*2.4. Diet Assessment*

At each visit, participants were asked to complete two 24-h dietary recalls on nonconsecutive days: one weekday and one weekend day. Baseline recalls were completed by trained interviewers using the Nutritional Data System for Research (NDSR) software version 2014, developed by the Nutrition Coordinating Center (University of Minnesota, Minneapolis, MN, USA) [34], while follow-up recalls used the Automated Self-Administered 24-h (ASA24) Dietary Assessment Tool, version (2018), developed by the National Cancer Institute, Bethesda, MD, USA [35]. An average of the values from both days was calculated for each diet component. At baseline, 16 participants (10.3%) completed only one recall, and 9 (10.2%) completed only one recall at follow-up. If a participant did not complete both recalls, values from the single recall were used.

Four diet indices were calculated from the recall data at both the baseline and followup visits: the 2015 Healthy Eating Index (HEI), DASH score, Mediterranean Diet Score (MDS), and DII. The HEI ranges from 0–100, is based on adherence to the United States Department of Agriculture (USDA) 2015 Dietary Guidelines [36] and contains the following thirteen elements standardized to calorie intake: total fruit, whole fruit, total vegetables, greens and beans, whole grains, refined grains, dairy, total protein foods, seafood and plant proteins, mono- and polyunsaturated fatty acids, saturated fats, sodium, and added sugars. The DASH scoring method follows the calculation proposed by Mellen et al. [37], using nutrient goals for DASH diet adherence. This DASH score ranges from 0 to 8 and includes the following elements standardized to calorie intake: protein, fiber, magnesium, calcium, potassium, total fat, saturated fat, cholesterol, and sodium. One point was assigned if the nutrient goal was met, and half of a point was assigned if an intermediate nutrient goal was met. The MDS was calculated using the method developed by Trichopoulou et al. [38], which ranges from 0 to 9 with ten components: vegetables, legumes, fruits and nuts, dairy, cereals, meat, poultry, fish, alcohol, and ratio of mono- to saturated fats. For each component, one point was assigned for exceeding the sex-specific median. The DII was adapted from Shivappa et al. [39], with negative values indicating an anti-inflammatory diet and positive values indicating a pro-inflammatory diet. For each element, a centered percentile was calculated by comparing the reported intake to a global mean and standard deviation of intake. This centered percentile was multiplied by the element's overall inflammatory effect score, and the scores for all elements were summed to produce the DII score. Twenty-eight of the forty-five elements from Shivappa et al. [39] were included: alcohol, beta-carotene, caffeine, carbohydrates, cholesterol, calories, total fat, fiber, iron, magnesium, folic acid, mono- and polyunsaturated fatty acids, omega-3 and omega-6 fatty acids, protein, saturated fat, selenium, zinc, and vitamins A, B1 (thiamin), B2 (riboflavin), B3 (niacin), C, D, and E. The remaining elements were excluded because they are not specifically captured by the recalls systems used in this study. Trans fats were banned by the United States Food and Drug Administration in 2015, with a 2018 deadline for implementation [40], and were excluded from the DII calculation in the follow-up visit.
