Comment on "Adaptation Processes to Loneliness Among Older Adults: A Qualitative Study".

Plant‐based diet (PBD) is an umbrella term referring to dietary patterns that are high in plant foods (fruits, vegetables, nuts, seeds, legumes, and wholegrains) and low or absent in meat and dairy foods []. A vegan diet is a type of PBD that completely excludes all foods of animal origin. PBDs contribute to reduced risk of primary and secondary coronary heart disease (CHD) []. Meta‐analyses of randomized controlled trials of vegan interventions show improvements in several cardiometabolic risk markers, including body weight and blood lipids [, ]. For example, Termannsen et al. found that in comparison with control diets, vegan diets reduced body, body mass index (BMI), glycated hemoglobin, total cholesterol (TC), and low‐density lipoprotein cholesterol in people with overweight or diabetes []. Despite clear evidence supporting the benefits of PBDs, advice to adopt a PBD is generally not a focus for management of CHD []. The reasons for this are unclear but may relate to a perception that patients are unable or unwilling to significantly alter their eating habits. Potential barriers to clinicians providing dietary advice include a lack of time or insufficient nutritional expertise []. Few studies have explored acceptability and adherence to PBDs in cardiology patients []. Evaluating a cardiology service that routinely prescribes a PBD will identify opportunities to enhance service delivery and provide a model for other cardiology clinics []. Diet acceptability refers to “an individual's judgment of the advantages and disadvantages of a therapeutic diet in relation to palatability, costs, and effects on eating behavior and health—that influence the likelihood of adherence” []. Acceptability can be assessed via tools such as the food acceptability questionnaire (FAQ) and/or interviews []. Adherence to PBD interventions has been assessed in various ways. Some researchers define adherence as the absence of proscribed foods (APF) []. This offers a quick and easy way to assess adherence but offers limited insight into the overall quality of the diet or the nature of dietary change. Diet quality indices (DQI) are predefined scoring systems to evaluate how closely an individual's eating pattern aligns with dietary recommendations []. DQIs that accommodate vegan dietary patterns include the plant‐based dietary index (PDI) [], the Alternate Healthy Eating Index (AHEI‐2010) [], and the Swiss‐based diet quality score for vegans (DQS‐V) []. However, these do not align closely with education centered around food groupings in the Australian Guide to Healthy Eating (AGHE) []. In order to be used in a service review, the DQI needs to be quick and easy to analyze, align with nutrition counseling and yield insightful information about adherence and diet quality.