Advances in dietary pattern analysis in nutritional epidemiology

Advances in methods for characterizing dietary patterns: A scoping review

There is a growing focus on better understanding the complexity of dietary patterns and how they relate to health and other factors. Approaches that have not traditionally been applied to characterize dietary patterns, such as machine learning algorithms and latent class analysis methods, may offer opportunities to measure and characterize dietary patterns in greater depth than previously considered. However, there has not been a formal examination of how this wide range of approaches has been applied to characterize dietary patterns. This scoping review synthesized literature from 2005-2022 applying methods not traditionally used to characterize dietary patterns, referred to as novel methods. MEDLINE, CINAHL, and Scopus were searched using keywords including machine learning, latent class analysis, and least absolute shrinkage and selection operator (LASSO). Of 5274 records identified, 24 met the inclusion criteria. Twelve of 24 articles were published since 2020. Studies were conducted across 17 countries. Nine studies used approaches that have applications in machine learning to identify dietary patterns. Fourteen studies assessed associations between dietary patterns that were characterized using novel methods and health outcomes, including cancer, cardiovascular disease, and asthma. There was wide variation in the methods applied to characterize dietary patterns and in how these methods were described. The extension of reporting guidelines and quality appraisal tools relevant to nutrition research to consider specific features of novel methods may facilitate complete and consistent reporting and enable evidence synthesis to inform policies and programs aimed at supporting healthy dietary patterns.

The Role of Water-Soluble Vitamins and Vitamin D in Prevention and Treatment of Depression and Seasonal Affective Disorder in Adults

Depression is a major global health concern expected to worsen by 2030. In 2019, 28 million individuals were affected by depressive disorders. Dietary and supplemental vitamins show overall favorable preventative and therapeutic effects on depression. B vitamins are crucial for neurological function and mood regulation. Deficiencies in these vitamins are linked to depression. Studies on individual B vitamins show promise in improving depressive symptoms, particularly thiamin, riboflavin, niacin, and folate. Vitamin C deficiency may heighten depressive symptoms, but its exact role is not fully understood. Seasonal Affective Disorder (SAD) is associated with insufficient sunlight exposure and vitamin D deficiency. Vitamin D supplementation for SAD shows inconsistent results due to methodological variations. Further investigation is needed to understand the mechanisms of vitamins in depression treatment. Moreover, more research on SAD and light therapy's efficacy and underlying mechanisms involving photoreceptors, enzymes, and immune markers is needed. Although dietary and supplemental vitamins show overall favorable preventative and therapeutic effects on depression, dietitians treating psychiatric disorders face challenges due to diverse study designs, making direct comparisons difficult. Therefore, this article reviews the current literature to assess the role of dietary and supplemental vitamins in the prevention and treatment of depression. This review found that, although evidence supports the role of B vitamins and vitamins C and D in preventing and treating depression, further research is needed to clarify their mechanisms of action and determine the most effective intervention strategies.

The Association between Cafestol and Cardiovascular Diseases: A Comprehensive Review

Cafestol, a bioactive compound found in coffee, has attracted considerable attention due to its potential impact on cardiovascular health. This review aims to comprehensively explore the association between cafestol and cardiovascular diseases. We delve into the mechanisms through which cafestol influences lipid metabolism, inflammation, and endothelial function, all of which are pivotal in cardiovascular pathophysiology. Moreover, we meticulously analyze epidemiological studies and clinical trials to elucidate the relationship between cafestol and cardiovascular outcomes. Through a critical examination of existing literature, we aim to provide insights into the potential benefits and risks associated with cafestol concerning cardiovascular health.

Sociodemographic and Lifestyle Characteristics Associated with Maternal Dietary Patterns in Mexico

There is scarce evidence on sociodemographic and lifestyle characteristics that may explain adherence to different dietary patterns (DPs) during pregnancy. Our aims were to identify dietary patterns in a sample of pregnant Mexican women and to describe their association with selected sociodemographic and lifestyle characteristics. This is a secondary cross-sectional analysis of 252 mothers of children that participated as controls in a hospital-based case-control study of childhood leukemia. We obtained parents' information about selected sociodemographic characteristics, as well as alcohol and tobacco consumption. We also obtained dietary information during pregnancy. We identified DPs using cluster and factor analyses and we estimated their association with characteristics of interest. We identified two DPs using cluster analysis, which we called "Prudent" and "Non healthy", as well as three DPs through factor analysis, namely "Prudent", "Processed foods and fish", and "Chicken and vegetables". Characteristics associated with greater adherence to "Prudent" patterns were maternal education, older paternal age, not smoking, and being a government employee and/or uncovered population. Likewise, the "Processed foods and fish" pattern was associated with greater maternal and paternal education, as well as those with less household overcrowding. We did not identify sociodemographic variables related to the "Chicken and Vegetables" pattern. Our results may be useful to identify target populations that may benefit from interventions aimed to improve individual dietary decisions during pregnancy.

Healthier Dietary Patterns Are Associated with Better Sleep Quality among Shanghai Suburban Adults: A Cross-Sectional Study

BACKGROUND

More is to be explored between dietary patterns and sleep quality in the Chinese adult population.

METHODS

A cross-sectional study including 7987 Shanghai suburban adults aged 20-74 years was conducted. Dietary information was obtained using a validated food frequency questionnaire. Adherence to a priori dietary patterns, such as the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet (MD), was assessed. Sleep quality was assessed from self-reported responses to the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Logistic regression models adjusting for confounders were employed to examine the associations.

RESULTS

The overall prevalence of poor sleep (PSQI score ≥ 5) was 28.46%. Factor analysis demonstrated four a posteriori dietary patterns. Participants with a higher CHEI (ORQ4 vs. Q1: 0.81, 95% CI: 0.70-0.95), DASH (ORQ4 vs. Q1: 0.70, 95% CI: 0.60-0.82) or MD (ORQ4 vs. Q1: 0.75, 95% CI: 0.64-0.87) had a lower poor sleep prevalence, while participants with a higher "Beverages" score had a higher poor sleep prevalence (ORQ4 vs. Q1: 1.18, 95% CI: 1.02-1.27).

CONCLUSIONS

In Shanghai suburban adults, healthier dietary patterns and lower consumption of beverages were associated with better sleep quality.

Protocol for evaluating the effects of the Reducing Cardiometabolic Diseases Risk dietary pattern in the Chinese population with dyslipidaemia: a single-centre, open-label, dietary intervention study

INTRODUCTION

Cardiometabolic disease (CMD) is the leading cause of mortality in China. A healthy diet plays an essential role in the occurrence and development of CMD. Although the Chinese heart-healthy diet is the first diet with cardiovascular benefits, a healthy dietary pattern that fits Chinese food culture that can effectively reduce the risk of CMD has not been found.

METHODS/DESIGN

The study is a single-centre, open-label, randomised controlled trial aimed at evaluating the effect of the Reducing Cardiometabolic Diseases Risk (RCMDR) dietary pattern in reducing the risk of CMDs in people with dyslipidaemia and providing a reference basis for constructing a dietary pattern suitable for the prevention of CMDs in the Chinese population. Participants are men and women aged 35-45 years with dyslipidaemia in Tianjin. The target sample size is 100. After the run-in period, the participants will be randomised to the RCMDR dietary pattern intervention group or the general health education control group with a 1:1 ratio. The intervention phases will last 12 weeks, with a dietary intervention of 5 working days per week for participants in the intervention group. The primary outcome variable is the cardiometabolic risk score. The secondary outcome variables are blood lipid, blood pressure, blood glucose, body composition indices, insulin resistance and 10-year risk of cardiovascular diseases.

ETHICS AND DISSEMINATION

The study complies with the Measures for Ethical Review of Life Sciences and Medical Research Involving Human Beings and the Declaration of Helsinki. Signed informed consent will be obtained from all participants. The study has been approved by the Medical Ethics Committee of the Second Hospital of Tianjin Medical University (approval number: KY2023020). The results from the study will be disseminated through publications in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

Chinese Clinical Trial Registry (ChiCTR2300072472).

Dietary patterns and their associations with postpartum weight retention: results of the MINA cohort study

PURPOSE

To examine the association of prepregnancy dietary patterns with postpartum weight retention at 6 months (PPWR6) among Lebanese and Qatari women.

METHODS

Data for this study were derived from the Mother and Infant Nutrition Assessment (MINA) prospective cohort study conducted in Lebanon and Qatar. Pregnant women were recruited during their first trimester and were followed up for three years. For the purpose of this study, data belonging to sociodemographic characteristics of participants, prepregnancy dietary intake, prepregnancy BMI as well as weight retention at 6 months were used. Dietary intake was examined using a 98-item food frequency questionnaire. Principal component analysis was used for the derivation of dietary patterns. The associations of dietary patterns with PPWR6 were examined using simple and multiple linear regressions.

RESULTS

Data was available for 177 participants (Lebanon: 93; Qatar: 84). Mean PPWR6 was 4.05 ± 5.29 kg. Significantly higher PPWR6 was observed among participants with pre-pregnancy overweight/obesity and among those with excessive gestational weight gain. Two dietary patterns were identified: the "Western" and the "Varied" patterns. After adjustment for confounders, a positive association was observed between the 'Western' pattern scores and PPWR6 (ß = 1.27; 95% CI 0.68-1.86; p value: < 0.0001).

CONCLUSION

Higher adherence to the Western pattern was associated with higher PPWR6 amongst women, hence underscoring the importance of public health interventions aimed at fostering healthier dietary habits during this crucial stage of the lifecycle.

Associations Between Dietary Patterns and Kidney Health Assessed in the Population-Based CHRIS Study Using Reduced Rank Regression

OBJECTIVE

While diet plays a key role in chronic kidney disease (CKD) management, the potential for diet to impact CKD prevention in the general population is less clear. Using a priori knowledge, we derived disease-related dietary patterns (DPs) through reduced rank regression (RRR) and investigated associations with kidney function, separately focusing on generally healthy individuals and those with self-reported kidney diseases, hypertension, or diabetes mellitus.

METHODS

Eight thousand six hundred eighty-six participants from the population-based Cooperative Health Research in South Tyrol study were split into a group free of kidney disease, hypertension and diabetes (n = 6,133) and a group with any of the 3 conditions (n = 2,553). Diet was assessed through the self-administered Global Allergy and Asthma Network of Excellence food frequency questionnaire and DPs were derived through RRR selecting food frequency questionnaire-derived sodium, potassium, phosphorus, and protein intake as mediators. Outcomes were creatinine-based estimated glomerular filtration rate, urinary albumin-to-creatinine ratio, CKD and microalbuminuria. Multiple linear and logistic models were used to assess associations between RRR-based DPs and kidney outcomes separately in the 2 analytic groups.

RESULTS

We identified 3 DPs, where high adherence reflected high levels of all nutrients (DP1), high potassium-phosphorus and low protein-sodium levels (DP2), and low potassium-sodium and high protein-phosphorus levels (DP3), respectively. We observed heterogeneous associations with kidney outcomes, varying by analytic group and sex. Kidney outcomes were much more strongly associated with DPs than with single nutrients.

CONCLUSION

RRR is a feasible approach to estimate disease-related DPs and explore the combined effects of nutrients on kidney health. Heterogeneous associations across kidney outcomes suggest possible specificity to kidney function or damage. In individuals reporting kidney disease, hypertension or diabetes, specific dietary habits were associated with better kidney health, indicating that disease-specific dietary interventions can be effective for disease control.

Sex-specific associations of empirically derived dietary patterns with colorectal cancer risk in a Korean population: a case‒control study

Dietary patterns may be a crucial modifiable factor in colorectal cancer (CRC) risk. This study aimed to examine the associations of dietary patterns derived from two methods with CRC risk in Korea. In a study of 1420 CRC patients and 2840 control participants, we obtained dietary patterns by principal component analysis (PCA) and reduced rank regression (RRR) using 33 predefined food groups. The associations between dietary patterns and CRC risk were assessed using unconditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (CIs). We identified two similar dietary patterns, derived from PCA 1 (prudent) and RRR (healthy), characterized by higher consumption of green/yellow vegetables, light-colored vegetables, fruits, eggs, and milk in both men and women. In women, higher prudent and healthy pattern scores were significantly associated with a lower risk of CRC (prudent, ORQ4 vs. Q1 = 0.59, 95% CI 0.40-0.86, P for trend = 0.005; healthy, ORQ4 vs. Q1 = 0.62, 95% CI 0.43-0.89, P for trend = 0.007). In men, a significant inverse association between dietary pattern and risk of rectal cancer was found only for the healthy dietary pattern (ORQ4 vs. Q1 = 0.66, 95% CI 0.45-0.97, P for trend = 0.036). Compared with the dietary pattern derived by PCA, the RRR dietary pattern had a slightly stronger association with a lower risk of distal colon cancer (ORQ4 vs. Q1 = 0.58, 95% CI 0.35-0.97, P for trend = 0.025) and rectal cancer (ORQ4 vs. Q1 = 0.29, 95% CI 0.15-0.57, P for trend < 0.001) in women. Our findings suggest cancer prevention strategies focusing on a diet rich in vegetables, fruits, eggs, and milk. Moreover, the use of both PCA and RRR methods may be advantageous to explore the associations between dietary patterns and risk of CRC.

Dietary patterns and biochemical markers related to diabetes mellitus: an association analysis based on data from the Study of Cardiovascular Risk in Adolescents (ERICA)

OBJECTIVE

The aim of this study was to investigate the association between dietary patterns and biochemical markers related to diabetes mellitus (DM): glucose, insulin, glycated hemoglobin (HbA1c), and homeostasis model assessment of insulin resistance index from 35 454 Brazilian adolescents 12 to 17 y of age.

METHODS

Dietary patterns were derived using factor analysis by the principal components method. The data originated from the school-based study ERICA (Study of Cardiovascular Risk in Adolescents) carried out between 2013 and 2014. Linear regression models analyzed the associations.

RESULTS

Three dietary patterns were found: traditional Brazilian, bread and coffee, and Western. An inverse association was found in young girls between the traditional Brazilian pattern and fasting glucose (β = -0.76; P = 0.005) and HbA1c in the second and third tertiles (β = -0.04; P = 0.002; β = -0 .06; P < 0.001), and the Western pattern with HbA1c (β = -0.02; P = 0.035). In boys, a positive association was found between the second tertile of the dietary pattern and insulin (β = 0.48; P = 0.009) and homeostasis model assessment of insulin resistance index (β = 0.11; P = 0.012).

CONCLUSIONS

This study showed that the traditional Brazilian pattern was inversely associated with blood glucose and HbA1c values in girls. Furthermore, the data suggest that there is an important difference between boys and girls in the association of dietary patterns and the markers used.

Empirically derived dietary patterns are associated with major adverse cardiovascular events, all-cause mortality, and congestive cardiac failure in older men: The Concord Health and Ageing in Men Project

BACKGROUND

Diet is associated with major adverse cardiovascular events (MACE).

OBJECTIVE

We evaluated the associations between empirically derived dietary patterns and MACE.

DESIGN

Prospective cohort study.

SETTING

The Concord Health and Ageing in Men Project, Sydney, Australia.

PARTICIPANTS

539 community-dwelling older Australian men aged 75 years and older.

METHODS

Men underwent dietary assessment using a validated dietitian-administered diet history questionnaire. Cox regression analyses were conducted between MACE and the three dietary patterns identified from factor analysis. Five-point MACE comprised of all-cause mortality, myocardial infarction (MI), congestive cardiac failure (CCF), coronary revascularisation, and/or ischaemic stroke. Four-point MACE included the four endpoints of MI, CCF, coronary revascularisation, and/or ischaemic stroke, and excluded all-cause mortality.

RESULTS

At a median of 5.3 (IQR 4.6-6.3) years of follow-up, the incidences were: five-point MACE 31.2% (n = 168); four-point MACE excluding all-cause mortality 17.8% (n = 96); all-cause mortality 20.1% (n = 111); CCF 11.3% (n = 61); MI 3.7% (n = 20); stroke 3.2% (n = 17); and coronary revascularisation 3.1% (n = 15). In fully adjusted analyses, compared to the bottom tertile, the middle tertile of 'vegetables-legumes-seafood' dietary pattern was associated with reduced five-point MACE (HR 0.67 [95% CI: 0.45, 0.99, P = .047]), and CCF (HR 0.31 [95% CI: 0.15, 0.65, P = .002]), whilst the middle tertile of 'wholegrains-milk-other fruits' dietary pattern was associated with increased five-point MACE (HR 1.78 [95% CI: 1.17, 2.70, P = .007]), four-point MACE (HR 1.92 [95% CI: 1.12, 3.30, P = .018]), and CCF (HR 2.33 [95% CI: 1.17, 4.65, P = .016]). For the 'discretionary-starchy vegetables-processed meats' dietary pattern, a higher score was associated with increased five-point MACE (HR 1.33 [95% CI: 1.09, 1.62, P = .004]), and all-cause mortality (HR 1.63 [95% CI: 1.26, 2.12, P < .001]), and compared to the bottom tertile, the top tertile was associated with increased all-cause mortality (HR 2.26 [95% CI: 1.27, 4.00, P = .005]).

CONCLUSION

Older men may benefit from consuming a 'vegetables-legumes-seafood' dietary pattern rather than 'discretionary-starchy vegetables-processed meats' and 'wholegrains-milk-other fruits' dietary patterns for the prevention of MACE.

Empirically derived dietary patterns in relation to periodontitis and number of teeth among Norwegian adults

OBJECTIVES

To explore dietary patterns in relation to periodontitis and number of teeth.

DESIGN

A cross-sectional study.

SETTING

We used data from the seventh survey of the Tromsø Study in Norway, 2015-2016. Three periodontitis groups were compared: (i) no periodontitis/slow bone loss; (ii) moderate bone loss; and (iii) rapid bone loss. Number of teeth was categorised as 25-28, 20-24 and ≤ 19. Dietary patterns were identified by principal component analysis. Multiple logistic regression was applied to examine associations between tertiles of dietary pattern scores and periodontitis, and between these same tertiles and number of teeth.

PARTICIPANTS

1487 participants (55·5 % women) aged 40-79 years who were free of major chronic diseases, attended an oral health examination and completed a FFQ.

RESULTS

Four dietary patterns were identified, which explained 24 % of the total variability in food intake: fruit and vegetables, Westernised, meat/fish and potatoes, and refined grain and dessert. The fruit and vegetables pattern was inversely associated with periodontitis characterised by rapid bone loss when compared with no periodontitis/slow bone loss (OR tertile 3 v. 1 0·49, 95 % CI: 0·25, 0·98). Participants who were in the highest tertile of the refined grain and dessert pattern (tertile 3 v. 1) had 2·38- and 3·52-fold increased odds of having ≤ 19 than 20-24 and 25-28 teeth, respectively.

CONCLUSION

Out of four identified dietary patterns, only the fruit and vegetables pattern was negatively associated with advanced periodontitis. A more apparent positive association was observed between the refined grain and dessert pattern and having fewer teeth (≤ nineteen teeth).

Antioxidant, enzymes inhibitory, physicochemical and sensory properties of instant bio-yoghurts containing multi-purpose natural additives

This study aimed to assess the antioxidant, enzyme inhibitory, physicochemical and sensory properties of instant bio-yoghurts containing multi-purpose natural additives. Multi-purpose natural additives were formulated with three natural additives (sweet detar seed, ginger rhizome, and hibiscus calyx flours, as a thickener, flavourant and colourant, respectively) blends at proportions derived from the Design Expert. The additives' synthetic counterparts were formulated with sodium carboxymethylcellulose, vanilla flavor, and red colourant at the same proportions. After that, yoghurt was produced and the additives blends were incorporated into it either in aqueous extract or flour form, yielding bio-yoghurts designated multi-purpose natural additive extract-containing yoghurt (MNAE-yoghurt), multi-purpose natural additive flour-added yoghurt (MNAF-yoghurt), and their multi-purpose synthetic additives-containing counterparts (MSAE-yoghurt and MSAF-yoghurt). A commercially-available bio-yoghurt served as a control. All the yoghurts were lyophilized to obtain instant bio-yoghurts. Subsequently, bioactive components (total phenolics, tannins, total flavonoids and saponins), antioxidants and enzymes [alpha-amylase, alpha-glucosidase, pancreatic lipase, and angiotensin 1-converting enzyme (ACE)] inhibitory activities, as well as proximate, physicochemical and sensory qualities of the bio-yoghurts were determined. The MNAE-yoghurt and MNAF-yoghurt had higher bioactive constituents, total titratable acid levels, and more potent antioxidant and enzyme inhibitory properties, but a lower pH than their synthetic counterparts and the control. The total phenolics, tannins, total flavonoids and saponins levels of MNAE-yoghurt and MNAF-yoghurt were 14.40 ± 0.24 and 16.54 ± 0.62 mg/g, 1.65 ± 0.04 and 1.74 ± 0.08 mg/g, 4.25 ± 0.03 and 4.40 ± 0.02 mg/g, 0.64 ± 0.01 and 0.66 ± 0.02 mg/g, respectively. Among the natural multi-purpose additives-containing bio-yoghurts, MNAF-yoghurt had higher bioactive constituents and stronger antioxidant and enzymes inhibitory properties. Its α-amylase, α-glucosidase, ACE, and pancreatic lipase IC50 values were 72.47 ± 0.47, 74.07 ± 0.02, 25.58 ± 2.58, and 33.56 ± 29.66 μg/mL, respectively. In contrast, MNAE-yoghurt had the highest protein (13.70 ± 0.85%) and the lowest fat (2.63 ± 0.71%) contents. The sensory attributes of all the bio-yoghurts fell within an acceptable likeness range. Overall, the inclusion of multi-purpose natural additives blends enhanced the instant bio-yoghurts' nutritional, health-promoting, and sensory qualities.

Cross-sectional and longitudinal associations between empirically derived dietary patterns and frailty among older men: The Concord Health and Ageing in Men Project

BACKGROUND

Diet may be associated with frailty.

OBJECTIVE

We aimed to evaluate the associations between empirically derived dietary patterns and frailty in older men.

DESIGN

Prospective cohort study.

SETTING

The Concord Health and Ageing in Men Project, Sydney, Australia.

PARTICIPANTS

785 community-dwelling older Australian men aged 75 years and older.

METHODS

Men underwent dietary assessment using a validated dietitian-administered diet history questionnaire. Factor analysis identified three dietary patterns. Multinomial logistic regression was conducted between frailty and dietary patterns for cross-sectional analyses and longitudinal analyses over a 3-year follow-up. Frailty was defined by the Fried frailty phenotype.

RESULTS

Of the 785 men, pre-frailty was prevalent in 47.1% (n = 370), and frailty in 8.3% (n = 65). In fully adjusted cross-sectional analyses, the top tertile and a higher 'vegetables-legumes-seafood' dietary pattern score were associated with reduced prevalence of frailty (OR 0.34 [95% CI: 0.12, 0.93, P = .036]) and OR 0.50 [95% CI: 0.30, 0.83, P = .007] respectively). The top tertile of the 'discretionary-starchy vegetables-processed meats' dietary pattern was also associated cross-sectionally with increased prevalence of pre-frailty (OR 1.75 [95% CI: 1.08, 2.83, P = .022]). Of the 296 robust men in fully adjusted longitudinal analyses, the incidence of pre-frailty was 52.4% (n = 155), and frailty was 5.4% (n = 16) over a 3-year follow-up. The middle tertile of the 'vegetables-legumes-seafood' dietary pattern had a non-significant trend towards reduced incident pre-frailty (OR 0.52 [95% CI: 0.27, 1.00, P = .050]).

CONCLUSION

Consumption of a 'vegetables-legumes-seafood' dietary pattern appears to be less favoured by frail older men.

Cardiometabolic-related dietary patterns and thyroid function: a population-based cross-sectional study

BACKGROUND

Little is known about the association of dietary patterns with thyroid function. Since thyroid function and cardiometabolic variables are inter-related, we investigated whether cardiometabolic-related dietary patterns are associated with thyroid function.

METHODS

This cross-sectional study included 3520 Tehran Lipid and Glucose Study participants. Reduced rank regression was used to find dietary patterns with body mass index, serum fasting glucose, triglycerides, HDL-C, and systolic and diastolic blood pressures as response variables. Two patterns were retained, one based on 35 food groups (native-based pattern) and the other based on the European Prospective Investigation into Cancer and Nutrition Germany (EPIC) food grouping (n = 33). A confirmatory cardio-metabolic dietary pattern was also created according to the weight of food groups proposed by the Framingham Offspring Study (FOS). The association of each pattern with thyroid-stimulating hormone (TSH), free thyroxine, and thyroid peroxidase antibody (TPOAb) and the odds of thyroid dysfunction was examined by linear and logistic regression, respectively.

RESULTS

The two exploratory dietary patterns were highly correlated and associated with greater TSH levels in euthyroid participants. The adjusted odds ratio (95% CI) of subclinical hypothyroidism per one standard deviation was 1.14 (1.01, 1.28) for the native-based pattern and 1.16 (1.03, 1.31) for the EPIC-based pattern. The odds of subclinical hypothyroidism was significantly greater in the second and third tertiles of the native-based pattern compared to the first tertile in the adjusted model (p-trend = 0.005). The odds of subclinical hypothyroidism increased across the tertiles of the EPIC-based pattern, but the odds was significantly higher only in tertile 3 compared to tertile 1, with an OR (95% CI) of 1.44 (1.07, 1.94) in the adjusted model. The adjusted odds of clinical hypothyroidism were greater in tertile 3 of the native-based pattern compared with tertile 1 (OR = 1.65, 95% CI 1.04, 2.62). The patterns were unrelated to hyperthyroidism or TPOAb positivity. The FOS-based confirmatory score was unrelated to thyroid function.

CONCLUSIONS

A diet high in fast foods, soft drinks, and legumes and low in confectionery, potatoes, butter, and jam and honey was associated with higher TSH levels in euthyroidism and higher odds of subclinical hypothyroidism.

Multi-nutrient interventions and cognitive ageing: are we barking up the right tree?

As we continue to elucidate the mechanisms underlying age-related brain diseases, the reductionist strategy in nutrition–brain function research has focused on establishing the impact of individual foods. However, the biological processes connecting diet and cognition are complex. Therefore, consideration of a combination of nutritional compounds may be most efficacious. One barrier to establishing the efficacy of multi-nutrient interventions is that the area lacks an established set of evidence-based guidelines for studying their effect on brain health. This review is an output of the International Life Sciences Institute (ILSI) Europe. A multi-disciplinary expert group was assembled with the aim of developing a set of considerations to guide research into the effects of multi-nutrient combinations on brain functions. Consensus recommendations converged on six key issues that should be considered to advance research in this area: (1) establish working mechanisms of the combination and contributions of each individual compound; (2) validate the relevance of the mechanisms for the targeted human condition; (3) include current nutrient status, intake or dietary pattern as inclusion/exclusion criteria in the study design; (4) select a participant population that is clinically and biologically appropriate for all nutritional components of the combination; (5) consider a range of cognitive outcomes; (6) consider the limits of reductionism and the ‘gold standard’ randomised controlled trial. These guiding principles will enhance our understanding of the interactive/complementary activities of dietary components, thereby strengthening the evidence base for recommendations aimed at delaying cognitive decline.

Associations of dietary patterns between age 9 and 24 months with risk of celiac disease autoimmunity and celiac disease among children at increased risk

BACKGROUND

Higher gluten intake in childhood is associated with increased incidence of celiac disease autoimmunity (CDA) and celiac disease. It remains to be studied whether different dietary patterns independent of gluten intake contribute to the incidence.

OBJECTIVES

This study aimed to explore associations of dietary patterns by age 2 y with risk of CDA and celiac disease in genetically susceptible children.

METHODS

Data was used from 6726 participants at genetic risk of type 1 diabetes and celiac disease enrolled in the observational cohort, The Environmental Determinants of Diabetes in the Young (TEDDY) study. Children were annually screened for tissue transglutaminase autoantibodies (tTGAs) from age 2 y. Principal component analysis extracted dietary patterns, based on intake of 27 food groups assessed by 3-d food records at age 9 to 24 mo. The primary outcome was CDA (i.e., persistently tTGA-positive in at least 2 consecutive samples), and the secondary outcome was celiac disease. During follow-up to mean age 11.0 (standard deviation 3.6) y, 1296 (19.3%) children developed CDA, and 529 (7.9%) were diagnosed with celiac disease. Associations of adherence to dietary patterns (per 5-unit increase) with the study outcomes were estimated by Cox regression models adjusted for risk factors including gluten intake.

RESULTS

At age 9 mo, a dietary pattern higher in the food groups vegetable fats and milk was associated with reduced risk of CDA (hazard ratio [HR]: 0.88; 95% confidence interval [CI]: 0.79, 0.98; P = 0.02). At 24 mo, a dietary pattern higher in the food groups wheat, vegetable fats, and juices, and lower in milk, meat, and oats at age 24 mo was associated with increased risk of CDA (HR: 1.18; 95% CI: 1.05, 1.33; P < 0.001) and celiac disease (HR: 1.24; 95% CI: 1.03, 1.50; P = 0.03).

CONCLUSIONS

Dietary patterns in early childhood are associated with risk of CDA and celiac disease in genetically predisposed children, independent of gluten intake.

Association between maternal metabolic profiles in pregnancy, dietary patterns during lactation and breast milk leptin: a retrospective cohort study

Breast milk leptin plays a potential role in preventing childhood obesity. However, the associations of breast milk leptin with maternal metabolism in pregnancy and dietary patterns during lactation are still unclear. We aimed to explore associations of breast milk leptin with maternal metabolic profiles in pregnancy and dietary patterns during lactation. A total of 332 participants were recruited for this retrospective cohort study. Breast milk samples were collected at approximately 6 weeks postpartum. Breast milk leptin and twenty-three metabolic profiles in pregnancy were measured in this study. A semi-quantitative FFQ was used to gather dietary information during lactation. Both principal component analysis and the diet balance index were used to derive dietary patterns. Among twenty-three maternal metabolic profiles, maternal serum glucose (β = 1·61, P = 0·009), γ-glutamyl transferase (β = 0·32, P = 0·047) and albumin (β = -2·96, P = 0·044) in pregnancy were correlated with breast milk leptin. All dietary patterns were associated with breast milk leptin. Given the joint effects of maternal metabolism in pregnancy and dietary patterns during lactation, only diet quality distance was significantly associated with leptin concentrations in breast milk (low level v. almost no diet problem: β = -0·46, P = 0·011; moderate/high level v. almost no diet problem: β = -0·43, P = 0·035). In conclusion, both maternal metabolism in pregnancy and dietary patterns during lactation were associated with breast milk leptin. Maternal diet balance during lactation was helpful to improve breast milk leptin concentration.

Dietary Assessment and Metabolomic Methodologies in Human Feeding Studies: A Scoping Review

Dietary metabolomics is a relatively objective approach to identifying new biomarkers of dietary intake and for use alongside traditional methods. However, methods used across dietary feeding studies vary, thus making it challenging to compare results. The objective of this study was to synthesize methodological components of controlled human feeding studies designed to quantify the diet-related metabolome in biospecimens, including plasma, serum, and urine after dietary interventions. Six electronic databases were searched. Included studies were as follows: 1) conducted in healthy adults; 2) intervention studies; 3) feeding studies focusing on dietary patterns; and 4) measured the dietary metabolome. From 12,425 texts, 50 met all inclusion criteria. Interventions were primarily crossover (n = 25) and parallel randomized controlled trials (n = 22), with between 8 and 395 participants. Seventeen different dietary patterns were tested, with the most common being the "High versus Low-Glycemic Index/Load" pattern (n = 11) and "Typical Country Intake" (n = 11); with 32 providing all or the majority (90%) of food, 16 providing some food, and 2 providing no food. Metabolites were identified in urine (n = 31) and plasma/serum (n = 30). Metabolites were quantified using liquid chromatography, mass spectroscopy (n = 31) and used untargeted metabolomics (n = 37). There was extensive variability in the methods used in controlled human feeding studies examining the metabolome, including dietary patterns tested, biospecimen sample collection, and metabolomic analysis techniques. To improve the comparability and reproducibility of controlled human feeding studies examining the metabolome, it is important to provide detailed information about the dietary interventions being tested, including information about included or restricted foods, food groups, and meal plans provided. Strategies to control for individual variability, such as a crossover study design, statistical adjustment methods, dietary-controlled run-in periods, or providing standardized meals or test foods throughout the study should also be considered. The protocol for this review has been registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/DAHGS).

Associations between dietary patterns and serum uric acid concentrations in children and adolescents: a cross-sectional study

The serum uric acid (SUA) concentrations in children and adolescents in southeast coastal China are generally high. The relationship between diet and SUA in children and adolescents remains unclear. The objective of the study was to assess the associations between data-driven dietary patterns with SUA concentrations and hyperuricemia in Chinese children and adolescents and to explore the role of food components. This study involved 3383 participants aged 9 to 17 years from a representative nutrition and growth survey conducted in Shenzhen, a southeast coastal city in China. The dietary intake data, obtained from a validated food frequency questionnaire, were categorized into 19 food groups for factor analysis to derive dietary patterns. Weighted least squares regression was performed to examine the associations between dietary patterns and SUA concentrations, logistic regression was used to analyze the relationship between dietary patterns and hyperuricemia, and the relationship between food groups and food components with SUA concentrations was further analyzed. The potential dietary factors contributing to the associations between dietary patterns and SUA concentrations were explored by adjusting various food components. Six dietary patterns were identified by factor analysis, including an ultra-processed diet, plant-based nutritious diet, meat-based diet, soup/seafood/egg diet, vegetarian diet, and mushroom/animal organ diet. After adjusting for confounders, the meat-based diet exhibited a positive correlation with SUA concentrations (β = 4.89; 95% confidence interval (CI): 0.60-9.18; P = 0.03), while the vegetarian diet could reduce the risk of hyperuricemia (odds ratio = 0.88; 95% CI: 0.80-0.98; P = 0.02). In addition, dietary intake of poultry (g per d) (β = 0.09, 95% CI: 0.02, 0.16, P = 0.02), animal organs, blood (g per d) (β = 0.32, 95% CI: 0.12, 0.51, P = 0.002) and hypoxanthine (mg per d) (β = 0.03, 95% CI: 0.01, 0.06, P = 0.02) showed a significantly positive correlation with SUA concentrations, while that of vegetables (g per d) (β = -0.02, 95% CI: -0.03, -0.01, P = 0.03) showed a significantly negative correlation. In summary, for children and adolescents, it is recommended to increase vegetable intake and reduce animal-based food intake in order to control SUA concentration and prevent hyperuricemia. This study was registered at the China Clinical Trials Registry (ChiCTR2100051722).

Adherence to Data-Driven Dietary Patterns and Lung Cancer Risk: A Systematic Review and Dose-Response Meta-Analysis

The effect of dietary patterns on lung cancer risk is currently debated. In this study, we evaluated the association between different "a posteriori" dietary patterns and lung cancer risk. The search was carried out (February 2023) through Scopus, Web of Science, and PubMed databases. Meta-analysis was performed by a random-effects model using risk values (RR and OR) extracted from the 12 selected studies. Two main dietary patterns were identified and named "Western/meat" and "Healthy/prudent". The highest adherence to the "Western/meat" dietary pattern significantly increased the lung cancer risk (OR = 1.39; 95% CI: 1.17-1.65; p = 0.0002) while the highest adherence to the "Healthy/prudent" pattern reduced it (OR = 0.65; 95% CI: 0.51-0.83; p = 0.001). A linear trend between both dietary patterns and lung cancer risk was observed. However, a statistically significant inverse dose-response trend was found only for the "Healthy/prudent" dietary pattern (regression coefficient = -0.0031, p = 0.003). Subgroup analyses showed that the "Western/meat" pattern significantly increased the lung cancer risk in former (n = 4) (OR = 1.93, 95% CI: 1.11-3.36) and current smokers (n = 7) (OR = 1.35, 95% CI: 1.06-1.71). Similarly, the "Healthy/prudent" pattern exerts a protective effect on former (n = 4) (OR = 0.61, 95% CI: 0.44-0.85) and current smokers (n = 8) (OR = 0.64, 95% CI: 0.46-0.88). For both dietary patterns, no significant effect was observed on never-smokers.

The association of dietary patterns with muscle mass and strength in old age: The Hordaland Health Study

PURPOSE

The single nutrient approach in nutrition research lacks the ability to account for synergistic relationships between dietary components. Current evidence suggests that diet quality, reflecting overall dietary intake, may influence muscle health. In a community-based observational study in Western Norway, we examined dietary patterns in relation to muscle mass and strength at age 67-70.

METHODS

The current analysis was conducted in men and women of The Hordaland Health Study (HUSK), who participated in both the second (HUSK2) and third study wave (HUSK3). Dietary patterns were extracted by principal component analysis (PCA) on food frequency questionnaire (FFQ) data. Individual dietary pattern scores (DPS) for HUSK2 (age 46-49) and HUSK3 (age 67-70), and overall DPS (oDPS) were calculated. Outcome variables were appendicular skeletal muscle mass (ASMM) and handgrip strength (HGS) measured in HUSK3. The relationships of HUSK3 DPS and oDPS with ASMM and HGS were assessed by multivariate linear regression analysis adjusted for potential confounding factors.

RESULTS

We identified three distinct dietary patterns, labelled 'Western', 'Healthy', and 'Sweets-focused'. A significant positive association was observed between the oDPS for the 'Healthy' dietary pattern and ASMM in both men and women at age 67-70. No significant associations were found between HUSK3 DPS or oDPS for any of the identified dietary patterns and HGS in our population.

CONCLUSION

Higher oDPS on a dietary pattern predominantly rich in fish, vegetables, nuts and seeds, fruit and berries, and eggs was associated with better ASMM at age 67-70. To establish the influence of diet quality on muscle health, further long-term studies with repeated dietary assessments are warranted.

Dietary Patterns and Association with Anemia in Children Aged 9-16 Years in Guangzhou, China: A Cross-Sectional Study

Anemia affects 1.8 billion people worldwide, and diet is one of the key modifiable factors for treating anemia in children. The dietary pattern has changed rapidly in recent decades, but its effect on childhood anemia has not been reported. This study aimed to identify dietary patterns among children in rural areas of Guangzhou, China, and explore their association with anemia. A total of 1476 children aged 9-16 years old were included in this study. Demographics, lifestyle, and anthropometric and dietary information were collected. Factor analysis was used to identify dietary patterns, and anemia was diagnosed based on hemoglobin levels. Robust Poisson regression and subgroup analysis were used to analyze the association between dietary patterns and anemia. The prevalence of anemia in children was 10.4%, with 6.1% in boys and 15.4% in girls. Four dietary patterns were identified, including a fast food pattern, a vegetarian pattern, a meat and egg pattern, and a rice and wheat pattern. A high score in the fast food pattern was positively associated with risk of anemia in children entering puberty (PR = 1.767, 95% CI: 1.026~3.043, p = 0.039), especially in girls after menarche, with marginal significance (PR = 1.740, 95% CI: 0.977~3.097, p = 0.059). A high score in the meat and egg pattern was negatively associated with risk of anemia in children entering puberty (PR = 0.498, 95% CI: 0.286~0.866, p = 0.013), especially in boys after spermatorrhea (PR = 0.237, 95% CI: 0.031~0.590, p = 0.007). The fast food pattern was a risk factor for anemia in children, and the meat and egg pattern was a protective factor for anemia in children entering puberty. The findings of this study could be used to guide the strategies of evidence-based preventive nutrition interventions to curb anemia in children.

Association between Dietary Patterns and Cognitive Function among Qatari Adults: A Cross-Sectional Analysis of the Qatar Biobank Study

This study aimed to assess the association between dietary patterns and cognitive function among Qatari adults. In a cross-sectional analysis, data on 1000 Qatari adults attending the Qatar Biobank Study (QBB) aged ≥18 years were obtained. Using factor analysis, dietary patterns were constructed based on habitual dietary intake assessed by food frequency questionnaires (FFQs). The mean reaction time (MRT) derived from self-administered touch screen tests was used as an indicator of cognitive function. The association between dietary patterns and MRT was investigated using linear regression. The mean age of the participants was 35.8 (SD 10.3) years, and the mean MRT was 715.3 (SD 204.1) milliseconds. Three dietary patterns were identified. The "traditional" dietary pattern, characterized by high intakes of white rice, mixed dishes and soups/starters possibly high in saturated fat and sodium, was positively associated with MRT. In the multivariable model, comparing the highest to lowest quartiles of the traditional pattern, the regression coefficient for MRT was 50.0 (95% CI 16.9, 83.1; p for trend 0.001). There was an effect modification of diabetes and age on the association between the "modern" dietary pattern and MRT. The "convenient" dietary pattern was not associated with cognition. In conclusion, the traditional rice-based dietary pattern may be associated with poor cognitive function.

Modified-Malay Eating Behavior and Pattern Questionnaire (Malay-EBPQ): translation and validation among Malaysian women

BACKGROUND

Eating behavior primarily depends on eating patterns which are largely influenced by interactions between physiology, environment, psychology, culture and socio-economic status. This study was designed to translate and validate the Eating Behavior Pattern Questionnaire (EBPQ) among Malaysian women.

METHODS

A cross-sectional study involving translation and validation of the English version of EBPQ. The original questionnaire, contained 51 items extracted into six domains was translated in Malay using forward and backward translation, pre-tested and validated among conveniently sampled female healthcare personnel. Vegetarians, pregnant ladies and women in confinement were excluded due to special daily dietary plans. Construct validity, reliability and feasibility were analyzed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA).

RESULTS

During translation, item modifications were made and subjected to field testing among 394 women. The original questionnaire was used as a reference to identify the positioning of items in constructs. Fifteen items were removed due to poor correlation with items within constructs. Seven factors were extracted using Varimax rotation with Kaiser-Meyer-Olkin (KMO) value range from 0.725-0.872 and significant Bartlett's test of Sphericity (p < 0.001). The item-loading of the items within the constructs ranged between 0.415-0.812 (explained variation = 62.7%). Cultural and lifestyle behavior was relabeled to lifestyle and behavioral eating, and snacking on sweets was relabeled as snacking pattern. Emotional eating was divided into two sub-factors as snacking behavior and emotional influence. CFA resulted with an acceptable fit with no presence of floor and ceiling effects. Intra-class correlation coefficient (ICC) for all the constructs were reported good and excellent. The overall internal consistency was reported as good.

CONCLUSION

The modified 36-item Malay-EBPQ had moderate internal consistency, reliable and fit with multi-dimensional measures of eating behaviors and dietary patterns among women in the multi-racial population with cultural diversity.

New Food Frequency Questionnaire to Estimate Vitamin K Intake in a Mediterranean Population

Vitamin K is a multifunctional micronutrient essential for human health, and deficiency has been linked to multiple pathological conditions. In this study, we aimed to develop and validate a new food frequency questionnaire (FFQ) to estimate total vitamin K intake, over the course of a 30-day interval, in a Portuguese, Mediterranean-based, population. We conducted a prospective study in a non-random sample of 38 healthy adult volunteers. The FFQ was designed based on a validated Portuguese FFQ used in nationally representative studies and on literature reviews, to include foods containing ≥5 μg of vitamin K/100 g and foods with a lower vitamin K content, yet commonly included in a Mediterranean diet. Vitamin K intake was estimated from 24 h recalls and six days of food records. The final FFQ included 54 food items which, according to regression analyses, explains 90% of vitamin K intake. Mean differences in vitamin K intake based on food records (80 ± 47.7 μg/day) and on FFQ (96.5 ± 64.3 μg/day) were statistically non-significant. Further, we found a strong correlation between both methods (r = 0.7; p = 0.003). Our results suggest that our new FFQ is a valid instrument to assess the last 30 days of vitamin K intake in the Portuguese Mediterranean population.

Iron Nutrition of Pre-Schoolers in High-Income Countries: A Review

Pre-schoolers are vulnerable to iron deficiency, which, in high-resource countries, is mainly caused by suboptimal or poorly absorbable iron intakes. This review examines the prevalence of inadequate iron intakes and status, and the non-dietary factors associated with these, among children aged between 2 and 5 years within high-income countries. It then considers the quality of the pre-schooler diet in terms of dietary factors, dietary patterns, and iron intakes. Additionally, it discusses the assessment of iron bioavailability and examines the various methods used to estimate the amount of absorbable iron in pre-schooler diets. Knowledge of the adequacy of iron intakes and bioavailability of iron intakes, and dietary patterns associated with iron intakes can facilitate the design and implementation of effectively targeted community-based intervention studies to improve iron intakes and iron bioavailability to minimise the risk of iron deficiency.

Association between dietary patterns and biomarkers in connection with diabetes mellitus in adolescents: A systematic review

AIMS

To perform a systematic review to investigate the association between adolescents' a posteriori dietary patterns with diabetes-related biomarkers (fasting blood glucose, fasting insulinemia, glycated hemoglobin and homeostatic model assessment insulin resistance index (HOMA-IR)).

DATA SYNTHESIS

Review registered with PROSPERO under number CRD42020185369. Studies with adolescents aged 10-19 years that identified dietary patterns by a posteriori methods were included. The databases used included: PubMed, SCOPUS, Web of Science, Food Science and Technology Abstracts, CINAHL, SPORTDiscus, Lilacs/BVS, The Cochrane Central Register of Controlled Trials, ProQuest Dissertations&Theses Global and Capes Theses Bank and Brazilian Digital Library of Theses and Dissertations. Risk of bias was assessed via the Agency for Healthcare Research and Quality tool. Eight cross-sectional studies that evaluated 6438 adolescents (55.5% females) were included. For fasting blood glucose, the results were inconsistent and some studies found no association for the dietary patterns called traditional (57%), Western (42%) and healthy (28%). For the fasting insulinemia and HOMA-IR outcomes, the Western dietary pattern showed a positive association or higher means in 60% and 50% of the studies, respectively. No studies that evaluated glycated hemoglobin were found.

CONCLUSION

Fasting insulinemia and HOMA-IR outcomes were positively associated with the Western dietary patterns. The studies reviewed did not present consistent evidence of an association with western, healthy and traditional dietary patterns with fasting blood glucose, as the results were conflicting or did not show statistical significance.

NEMoE: a nutrition aware regularized mixture of experts model to identify heterogeneous diet-microbiome-host health interactions

BACKGROUND

Unrevealing the interplay between diet, the microbiome, and the health state could enable the design of personalized intervention strategies and improve the health and well-being of individuals. A common approach to this is to divide the study population into smaller cohorts based on dietary preferences in the hope of identifying specific microbial signatures. However, classification of patients based solely on diet is unlikely to reflect the microbiome-host health relationship or the taxonomic microbiome makeup.

RESULTS

We present a novel approach, the Nutrition-Ecotype Mixture of Experts (NEMoE) model, for establishing associations between gut microbiota and health state that accounts for diet-specific cohort variability using a regularized mixture of experts model framework with an integrated parameter sharing strategy to ensure data-driven diet-cohort identification consistency across taxonomic levels. The success of our approach was demonstrated through a series of simulation studies, in which NEMoE showed robustness with regard to parameter selection and varying degrees of data heterogeneity. Further application to real-world microbiome data from a Parkinson's disease cohort revealed that NEMoE is capable of not only improving predictive performance for Parkinson's Disease but also for identifying diet-specific microbial signatures of disease.

CONCLUSION

In summary, NEMoE can be used to uncover diet-specific relationships between nutritional-ecotype and patient health and to contextualize precision nutrition for different diseases. Video Abstract.

Biomarkers of Micronutrients and Phytonutrients and Their Application in Epidemiological Studies

Nutritional biomarkers can be used as important indicators of nutritional status and play crucial roles in the prevention as well as prognosis optimization of various metabolism-related diseases. Measuring dietary with the deployment of biomarker assessments provides quantitative nutritional information that can better predict the health outcomes. With the increased availability of nutritional biomarkers and the development of assessment tools, the specificity and sensitivity of nutritional biomarkers have been greatly improved. This enables efficient disease surveillance in nutrition research. A wide range of biomarkers have been used in different types of studies, including clinical trials, observational studies, and qualitative studies, to reflect the relationship between diet and health. Through a comprehensive literature search, we reviewed the well-established nutritional biomarkers of vitamins, minerals, and phytonutrients, and their association with epidemiological studies, to better understand the role of nutrition in health and disease.

Whole Dietary Patterns, Cognitive Decline and Cognitive Disorders: A Systematic Review of Prospective and Intervention Studies

Dementia prevalence is a global public health concern. Adherence towards a healthy dietary pattern (DP) may reduce the risk of cognitive decline and dementia. This narrative systematic review aimed to synthesise prospective and intervention study data to evaluate the impact of a-posteriori and a-priori derived DPs on cognitive ageing, from cognitive decline to incident dementia. Ninety-three studies were included: 83 prospective studies and 10 randomised controlled trials (RCT). Most prospective studies (77%) examined a-priori DPs, with the Mediterranean diet examined most frequently. A total of 52% of prospective and 50% of RCTs reported a protective relationship between 'healthy' DPs and global cognitive decline. Overall, 59% of prospective studies reported positive associations between healthy DPs and risk of cognitive disorder. Incident cognitive disorder was examined by only one intervention study (subgroup analysis) which reported a beneficial effect of a low-fat diet on risk of probable dementia in women. Unhealthy DPs were examined less frequently (n = 17; 21%), with 41% of these studies reporting associations between adherence and poorer cognitive outcomes. Overall, there were mixed results for healthy and unhealthy DPs on cognition, likely due to between-study heterogeneity. Standardisation of diet exposure and cognitive outcome measurement would help to reduce this. Future research would benefit from investigating effects of culturally appropriate DPs on individual cognitive domains and incident cognitive disorders in diverse and high-risk populations.

Dietary patterns and their association with cardiovascular risk factors in Ethiopia: A community-based cross-sectional study

Purpose

To identify the dietary patterns and their association with cardiovascular risk factors among adult people in urban and rural areas of Wolaita, southern Ethiopia.

Methods

A total of 2,483 participants aged 25-64 years were selected using a three-stage random sampling. Data for this study were collected using structured questionnaires, the previous 24-h dietary intake assessment, anthropometric, blood pressure, and biochemical measurements. We used factor analysis to identify dietary patterns. Factors associated with dietary patterns were analyzed using multiple linear regression models. The adjusted regression coefficients with their 95% CI were used to ascertain the association.

Result

We identified three major dietary patterns that explained 51% of the variance in food consumption. The western dietary pattern was characterized by the consumption of meat/organ meat, biscuits/sweets, chicken stew, pasta-macaroni recipes, butter, white wheat bread, egg recipe, and Ethiopian dish shiro-wet, and was positively associated with urban residence, obesity, hypertension, blood glucose, and total cholesterol levels. Adherence to the consumption of tubers, whole-grain maize products, coffee leaves-and-herbs beverage, legumes, and sweet potatoes featured the traditional dietary pattern. The traditional dietary pattern showed a positive relationship with rural residence, physical activity, and obesity, and it had a negative relationship with hypertension. The healthy dietary pattern was characterized by the intake of green leafy vegetables, green pepper, and whole-grain maize products, and negatively related to obesity, and hypertension, while positively related to urban residence.

Conclusion

The coexistence of western, traditional, and healthy dietary patterns in the present study indicates the transition to a new dietary pattern in the study area. All dietary patterns were associated with one or more cardiovascular risk factors, but the western dietary pattern was associated with most of these, while the traditional diet showed fewer such associations. Therefore, it might be useful to promote healthy and traditional dietary patterns along with physical activity. Interventions related to the current findings, if initiated early in life, may benefit the public in preventing cardiovascular risk factors such as obesity, hypertension, and type 2-diabetes.

Different statistical methods identify similar population-specific dietary patterns: an analysis of Longitudinal Study of Adult Health (ELSA-Brasil)

In recent decades, different data-driven approaches have emerged to identify dietary patterns (DP) and little is discussed about how these methods are able to capture diet complexity within the same population. This study aimed to apply three statistical methods to identify the DP of the Longitudinal Study of Adult Health (ELSA-Brasil) population and evaluate the similarities and differences between them. Dietary data were assessed at baseline in the ELSA-Brasil study using a FFQ. DP were identified by applying three statistical methods: (1) factor analysis (FA), (2) treelet transform (TT) and (3) reduced rank regression (RRR). The characteristics of individuals classified in the last tertile of each DP were compared. Cross-classification and Pearson's correlation coefficients were assessed to evaluate the agreement between individuals' adherence to DP of the three methods. A similar convenience DP was identified for all three methods. FA and TT also identified a similar prudent DP and a DP highly loaded for the food groups rice and beans. Individuals classified in the third tertile of similar DP of each method presented similar socio-demographic and nutrient intake characteristics. Regarding the cross-classification, prudent DP from FA and TT presented a higher level of agreement (75 %), while convenience DP from TT and RRR presented the lowest agreement (44·8 %). The different statistical methods were able to capture the populations' DP in a similar way while highlighting the particularities of each method.

Nutritional Status and Habits among People on Vegan, Lacto/Ovo-Vegetarian, Pescatarian and Traditional Diets

Background: This study assessed the possible dependencies between nutritional habits and body composition among subjects with different dietary habits. Materials: A total of 196 healthy (aged 18−50 yrs) participants were enrolled in the study and divided into 4 groups according to their diet: vegans-VEGAN (n = 53), lacto/ovo-vegetarians—VEGE (n = 52), pescatarians-PESCA (n = 28), and omnivores-OMN (n = 43). Methods: The Food Frequency Questionnaire (FFQ) was used, and body composition was assessed on the In-Body120 analyzer. Results: Our result revealed in OMN + PESCA groups a higher average consumption frequency of sweets (p = 0.024), cheese/plant cheese (p < 0.001), eggs and egg dishes/egg substitutes (p < 0.001), butter, margarine/plant margarine (p < 0.001), cream /plant cream (p = 0.018), wine and cocktails (p = 0.028), vodka (p = 0.039) and lower of natural cottage cheese/tofu/tempeh (p < 0.001), vegetable oils (p = 0.036), legumes (p < 0.001) and nuts and seeds(p < 0.001) compared to the VEGAN + VEGE groups. The body composition analysis showed significant differences in skeletal muscle mass (SMM) (p = 0.019) and the content of minerals (p = 0.048) between groups. VEGAN disclosed the lowest average values of body fat mass (BFM), percentage body fat (PBF), and visceral adipose tissue (VAT) than other studied groups. Conclusions: The body composition analysis showed mean values within normal ranges in all of the groups, but some average results of OMN, PESCA, and VEGE compared to VEGAN were not highly satisfactory (in addition to eating behavior outcomes).

The Relationship between Dietary Patterns and High Blood Glucose among Adults Based on Structural Equation Modelling

The aim of this study was to examine the association between dietary patterns and high blood glucose in Jiangsu province of China by using structural equation modelling (SEqM). Methods: Participants in this cross-sectional study were recruited through the 2015 Chinese Adult Chronic Disease and Nutrition Surveillance Program in Jiangsu province using a multistage stratified cluster random sampling method. Dietary patterns were defined by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) was used to test the fitness of EFA. SEqM was used to investigate the association between dietary patterns and high blood glucose. Results: After exclusion, 3137 participants with complete information were analysed for this study. The prevalence of high blood glucose was 9.3% and 8.1% in males and females, respectively. Two dietary patterns: the modern dietary pattern (i.e., high in red meats and its products, vegetables, seafood, condiments, fungi and algae, main grains and poultry; low in other grains, tubers and preserves), and the fruit−milk dietary pattern (i.e., high in milk and its products, fruits, eggs, nuts and seeds and pastry snacks, but low in vegetable oils) were established. Modern dietary pattern was found to be positively associated with high blood glucose in adults in Jiangsu province (multivariate logistic regression: OR = 1.561, 95% CI: 1.025~2.379; SEqM: β = 0.127, p < 0.05). Conclusion: The modern dietary pattern—high intake of red meats—was significantly associated with high blood glucose among adults in Jiangsu province of China, while the fruit−milk dietary pattern was not significantly associated with high blood glucose.

Geographic Variations in Dietary Patterns and Their Associations with Overweight/Obesity and Hypertension in China: Findings from China Nutrition and Health Surveillance (2015-2017)

Regional dietetic cultures were indicated in China, but how dietary patterns geographically varied across China is unknown. Few studies systematically investigated the association of dietary patterns with overweight/obesity and hypertension and the potential mechanism with a national sample. This study included 34,040 adults aged 45 years and older from China Nutrition and Health Surveillance (2015−2017), who had complete outcome data, reliable intakes of calorie and cooking oils, unchanged diet habits, and without diagnosed cancer or cardiovascular disease. Outcomes were overweight/obesity and hypertension. By using the Gaussian finite mixture models, four dietary patterns were identified—common rice-based dietary pattern (CRB), prudent diversified dietary pattern (PD), northern wheat-based dietary pattern (NWB), and southern rice-based dietary pattern (SRB). Geographic variations in dietary patterns were depicted by age−sex standardized proportions of each pattern across 31 provinces in China. We assessed the association of these dietary patterns with outcomes and calculated the proportion mediated (PM) by overweight/obesity in the association of the dietary patterns with hypertension. Evident geographic disparities in dietary patterns across 31 provinces were observed. With CRB as reference group and covariates adjusted, the NWB had higher odds of being overweight/obese (odds ratio (OR) = 1.44, 95% confidence interval (CI): 1.36−1.52, p < 0.001) and hypertension (OR = 1.07, 95%CI: 1.01−1.14, p < 0.001, PM = 43.2%), while the SRB and the PD had lower odds of being overweight/obese (ORs = 0.84 and 0.92, 95%CIs: 0.79−0.89 and 0.85−0.99, p < 0.001 for both) and hypertension (ORs = 0.93 and 0.87, 95%CIs: 0.87−0.98 and 0.80−0.94, p = 0.038 for SRB and p < 0.001 for PD, PMs = 27.8% and 9.9%). The highest risk of overweight/obesity in the NWB presented in relatively higher carbohydrate intake (about 60% of energy) and relatively low fat intake (about 20% of energy). The different trends in the association of protein intake with overweight/obesity among dietary patterns were related to differences in animal food sources. In conclusion, the geographic distribution disparities of dietary patterns illustrate the existence of external environment factors and underscore the need for geographic-targeted dietary actions. Optimization of the overall dietary pattern is the key to the management of overweight/obesity and hypertension in China, with the emphasis on reducing low-quality carbohydrate intake, particularly for people with the typical northern diet, and selection of animal foods, particularly for people with the typical southern diet.

Visceral adiposity-related dietary patterns and the risk of cardiovascular disease in Iranian adults: A population-based cohort study

Background

Visceral obesity is a significant predictor of cardiovascular disease (CVD). Diet may associate with CVD risk through its effects on visceral adiposity. This study aimed to find dietary patterns (DPs) related to indicators of visceral adiposity and to determine whether the DPs were associated with CVD risk.

Methods

This prospective study included 2,496 participants of the Tehran Lipid and Glucose Study (TLGS) without CVD, who were followed from the third study examination (2005–2008; baseline) to March 2018. DPs at baseline were determined using reduced rank regression (RRR) and partial least squares regression (PLS). The response variables were age and BMI-adjusted waist circumference (WC) and age-adjusted visceral adiposity index (VAI).

Results

Two and three DPs were retained with RRR and PLS, respectively. The first patterns of each method were mainly characterized by adjusted-WC (RRR: 10.8%, PLS: 8.6%); none of them were associated with CVD risk. The second pattern of RRR and the third pattern of PLS were mainly explained by adjusted-VAI (RRR: 3.3, PLS: 2.1%). After adjusting for CVD risk factors, the hazard ratios [95% confidence intervals (CI)] for CVD in the second and third tertiles of the RRR-pattern 2 were 1.76 (1.15, 2.69) and 1.55 (1.00, 2.43) vs. the first tertile (p-trend: 0.058). This pattern had high positive loadings for non-leafy vegetables, pickled vegetables, fried vegetables, and bread and high negative loadings for eggs, cakes, butter, jam-honey, red meat, poultry, fish, juice, non-fermented dairy, and fruits. Per one SD increase in PLS-pattern 3 score, the risk of CVD was 19% higher (95%CI = 3–38%). This positive association was also observed across tertiles of the pattern (p-trend: 0.032). This pattern was characterized by high intakes of leafy vegetables, non-leafy vegetables, organ meat, soft drinks, olive oil, pickled vegetables, fried vegetables, and bread and low intakes of biscuits, cakes, butter, eggs, and non-fermented dairy.

Conclusion

For each of the RRR and PLS approaches, a visceral-related DP that was positively linked to CVD was identified. These two patterns had a modest correlation. The pattern generated by PLS explained more variations in food groups and offered stronger evidence of association with CVD than the RRR-derived pattern.

Using Multiple Statistical Methods to Derive Dietary Patterns Associated with Cardiovascular Disease in Patients with Type 2 Diabetes: Results from a Multiethnic Population-Based Study

Background

There are few reports on the relationship between dietary patterns and cardiovascular disease (CVD) risk in patients with type 2 diabetes (T2D). This study aimed to explore relationships between dietary patterns and CVD risk in the T2D population using multiple statistical analysis methods.

Methods

A total of 2,984 patients with T2D from the Xinjiang Multi-Ethnic Cohort, 555 of whom were suffering from CVD, were enrolled in this study. Participants' dietary intake was measured by the semiquantitative food frequency questionnaire (FFQ). Three statistical methods were used to construct dietary patterns, including principal component analysis (PCA) method, reduced-rank regressions (RRR) method, and partial least-squares regression (PLS) method. Then, the association between dietary patterns and CVD risk in T2D patients was analyzed by logistic regression. After excluding participants with CVD, the associations between dietary patterns and 10-year CVD risk scores were subsequently evaluated to reduce reverse causality.

Results

In this study, four dietary patterns were identified by three methods. Adjustment for confounding factors, subjects with the highest scores on the "high-protein and high-carbohydrate" patterns derived from PCA, RRR, and PLS had higher odds of CVD than those with the lowest scores (OR: 2.89, 95% CI: 2.11-3.96, P _trend < 0.001; OR: 2.96, 95% CI: 2.17-4.03, P _trend < 0.001; OR: 2.01, 95% CI: 1.50-2.70, P _trend < 0.001, respectively). However, the dietary pattern of PCA-prudent was not significantly related to the odds of having CVD in T2D patients (adjusted OR_Q4vsQ1: 0.93, 95% CI: 0.70-1.24, P _trend =0.474). Interestingly, we also found significant associations between "high-protein and high-carbohydrate" patterns and the elevated predicted 10-year CVD risk in T2D patients (all P _trend < 0.05).

Conclusion

The positive correlation between "high-protein and high-carbohydrate" patterns and CVD risk in T2D patients was robust across all three data-driven approaches. These findings may have public health significance, encouraging an emphasis on food choices in the usual diet and promoting nutritional interventions for patients with T2D to prevent CVD.

Fried food consumption and the risk of pancreatic cancer: A large prospective multicenter study

Background and aims

Whether fried food consumption is associated with the risk of pancreatic cancer remains elusive. We aimed to examine this association in a US population.

Methods

A population-based cohort of 101,729 US adults was identified. Fried food consumption was assessed with a validated food frequency questionnaire. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Explanatory analyses were conducted to identify main contributor(s) to the observed association.

Results

During an average follow-up of 8.86 years (900871.2 person-years), 402 pancreatic cancer cases occurred. High consumption of total fried foods (deep-fried plus pan-fried foods; HRquartile4 vs. 1 0.71, 95% CI 0.51-0.99, P trend = 0.047) and deep-fried foods (HRquartile 4 vs. 1 0.64, 95% CI 0.47-0.88, P trend = 0.011), but not pan-fried foods (HRquartile 4 vs. 1 0.98, 95% CI 0.73-1.32; P trend = 0.815), was found to be associated with a reduced risk of pancreatic cancer in a non-linear dose-response manner, which was not modified by predefined stratification factors and persisted in sensitivity analyses. In explanatory analyses, only chip consumption was found to be inversely associated with the risk of pancreatic cancer; consistently, the initial significant associations between total fried food and deep-fried food consumption and the risk of pancreatic cancer changed to be non-significant after omitting or further adjusting for chip consumption.

Conclusion

Consumption of deep-fried foods, but not pan-fried foods, is inversely associated with the risk of pancreatic cancer in this US population. The role of deep-fried foods in reducing the risk of pancreatic cancer appears to be mainly attributable to chips. More studies are needed to confirm our findings in other populations and settings.

Dietary trajectories through the life course: opportunities and challenges

Studying the dynamic patterns of dietary changes or stability (otherwise known as dietary trajectories) across the life course can provide important information about when and in whom to intervene with nutritional interventions. This article reviews evidence from longitudinal studies that describe dietary trajectories through the different life stages, covering early life, adolescence to young adulthood and from mid to late adulthood. Current findings suggest that the establishment of diet patterns likely occurs before 3 years of age and allude to other potential ‘windows of change’ in the life course such as the period of 7–9 years of age and during the period of adolescence and early adulthood. Examining diets using various diet parameters appears to be valuable in elucidating different aspects of the diet that can be changed to potentially alter trajectories. In adults, examining long-term diet trends at a population level can reveal shifts in eating patterns as countries undergo epidemiological and nutrition transitions and elucidate the longer-term impact of adherence to particular diets on the development of chronic diseases. While challenges such as the availability of adequate diet data points, consistency in the dietary assessment tools used and the limitations of statistical methods for trajectory modelling remain, integrating diet data with other lifestyle behaviours, high-dimensional biomarkers and genetics data into pattern analyses and examining them from a longitudinal approach, open up potential opportunities to gain deeper insights into diet–disease relationships and support the development of more holistic lifestyle disease prevention recommendations stratified for population groups.

Relationship Between Dietary Patterns and Chronic Diseases in Rural Population: Management Plays an Important Role in the Link

Objective

Health dietary pattern is related with reduced risk of chronic metabolic disease, but the benefits were not fully clear in the Chinese population. The aim of this study was to explore the association between dietary patterns and multiple chronic metabolic diseases in middle-aged and elderly Chinese.

Methods

A total of 718 Chinese adults aged ≥ 45 who lived in the Huairou regions of Beijing were included in the present cross-sectional analysis from 2019 to 2020. Dietary data were obtained by food frequency questionnaires (FFQs). Dietary patterns were identified by principal components analysis (PCA). Logistic regression analysis and hierarchical analysis were used to examine the relationship among dietary patterns, health management, and chronic diseases.

Results

Five dietary patterns were discovered in the subjects. The pattern with the higher percentage of energy supply by lipid was a risk factor for hypertension [odds ratio (OR) = 2.067, p = 0.013]. Lower energy intake (OR = 0.512, p = 0.012) and a reasonable ratio of dietary energy supply (OR = 0.506, p = 0.011) were beneficial to diabetes. The substitution of potato for grain might be an effective way of reducing diabetes (OR = 0.372, p &lt; 0.001). The higher intake of high-quality protein was the protective factor for coronary heart disease (CHD; OR = 0.438, p = 0.008). Moderate intervention (OR = 0.185, p = 0.033) and appropriate health education (OR = 0.432, p = 0.016) could greatly subserve the prevention of chronic diseases, especially for hyperlipidemia. Men were more likely to be affected by health education, intervention, and follow-up than women. The prevalence of multimorbidity was higher in women (43.2%) than men (41.5%). The staple food intake and health management were also important factors to prevent multimorbidity.

Conclusion

Dietary pattern with appropriate energy intake, a reasonable source of energy supply, high quality of macronutrients, and moderate management was associated with decreased risk of chronic metabolic diseases. Further studies are needed to clarify the cause–effect relationship between dietary patterns, health management, and chronic diseases and give suggestions to chronic metabolic disease prevention in middle-aged and elderly people in a rural area.

Metagenomic Analysis of the Pediatric-Onset Multiple Sclerosis Gut Microbiome

BACKGROUND AND OBJECTIVES

Little is known of the functional potential of the gut microbiome in pediatric-onset multiple sclerosis (MS). We performed metagenomic analyses using stool samples from individuals with pediatric-onset MS and unaffected controls.

METHODS

Persons ≤21 years old enrolled in the Canadian Pediatric Demyelinating Disease Network providing a stool sample were eligible. Twenty patients with MS (McDonald criteria) with symptom onset <18 years were matched to 20 controls by sex, age (±3 years), stool consistency, and race. Microbial taxonomy and functional potentials were estimated from stool sample-derived metagenomic reads and compared by disease status (MS vs controls) and disease-modifying drug (DMD) exposure using alpha diversity, relative abundance, and prevalence using Wilcoxon rank sum, ALDEx2, and Fisher exact tests, respectively.

RESULTS

Individuals with MS were aged 13.6 years (mean) at symptom onset and 8 were DMD-naive. Mean ages at stool sample were 16.1 and 15.4 years for MS and control participants, respectively; 80% were girls. Alpha diversity of enzymes and proteins did not differ by disease or DMD status (p > 0.20), but metabolic pathways, gene annotations, and microbial taxonomy did. Individuals with MS (vs controls) exhibited higher methanogenesis prevalence (odds ratio 10, p = 0.044) and Methanobrevibacter abundance (log₂ fold change [LFC] 1.7, p = 0.0014), but lower homolactic fermentation abundance (LFC -0.48, p = 0.039). Differences by DMD status included lower phosphate butyryl transferase for DMD-naive vs exposed patients with MS (LFC -1.0, p = 0.033).

DISCUSSION

The gut microbiome's functional potential and taxonomy differed between individuals with pediatric-onset MS vs controls, including higher prevalence of a methane-producing pathway from Archaea and depletion of the lactate fermentation pathway. DMD exposure was associated with butyrate-producing enzyme enrichment. Together these findings indicate that the gut microbiome of individuals with MS may have a disturbed functional potential.

Social Factors of Dietary Risk Behavior in Older German Adults: Results of a Multivariable Analysis

With this analysis, we aimed to examine the associations between social factors and dietary risk behavior in older adults. Data were collected through a full-population postal survey of German adults aged 65 years or older (n = 1687, 33% response proportion, 52% female, mean age = 76 years). Using principal component analysis (PCA), a data-driven Dietary Risk Behavior Index (DRB) was computed. Dietary risk behavior was defined as consumption frequencies of vegetables/fruit, whole grains, and dairy products below national dietary recommendations. By performing a multiple linear regression, we analyzed associations between sociodemographic, socioeconomic, psychosocial, and behavioral factors and dietary risk behavior. Physical activity, female gender, socioeconomic status, social support, and age (in the male sample) were negatively associated with dietary risk behavior. Alcohol consumption and smoking were positively associated with dietary risk behavior. A group-specific analysis revealed a higher goodness-of-fit for the low socioeconomic status group, older adults aged 65–79 years, and women. A comprehensive understanding of the relationships between social factors and dietary risk behavior in older adults assists the group-specific targeting of dietary-related interventions. Demand-oriented dietary interventions should account for underlying social conditions to reduce inequity in dietary risk behavior among older adults. The results of this work may be transferable to municipalities in high-income European countries.

Mediterranean, DASH, and MIND Dietary Patterns and Cognitive Function: The 2-Year Longitudinal Changes in an Older Spanish Cohort

Background and Aims: Plant-forward dietary patterns have been associated with cardiometabolic health benefits, which, in turn, have been related to cognitive performance with inconsistent findings. The objective of this study was to examine the relationship between baseline adherence to three a priori dietary patterns (Mediterranean, DASH, and MIND diets) with 2-year changes in cognitive performance in older adults with overweight or obesity and high cardiovascular disease risk. Methods: A prospective cohort analysis was conducted within the PREDIMED-Plus trial, involving 6,647 men and women aged 55-75 years with overweight or obesity and metabolic syndrome. Using a validated, semiquantitative 143-item food frequency questionnaire completed at baseline, the dietary pattern adherence scores were calculated. An extensive neuropsychological test battery was administered at baseline and 2-year follow-up. Multivariable-adjusted linear regression models were used to assess associations between 2-year changes in cognitive function z-scores across tertiles of baseline adherence to the a priori dietary patterns. Results: Adherence to the Mediterranean diet at baseline was associated with 2-year changes in the general cognitive screening Mini-Mental State Examination (MMSE, β: 0.070; 95% CI: 0.014, 0.175, P-trend = 0.011), and two executive function-related assessments: the Trail Making Tests Part A (TMT-A, β: -0.054; 95% CI: -0.110, - 0.002, P-trend = 0.047) and Part B (TMT-B, β: -0.079; 95% CI: -0.134, -0.024, P-trend = 0.004). Adherence to the MIND diet was associated with the backward recall Digit Span Test assessment of working memory (DST-B, β: 0.058; 95% CI: 0.002, 0.114, P-trend = 0.045). However, higher adherence to the DASH dietary pattern was not associated with better cognitive function over a period of 2 years. Conclusion: In older Spanish individuals with overweight or obesity and at high cardiovascular disease risk, higher baseline adherence to the Mediterranean dietary pattern may be associated with better cognitive performance than lower adherence over a period of 2 years.

An Ultra-Processed Food Dietary Pattern Is Associated with Lower Diet Quality in Portuguese Adults and the Elderly: The UPPER Project

This study aimed to identify dietary patterns (DPs) and their associations with sociodemographic factors and diet quality in Portuguese adults and the elderly. Cross-sectional data were obtained from the National Food, Nutrition and Physical Activity Survey (2015-2016), with two non-consecutive dietary 24 h recalls. Food items were classified according to the NOVA system and its proportion (in grams) in the total daily diet was considered to identify DPs by latent class analysis, using age and sex as concomitant variables. Multinomial logistic and linear regressions were performed to test associations of DPs with sociodemographic characteristics and diet quality, respectively. Three DPs were identified: "Traditional" (higher vegetables, fish, olive oil, breads, beer and wine intake), "Unhealthy" (higher pasta, sugar-sweetened beverages, confectionery and sausages intake) and "Diet concerns" (lower intake of cereals, red meat, sugar-sweetened and alcoholic beverages). "Unhealthy" was associated with being younger and lower intake of dietary fiber and vitamins and the highest free sugars and ultra-processed foods (UPF). "Diet concerns" was associated with being female and a more favorable nutrient profile, but both DPs presented a higher contribution of UPF than the "Traditional" DP. These findings should be considered for the design of food-based interventions and public policies for these age groups in Portugal.

Using Wearable Cameras to Assess Foods and Beverages Omitted in 24 Hour Dietary Recalls and a Text Entry Food Record App

Technology-enhanced methods of dietary assessment may still face common limitations of self-report. This study aimed to assess foods and beverages omitted when both a 24 h recall and a smartphone app were used to assess dietary intake compared with camera images. For three consecutive days, young adults (18–30 years) wore an Autographer camera that took point-of-view images every 30 seconds. Over the same period, participants reported their diet in the app and completed daily 24 h recalls. Camera images were reviewed for food and beverages, then matched to the items reported in the 24 h recall and app. ANOVA (with post hoc analysis using Tukey Honest Significant Difference) and paired t-test were conducted. Discretionary snacks were frequently omitted by both methods (p < 0.001). Water was omitted more frequently in the app than in the camera images (p < 0.001) and 24 h recall (p < 0.001). Dairy and alternatives (p = 0.001), sugar-based products (p = 0.007), savoury sauces and condiments (p < 0.001), fats and oils (p < 0.001) and alcohol (p = 0.002) were more frequently omitted in the app than in the 24 h recall. The use of traditional self-report methods of assessing diet remains problematic even with the addition of technology and finding new objective methods that are not intrusive and are of low burden to participants remains a challenge.

Mediterranean, DASH, and MIND Dietary Patterns and Cognitive Function: The 2-Year Longitudinal Changes in an Older Spanish Cohort

Background and Aims: Plant-forward dietary patterns have been associated with cardiometabolic health benefits, which, in turn, have been related to cognitive performance with inconsistent findings. The objective of this study was to examine the relationship between baseline adherence to three a priori dietary patterns (Mediterranean, DASH, and MIND diets) with 2-year changes in cognitive performance in older adults with overweight or obesity and high cardiovascular disease risk. Methods: A prospective cohort analysis was conducted within the PREDIMED-Plus trial, involving 6,647 men and women aged 55-75 years with overweight or obesity and metabolic syndrome. Using a validated, semiquantitative 143-item food frequency questionnaire completed at baseline, the dietary pattern adherence scores were calculated. An extensive neuropsychological test battery was administered at baseline and 2-year follow-up. Multivariable-adjusted linear regression models were used to assess associations between 2-year changes in cognitive function z-scores across tertiles of baseline adherence to the a priori dietary patterns. Results: Adherence to the Mediterranean diet at baseline was associated with 2-year changes in the general cognitive screening Mini-Mental State Examination (MMSE, β: 0.070; 95% CI: 0.014, 0.175, P-trend = 0.011), and two executive function-related assessments: the Trail Making Tests Part A (TMT-A, β: -0.054; 95% CI: -0.110, - 0.002, P-trend = 0.047) and Part B (TMT-B, β: -0.079; 95% CI: -0.134, -0.024, P-trend = 0.004). Adherence to the MIND diet was associated with the backward recall Digit Span Test assessment of working memory (DST-B, β: 0.058; 95% CI: 0.002, 0.114, P-trend = 0.045). However, higher adherence to the DASH dietary pattern was not associated with better cognitive function over a period of 2 years. Conclusion: In older Spanish individuals with overweight or obesity and at high cardiovascular disease risk, higher baseline adherence to the Mediterranean dietary pattern may be associated with better cognitive performance than lower adherence over a period of 2 years.