 63.57 288.04 ± 73.55 0.32 Protein(gr/day) 80.63 ± 13.24 77.72 ± 18.62 0.15 Total fat(gr/day) 100.57 ± 31.12 75.75 ± 24.77 < 0.001 CHOL(gr/day) 286.45 ± 88.94 198.58 ± 75.26 < 0.001 Saturated fat(gr/day) 34.02 ± 12.51 20.64 ± 7.26 < 0.001 Trans fat(gr/day) 0.0004 ± 0.0009 0.0000 ± 0.0001 < 0.001 MUFA(gr/day) 33.13 ± 11.50 24.74 ± 10.98 < 0.001 PUFA(gr/day) 18.30 ± 8.11 14.99 ± 7.95 0.001 DHA(gr/day)) 0.07 ± 0.06 0.10 ± 0.13 0.007 EPA(gr/day 0.01 ± 0.02 0.03 ± 0.04 < 0.001 Oleic(gr/day) 29.78 ± 10.99 22.12 ± 10.81 < 0.001 Linoleic(gr/day) 15.54 ± 7.65 12.62 ± 7.53 0.002 Linolenic(gr/day) 1.38 ± 0.61 0.97 ± 0.55 < 0.001 Total fiber(gr/day) 34.36 ± 12.78 44.58 ± 15.05 < 0.001 Micronutrients Thiamin(mg/day) 1.67 ± 0.43 1.73 ± 0.60 0.30 Riboflavin(mg/day) 1.82 ± 0.39 2.02 ± 0.55 0.001 Niacin(mg/day) 22.71 ± 5.11 22.62 ± 6.47 0.90 Pantothenic acid(mg/day) 4.65 ± 0.95 4.87 ± 1.26 0.12 Pyridoxine(mg/day) 1.76 ± 0.37 2.05 ± 0.51 < 0.001 Folic acid(mg/day) 495.31 ± 115.27 568.05 ± 135.23 < 0.001 Cobalamin (mg/day) 4.23 ± 1.34 2.79 ± 1.04 < 0.001 Vitamin K(mg/day) 325.94 ± 364.86 606.29 ± 451.55 < 0.001 Vitamin D(µ/day) 2.36 ± 1.08 1.62 ± 0.86 < 0.001 Vitamin E(mg/day) 11.76 ± 4.97 11.52 ± 4.61 0.69 Vitamin C(mg/day) 105.23 ± 69.50 177.40 ± 90.47 < 0.001 Biotin(mg/day) 23.77 ± 6.77 29.84 ± 10.53 < 0.001 Retinol(mg/day) 632.56 ± 233.56 807.83 ± 355.69 < 0.001 Lutein (mg/day) 1964.91 ± 1632.38 3540.38 ± 2165.51 < 0.001 lycopene (mg/day) 2150.40 ± 1724.83 3624.58 ± 2090.08 < 0.001 Sodium(mg/day) 3859.95 ± 862.72 3610.37 ± 680.13 0.009 Potassium(mg/day) 3548.23 ± 1034.38 4640.25 ± 1507.01 < 0.001 Calcium(mg/day) 1120.75 ± 402.63 1440.21 ± 495.18 < 0.001 Iron(mg/day) 33.36 ± 24.72 51.18 ± 31.21 < 0.001 Phosphor(mg/day) 1359.69 ± 260.59 1433.04 ± 356.01 0.06 Magnesium(mg/day) 363.55 ± 78.54 441.79 ± 137.65 < 0.001 Chromium (mg/day) 0.08 ± 0.06 0.12 ± 0.11 0.002 Copper (mg/day) 1.40 ± 0.28 1.56 ± 0.45 0.001 Glucose 16.41 ± 8.07 15.95 ± 4.53 0.55 Galactose 1.96 ± 0.97 2.14 ± 1.09 0.16 Fructose 18.77 ± 9.28 18.41 ± 5.40 0.69 Sucrose 21.14 ± 8.68 19.53 ± 9.67 0.15 CHOL: cholesterol, MUFA: monounsaturated fatty acid, PUFA: polyunsaturated fatty acid, EPA: eicosapentaenoic acid, DHA: docosahexaenoic acid, AHEI: alternate healthy eating index. P-value obtained from T-test. All data are presented as mean ± SD. P-value < 0.05 was considered significant. Table 3. The association between adherence of AHEI and severity, duration, frequency, and MIDAS of migraine. Variables Crude Adjust OR 95% Cl P-value OR 95% Cl P-value Headache duration ≤ 10 h Reference group > 10 h 0.57 0.34,0.97 0.03 0.56 0.31,0.99 0.04 Headache frequency > 15 days/month Reference group ≥ 15 days month 1.44 0.87,2.36 0.15 1.19 0.66,2.14 0.55 VAS Mild Reference group Moderate 0.82 0.40,1.64 0.60 0.69 0.31,1.51 0.36 Severe 0.81 0.40,1.67 0.58 0.72 0.31,1.67 0.45 MIDAS Without disability Reference group Mild disability 1.47 0.64,3.39 0.36 1.28 0.53,3.12 0.57 Moderate disability 0.84 0.34,2.03 0.70 0.76 0.28,2.07 0.60 Severe disability 0.87 0.40,1.85 0.72 0.76 0.31,1.88 0.56 VAS visual analog scale, MIDAS migraine disability assessment, AHEI: alternate healthy eating index. All data are presented as OR and 95% Cl by multinomial logistic regression. P-value for adjustment model: based on energy, age, marital situation, education, job, drinking water. Discussion To our knowledge, this cross-sectional study is the first to explain the association between AHEI and severity, duration, and frequency of migraine headache among women. Adherence to AHEI has a significant association on lower duration of headache even after adjusting for confounding factors, although other variables of severity migraine, such as VAS, MIDAS, and frequency of headache showed a decreasing trend associated with AHEI, these results were not significant. Our study had similar results to previous studies, such that the frequency of headache appeared to be decreased by diet rich in vegetables, fruits, and potassium, and low in fat [24]. Vascular headache in adults can be affected by many dietary factors, including chocolate, cheese, fasting, alcoholic drinks, and coffee [25–28]. Some studies have shown that occurrence of headaches is related to increased intake of monosodium glutamate [29–31]. On the other hand, a recent study indicated inconsistent evidence on the association between sodium glutamate consumption and headaches [32], and another study showed that monosodium glutamate is responsible for migraine headache in only 2.5% of study participants [28]. In a recent study, women with migraine, compared to women without migraine, had a lower intake of orange vegetables, green vegetables, fruits, whole grains, legumes, and oil [33]. Another study concluded that vegetables, such as broccoli, cabbage, parsley, beets, carrots, and spinach, have active components with an antagonistic ability against CGRP, which can be used to counter migraines, and potentially more effective than commonly administered drugs [34]. Further, in women with migraine, consumption of pro-inflammatory omega-6 fatty acids, as compared to anti-inflammatory omega-3 fatty acids, is associated with an 11-fold increase in the development of inflammation [35]. AHEI includes healthy foods such as fruits, vegetables, whole grains, nuts and legumes, n-3 chain fatty acids, polyunsaturated fatty acids, and fruit juice [15]. Several clinical studies evaluated the association between serum inflammatory markers and high-fiber diets [36–38] and found that there is an inverse relation between plasma CRP levels and high-fiber diets [39–42]. The mechanisms of these changes are still unknown, however, probable mechanisms include the absorption of glucose, fiber-rich meal modulation of cytokine responses blunting oxidative stress and inflammation, and production of anti-inflammatory cytokines, which can be decreased by high-fiber diets by gut flora [37, 38]. Some studies have indicated that, in migraine patients, the levels of riboflavin, magnesium, and coenzyme Q10s in the brain and plasma were low [43–45]. The deficiency of these micro-nutrients can have a key role in the development of migraine. Riboflavin, magnesium, and coenzyme Q10 play crucial role in the production of energy in the mitochondria [46] and their deficiency can cause mitochondrial dysfunction and then migraine [47, 48]. Furthermore, hypomagnesemia appears to play a key role in the pathogenesis of migraine, whilst magnesium, as a co-factor, is necessary in the generation of ATP. An inverse association between CRP levels and serum magnesium concentrations has been reported by several studies in children [49], women [50], and obese patients [51]. Also, it has been shown that in participants with total daily magnesium consumption below the RDA, elevated CRP levels were evident [52]. In addition, a cross-sectional study also found an inverse association between total daily magnesium intake and serum CRP levels [53]. However, another recent cross-sectional study found no association between dietary magnesium intake and CRP levels [54]. AHEI, however, is a diet rich in magnesium and riboflavin because of high amounts of vegetables, and it may be efficacious in improving the frequency, or even prevention, of migraine headaches. To our knowledge, this is the first study to evaluate the association between adherence to the AHEI diet with severity, duration, and frequency of migraine headache among women. In this study, a validated FFQ was used to determine AHEI dietary adherence and assess regular dietary intake. However, there are several limitations that need to be considered when interpreting our findings. The main limitation of the present study was its relatively small number of subjects, as well as the study population being limited to women. Therefore, the results may not be extended to men, whilst the cross-sectional nature of the study precludes causal inferences being made, and thus, we advocate for the conduct of future randomized clinical trials. Additionally, the rationale for the recruitment of women only is that migraine’s prevalence in women (More than 20%) is markedly more than men (more than 10%). One of the inevitable limitations of this type of study is that questionnaire responses are subjectively based on participants’ memory and their perception of pain. Additionally, dietary intake was assessed by a food-frequency questionnaire (FFQ), which is self-reported by the patient and therefore dependent on their memory. Conclusion The present study showed that, with regard to the association between migraine headache and AHEI, people with high adherence of AHEI had a reduction in duration of migraine. However, owing to the study limitations, further clinical trials are suggested to better evaluate and understand this association. Abbreviations AHEI : Alternative Healthy Diet Index, ICHD3 : International Classification of Headache Disorders 3, CVD : CardioVascular Disease, BMI : Body Mass Index, WC : Waist Circumference, HC : Hip Circumference, WHR : Waist and Hip Ratio, PAL : Physical Activity level, IPAQ : International Physical Activity Questionnaire, FFQ : Food Frequency Questionnaire, IHS : International Headache Society, PA : Physical Activity, MBA : Migraine with Brainstem Aura, MIDAS : Migraine Disabiliy Assessment Qestionnaire, VAS : Visual Analog Scale, MUFA : MonoUnsatturated Fatty Acid, DHA : DocosaHexaenoic Acid, EPA : EicosaPentaenoic Acid, DHA : DocosaHexaenoic Acid Declarations Ethics approval and consent to participate The study protocol has approved by the ethics committee of Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences (TUMS) with the following identification: IR. TUMS.VCR.REC.1395.1597 Consent for publication Each participant was completely informed about the study protocol and provided a written and informed consent form before taking part in the study. Availability of data and materials The data that support the findings of this study are available from Khadijeh Mirzaei ,but restrictions apply to the availability of these data, which were used under license for the current study, and are not publicly available. Data are however available from the authors upon reasonable request and with permission of Khadijeh Mirzaei. Competing interests The authors declare that they have no competing interests. Funding This study was supported by Tehran University of Medical Sciences and by grants from Tehran university of medical sciences (Grant number: ID: 95‐03‐161‐33142 and 96‐01‐161‐34479) Authors' contributions Pardis Khalili (PKH), Atieh Mirzababaei (AM), Faezeh Abaj (FA), Asma Rajabi Harsini, Mahya ( ARH ), Mehri Hajmir ( MMH ), Cain Clark (CC) , Khadijeh Mirzaei (KhM). The project was designed and managed by AM and KhM. The manuscript was written by PKH, ARH, MMH, CC. Data were analyzed and interpreted by FA. All authors read and approved the final manuscript. Acknowledgments We thank the school of Nutritional and Dietetics at Tehran University of medical sciences and participants in this investigation. References M. Arnold, Headache classification committee of the international headache society (IHS) the international classification of headache disorders, Cephalalgia 38(1) (2018) 1-211. M. Askarpour, A. Sheikhi, F. Khorsha, K. Mirzaei, Associations between adherence to MIND diet and severity, duration and frequency of migraine headaches among migraine patients, BMC research notes 13(1) (2020) 1-6. Y.W. Woldeamanuel, R.P. Cowan, Migraine affects 1 in 10 people worldwide featuring recent rise: a systematic review and meta-analysis of community-based studies involving 6 million participants, Journal of the neurological sciences 372 (2017) 307-315. T.J. Steiner, L.J. Stovner, T. Vos, GBD 2015: migraine is the third cause of disability in under 50s, Springer, 2016, pp. 1-4. N. Bahrampour, A. Mirzababaei, H. Yarizadeh, A.M. Barekzai, F. Khorsha, C.C. Clark, K. Mirzaei, The relationship between dietary nutrients patterns and intensity and duration of migraine headaches, British Journal of Nutrition (2022) 1-23. C. Finocchi, G. Sivori, Food as trigger and aggravating factor of migraine, Neurological Sciences 33(1) (2012) 77-80. A. Özturan, N. Şanlıer, Ö. 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Pain, Relationships between food, wine, and beer‐precipitated migrainous headaches, 35(6) (1995) 355-357. F.J. Carod-Artal, D. Ezpeleta, M.L. Martín-Barriga, A.L.J.J.o.t.n.s. Guerrero, Triggers, symptoms, and treatment in two populations of migraneurs in Brazil and Spain. A cross-cultural study, 304(1-2) (2011) 25-28. P.T. Fukui, T.R.T. Gonçalves, C.G. Strabelli, N.M.F. Lucchino, F.C. Matos, J.P.M.d. Santos, E. Zukerman, V. Zukerman-Guendler, J.P. Mercante, M.R.J.A.d.n.-p. Masruha, Trigger factors in migraine patients, 66 (2008) 494-499. W.H. Yang, M.A. Drouin, M. Herbert, Y. Mao, J.J.J.o.A. Karsh, C. Immunology, The monosodium glutamate symptom complex: assessment in a double-blind, placebo-controlled, randomized study, 99(6) (1997) 757-762. T.G. Randolph, J.P.J.T.J.o.L. Rollins, C. Medicine, Beet sensitivity: allergic reactions from the ingestion of beet sugar (sucrose) and monosodium glutamate of beet origin, 36(3) (1950) 407-415. D. Ratner, E. Eshel, E.J.I.j.o.m.s. Shoshani, Adverse effects of monosodium glutamate: a diagnostic problem, 20(3) (1984) 252-253. M.J.J.o.t.A.A.o.N.P. Freeman, Reconsidering the effects of monosodium glutamate: a literature review, 18(10) (2006) 482-486. E.W. Evans, R.B. Lipton, B.L. Peterlin, H.A. Raynor, J.G. Thomas, K.C. O'Leary, J. Pavlovic, R.R. Wing, D.S.J.H.T.J.o.H. Bond, F. Pain, Dietary intake patterns and diet quality in a nationally representative sample of women with and without severe headache or migraine, 55(4) (2015) 550-561. M.M. Jain, N. Kumari, G.J.I.j.o.c.b. Rai, d. design, A novel formulation of veggies with potent anti–migraine activity, 8(1) (2015) 54-61. A.P.J.B. Simopoulos, pharmacotherapy, The importance of the ratio of omega-6/omega-3 essential fatty acids, 56(8) (2002) 365-379. M. Bulló, P. Casas-Agustench, P. Amigó-Correig, J. Aranceta, J.J.P.h.n. Salas-Salvadó, Inflammation, obesity and comorbidities: the role of diet, 10(10A) (2007) 1164-1172. M.O. Weickert, A.F.J.T.J.o.n. Pfeiffer, Metabolic effects of dietary fiber consumption and prevention of diabetes, 138(3) (2008) 439-442. J.H. O’Keefe, N.M. Gheewala, J.O.J.J.o.t.A.C.o.C. O’Keefe, Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health, 51(3) (2008) 249-255. U.A. Ajani, E.S. Ford, A.H.J.T.J.o.n. Mokdad, Dietary fiber and C-reactive protein: findings from national health and nutrition examination survey data, 134(5) (2004) 1181-1185. Y. Ma, J.A. Griffith, L. Chasan-Taber, B.C. Olendzki, E. Jackson, E.J. Stanek III, W. Li, S.L. Pagoto, A.R. Hafner, I.S.J.T.A.j.o.c.n. Ockene, Association between dietary fiber and serum C-reactive protein, 83(4) (2006) 760-766. L. Qi, R.M. Van Dam, S. Liu, M. Franz, C. Mantzoros, F.B.J.D.c. Hu, Whole-grain, bran, and cereal fiber intakes and markers of systemic inflammation in diabetic women, 29(2) (2006) 207-211. Y. Ma, J.R. Hébert, W. Li, E.R. Bertone-Johnson, B. Olendzki, S.L. Pagoto, L. Tinker, M.C. Rosal, I.S. Ockene, J.K.J.N. Ockene, Association between dietary fiber and markers of systemic inflammation in the Women's Health Initiative Observational Study, 24(10) (2008) 941-949. A. Hershey, S. Powers, A.J.H. Bentti, deGrauw TJ. Characterization and response pattern on children presenting to a multi-disciplinary pediatric headache center using a detailed computer database, 39 (1999) 358. A.D. Hershey, S.W. Powers, A.L.B. Vockell, S.L. LeCates, P.L. Ellinor, A. Segers, D. Burdine, P. Manning, M.A.J.H.t.j.o.h. Kabbouche, f. pain, Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine, 47(1) (2007) 73-80. A. Mauskop, B.M.J.C.N. Altura, Role of magnesium in the pathogenesis and treatment of migraines, 5(1) (1998) 24-27. A. Bianchi, S. Salomone, F. Caraci, V. Pizza, R. Bernardini, C.C.J.V. D Amato, hormones, Role of magnesium, coenzyme Q~ 1~ 0, riboflavin, and vitamin B~ 1~ 2 in migraine prophylaxis, 69 (2004) 297-312. M. Sparaco, M. Feleppa, R. Lipton, A. Rapoport, M.J.C. Bigal, Mitochondrial dysfunction and migraine: evidence and hypotheses, 26(4) (2006) 361-372. R. Lodi, S. Iotti, P. Cortelli, G. Pierangeli, S. Cevoli, V. Clementi, S. Soriani, P. Montagna, B.J.B.r.b. Barbiroli, Deficient energy metabolism is associated with low free magnesium in the brains of patients with migraine and cluster headache, 54(4) (2001) 437-441. D.E. King, A.G. Mainous III, M.E. Geesey, T.J.M.r. Ellis, Magnesium intake and serum C-reactive protein levels in children, 20(1) (2007) 32-36. Y. Song, P.M. Ridker, J.E. Manson, N.R. Cook, J.E. Buring, S.J.D.c. Liu, Magnesium intake, C-reactive protein, and the prevalence of metabolic syndrome in middle-aged and older US women, 28(6) (2005) 1438-1444. F. Guerrero-Romero, M.J.I.j.o.o. Rodriguez-Moran, Relationship between serum magnesium levels and C-reactive protein concentration, in non-diabetic, non-hypertensive obese subjects, 26(4) (2002) 469-474. D.E. King, A.G. Mainous III, M.E. Geesey, B.M. Egan, S.J.N.r. Rehman, Magnesium supplement intake and C-reactive protein levels in adults, 26(5) (2006) 193-196. S.A. Chacko, Y. Song, L. Nathan, L. Tinker, I.H. De Boer, F. Tylavsky, R. Wallace, S.J.D.c. Liu, Relations of dietary magnesium intake to biomarkers of inflammation and endothelial dysfunction in an ethnically diverse cohort of postmenopausal women, 33(2) (2010) 304-310. M.C. de Oliveira Otto, A. Alonso, D.-H. Lee, G.L. Delclos, N.S. Jenny, R. Jiang, J.A. Lima, E. Symanski, D.R. Jacobs Jr, J.A.J.T.J.o.n. Nettleton, Dietary micronutrient intakes are associated with markers of inflammation but not with markers of subclinical atherosclerosis, 141(8) (2011) 1508-1515. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 23 Aug, 2023 Read the published version in Nutrition Journal → Version 1 posted Editorial decision: Major revision 02 May, 2023 Reviews received at journal 25 Mar, 2023 Reviewers agreed at journal 22 Mar, 2023 Reviewers invited by journal 20 Feb, 2023 Editor assigned by journal 16 Feb, 2023 Submission checks completed at journal 07 Feb, 2023 First submitted to journal 07 Feb, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2561598","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":174264622,"identity":"9e2d0435-4447-4f04-b67c-edc630037967","order_by":0,"name":"Pardis Khalili","email":"","orcid":"","institution":"Islamic Azad University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Pardis","middleName":"","lastName":"Khalili","suffix":""},{"id":174264623,"identity":"fdc76f63-7704-4604-bf93-c94590b22f73","order_by":1,"name":"Atieh Mirzababaei","email":"","orcid":"","institution":"Tehran University of Medical Sciences (TUMS)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Atieh","middleName":"","lastName":"Mirzababaei","suffix":""},{"id":174264624,"identity":"6a288c89-bf6e-4d53-b5a8-c0ded2e65d79","order_by":2,"name":"Faezeh Abaj","email":"","orcid":"","institution":"Tehran University of Medical Sciences (TUMS)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Faezeh","middleName":"","lastName":"Abaj","suffix":""},{"id":174264625,"identity":"8555743b-a336-49fc-b2ec-7fa4881a8efe","order_by":3,"name":"Asma Rajabi Harsini","email":"","orcid":"","institution":"Tehran University of Medical Sciences","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Asma","middleName":"Rajabi","lastName":"Harsini","suffix":""},{"id":174264626,"identity":"233d8a08-f0b9-4ba0-bf8f-bdcc62833a31","order_by":4,"name":"Mahya Mehri Hajmir","email":"","orcid":"","institution":"Tehran University of Medical Sciences (TUMS)","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mahya","middleName":"Mehri","lastName":"Hajmir","suffix":""},{"id":174264627,"identity":"207a244b-2c15-4dcf-b80e-c9e487742158","order_by":5,"name":"Cain C. 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T.","lastName":"Clark","suffix":""},{"id":174264628,"identity":"8267f6c5-e796-4970-bed6-486f62bab1d7","order_by":6,"name":"Khadijeh Mirzaei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYDACZjApwSAhwXyAIQFZho2wFrYEsBYeglpgQEKCxwDM4CGgkEG3nffxhx8VFgySs3s+f3i4w47BXiI7+QNDjR0Dn/QBrFrMDrMbGPackWCQljm7TSLxTDIDj0TuNgmGY8kMbHwJOLSwMSTwtkkwyAFVMiS2MYO1AD1ygIENhxNBWg7+/QfSkvP4Q2JbPUjL5g8M//BqYWzmbQA6TCKHQSKx7TBIywYJxja8WpiZZY5JMEjOSDMDajnOw3PmLdBTfck8OLWcP8b88U1NHYPEjeTHH3+2VcuxtwMd9uGbnZx8D3YtMFDfAGVAjE4gIn5GwSgYBaNgFOAGALEtTI2NU8DRAAAAAElFTkSuQmCC","orcid":"","institution":"Islamic Azad University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Khadijeh","middleName":"","lastName":"Mirzaei","suffix":""}],"badges":[],"createdAt":"2023-02-07 19:29:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2561598/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2561598/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12937-023-00867-4","type":"published","date":"2023-08-23T15:01:44+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":42781041,"identity":"c9edf056-cb09-4c27-9b2f-266200f509f1","added_by":"auto","created_at":"2023-09-07 15:07:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":484382,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2561598/v1/b8c2cd20-4377-4c50-b9ed-988e5542bdf0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The association between adherence to Alternative Healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache among women: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMigraine is a common brain disorder characterized by recurrent seizures lasting between 4 and 72 hours. Its pain characteristics can be attributed to moderate to severe unilateral throbbing pain, that worsen in physical activity, and can be concomitantly associated with nausea [1]. Approximately 12% of the world's population has migraines [2], it is the third most common disease in adults worldwide, and the third leading cause of disability in people under 50y with a prevalence of 11.6% [3, 4]. Moreover, its prevalence in women (More than 20%) is twofold more than men (more than 10%) [5]. Migraine headaches are caused by various factors, such as diet, hunger, time of day, hormonal changes, family history, depression, stress ,and irregular sleep patterns [6].\u003c/p\u003e \u003cp\u003eThere are several factors involved in the pathogenesis of migraine, but the underlying cause is still unknown. Some studies have suggested the role of nerve damage in the brain, as well as the density and pressure of the nervous system, in causing migraines. Also, the role of food in engendering migraine should not be ignored, indeed, food may elicit pain through the effect of vasoconstriction and expansion on the nervous system [6]. Pickled fermented products, salty, monosodium glutamate in fast food, caffeine in coffee and chocolate, nitrate in food containing protein, aspartame, seafood, dairy, and foods containing tyramine, including red wine and alcohol, caffeine, smoked fish, old cheese, beans, onions, fruits such as figs, citrus fruits, avocados, and bananas are among the highest migraine-stimulating foods. It has also been shown that alpha-lipoic acid and eicosapentaenoic acid may play a role in reducing the severity and frequency of migraines [7]. The other factors include vitamin D deficiency, production of inflammatory agents and prostaglandins, production of serotonin from platelets, stimulation of norepinephrine production, and increased sensitivity to nitric oxide and hyperhomocysteine [8, 9]. People with migraines are more likely to develop cardiovascular disease and death [10], and therefore, control and management of this disorder is very important [11]. Drug regimen are used extensively, however, have major side effects [12], and so, identifying alternative treatment approaches is important. Some studies have shown that a variety of diets, including high-folate, low-fat, omega-3 and low-omega-6 fats, ketogenic, atkins, and low-sodium diets, may be a promising approach in managing migraines and reducing the severity of seizures [13]. A nutritious diet is an important factor that is relatively easily modifiable. Indeed, it has been reported that consuming more vegetables, fruits, and legumes is associated with a reduction in headache duration and intensity [14]. Additionally, nutrients are usually not consumed alone, where food groups consisting of several foods are consumed, which is assumed to be a factor for the existence of synergistic effects of complex food combinations [6]. The AHEI is a measure of diet quality and adherence to healthy dietary patterns, suggesting better recommendations for healthy diets to improve health observation to factors, as well as greater predictive power for chronic diseases. AHEI includes healthy foods, such as fruits, vegetables, whole grains, nuts and legumes, n-3 chain fatty acids, polyunsaturated fatty acids, fruit juice and sugar-sweetened beverages, red and processed meat, trans fatty acids, sodium, and alcohol [15]. Previous studies have shown that migraine is associated with inflammation and oxidative stress [16], and since high fiber, whole grains, vegetables, fruits, magnesium, which are known to improve systemic inflammation, as well as suppress the inflammatory process, and these foods are components of AHEI.\u003c/p\u003e \u003cp\u003eAlthough there have been studies on the effect of diet on migraines, to our knowledge, no study has investigated the impact of AHEI on migraines. In the present study, we sought to investigate the association between adherence to Alternative Healthy Diet Index (AHEI) and severity, duration, and frequency of migraine headaches among women.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, 266 women (18 to 50 years old) who suffered with migraines, who visited the brain and neurology clinics of Khatam al-Anbia and Sina hospitals and the professional headache clinic in Tehran, were selected. Migraine was clinically diagnosed by a neurologist. Participants were included in the study based on the following inclusion and exclusion criteria. Entry criteria: Body Mass Index (BMI) 18.5\u0026ndash;30 kg/m\u003csup\u003e2\u003c/sup\u003e, visiting the headache clinic for the first time, and the diagnosis of migraine by a neurologist based on the International Classification of Headache Disorders 3 (ICHD3) criteria. If subjects in the study had a history of Cardiovascular Disease (CVD), cancer, diabetes, liver or kidney disease, and other neurological disorders because of possible disease-related changes in diet, along with subjects taking medications that affect serum lipoprotein concentrations (e.g. lovastatin, atorvastatin) a or those consuming less than 800 kcal/day (3347 kJ/day) or more than 4200 kcal/day (17573 kJ/day) were excluded from the study (28). All participants signed written informed consent forms prior to participation. The study protocol was approved by the local ethics committee: IR. TUMS.VCR.REC.1395.1597\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric Measurements\u003c/h2\u003e \u003cp\u003eAnthropometric measurements were taken from all study participants. Weight was measured while subjects were minimally clothed (i.e., no jacket, jacket or belt and shoes) using a digital scale, to an accuracy of 100 grams. Height was measured using a stadiometer while the participant was standing, without shoes, with heels touching the wall, feet together and head facing forward. BMI was calculated from height and weight data using the equation \"weight (kg)/height \u003csup\u003e2\u003c/sup\u003e (square meter)\". Waist Circumference (WC) was measured halfway between the lower part of the xiphoid process and the umbilicus, and Hip Circumference (HC) was taken at the greatest anterior projection. Waist and hip circumferences were measured using a flexible plastic tape with an accuracy of 0.5 cm. The ratio between Waist and Hip Ratio (WHR) was also calculated.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of dietary intake\u003c/h2\u003e \u003cp\u003eDietary intake over the past year was assessed using a semi-quantitative food frequency questionnaire (FFQ). This questionnaire includes a list of 147 food items, along with the standard serving size for each nutrient [17]. The reliability and validity of this questionnaire has been confirmed in Iran [18].\u003c/p\u003e \u003cp\u003eFoods commonly consumed at home were reported and converted to grams of food per day using the IV nutrition software [19]. Nutrient intake was calculated using Nutritionist IV software modified for Iranian foods based on the United States Food Composition Table of the Department of Agriculture (USDA).\u003c/p\u003e \u003cp\u003eAt baseline, scores of intensity (from 0 to 10 on a Visual Analogue Scale (VAS)), and duration were recorded after each migraine attack, regardless of the time of day. Instructions for completing this form were provided by a neurologist. If the participants had a problem completing their diaries, a staff member was available to assist. At the time of recruitment, participants were asked to complete their headache diaries over the proceeding month [20].\u003c/p\u003e \u003cp\u003ePhysical activity levels (PAL) were measured using the International Physical Activity Questionnaire (IPAQ) and according to the time spent on light, moderate, high, and very intense activities. PAL was expressed as metabolic equivalent hours per week (METs hours per week).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCalculation of AHEI score\u003c/h2\u003e \u003cp\u003eAHEI includes 11 components: fruits, vegetables, whole grains, nuts and legumes, n-3 chain fatty acids, polyunsaturated fatty acids, fruit juice and sugar-sweetened beverages, red and processed meat, trans fatty acids, sodium, and alcohol. Alcohol consumption was not assessed in this study due to lack of data. Scores for consumption of fruits, vegetables, whole grains, nuts and legumes, long-chain n-3 fatty acids and polyunsaturated fatty acids were considered as '10' and '0', respectively, for the highest and lowest amount.\u003c/p\u003e \u003cp\u003eFor fruit juice and drinks sweetened with sugar, red and processed meat, trans fatty acids and sodium, respectively, the AHEI score for each component ranged from 0 to 10 for nonadherence to full adherence, respectively, and then participants were categorized into three groups based on their AHEI scores (1, 2, and 3) [15].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eMigraine Diagnosis\u003c/h2\u003e \u003cp\u003eBased on ICHD3 criteria, episodic migraine was diagnosed by a neurologist. Episodic migraine diagnosis criteria include two types of migraine, with aura and without aura. A diagnosis of migraine without aura, according to the International Headache Society (IHS), can include five or more attacks lasting 4 to 72 hours. The headache must have two or more of the following features: unilateral, throbbing, moderate or severe pain, worsening or avoidance of usual Physical Activity (PA), as well as one or more of the following: nausea and/or vomiting, sensitivity to light (photophobia) and sound (ova phobia), feature of migraine with normal aura (with or without headache), Migraine with Brainstem Aura (MBA), hemiplegic, and retinal involvement. MBA is a type of migraine headache with aura, which is accompanied by pain in the back of the head. An aura is a group of warning signs known as a bad headache coming on. Auras may include symptoms such as vertigo, slurred speech, ataxia, tinnitus, visual changes, and/or loss of balance, as diagnosed by a neurologist [21].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eMIDAS and VAS handbook\u003c/h2\u003e \u003cp\u003eMigraine Disability Assessments (MIDAS) questionnaire was used to evaluate migraine disability and migraine severity [22]. This questionnaire consists of five questions that evaluate the severity of headache in the last three months. The first to fifth questions of the questionnaire evaluate the decrease in performance caused by migraine. Based on the total score of these five questions, participants are placed into one of four groups: 0\u0026ndash;5 (MIDAS grade I, little or no disability), 6\u0026ndash;10 (MIDAS grade II, mild disability), 11\u0026ndash;20 (MIDAS grade III, moderate disability), 21+ (MIDAS grade IV, severe disability). This questionnaire was previously validated in Iranian populations [23].\u003c/p\u003e \u003cp\u003eAlso, visual Analog Scale (VAS) was used to measure pain. The VAS consists of a 10 cm long horizontal line fixed by word descriptors at each end. The patient marks a point on the line that they feel represents an understanding of their current situation. The VAS score is determined by measuring the centimeter from the end of the left line to the point marked by the patient. Cut points include: mild pain (1\u0026ndash;3), moderate pain (4\u0026ndash;7), and severe pain (8\u0026ndash;10) [17].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of Other Variables\u003c/h2\u003e \u003cp\u003eAge, marital status, education, and job were collected by the researchers through a demographic questionnaire. Physical activity levels (PAL) were measured using the International Physical Activity Questionnaire (IPAQ) and evaluated according to the time spent on light, moderate, high and very intense activities. PAL was expressed as metabolic equivalent hours per week (METs hours per week).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eChi-square test were used to examine the association between AHEI and qualitative variables. Also, independent T-Tests were used to investigate the association between AHEI and quantitative variables (such as dietary intake, age, weight, body mass index, waist circumference, etc.). Mild pain in VAS variable, no disability in MIDAS variable, low adherence of AHEI variable were considered as reference group. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant, and SPSS version 24 (SPSS Inc., Chicago, IL, USA) was used for statistical analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec12\"\u003e\n \u003ch2\u003eParticipant characteristics\u003c/h2\u003e\n \u003cp\u003eThe mean (\u0026plusmn;\u0026thinsp;SD) age, height, weight, BMI, and physical activity of participants were 34.29 (7.95) years, 1.61 (0.05) m, 67.71 (13.04) kg, 25.88 (4.74) kg/m\u003csup\u003e2\u003c/sup\u003e, 380.03 (599.63) MET/min/week, respectively. Except for duration (less than and more than 10 hours of migraine), there was no significant association between high adherence AHDI compared with low adherence. However, people with higher adherence to the AHEI compared to lower adherence had better scores for VAS, disability, and headache frequency.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec13\"\u003e\n \u003ch2\u003eParticipant characteristics among intake of AHEI\u003c/h2\u003e\n \u003cp\u003eThe mean intake of AHEI was significantly different among those with higher adherence to AHEI, Table\u0026nbsp;2. Individuals with higher AHEI adherence had higher energy, total fat, cholesterol, saturated fatty acid, trans, Mono Unsaturated Fatty Acid (MUFA), Poly Unsaturated Fatty Acid (PUFA), oleic acid, linoleic acid, linolenic acid, Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA), total fiber, riboflavin (B2), pyridoxine (B6), cobalamin (B12), vitamins K, E, D, C, biotin, retinol, lutein, lycopene, sodium, potassium, calcium, iron, phosphor, magnesium, and copper (p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) intakes compared to individuals with lower adherence.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec14\"\u003e\n \u003ch2\u003eThe association between AHEI and severity, duration, and frequency of migraine headache\u003c/h2\u003e\n \u003cp\u003eMultivariable-adjusted OR and 95% CI for AHEI and migraine VAS, MIDAS, frequency, and duration migraine are shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e. A significant positive association was found between adherence to the AHEI and headache duration. People with high adherence of AHEI, compared with low adherence, had 43% reduction of headache duration (OR\u0026thinsp;=\u0026thinsp;0.57; 95% CI 0.34, 0.97; P\u0026thinsp;=\u0026thinsp;0.03) in the crude model; this association remained significant in the adjusted model (OR\u0026thinsp;=\u0026thinsp;0.56; 95% CI 0.31, 0.99; P\u0026thinsp;=\u0026thinsp;0.04). Frequency of migraine in crude and adjusted models did not show any significant association. High adherence of AHEI compared to low adherence for people with severe headaches (OR\u0026thinsp;=\u0026thinsp;0.72; 95% CI 0.31, 1.67; P\u0026thinsp;=\u0026thinsp;0.45) compared to people with moderate (OR\u0026thinsp;=\u0026thinsp;0.69; 95% CI 0.31, 1.51; P\u0026thinsp;=\u0026thinsp;0.36), despite a decrease in OR, was not significant. Similarly, people with moderate disability (OR\u0026thinsp;=\u0026thinsp;0.76; 95% CI 0.28, 2.07; P\u0026thinsp;=\u0026thinsp;0.60) compared to people with mild disability (OR\u0026thinsp;=\u0026thinsp;1.28; 95% CI 0.53, 3.12; P\u0026thinsp;=\u0026thinsp;0.57), despite a decrease in OR, was not significant. Furthermore, in people with severe disability (OR\u0026thinsp;=\u0026thinsp;0.76; 95% CI 0.31, 1.88; P\u0026thinsp;=\u0026thinsp;0.76) compared to mild disability (OR\u0026thinsp;=\u0026thinsp;0.76; 95% CI 0.28, 2.07; P\u0026thinsp;=\u0026thinsp;0.60), despite reductions, statistical significance was not found.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLow adherence of AHEI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHigh adherence of AHEI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of study population based on adherence of AHEI.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQuantitative variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.29\u0026thinsp;\u0026plusmn;\u0026thinsp;7.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.34\u0026thinsp;\u0026plusmn;\u0026thinsp;7.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeight (m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.71\u0026thinsp;\u0026plusmn;\u0026thinsp;13.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.44\u0026thinsp;\u0026plusmn;\u0026thinsp;12.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.88\u0026thinsp;\u0026plusmn;\u0026thinsp;4.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.23\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHC (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103.94\u0026thinsp;\u0026plusmn;\u0026thinsp;11.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103.91\u0026thinsp;\u0026plusmn;\u0026thinsp;13.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWC (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.55\u0026thinsp;\u0026plusmn;\u0026thinsp;12.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87.45\u0026thinsp;\u0026plusmn;\u0026thinsp;13.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWHR (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhysical activity (MET/h/week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e380.03\u0026thinsp;\u0026plusmn;\u0026thinsp;599.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e437.18\u0026thinsp;\u0026plusmn;\u0026thinsp;406.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQualitative variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital situation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98 (52.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90 (47.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66 (51.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (48.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBachelor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMaster or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40 (56.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(43.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eJob\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47 (66.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95 (60.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75 (39.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMigraine severity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61 (53.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51 (46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMIDAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout or low disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42 (63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23 (50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60 (50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58 (49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeadache duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;10 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (49.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90 (50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55 (63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeadache frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;15 days/month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95 (57.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70 (42.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;15 days month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52 (51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eBMI: body mass index, WC: waist circumference, HC: hip circumference, WHR: weight to hip ratio, VAS: visual analog scale, MIDAS: migraine disability assessment, AHEI: alternate healthy eating index.\u003c/p\u003e\n \u003cp\u003eQuantitative variables calculated by T-test and presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\n \u003cp\u003eQualitative variables calculated by chi-square test and presented as N (%).\u003c/p\u003e\n \u003cp\u003eP-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003eTable 2. Dietary intake based on adherence of AHEI.\u003c/p\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\u003c/tbody\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow adherence of AHEI (n\u0026thinsp;=\u0026thinsp;144)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh adherence of AHEI (n\u0026thinsp;=\u0026thinsp;122)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMacronutrients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEnergy(kcal/d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2363.62\u0026thinsp;\u0026plusmn;\u0026thinsp;490.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2074.48\u0026thinsp;\u0026plusmn;\u0026thinsp;510.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCarbohydrates(gr/ day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e296.38\u0026thinsp;\u0026plusmn;\u0026thinsp;63.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e288.04\u0026thinsp;\u0026plusmn;\u0026thinsp;73.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProtein(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.63\u0026thinsp;\u0026plusmn;\u0026thinsp;13.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.72\u0026thinsp;\u0026plusmn;\u0026thinsp;18.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal fat(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.57\u0026thinsp;\u0026plusmn;\u0026thinsp;31.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.75\u0026thinsp;\u0026plusmn;\u0026thinsp;24.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCHOL(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e286.45\u0026thinsp;\u0026plusmn;\u0026thinsp;88.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e198.58\u0026thinsp;\u0026plusmn;\u0026thinsp;75.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSaturated fat(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.02\u0026thinsp;\u0026plusmn;\u0026thinsp;12.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.64\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTrans fat(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0004\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.0000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.0001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMUFA(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.13\u0026thinsp;\u0026plusmn;\u0026thinsp;11.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.74\u0026thinsp;\u0026plusmn;\u0026thinsp;10.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePUFA(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.30\u0026thinsp;\u0026plusmn;\u0026thinsp;8.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.99\u0026thinsp;\u0026plusmn;\u0026thinsp;7.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDHA(gr/day))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEPA(gr/day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOleic(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.78\u0026thinsp;\u0026plusmn;\u0026thinsp;10.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.12\u0026thinsp;\u0026plusmn;\u0026thinsp;10.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinoleic(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.54\u0026thinsp;\u0026plusmn;\u0026thinsp;7.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.62\u0026thinsp;\u0026plusmn;\u0026thinsp;7.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLinolenic(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.97\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal fiber(gr/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.36\u0026thinsp;\u0026plusmn;\u0026thinsp;12.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.58\u0026thinsp;\u0026plusmn;\u0026thinsp;15.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMicronutrients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThiamin(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.73\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRiboflavin(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.02\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNiacin(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.71\u0026thinsp;\u0026plusmn;\u0026thinsp;5.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22.62\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePantothenic acid(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.87\u0026thinsp;\u0026plusmn;\u0026thinsp;1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePyridoxine(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.05\u0026thinsp;\u0026plusmn;\u0026thinsp;0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFolic acid(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e495.31\u0026thinsp;\u0026plusmn;\u0026thinsp;115.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e568.05\u0026thinsp;\u0026plusmn;\u0026thinsp;135.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCobalamin (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVitamin K(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e325.94\u0026thinsp;\u0026plusmn;\u0026thinsp;364.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e606.29\u0026thinsp;\u0026plusmn;\u0026thinsp;451.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVitamin D(\u0026micro;/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVitamin E(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVitamin C(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105.23\u0026thinsp;\u0026plusmn;\u0026thinsp;69.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e177.40\u0026thinsp;\u0026plusmn;\u0026thinsp;90.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBiotin(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.84\u0026thinsp;\u0026plusmn;\u0026thinsp;10.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRetinol(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e632.56\u0026thinsp;\u0026plusmn;\u0026thinsp;233.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e807.83\u0026thinsp;\u0026plusmn;\u0026thinsp;355.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLutein (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1964.91\u0026thinsp;\u0026plusmn;\u0026thinsp;1632.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3540.38\u0026thinsp;\u0026plusmn;\u0026thinsp;2165.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003elycopene (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2150.40\u0026thinsp;\u0026plusmn;\u0026thinsp;1724.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3624.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2090.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSodium(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3859.95\u0026thinsp;\u0026plusmn;\u0026thinsp;862.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3610.37\u0026thinsp;\u0026plusmn;\u0026thinsp;680.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePotassium(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3548.23\u0026thinsp;\u0026plusmn;\u0026thinsp;1034.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4640.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1507.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCalcium(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1120.75\u0026thinsp;\u0026plusmn;\u0026thinsp;402.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1440.21\u0026thinsp;\u0026plusmn;\u0026thinsp;495.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIron(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33.36\u0026thinsp;\u0026plusmn;\u0026thinsp;24.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.18\u0026thinsp;\u0026plusmn;\u0026thinsp;31.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePhosphor(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1359.69\u0026thinsp;\u0026plusmn;\u0026thinsp;260.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1433.04\u0026thinsp;\u0026plusmn;\u0026thinsp;356.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMagnesium(mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e363.55\u0026thinsp;\u0026plusmn;\u0026thinsp;78.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e441.79\u0026thinsp;\u0026plusmn;\u0026thinsp;137.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChromium (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.08\u0026thinsp;\u0026plusmn;\u0026thinsp;0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCopper (mg/day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.40\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.56\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGlucose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16.41\u0026thinsp;\u0026plusmn;\u0026thinsp;8.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGalactose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.14\u0026thinsp;\u0026plusmn;\u0026thinsp;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFructose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.77\u0026thinsp;\u0026plusmn;\u0026thinsp;9.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.41\u0026thinsp;\u0026plusmn;\u0026thinsp;5.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSucrose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.14\u0026thinsp;\u0026plusmn;\u0026thinsp;8.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.53\u0026thinsp;\u0026plusmn;\u0026thinsp;9.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eCHOL: cholesterol, MUFA: monounsaturated fatty acid, PUFA: polyunsaturated fatty acid, EPA: eicosapentaenoic acid, DHA: docosahexaenoic acid, AHEI: alternate healthy eating index.\u003c/p\u003e\n \u003cp\u003eP-value obtained from T-test.\u003c/p\u003e\n \u003cp\u003eAll data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\n \u003cp\u003eP-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003eTable 3. The association between adherence of AHEI and severity, duration, frequency, and MIDAS of migraine.\u003c/div\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable border=\"1\" id=\"Taba\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eCrude\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eAdjust\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% Cl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e95% Cl\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeadache duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;10 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eReference group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;10 h\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34,0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31,0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeadache frequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;15 days/month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eReference group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;15 days month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87,2.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66,2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eReference group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40,1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31,1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40,1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31,1.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMIDAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWithout disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eReference group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMild disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64,3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53,3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34,2.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28,2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSevere disability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.40,1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31,1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eVAS visual analog scale, MIDAS migraine disability assessment, AHEI: alternate healthy eating index.\u003c/p\u003e\n \u003cp\u003eAll data are presented as OR and 95% Cl by multinomial logistic regression.\u003c/p\u003e\n \u003cp\u003eP-value for adjustment model: based on energy, age, marital situation, education, job, drinking water.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo our knowledge, this cross-sectional study is the first to explain the association between AHEI and severity, duration, and frequency of migraine headache among women. Adherence to AHEI has a significant association on lower duration of headache even after adjusting for confounding factors, although other variables of severity migraine, such as VAS, MIDAS, and frequency of headache showed a decreasing trend associated with AHEI, these results were not significant.\u003c/p\u003e \u003cp\u003eOur study had similar results to previous studies, such that the frequency of headache appeared to be decreased by diet rich in vegetables, fruits, and potassium, and low in fat [24]. Vascular headache in adults can be affected by many dietary factors, including chocolate, cheese, fasting, alcoholic drinks, and coffee [25\u0026ndash;28]. Some studies have shown that occurrence of headaches is related to increased intake of monosodium glutamate [29\u0026ndash;31]. On the other hand, a recent study indicated inconsistent evidence on the association between sodium glutamate consumption and headaches [32], and another study showed that monosodium glutamate is responsible for migraine headache in only 2.5% of study participants [28]. In a recent study, women with migraine, compared to women without migraine, had a lower intake of orange vegetables, green vegetables, fruits, whole grains, legumes, and oil [33]. Another study concluded that vegetables, such as broccoli, cabbage, parsley, beets, carrots, and spinach, have active components with an antagonistic ability against CGRP, which can be used to counter migraines, and potentially more effective than commonly administered drugs [34].\u003c/p\u003e \u003cp\u003eFurther, in women with migraine, consumption of pro-inflammatory omega-6 fatty acids, as compared to anti-inflammatory omega-3 fatty acids, is associated with an 11-fold increase in the development of inflammation [35]. AHEI includes healthy foods such as fruits, vegetables, whole grains, nuts and legumes, n-3 chain fatty acids, polyunsaturated fatty acids, and fruit juice [15]. Several clinical studies evaluated the association between serum inflammatory markers and high-fiber diets [36\u0026ndash;38] and found that there is an inverse relation between plasma CRP levels and high-fiber diets [39\u0026ndash;42]. The mechanisms of these changes are still unknown, however, probable mechanisms include the absorption of glucose, fiber-rich meal modulation of cytokine responses blunting oxidative stress and inflammation, and production of anti-inflammatory cytokines, which can be decreased by high-fiber diets by gut flora [37, 38]. Some studies have indicated that, in migraine patients, the levels of riboflavin, magnesium, and coenzyme Q10s in the brain and plasma were low [43\u0026ndash;45]. The deficiency of these micro-nutrients can have a key role in the development of migraine. Riboflavin, magnesium, and coenzyme Q10 play crucial role in the production of energy in the mitochondria [46] and their deficiency can cause mitochondrial dysfunction and then migraine [47, 48]. Furthermore, hypomagnesemia appears to play a key role in the pathogenesis of migraine, whilst magnesium, as a co-factor, is necessary in the generation of ATP.\u003c/p\u003e \u003cp\u003eAn inverse association between CRP levels and serum magnesium concentrations has been reported by several studies in children [49], women [50], and obese patients [51]. Also, it has been shown that in participants with total daily magnesium consumption below the RDA, elevated CRP levels were evident [52]. In addition, a cross-sectional study also found an inverse association between total daily magnesium intake and serum CRP levels [53]. However, another recent cross-sectional study found no association between dietary magnesium intake and CRP levels [54]. AHEI, however, is a diet rich in magnesium and riboflavin because of high amounts of vegetables, and it may be efficacious in improving the frequency, or even prevention, of migraine headaches.\u003c/p\u003e \u003cp\u003eTo our knowledge, this is the first study to evaluate the association between adherence to the AHEI diet with severity, duration, and frequency of migraine headache among women. In this study, a validated FFQ was used to determine AHEI dietary adherence and assess regular dietary intake. However, there are several limitations that need to be considered when interpreting our findings. The main limitation of the present study was its relatively small number of subjects, as well as the study population being limited to women. Therefore, the results may not be extended to men, whilst the cross-sectional nature of the study precludes causal inferences being made, and thus, we advocate for the conduct of future randomized clinical trials. Additionally, the rationale for the recruitment of women only is that migraine\u0026rsquo;s prevalence in women (More than 20%) is markedly more than men (more than 10%). One of the inevitable limitations of this type of study is that questionnaire responses are subjectively based on participants\u0026rsquo; memory and their perception of pain. Additionally, dietary intake was assessed by a food-frequency questionnaire (FFQ), which is self-reported by the patient and therefore dependent on their memory.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe present study showed that, with regard to the association between migraine headache and AHEI, people with high adherence of AHEI had a reduction in duration of migraine. However, owing to the study limitations, further clinical trials are suggested to better evaluate and understand this association.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAHEI\u003c/strong\u003e: Alternative Healthy Diet Index,\u0026nbsp;\u003cstrong\u003eICHD3\u003c/strong\u003e: International Classification of Headache Disorders 3, \u003cstrong\u003eCVD\u003c/strong\u003e: CardioVascular Disease, \u003cstrong\u003eBMI\u003c/strong\u003e: Body Mass Index, \u003cstrong\u003eWC\u003c/strong\u003e: Waist Circumference, \u003cstrong\u003eHC\u003c/strong\u003e: Hip Circumference, \u003cstrong\u003eWHR\u003c/strong\u003e: Waist and Hip Ratio, \u003cstrong\u003ePAL\u003c/strong\u003e: Physical Activity level, \u003cstrong\u003eIPAQ\u003c/strong\u003e: International Physical Activity Questionnaire, \u0026nbsp;\u003cstrong\u003eFFQ\u003c/strong\u003e: Food Frequency Questionnaire, \u003cstrong\u003eIHS\u003c/strong\u003e:\u0026nbsp;International Headache Society,\u0026nbsp;\u003cstrong\u003ePA\u003c/strong\u003e: Physical Activity, \u003cstrong\u003eMBA\u003c/strong\u003e: Migraine with Brainstem Aura, \u003cstrong\u003eMIDAS\u003c/strong\u003e: Migraine Disabiliy Assessment Qestionnaire, \u003cstrong\u003eVAS\u003c/strong\u003e:\u0026nbsp;Visual Analog Scale,\u0026nbsp;\u003cstrong\u003eMUFA\u003c/strong\u003e: MonoUnsatturated Fatty Acid, \u003cstrong\u003eDHA\u003c/strong\u003e: \u0026nbsp;DocosaHexaenoic Acid, \u003cstrong\u003eEPA\u003c/strong\u003e: EicosaPentaenoic Acid, \u003cstrong\u003eDHA\u003c/strong\u003e: DocosaHexaenoic Acid\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol has approved by the ethics committee of Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences (TUMS) with the following identification: IR. TUMS.VCR.REC.1395.1597\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach participant was completely informed about the study protocol and provided a written and informed consent form before taking part in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from Khadijeh Mirzaei ,but restrictions apply to the availability of these data, which were used under license for the current study, and are not publicly available. Data are however available from the authors upon reasonable request and with permission of Khadijeh Mirzaei.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Tehran University of Medical Sciences and by grants from Tehran university of medical sciences (Grant number: ID: 95‐03‐161‐33142 and 96‐01‐161‐34479) \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePardis Khalili (PKH), Atieh Mirzababaei (AM), Faezeh Abaj (FA),\u003c/strong\u003e \u003cstrong\u003eAsma Rajabi Harsini, Mahya (\u003c/strong\u003e\u003cstrong\u003eARH\u003c/strong\u003e\u003cstrong\u003e), Mehri Hajmir\u003c/strong\u003e (\u003cstrong\u003eMMH\u003c/strong\u003e), \u003cstrong\u003eCain Clark (CC)\u003c/strong\u003e,\u003cstrong\u003e Khadijeh Mirzaei (KhM).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe project was designed and managed by AM and KhM. The manuscript was written by PKH, ARH, MMH, CC. Data were analyzed and interpreted by FA. All authors read and approved the final manuscript. \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the school of Nutritional and Dietetics at Tehran University of medical sciences and participants in this investigation. \u003c/p\u003e"},{"header":"References ","content":"\u003col\u003e\n\u003cli\u003eM. Arnold, Headache classification committee of the international headache society (IHS) the international classification of headache disorders, Cephalalgia 38(1) (2018) 1-211.\u003c/li\u003e\n\u003cli\u003eM. Askarpour, A. Sheikhi, F. Khorsha, K. Mirzaei, Associations between adherence to MIND diet and severity, duration and frequency of migraine headaches among migraine patients, BMC research notes 13(1) (2020) 1-6.\u003c/li\u003e\n\u003cli\u003eY.W. Woldeamanuel, R.P. 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Nettleton, Dietary micronutrient intakes are associated with markers of inflammation but not with markers of subclinical atherosclerosis, 141(8) (2011) 1508-1515.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"nutrition-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutj","sideBox":"Learn more about [Nutrition Journal](http://nutritionj.biomedcentral.com/)","snPcode":"12937","submissionUrl":"https://submission.nature.com/new-submission/12937/3","title":"Nutrition Journal","twitterHandle":"@NutrJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Alternative Healthy Diet Index, severity of migraine, duration of migraine, frequency of migraine ","lastPublishedDoi":"10.21203/rs.3.rs-2561598/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2561598/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMigraine is a common brain disorder with pain characteristics that can be defined by moderate to severe unilateral throbbing pain, worsening in physical activity, and can be associated with nausea. Migraine headaches can be caused by numerous factors, including diet. This study aimed to assess the association of adherence to Alternative Healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this cross-sectional study, 266 women (18 to 50 years old) who suffered with migraines, who visited the brain and neurology clinics of Khatam al-Anbia and Sina hospitals and the professional headache clinic in Tehran, were selected. Anthropometric measurements and demographic information were collected. Dietary intake in the past year was assessed using a semi-quantitative, 147-item, food frequency questionnaire (FFQ). AHEI was calculated based on FFQ, and episodic migraine was diagnosed by a neurologist. The Migraine Disability Assessments (MIDAS) questionnaire was used to evaluate migraine disability and migraine severity, visual Analog Scale (VAS) questionnaire was used to measure pain, and duration and frequency were ascertained via questionnaire.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePeople with high adherence to AHEI, compared with low adherence, had a 43% reduction in headache duration in the crude model (OR\u0026thinsp;=\u0026thinsp;0.57; 95% CI 0.34, 0.97; P\u0026thinsp;=\u0026thinsp;0.03), which remained significant after adjusting for potential confounders (OR\u0026thinsp;=\u0026thinsp;0.56; 95% CI 0.31, 0.99; P\u0026thinsp;=\u0026thinsp;0.04). However, other variables, VAS, MIDAS and frequency of headache in month, were not significant.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eRegarding the association between migraine headache and AHEI, the results of our study showed that people with high adherence of AHEI had a reduction in duration of migraine. Further studies are suggested to better evaluate and understand this association.\u003c/p\u003e","manuscriptTitle":"The association between adherence to Alternative Healthy Diet Index (AHEI) and severity, disability, duration, and frequency of migraine headache among women: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-02-09 09:29:41","doi":"10.21203/rs.3.rs-2561598/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-05-02T18:19:04+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-03-25T17:07:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"47ffcb34-f2bf-406d-9557-331dbc71d4c5","date":"2023-03-22T06:07:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-02-20T19:18:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-02-16T15:23:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-02-07T23:20:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"Nutrition Journal","date":"2023-02-07T19:17:34+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"nutrition-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"nutj","sideBox":"Learn more about [Nutrition Journal](http://nutritionj.biomedcentral.com/)","snPcode":"12937","submissionUrl":"https://submission.nature.com/new-submission/12937/3","title":"Nutrition Journal","twitterHandle":"@NutrJournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f36e01b-5e2a-4d7e-b03d-a8c7896276f0","owner":[],"postedDate":"February 9th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-09-07T15:04:19+00:00","versionOfRecord":{"articleIdentity":"rs-2561598","link":"https://doi.org/10.1186/s12937-023-00867-4","journal":{"identity":"nutrition-journal","isVorOnly":false,"title":"Nutrition Journal"},"publishedOn":"2023-08-23 15:01:44","publishedOnDateReadable":"August 23rd, 2023"},"versionCreatedAt":"2023-02-09 09:29:41","video":"","vorDoi":"10.1186/s12937-023-00867-4","vorDoiUrl":"https://doi.org/10.1186/s12937-023-00867-4","workflowStages":[]},"version":"v1","identity":"rs-2561598","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2561598","identity":"rs-2561598","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}