Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies

Thiazole modified covalent triazine framework as carcinogenic metabolites adsorbent: A DFT insight

The potential of a novel thiazole-modified covalent triazine framework (S-CTF) as surface for the adsorption and sensing of the carcinogenic metabolites acrylamide (AM), 2-amino-3,8-dimethylimidazo-[4,5-f]quinoxaline (MEIQX), 2-amino-1-methyl-6-phenylimidazole[4,5-f]pyridine (PhlP) and 3-amino-1,4-dimethyl-5H-pyrido[4,3-b]indole (Trp-P-1) is explored. The selectivity, sensitivity, and adsorption properties of the S-CTF surface are investigated through noncovalent interaction (NCI), quantum theory of atoms in molecules (QTAIM) and symmetry adapted perturbation theory (SAPT0) analyses. All the analytes were found to be physiosorbed on the surface of the sensor with the following strength of interaction: MEIQX@S-CTF = PhlP@S-CTF > Trp-P-1@S-CTF > AM@S-CTF. Evaluation of the electronic properties was done by natural bond orbital (NBO), electron density difference (EDD), frontier molecular orbital (FMO) and density of states (DOS) analyses. Through SAPT0 analysis, MEIQX@S-CTF has shown to have the highest ESAPT0 energy data (-24.58 kcal/mol) whereas FMO analysis reveals that the S-CTF surface shows the highest sensing power for Trp-P-1 among all analytes.

The quality of plant-based diets and liver cancer incidence and liver disease mortality in the UK Biobank

BACKGROUND & AIMS

Plant-based diets have been associated with a lower risk of various chronic diseases. However, their role in preventing liver cancer and liver-related death is currently unclear. We aimed to investigate the association between plant-based diets and the risk of liver cancer incidence and liver disease mortality in the UK Biobank.

METHODS

We included 85,810 males and 101,971 females from the UK Biobank in our analyses. Three plant-based diet indices, including an overall plant-based diet index (PDI), a healthful plant-based diet index (hPDI), and an unhealthful plant-based diet index (uPDI), were created based on 17 food groups using data from at least one 24-h dietary assessments. Cox proportional hazards models were used to estimate multivariable-adjusted hazard ratios (HRs) and 95 % confidence intervals (CIs).

RESULTS

During follow-up, 109 males and 68 females developed liver cancer, and 190 males and 108 females died from liver diseases. Overall PDI scores were not associated with liver cancer incidence or liver disease mortality in either males or females. However, higher hPDI scores were linked to a lower risk of liver cancer incidence (HRQ5 vs. Q1: 0.47; 95%CI: 0.26, 0.85; P-trend = 0.005) and liver disease mortality (HRQ5 vs. Q1: 0.46; 95%CI: 0.27, 0.77; P-trend = 0.011) in males. Higher uPDI scores were associated with an increased incidence of liver cancer (HRQ5 vs. Q1: 1.90; 95%CI: 1.00, 3,63; P-trend = 0.038) and a higher risk of liver disease-related deaths (HRQ5 vs. Q1: 2.21; 95%CI: 1.37, 3.57; P-trend <0.001). However, no such associations between hPDI or uPDI and the risk of liver cancer or liver disease mortality were observed in females.

CONCLUSIONS

Our results suggest that higher adherence to plant-based diets, emphasizing healthful plant-based foods while restricting less healthful plant foods, may protect against liver cancer and liver disease-related deaths in males, but not in females.

An umbrella review of the association between dietary factors and hepatocellular carcinoma risk

Background: Several meta-analyses have summarized the associations between dietary factors and the risk of hepatocellular carcinoma (HCC). However, no research has comprehensively assessed the certainty of this evidence. Methods: PubMed, Embase, and the Cochrane Library were searched from inception to August 2024. The credibility of the evidence was assessed using the pre-specified evidence classification criteria, graded as convincing ("class I"), highly suggestive ("class II"), suggestive ("class III"), weak ("class IV"), or no evidence ("class V"). To evaluate the quality of evidence, the GRADE framework was applied, categorized as "high", "moderate", "low", or "very low" quality. This study was registered at PROSPERO (CRD42023417373). Results: In total, 22 meta-analyses describing 33 non-dose-response and 10 dose-response associations were included. In the non-dose-response associations, convincing evidence (class I) supported an inverse association between coffee intake [risk ratio (RR) 0.50, 95% confidence interval 0.42 to 0.59, GRADE = very low] and risk for HCC. Suggestive evidence (class III) supported the effect of fish (RR 0.81, 0.73 to 0.90; very low), fiber (RR 0.71, 0.61 to 0.84; low), and the Mediterranean diet (RR 0.67, 0.56 to 0.80; very low) in lowering the risk for HCC. Weak evidence (class IV) suggested the protective effects of ginseng, selenium, cruciferous vegetables, whole grains, and vegetables, against HCC, and the negative effect of saturated fat in increasing the risk for HCC. In the dose-response association, convincing evidence (class I) supported that an additional two cups of coffee per day (RR 0.71, 0.60 to 0.77; moderate) lowered HCC risk, and suggestive evidence (class III) indicated that an increase of 10 g day-1 in fiber intake (RR 0.83, 0.76 to 0.91; moderate) lowered HCC risk. Weak evidence (class IV) suggests positive associations between HCC risk and a 1% daily increase in energy from saturated fat and a 100 mg day-1 increase in cholesterol. Conclusions: Dietary factors, especially coffee, fish, fiber, and the Mediterranean diet, are associated with HCC risk. These findings provide a theoretical basis for developing and evaluating dietary interventions to reduce HCC risk.

Adherence to the EAT-Lancet diet reduces the risk of renal cancer: Results from a population-based prospective study

OBJECTIVES

The EAT-Lancet diet (ELD) has shown potential in reducing obesity and type 2 diabetes, both of which are closely associated with the development of renal cancer. However, the specific relationship between this dietary pattern and renal cancer remains largely unexplored. This study aims to address this gap in knowledge by investigating the association between ELD adherence and renal cancer risk.

STUDY DESIGN

A population-based prospective study of 101,755 American adults from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

METHODS

Cox proportional hazards models were utilized to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between ELD adherence and renal cancer risk, adjusting for potential confounders. Restricted cubic spline plots visualized the dose-response relationship. Subgroup analyses evaluated potential effect modifiers, and sensitivity analyses assessed the robustness of findings.

RESULTS

Over 899,337.5 person-years of follow-up, 446 cases of renal cancer were identified. In the fully adjusted model, a significant inverse association was observed between higher ELD adherence and renal cancer risk (HR for highest vs. lowest quartile: 0.65; 95 % CI: 0.49-0.88; P for trend = 0.002). A restricted cubic spline plot revealed a nonlinear, inverse dose-response relationship (P for nonlinearity = 0.046). Subgroup analyses showed consistent findings across participant characteristics. Sensitivity analyses further reinforced the robustness of the primary association.

CONCLUSIONS

In this large prospective study, adherence to the EAT-Lancet diet was inversely associated with the risk of developing renal cancer, suggesting the potential benefits of this dietary pattern in mitigating renal cancer burden.

Dietary context in the association between red meat consumption and risk of type 2 diabetes

BACKGROUND

It has been suggested that dietary factors correlated with red meat may contribute to its adverse health effects, while consuming red meat within a healthy diet may not necessarily increase disease risk.

METHODS

Among 204,740 participants from three prospective cohorts, we examined the association between red meat consumption and risk of type 2 diabetes (T2D) across different levels of diet quality, measured by Alternative Healthy Eating Index (AHEI)-2010 (excluding red and processed meat component), using multivariable-adjusted Cox proportional hazards models. Dietary intake was assessed using repeated food frequency questionnaires.

RESULTS

During a median follow-up of 28 years, 18,868 cases were documented. Mean values were 47.3 (SD 8.5) for AHEI-2010 and 6.5 (SD 3.5), 1.8 (SD 1.5), and 4.8 (SD 2.5) servings/week for total, processed, and unprocessed red meat, respectively. Greater red meat consumption was consistently associated with a higher T2D risk across AHEI-2010 strata. Comparing the highest with the lowest quintile of red meat consumption in the highest diet quality quintile, the multivariable-adjusted HRs were 1.95 (1.72, 2.21) for total, 1.88 (1.67, 2.13) for processed, and 1.67 (1.47, 1.90) for unprocessed red meat. Substituting red meat with major food groups was associated with a lower T2D risk, particularly among those with high diet quality. The benefit of lowering red meat consumption was greater in participants with higher diet quality.

CONCLUSIONS

The risk associated with high red meat consumption persisted even among participants with a relatively high diet quality, underscoring the importance of limiting red meat consumption to prevent T2D.

Dietary patterns and colorectal cancer risk: Global Cancer Update Programme (CUP Global) systematic literature review

BACKGROUND

The 2018 World Cancer Research Fund/American Institute for Cancer Research Third Expert Report, including studies up to 2015, determined limited-no conclusion evidence on dietary patterns and colorectal cancer (CRC) risk due to insufficient data and varying pattern definitions.

OBJECTIVES

This updated review synthesized literature on dietary patterns and CRC risk/mortality.

METHODS

PubMed and Embase were searched through 31 March, 2023, for randomized controlled trials (RCTs) and prospective cohort studies on adulthood dietary patterns. Patterns were categorized by derivation method: a priori, a posteriori, or hybrid, and were then descriptively reviewed in relation to the primary outcomes: CRC risk or mortality. The Global Cancer Update Programme Expert Committee and Expert Panel independently graded the evidence on the likelihood of causality using predefined criteria.

RESULTS

Thirty-two dietary scores from 53 observational studies and 3 RCTs were reviewed. Limited-suggestive evidence was concluded for higher alignment with a priori-derived patterns: Mediterranean, healthful plant-based index, Healthy Eating Index (HEI)/alternate HEI, and Dietary Approaches to Stop Hypertension (DASH), in relation to lower CRC risk. Common features across these diets included high plant-based food intake and limited red/processed meat. Hybrid-derived patterns: the empirical dietary index for hyperinsulinemia (EDIH) and the empirical dietary inflammatory pattern (EDIP), showed strong-probable evidence for increased CRC risk. Evidence for a priori-derived low-fat dietary interventions and a posteriori-derived patterns was graded as limited-no conclusion. By cancer subsite, higher alignment with Mediterranean diet showed limited-suggestive evidence for lower rectal cancer risk, and that with HEI/alternate HEI and DASH showed limited-suggestive evidence for lower colon and rectal cancer risks. EDIH and EDIP showed strong-probable evidence for increased colon cancer risks. All exposure-mortality pairs and other pattern-outcome associations were graded as limited-no conclusion.

CONCLUSIONS

This review highlights the role of dietary patterns in CRC risk/mortality, providing insights for future research and public health strategies. This review was registered at PROSPERO as CRD42022324327 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022324327).

What's in a name? Examining the confusion of meat-like terminology on meat imitating plant-based products

Meat alternatives are becoming increasingly popular amongst consumers. The names on these products, specifically the use of meat-like designations on non-animal products, remains a major point of contention. The aim of this study was to investigate whether meat-like vs. non-meat-like names are potentially confusing or even misleading. In this study, a categorisation task was used where participants classified products as animal-based or plant-based. Our results show that the presence of a meat-like name on a meat alternative label leads to significantly more mistakes when classifying a product as plant-vs. animal-based. The response latency was on average 116ms longer when classifying these products compared with the other categories. This indicates that a consumer is in doubt whether the product should be classified as plant- or animal-based, possibly explained by the activation of unconscious cognitive processing and interference due to stimulus-response compatibility. When participants were asked to give their opinion about meat alternative labelling, views divided into two camps: some strongly believe that using meat-like names is misleading, while others consider it fully acceptable and not misleading in any way. Assessing whether a meat-like name is misleading involves more than the name itself; it requires considering label details, retail placement, and advertising. Ensuring accurate and transparent meat alternative labels begins with a clear legal basis and policy guidelines based on scientific research.

Effect of Preoperative Inflammatory Diet on Clinical and Oncologic Outcomes Following Colorectal Cancer Surgery

Objectives: The dietary inflammatory index (DII), a validated tool for assessing the inflammatory potential of diet, has been widely identified as a significant risk factor for colorectal cancer (CRC). However, its role as a prognostic factor for CRC remains unexplored. This study examined the impact of preoperative dietary inflammation on clinical and oncologic outcomes following CRC surgery. Methods: The study population consisted of 126 patients who had surgical procedures for CRC and completed a food frequency questionnaire (FFQ) preoperatively between January 2018 and June 2020. Results: An optimal DII cut-off value of 0.90182 was used to categorize patients into the high-DII (n = 28) and low-DII (n = 98) groups. The high-DII group exhibited an older age (71.5 vs. 67.0, p = 0.020) and a significantly higher complication risk within 30 days postoperatively than the low-DII group (57.1% vs. 35.7%, p = 0.042). Other perioperative clinical outcomes did not demonstrate any significant differences between the two groups. The 5-year overall survival (OS) rates were 90.4% and 41.3% in the low-DII and high-DII groups, respectively, in univariate survival analysis (p = 0.044). However, no statistical difference was observed in the disease-free survival (DFS) rate. In the multivariate survival analysis, low-DII (hazard ratio [HR]: 0.118; 95% confidence interval [CI]: 0.023-0.613, p = 0.011) and M1 stage (HR: 10.910; 95% CI: 1.491-79.847, p = 0.019) were identified as independent prognostic factors for OS, while perineural invasion (HR: 3.495; 95% CI: 1.059-11.533, p = 0.040) served as an independent prognostic factor for DFS. Conclusions: A high preoperative DII score, indicative of an inflammatory dietary pattern, was correlated with increased postoperative complications and functioned as an independent prognostic indicator for OS.

Survival Tree Analysis of Interactions Among Factors Associated With Colorectal Cancer Risk in Patients With Type 2 Diabetes: Retrospective Cohort Study

Background

Colorectal cancer (CRC) and diabetes share many common lifestyle risk factors, such as obesity. However, it remains largely unknown how different factors interact to influence the risk of CRC development among patients with diabetes.

Objective

This study aimed to identify the interaction patterns among factors associated with the risk of CRC incidence among patients with diabetes.

Methods

This is a retrospective cohort study conducted using electronic health records from Hong Kong. Patients who were diagnosed with type 2 diabetes and received care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. A conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of CRC.

Results

A total of 386,325 patients were included. During a median follow-up of 6.2 years (IQR 3.3-8.0), 4199 patients developed CRC. Patients were first partitioned into 4 age groups by increased levels of CRC risk (≤54 vs 55 to 61 vs 62 to 73 vs >73 years). Among patients aged more than 54 years, male sex was the dominant risk factor for CRC within each age stratum and the associations lessened with age. Abdominal obesity (waist-to-hip ratio >0.95) and longer duration of diabetes (median 12, IQR 7-18 vs median 4, IQR 1-11 years) were identified as key risk factor for CRC among men aged between 62 and 73 years and women aged more than 73 years, respectively.

Conclusions

This study suggests the interaction patterns among age, sex, waist-to-hip ratio, and duration of diabetes on the risk of CRC incidence among patients with diabetes. Findings of the study may help identify target groups for public health intervention strategies.

Assessing the impact of gout on cancer risk and the role of healthy lifestyles

Background

Conflicting evidence exists on the link between gout and cancer risk, with limited clarity on the impact of healthy lifestyle factors.

Methods

In the UK Biobank, 7,169 gout patients were matched with 21,507 non-gout controls (1:3 ratio) using propensity scores. Cox regression models assessed cancer risk associated with gout. Among 6,105 gout patients, cancer risk was further evaluated using an eight-factor Healthy Lifestyle Score (HLS) and a weighted HLS.

Results

Gout was linked to a higher cancer incidence [HR (95% CI) = 1.075 (1.013-1.140)]. High HLS in gout patients correlated with a lower cancer risk [HR (95% CI) = 0.825 (0.717-0.948)], with the strongest protective effect observed in those aged ≥60. Sensitivity analyses confirmed these findings.

Conclusion

Gout patients have a higher risk of developing cancer, but a healthy lifestyle, particularly in those aged 60 and older, significantly reduces this risk. These findings highlight the importance of lifestyle interventions for cancer prevention in patients with gout.

A recipe for a disaster: food, climate change, and cancer

Climate change impacts each step of the cancer control continuum, from prevention to survivorship. Importantly, several human activities driving greenhouse gas emissions also impact cancer risk and outcomes. Therefore, there is significant overlap between climate and cancer control solutions. This article describes the connection between the current food system, climate change, and cancer; one realm of human activities with enormous potential for modifications and implementation of win-win solutions.

Association between red and processed meat consumption and colorectal cancer risk: a comprehensive meta-analysis of prospective studies

Increasing evidence suggests that red and processed meat consumption may elevate the risk of colorectal cancer (CRC), yet the magnitude and consistency of this association remain debated. This meta-analysis aims to quantify the relationship between red and processed meat intake and the risk of CRC, colon cancer, and rectal cancer using the most comprehensive set of prospective studies to date. We conducted a comprehensive search in PubMed, Web of Science, Cochrane Library, Embase, and Google Scholar databases from 1990 to November 2024, to identify relevant prospective studies examining red, processed, and total meat consumption in relation to colorectal, colon, and rectal cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were extracted for each study and pooled using a random-effects model to account for variability among studies. Statistical evaluation was executed using the online platform MetaAnalysisOnline.com. A total of 60 prospective studies were included. Red meat consumption was associated with a significantly increased risk of colon cancer (HR = 1.22, 95% CI 1.15-1.30), colorectal cancer (HR = 1.15, 95% CI 1.10-1.21), and rectal cancer (HR = 1.22, 95% CI 1.07-1.39). Processed meat consumption showed similar associations with increased risk for colon cancer (HR = 1.13, 95% CI 1.07-1.20), colorectal cancer (HR = 1.21, 95% CI 1.14-1.28), and rectal cancer (HR = 1.17, 95% CI 1.05-1.30). Total meat consumption also correlated with an elevated risk of colon cancer (HR = 1.22, 95% CI 1.11-1.35), colorectal cancer (HR = 1.17, 95% CI 1.12-1.22), and rectal cancer (HR = 1.28, 95% CI 1.10-1.48). This meta-analysis provides robust evidence that high consumption of red and processed meats is significantly associated with an increased risk of colorectal, colon, and rectal cancers. These findings reinforce current dietary recommendations advocating for the limitation of red and processed meat intake as part of cancer prevention strategies.

Important Nutritional Concepts and Recommendations at the Level of Medical School Education

PURPOSE OF REVIEW

The purpose of the review is to share experiential recommendations to improve nutrition education for medical students. The review examines the history and the current state of nutrition education in order to identify opportunities to strengthen medical provider nutrition knowledge. Methods currently in use by medical school educators are highlighted to promote wellness and prevent development of chronic disease. Lastly, strategies and resources are described to integrate fundamental nutrition concepts into medical school education.

RECENT FINDINGS

Several surveys reveal that most U.S. medical students and residents feel underprepared to address patient nutrition and lifestyle concerns. Innovative programs such as culinary medicine, hands-on cooking electives, and modules on motivational interviewing show promise in improving students' competence and confidence. There is a lack of guidance from nutrition experts on how to improve medical school education by incorporating nutrition. A growing number of experts agree that medical school curricula should include more comprehensive nutrition content to prepare future physicians for addressing chronic diseases. Structured learning modules, enrichment electives, real-world community involvement, and interdisciplinary approaches can enhance evidence-based dietary counseling skills in medical trainees.

Mitigating Identity Threat in Health Messaging: A Social Identity Complexity Perspective

Health messages aiming to reduce red meat consumption may threaten multiple social identities because people's dietary choices are intertwined with personal, social, and cultural aspects of their lives. Leveraging social identity theory and the concept of social identity complexity, this experiment tested how identity-threatening messages affect people's intention to reduce red meat consumption and how the effect of identity threat may be moderated by messages highlighting the relationships between multiple identities that define a person. Participants (N = 409) read messages that varied identity threat (i.e. the extent to which people feel devalued because of their membership in a social group) and identity complexity (i.e. the extent to which people perceive multiple identities as independent). The study found that identity-threatening messages decreased intentions to reduce red meat consumption when people perceived their dietary identity as overlapping with other identities, but increased the intentions when the dietary identity was seen as independent from other identities. Further, the effects of identity threat and complexity were limited to people with high (vs. low) levels of red meat consumption. We discuss the role of identity complexity in alleviating identity threat and increasing persuasion.

Metabolic interplays between the tumour and the host shape the tumour macroenvironment

Metabolic reprogramming of cancer cells and the tumour microenvironment are pivotal characteristics of cancers, and studying these processes offer insights and avenues for cancer diagnostics and therapeutics. Recent advancements have underscored the impact of host systemic features, termed macroenvironment, on facilitating cancer progression. During tumorigenesis, these inherent features of the host, such as germline genetics, immune profile and the metabolic status, influence how the body responds to cancer. In parallel, as cancer grows, it induces systemic effects beyond the primary tumour site and affects the macroenvironment, for example, through inflammation, the metabolic end-stage syndrome of cachexia, and metabolic dysregulation. Therefore, understanding the intricate metabolic interplay between the tumour and the host is a growing frontier in advancing cancer diagnosis and therapy. In this Review, we explore the specific contribution of the metabolic fitness of the host to cancer initiation, progression and response to therapy. We then delineate the complex metabolic crosstalk between the tumour, the microenvironment and the host, which promotes disease progression to metastasis and cachexia. The metabolic relationships among the host, cancer pathogenesis and the consequent responsive systemic manifestations during cancer progression provide new perspectives for mechanistic cancer therapy and improved management of patients with cancer.

Burden of colon and rectum cancer attributable to processed meat consumption in China, 1990-2021

Background

Colon and rectum cancer (CRC) poses a significant public health challenge, and diets high in processed meat have been identified as key risk factors. This study aims to assess the burden of CRC attributable to processed meat consumption in China from 1990 to 2021, focusing on mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs).

Methods

Data were obtained from the Global Burden of Disease (GBD) study for CRC attributable to processed meat consumption in China from 1990 to 2021. The analysis included age-standardized rates for deaths, DALYs, YLDs, and YLLs, alongside age-period-cohort (APC) and decomposition analyses to examine temporal trends and contributing factors. Joinpoint regression was used to detect significant changes in trends.

Results

The burden of CRC attributable to processed meat consumption in China increased significantly between 1990 and 2021. In 2021, males exhibited higher mortality and DALY rates than females, particularly in older age groups. The age-standardized death rate rose from 0.23 to 0.32 per 100,000, and DALYs increased from 5.83 to 8.57 per 100,000. Joinpoint analysis revealed steep rises in DALYs and YLLs, especially during 2007-2011. APC analysis showed that older cohorts consistently exhibited higher death rates, while more recent cohorts displayed lower mortality. Decomposition analysis indicated that population growth and epidemiological changes drove the rise in mortality, with aging contributing to a reduction in deaths. These factors had a more pronounced impact on males.

Conclusion

The study highlights the growing burden of CRC linked to processed meat consumption in China over three decades, with significant gender differences and strong cohort effects. The findings call for targeted interventions to reduce processed meat consumption and mitigate CRC risk.

Characterization of diet-linked amino acid pool influence on Fusobacterium spp. growth and metabolism

The genus Fusobacterium contains multiple proteolytic opportunistic pathogens that have been increasingly linked to colorectal cancer (CRC). "Oncomicrobes" such as these fusobacterial species within the gut microbiota may contribute to CRC onset and/or progression. Protein-rich diets may both directly increase CRC risk and enrich for proteolytic oncomicrobes, including Fusobacterium spp. Individual food substrates vary in amino acid content, and released amino acid content that is not absorbed in the small intestine may influence the growth of colonic proteolytic fermenters. Fusobacteria such as Fusobacterium spp. are known to preferentially metabolize certain amino acids. As such, some foods may better support the growth of these species within the colonic environment than others. To explore this, in this study, we created free amino acid pools (FAAPs) to represent proportions of amino acids in major proteins of three common dietary protein sources (soy, beef, and bovine milk). Growth curves were generated for 39 Fusobacterium spp. strains cultured in a dilute medium supplemented with each of the three FAAPs. Thereafter, amino acid use by 31 of the 39 Fusobacterium spp. strains in each FAAP treatment was assessed. FAAP supplementation increased growth metrics of all Fusobacterium spp. strains tested; however, the strains varied greatly in terms of the FAAP(s) generating the greatest increase in growth. Furthermore, the amino acid utilization strategy was highly variable between strains of Fusobacterium spp. Neither growth metrics nor amino acid utilization could be explained by species classification of Fusobacterium spp. strains. This report expands upon the previous knowledge of fusobacterial amino acid metabolism and indicates that proteolytic oncomicrobial activity should be assessed in the context of available protein sources.IMPORTANCEFusobacterium spp. including F. animalis, F. nucleatum, F. vincentii, and F. polymorphum are common oral commensals with emerging importance in diseases across multiple body sites, including CRC. CRC lesions associated with fusobacteria tend to result in poorer prognosis and increased disease recurrence. While Fusobacterium spp. are thought to colonize after tumorigenesis, little is known about the factors that facilitate this colonization. Protein-rich diets yielding readily metabolized free amino acids within the colon may promote the growth of proteolytic fermenters such as fusobacteria. Here, we show that variable concentrations of free amino acids within pools that represent different dietary protein sources differentially influence fusobacterial growth, including CRC-relevant strains of Fusobacterium spp. This work highlights the high degree of variation in fusobacterial amino acid utilization patterns and suggests differing proportions of dietary amino acids that reach the colon could influence fusobacterial growth.

Dietary Components Associated with the Risk of Gastric Cancer in the Latin American Population: A Systematic Review and Meta-Analysis

Gastric cancer is one of the most frequent cancer types in the Latin American population, and its development is related to multiple factors, including diet. The present systematic review and meta-analysis, based on PRISMA, aims to determine dietary components associated with gastric cancer in Latin America. The dietary components were divided into food and micro- and macronutrients. Meta-analyses were performed for the different groups of foods, and the effects were calculated using Odds Ratios. A total of 483 studies were identified; thirteen articles were included after removing duplicates and applying the inclusion and exclusion criteria. The meta-analysis for the different groups of food showed that daily consumption of vegetables (OR 0.54; 95% CI [0.41, 071]) and fruits (OR 0.57; 95% CI [0.45, 0.73]) were protective factors for gastric cancer; consumption of fresh meat and eggs (OR 1.47; 95% CI [1.12, 1.95]), and salted, canned, and pickled foods (OR 2.30; 95% CI [1.10, 4.80]) were risk factors for gastric cancer. Consuming carotenoids, plant sterols, total polyphenols, proteins, and polyunsaturated fats was a protective factor regarding micro- and macronutrients. Therefore, the consumption of nitrite and nitrate in meat products and capsaicin was considered a risk factor for gastric cancer.

The protein paradox, carnivore diet & hypertrophy versus longevity.: Short term nutrition and hypertrophy versus longevity

Meat consumption has been a common food selection for humans for millennia. Meat is rich in amino acids, delivers vast amounts of nutrients and assists in short term health and hypertrophy. However, meat consumption can induce the activation of mTOR and IGF-1, accelerated aging, vascular constriction, atherosclerosis, heart disease, increased risk of diabetes, systemic inflammatory effects, cancers (including colorectal and prostate cancers), advanced glycation end products, impaired immune function / increased susceptibility to infection via downstream advanced glycation end product accumulation, polycyclic aromatic hydrocarbon ingestion, increased homocysteine levels among many other pathophysiologies. Research papers showing health benefits of meat consumption versus other papers showing the detriment of meat have led to confusion as many cohorts such as bodybuilding, health and wellness groups, carnivore diet practitioners, online social media longevity groups and more are interested in data that exists across the peer reviewed literature, however, few papers offer a super wide view where meat consumption benefits and pitfalls are taken into account.BackgroundThe need for such a systematic review is high as health enthusiasts incorrectly often quote single data points from papers showing a single benefit from consuming meat. This often leads to a higher consumption of meat. However, not all meat consumption is the same, and not all meat delivers the same benefits or detriments. Therefore, a systematic review of current literature has been performed to extrapolate the data into whether those interested in hypertrophy, short term nutrition and energy, and longevity should consume meat. Aim: The aim of this research is to dispel myths about meat consumption, such as that meat has a one size fits all benefit to all those that consume it regardless of genetics, or that consuming meat-based protein is the same across all meats.MethodsA deep analysis of almost one hundred peer reviewed papers and surveys spanning decades of cohorts having a meat-based diet compared to those consuming a plant based diet has been performed. Further analysis on specific side effects and disease has also been performed.ResultsThe results of our systematic review show clearly that meat is great for hypertrophy, short term nutrition, short term energy requirements, but a very poor choice when it comes to healthy aging and longevity.ConclusionAnimal protein is great for building muscle, short term energy, maintaining high levels of nutrients, but a carnivore diet holds too many adverse long term side effects to be considered a staple for a longevity-based diet. The evidence is very strong, that subjects interested in longevity and aging should shift their protein intake away from red and processed meats, and either toward white meats or plant-based sources if longevity is the goal.

DIVERT-Ca: unveiling the hidden link between acute diverticulitis and colorectal cancer risk-multicentre retrospective study

INTRODUCTION

Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all malignancies. Emerging trends of association with risk factors such as diverticulitis highlight the need for updated screening and follow-up protocols. We aimed to examine risk factors associated with the development of CRC within 12 months following an episode of acute diverticulitis, and identify areas to streamline follow-up.

METHODS

We performed a retrospective multicentre study of adult patients admitted in 2022 with computed tomography (CT) confirmed acute diverticulitis across four large NHS Trusts in the UK. Patient demographics, comorbidities, clinical presentation, vital signs, laboratory results, details of in-patient stay, and follow-up investigations were collected and analysed. Our primary outcome was the incidence of CRC within 12 months of index presentation with acute diverticulitis. Analysed secondary outcomes were potential patient risk factors associated with a diagnosis of CRC and follow-up protocols. All statistical analysis was performed using R (version 4.4) and P-values of < 0.05 were considered statistically significant.

RESULTS

A total of 542 patients with acute diverticulitis over the study period were included. The median age of our cohort was 62 (51-73) years, and 204 (37.6%) were male. Ten (1.8%) patients were diagnosed with CRC within the 12-month period. Hinchey grade Ib was significantly associated with CRC (OR 4.51, P = 0.028). Colonoscopic follow-up requests were associated with age between 40 and 60 years, mild white cell count (WCC) elevation, and a hospital stay of 3-7 days. Male gender, age between 18 and 40 years, and elevated C-reactive protein (CRP) were all strongly associated with CRC but not statistically significant. Follow-up was inconsistent with 53.7% of the cohort having luminal investigations.

CONCLUSION

The incidence of CRC was in-keeping with published literature. Hinchey grade 1b was significantly associated with a subsequent CRC diagnosis. These findings emphasise the need for specialised radiological review of CT scans to detect underlying malignancy. Moreover, standardised follow-up protocols following an episode of acute diverticulitis are needed to avoid missing malignant lesions.

Association of red and processed meat consumption with cancer incidence and mortality: An umbrella review protocol

BACKGROUND

Many meta-analyses have reported the associations between red and processed meat consumption and cancer outcomes, but few have assessed the credibility of the evidence. In addition, the results of dose-effect analyses of the association between red and processed meat consumption and cancer outcomes were inconsistently reported in different articles. Here we propose a protocol for an umbrella review (UR) that be designed to assess these associations and explore the potential dose-response relationships.

METHODS

We will independently search five electronic databases and two registers from inception to July 2024 for systematic reviews with meta-analysis concerning the associations of red and processed meat consumption with cancer incidence and mortality. We will conduct the statistical analysis between August 2024 and December 2024. Also, an up-to-date search for additional primary studies of cancer outcomes that were not included in previously published meta-analyses will be conducted. The main outcomes will include the incidence and mortality of any cancer related to red and processed meat exposure. A series of unique associations will be created based on the cancer outcome, exposure, and clinical or population setting. For each association, we will update the meta-analysis by combining studies included in prior meta-analyses and new studies that were not included in prior meta-analyses, and re-perform the meta-analysis using the random-effects models. According to the credibility of the evidence assessment, all associations with a P value of ≤  0.05 will be categorized as convincing, highly suggestive, suggestive, or weak evidence. All analyses will be performed in R (version 4.2.3).

RESULTS

The results of this UR are planned to be submitted to a peer-reviewed journal.

CONCLUSION

The main aim of protocol publication is to get feed back from the reviewers to develop a standard protocol before its publication and after publication, it should guide this protocol to take up similar research by any researcher(s) by following meticulously this standard protocol.

REGISTRATION

PROSPERO CRD42023414550.

Disentangling the effects of various risk factors and trends in lung cancer mortality

Lung cancer is a leading cause of mortality in oncological classifications, yet the impact of various risk factors on lung cancer mortality (LCM) in non-smokers remains unclear. This study aims to weigh out the diverse impact of multiple risk factors on LCM rates and identify trends in LCM rates worldwide. We initially employed Random Forest Tree (RFT) and Gradient Boosting Regression (GBR) to identify common primary factors influencing LCM. After eliminating four common primary factors, a comparative analysis between partial and Pearson correlations was conducted to filter out significant factors in the correlations between risk factors and LCM rates across 204 countries from 2005 to 2019. The findings show that excluding the impacts of occupational exposure to arsenic, smoking, residential radon, occupational exposure to silica, occupational exposure to asbestos, high systolic blood pressure, secondhand smoke, child wasting, and alcohol use had a considerably greater impact on LCM than particular matter pollution (PM2.5). Furthermore, a Multiple Joinpoint Regression analysis identified increasing trends of LCM rates in the 142 countries (e.g., China and India); decreasing trends in 38 countries (e.g., Denmark and Norway), and stable trends in 24 countries (e.g., Sudan, Mali, and Australia). This research suggests that in addition to considering the effects of occupational exposure to arsenic, smoking, residential radon, and occupational exposure to silica on LCM rates, occupational exposure to asbestos, high systolic blood pressure, secondhand smoke, child wasting, and alcohol use should be considered in lung cancer prevention strategies, especially in countries with increasing trends of LCM rates.

Red Meat Amino Acids for Beginners: A Narrative Review

Meat is a major source of dietary protein and fat across the globe. Red and white meat are the major terms consumers use to refer to types of meat; however, these terms do not fully encompass the range of nutrients provided by meat sources. Red meat refers to meat from mammalian skeletal muscle, while white meat refers to poultry. Red and white meat both provide a wide range of nutritional components in the context of fatty acids, amino acids and micronutrients. Importantly, it has been demonstrated that amino acid profiles differ between red meat and white meat as well as between different sources of red meat. Red meat is a complete source of dietary amino acids, meaning it contains all essential amino acids (EAAs), and in addition, it contains all the non-essential amino acids (NEAAs). Red meat is also the most abundant source of bioavailable heme-iron essential for muscle growth and cardiovascular health. Red meat has been indicated as a major contributor to the rising incidence of metabolic disorders and even colorectal cancer. However, it is important to note that while red meat consumption is linked to these conditions, it is typically the overconsumption of red meat that is associated with obesity and other metabolic symptoms. Similarly, the preparation of red meat is a key factor in its link to colorectal cancer as some methods of preparation produce carcinogens while others do not. Finally, red meat may also be situationally more beneficial to some groups than others, particularly in the cases of sex and aging. For pregnant women, increases in red meat consumption may be beneficial to increase the intake of semi-essential amino acids, while in the elderly, increases in red meat consumption may better preserve muscle mass compared with other dietary protein sources.

Diversity of dietary protein patterns across Europe - Impact on nutritional quality and environmental sustainability

Transitioning from animal-based to plant-rich diets could potentially improve both human and planetary health, but a thorough understanding of the protein component in the diet is essential. This research aimed to identify dietary protein patterns in the European adult population and evaluate differences in nutritional quality and environmental sustainability. Individual-level food consumption data were obtained from 25 European countries (40,101 participants, 18-64 years), available from the EFSA Comprehensive European Food Consumption Database. We applied statistical clustering to classify individuals according to their consumption of 24 protein source food groups. The patterns were evaluated for nutrient requirements, the Nutrient Rich Diet (NRD) 15.3 score, greenhouse gas emissions (GHGE) and land use (LU). Six patterns emerged: Common (42.2%), Fast-food (19.5%), Traditional (14.8%), Health-conscious (12.0%), Milk-rich (9.8%) and Plant-forward (1.6%), with country-specific variations. Most patterns obtained 64-69% of their protein intake from animal products, except for the Plant-forward pattern (52%). The Plant-forward pattern achieved the highest NRD15.3 (+11%), and lowest GHGE (-20%) and LU (-25%) compared to the population average and was most commonly consumed in Austria, Finland, Spain, Portugal and Belgium (4.1-4.5%). The Health-conscious pattern also scored high in nutritional quality (NRD15.3: +9%), whereas the Traditional pattern showed higher environmental impacts (GHGE: +5%, LU: +7%). These findings highlight the diversity of dietary protein patterns across Europe, each with unique nutritional profiles and varying environmental impacts. The Plant-forward pattern provides a promising example for healthier, more sustainable diets, but tailored approaches that consider the cultural and demographic contexts of individual countries are needed to optimize health and environmental outcomes for all patterns.

Red Meat, Poultry, and Fish Consumption and the Risk of Liver Cancer: A Prospective Cohort Study of 0.5 Million Chinese Adults

BACKGROUND

Epidemiological evidence on meat consumption and liver cancer risk is limited and inconclusive; moreover, no prospective study has been conducted to investigate this association in China. Hence, we performed this study to examine the association of red meat, poultry, and fish consumption with the risk of liver cancer in a Chinese population.

METHODS

A total of 510,048 Chinese adults of ages 30 to 79 years were included and were followed up through December 31, 2016. Red meat, poultry, and fish consumption was evaluated using an interviewer-administered laptop-based questionnaire. HRs and 95% confidence intervals (CI) for liver cancer incidence were calculated using Cox regression.

RESULTS

Over a mean follow-up of 9.94 years, 1,906 liver cancer cases were observed. Each 50 g/day increase in red meat (HR 0.72; 95% CI, 0.49-1.05), poultry (HR 0.93; 95% CI, 0.83-1.03), and fish (HR 0.95; 95% CI, 0.85-1.05) consumption was not associated with the risk of liver cancer in the whole study population; however, subgroup analysis revealed an inverse association with poultry consumption in rural residents but not in urban residents (Pinteraction = 0.046). The initial associations did not change materially in a series of sensitivity analyses.

CONCLUSIONS

Red meat and fish consumption is not associated with the risk of liver cancer in this Chinese population. The inverse association with poultry consumption in Chinese rural residents should be interpreted with caution.

IMPACT

This is the first prospective study examining the association between meat consumption and the risk of liver cancer in the Chinese population.

Environmental pollution and cancer

OBJECTIVE

To identify and describe pollutants with carcinogenic potential that contaminate indoor and outdoor air, food and soil.

DATA SOURCE

The descriptors environmental pollutants, occupational cancer, prevention and soil pollutants were used to conduct the research for literature review. Articles published from 2003 to 2024 in the electronic databases Pubmed Medline, Lilacs and Scielo, in Portuguese and English, were included.

SUMMARY OF FINDINGS

There are multiple sources of pollution in the external and internal environments, including motor vehicles, industrial facilities, smoke from tobacco products, agricultural activities, fires and domestic combustion devices. The most important pollutants related to chemical substances include all forms of asbestos, benzene, exhaust gases from gasoline engines, food and water contaminants, such as arsenic and inorganic arsenic compounds, in addition to persistent organic pollutants, such as dioxins. The use of fossil fuels and biomass for domestic heating are also important sources of pollution. The carcinogenic potential of pollutants varies according to the sources of pollution, climate conditions and the region's topography.

CONCLUSIONS

Global environmental pollution is an international public health problem with multiple health effects. Many environmental pollutants are proven to be carcinogenic to adults, while few causes have been scientifically established for children. Pollution is mainly caused by uncontrolled urbanization and industrialization. Preventing environmental exposure to carcinogenic pollutants requires both government regulation and community action and commitment.

Sociodemographic and behavioural determinants of vegetarian main dish selection in a French university cafeteria: A three-month observational study with repeated measures

Reducing meat consumption is crucial for improving population and planetary health. Millions of students regularly eat at university cafeterias, which offer a unique opportunity to promote meat-free meals to new generations by addressing barriers such as accessibility, price, and cooking skills. This study aimed to analyse the individual characteristics associated with the proportion of vegetarian main dish choices in a university cafeteria and to determine whether this behaviour influenced the nutritional quality and environmental impact of student meals. A sample of 257 French students who ate regularly at a large university cafeteria took part in an observational study with repeated measures. They took pictures of their meal trays each time they ate at the cafeteria for three months. They completed an online questionnaire to assess their sociodemographic characteristics and various behavioural determinants of the choice of a vegetarian main dish based on the Capability, Opportunity, Motivation Behaviour (COM-B) framework. Being a woman was the only sociodemographic characteristic significantly associated with more frequent vegetarian main dish selection. The proportion of vegetarian choices was negatively associated with attachment to meat (p < 0.001, η2 = 0.189) and positively associated with environmental knowledge (p = 0.034, η2 = 0.018) and the following food choice motives: animal welfare (p < 0.001, η2 = 0.062), health (p < 0.001, η2 = 0.044), ethics (p = 0.002, η2 = 0.039), natural content (p = 0.010, η2 = 0.026), religion (p = 0.014, η2 = 0.025), and mood (p = 0.022, η2 = 0.020). Students who chose vegetarian main dishes more frequently composed healthier (p = 0.023, η2 = 0.020) and more environmentally friendly meal trays (p < 0.001, η2 = 0.349). These findings highlight the variability in the students' propensity to choose vegetarian main dishes in a university cafeteria and its association with motivational factors in a food environment bound by design.

Plant-based dietary patterns, genetic risk, proteome, and lung cancer risk: a large prospective cohort study

PURPOSE

We aimed to examine the associations between plant-based dietary patterns, genetic risk, proteins, and lung cancer risk.

METHODS

189,541 participants of the UK Biobank were included. The Cox proportional hazards models and restricted cubic splines were performed to assess the associations between overall plant-based diet index(PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) and lung cancer risk. Polygenic risk score (PRS) was constructed to assess its joint effect with PDIs on lung cancer risk. Mediation analysis was conducted to examine which proteins mediated the associations of PDIs with incident lung cancer.

RESULTS

Higher PDI was significantly correlated with reduced lung cancer risk(HR:0.90, 95% CI: 0.85-0.96, per SD). An elevated uPDI showed a significant correlation with an increased lung cancer risk(HR:1.08, 95% CI: 1.01-1.15, per SD). Individuals with a combination of high PRS and low PDI (HR: 2.09 [95% CI: 1.48-2.95]) or high uPDI (HR: 1.86 [95% CI: 1.36-2.53]) exhibited a notably higher lung cancer risk compared to those with low PRS and a high PDI or low uPDI. 42 proteins mediated the effect of PDI on lung cancer risk, and the association between uPDI with lung cancer was mediated by 117 proteins. The number of proteins displaying pathway enrichment within the cytokine-cytokine receptor interaction was the highest of the proteins mediated the effect of associations of PDI and uPDI with lung cancer risk.

CONCLUSION

A higher PDI correlated with reduced lung cancer risk, while a higher uPDI correlated with an elevated lung cancer risk. Low PDI jointing with high genetic risk increased lung cancer risk. Proteins enriched in cytokine-cytokine receptor interaction may mediate the association between plant-based dietary patterns with lung cancer risk.

Population attributable fraction of dietary risk factors for cancer mortality with a focus on gastrointestinal cancers in a population based cohort study

Diet and nutrition are critical factors influencing cancer, the second leading cause of death worldwide. This study evaluated dietary risk factors and cancer mortality. 49,773 participants aged 40-75 years from the Golestan Cohort Study (GCS) were followed for a median of 15 years. Dietary intake was assessed using a validated food frequency questionnaire. Cox proportional hazard models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), while population attributable fractions (PAFs) quantified the impact of reducing dietary risk factors. Low fruit intake accounted for 4.7% (95% CI: 0.5-8.7%) of all cancer deaths and 4.91% (95% CI: 0-9.85%) of male cancer deaths. It contributed to 23.5% (95% CI: 4.7-38.59%) of pancreatic cancer mortality in both sexes and 29.36% (95% CI: 5.15-47.38%) of male pancreatic cancer deaths. Low omega-3 intake increased esophageal and gastric cancer mortality risks, with PAFs of 21.65% (95% CI: 1.14-37.9%) and 21.46% (95% CI: 2.81-36.53%), respectively. In females, low omega-3 intake accounted for 38.68% (95% CI: 4.05-60.81%) of gastric cancer deaths. Low fruit and omega-3 consumption elevated cancer mortality risk. Community- and individual-level interventions are essential to enhance nutrient intake and reduce cancer mortality.

Association between Healthy Eating Index-2020, alternative Mediterranean Diet scores, and gastrointestinal cancer risk in NHANES 2005-2018

Diet quality is closely related to the occurrence of gastrointestinal (GI) cancers; however, few studies have investigated the association between the Healthy Eating Index (HEI-2020) and the alternative Mediterranean diet (aMED) scores and GI (GI) cancers. This study aims to assess the association between HEI-2020, aMED scores and GI cancers. Information from a total of 26,320 participants was included in the National Health and Nutrition Examination Survey (NHANES). In our sub-analysis, we focused on participants with complete dietary and health data, specifically assessing the relationship between diet quality and GI cancers outcomes. The 24-hour recall questionnaire was used to collect and assess the participants' average dietary intake. Diagnoses of GI cancers were based on self-reported medical history confirmed through physician interviews or linked cancer registry data, ensuring diagnostic reliability. Logistic regression models, restricted cubic splines (RCS), subgroup analysis, and interaction methods were employed to fully evaluate the associations between HEI-2020, aMED scores, and GI cancers. Mediation analysis was also conducted to identify potential mediators of this relationship. Even after fully adjusting for potential confounders, participants with high adherence to the HEI-2020-2020 and aMED scores were significantly associated with a reduced risk of GI cancers. Compared to the lowest tertile of HEI-2020, participants in the highest tertile had a 30% reduced risk of GI cancers (OR 0.70, 95% CI 0.50 to 0.98, p = 0.037). Compared to the lowest tertile of aMED scores, participants in the highest tertile had a 37% reduced risk of GI cancers (OR 0.63, 95% CI 0.44 to 0.92, p = 0.014). RCS analysis indicated that both HEI-2020 and aMED scores were significantly associated with GI cancers; however, no significant non-linear relationship was observed. The primary findings confirm that higher adherence to HEI-2020 and aMED scores is associated with a lower risk of GI cancers. These results suggest that maintaining a high-quality diet may play a crucial role in the prevention and management of these cancers. Further research is needed to elucidate the mechanisms and effects of healthy diet management and high-quality diets in the prevention of GI cancers.

What is in a label: Effects of labeling on the preference for plant-based products

Our study investigated the effects of three labels on the preference for plant-based products: plant-based, vegan, and Lenten, referring to products appropriate to consume during religious fasting. We conducted two preregistered experiments to measure the effects of labeling on product preference (Study 1, N = 290) and actual tasting preferences (Study 2, N = 251) in a predominantly meat-eating European society (Serbia). We did not find statistically significant effects of labels on the preference for plant-based products in Study 1. In Study 2, the labels affected the preference for plant-based cheese, with Lenten and plant-based labels being slightly preferred over the vegan label. Labeling did not affect the tasting preference for plant-based milk or prosciutto. Across the two studies, the plant-based products were consistently favorably rated, regardless of the label. Plant-based milk emerged as the most preferred product in both studies. We also found that previous experience with plant-based products, as well as speciesism - endorsement of animal exploitation - consistently predicted preferences for plant-based products, irrespective of the label. These findings underscore the influence of labeling on some plant-based products while also revealing the overall minor impact of labeling on consumer preferences. We further discuss the absence of adverse effects of vegan labeling.

Causal associations between dietary factors with head and neck cancer: A two-sample Mendelian randomization study

Objective

Although an association exists between dietary habits and head and neck cancer (HNC), the direct cause-and-effect connection remains elusive. Our objective was to investigate the causal associations between dietary factors and the likelihood of developing HNC.

Methods

Genome-wide association study (GWAS) summary statistics for dietary habits were screened from the UK Biobank, the OncoArray Oral Cavity and Oropharyngeal Cancer consortium, and the FinnGen biobank for HNC. A two-sample Mendelian randomization (MR) analysis was utilized to establish causality. The primary method of analysis was inverse variance weighting (IVW).

Results

Clear evidence of an inverse association existed between dried fruit intake and HNC in both cohorts (OncoArray consortium: IVW OR = 0.183; 95% CI, 0.037-0.915; p = .03864; FinnGen: IVW OR = 0.281; 95% CI, 0.115-0.688; p = .00547). In addition, fresh fruit (IVW-mre OR = 0.066; 95% CI, 0.011-0.413; p = .00369), beef (IVW OR = 15.094; 95% CI, 1.950-116.853; p = .00934), and lamb/mutton intakes (IVW OR = 5.799; 95% CI, 1.044-32.200; p = .0448) were significantly associated with HNC in the OncoArray consortium cohort.

Conclusions

Dried fruit intake may be a protective factor against HNC. The association of fresh fruit and red meat intakes with HNC warrants careful interpretation. Additional studies are necessary to explore potential mechanisms for further evidence.Level of evidence: III.

Extraction and analytical approaches for the determination of post-food processing major carcinogens: A comprehensive review towards healthier processed food

Different food processing methods, e.g. fermentation, grilling, frying, etc., to improve food sensory attributes or shelf-stability are typically employed in different cuisines worldwide. These methods may illicit in-situ health-hazardous chemicals via thermal or enzymatic-mediated processes or chemical interactions with food preservatives. This review provides a comparative overview of the occurrence, extraction, and determination of the major food carcinogens such as nitrosamines (NAs), biogenic amines (BAs), heterocyclic aromatic amines (HAAs), polycyclic aromatic hydrocarbons (PAHs), ethyl carbamate (EC), and malondialdehyde (MDA). Their carcinogenicity levels vary from group 1 (carcinogenic to humans) e.g. benzo[a]pyrene, group 2A (probably carcinogenic to humans) e.g. N-nitrosodiethylamine, group 2B (possibly carcinogenic to humans) e.g. chrysene or group 3 (non-classifiable as carcinogenic to humans) e.g. MDA. Chromatography-based methods are the most predominant techniques used for their analysis. LC-MS is widely used for both volatile/non-volatile NAs, HAAs, BAs, and EC, whereas GC-MS is applied more for volatile NAs, PAHs and MDA.

Considering the nutritional benefits and health implications of red meat in the era of meatless initiatives

Driven by perceived health and environmental benefits, initiatives to remove red meat from recommended eating patterns are increasingly being implemented in United States institutions, including schools and hospitals. While these efforts aim to address important issues, they may inadvertently lead to unintended consequences, particularly regarding essential nutrient intake for certain populations. This perspective considers the nutritional value of red meat, examines its potential health benefits, and highlights nutritional risks when intake is reduced or eliminated. Red meat is a nutrient-dense food that provides highly bioavailable protein and several essential micronutrients often lacking in the diet, including iron, zinc, and vitamin B12. These nutrients can be limited or absent in many plant-source foods as well as in some animal-source foods. Red meat's micronutrient profile is especially valuable for young children and women of reproductive age, including pregnant women. In addition, the protein density of red meat is beneficial for individuals managing obesity and older adults at risk of sarcopenia. Many epidemiological studies suggest potential associations between excessive red meat consumption and increased risk of certain chronic diseases, but this evidence does not conclusively implicate red meat in the development or progression of chronic disease. The nutritional and health implications of reducing red meat consumption must be balanced against the low certainty of evidence used to discourage red meat intake when making dietary recommendations.

Dietary Intakes Among University Students in Iceland: Insights from the FINESCOP Project

Objectives: Using data from the Food Insecurity among European University Students during the COVID-19 Pandemic (FINESCOP) project, this study aims to investigate the dietary intakes among university students in Iceland, focusing specifically on their current diet after March 2020. Additionally, it examines correlations among different food groups to reveal associations in dietary patterns. Methods: The investigation uses data from the observational FINESCOP project in Iceland. Spearman's correlation coefficients were used to identify associations between different dietary intakes. p values show significance at a level of <0.05. Results: Icelandic university students have a low intake of vegetables and salad ("3-4 times per week", n = 159, 24.8%), fruit ("1-2 times per week", n = 164, 25.6%), and whole wheat ("3-4 times per week", n = 147, 23.2%). Lower than these was legume intake ("Never/seldom", n = 203, 32.0%). Meat and eggs were consumed more frequently ("3-4 times per week", n = 231, 36.3%) compared to fish and seafood ("1-2 times per week", n = 277, 43.5%). While the findings do indicate a significant correlation between vegetables and salad and fruit intake (p < 0.001) and between vegetable and salad and legume intake (p < 0.001), causal relationships cannot be established. Among discretionary foods, sweets and snacks were moderately and significantly correlated (p < 0.001). Conclusions: This study explores dietary intakes and correlations between dietary factors among university students in Iceland. Further research is needed to explore the potential for causal inferences and better understand these dietary behaviors of university students in Iceland.

Global, regional, and national burden of early-onset colorectal cancer and projection to 2050: An analysis based on the Global Burden of Disease Study 2021

OBJECTIVES

Early-onset colorectal cancer (EO-CRC) is becoming increasingly concerning due to its impact on individuals under 50 years old. We explored the burden of EO-CRC to provide information for planning effective management and prevention strategies.

STUDY DESIGN

We conducted secondary analyses to assess the burden of EO-CRC using data from GBD 2021.

METHODS

The incidence, prevalence, deaths, disability-adjusted life years (DALYs) and their rates across 204 countries and territories were obtained from GBD 2021 database. The estimated annual percentage change (EAPC) calculation was used to assess temporal trends in these metrics. Additionally, we reported the proportion of DALYs attributable to risk factors and projected future disease burden till 2050.

RESULTS

The global number of new EO-CRC cases increased from 107,310 in 1990 to 211,890 in 2021. Both age-standardized incidence rate (ASIR) and prevalence rate (ASPR) of EO-CRC showed overall increases over the study period (ASIR: EAPC = 0.96 (0.9-1.02), ASPR: EAPC = 1.5 (1.44-1.55)). However, a decline in ASIR and ASPR was observed in 2020 and 2021. Males consistently showed higher EO-CRC indicators compared to females. Furthermore, projections indicated that deaths and DALYs cases are likely to fluctuate but generally increase by 2050, reaching 85,602 and 4,283,093, respectively.

CONCLUSIONS

The global impact of EO-CRC has increased significantly from 1990 to 2021, revealing notable variations across SDI regions, countries, age groups, and sexes. Besides, deaths and DALYs are predicted to rise by 2050. These results highlight the importance of implementing measures to address the growing burden of EO-CRC globally.

Positive associations between dietary potential acid load and renal cancer incidence and mortality: Results from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial

OBJECTIVES

To explore the relationships between dietary potential acid load and renal cancer (RC) incidence and mortality.

STUDY DESIGN

A prospective cohort study involving 97,166 U S. adults aged 55-74 years.

METHODS

Data utilized in this study were drawn from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Dietary potential acid load was assessed by dietary acid load (DAL), potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores using a validated Diet History Questionnaire (DHQ). Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for RC incidence and mortality with adjustment for potential confounders. Restricted cubic spline (RCS) plots were utilized to reveal whether there were nonlinear associations between the DAL, PRAL, and NEAP scores and RC incidence and mortality.

RESULTS

During a follow-up period of 859,907 and 1,467,573 person-years, 423 RC cases and 221 mortality cases were documented. DAL, PRAL, and NEAP scores were positively associated with RC incidence (DAL: HR 1.41; 95% CI 1.05, 1.90; P-trend = 0.010; PRAL: HR 1.45; 95% CI 1.10, 1.91; P-trend = 0.010; NEAP: HR 1.39; 95% CI 1.04, 1.85; P-trend = 0.029). Similar associations were observed between DAL, PRAL, and NEAP scores and RC mortality. The RCS plots demonstrated a nonlinear association between DAL score and RC risk, while a linear association was observed between DAL score and RC mortality. Similar linear associations were found between PRAL and NEAP scores and RC incidence and mortality.

CONCLUSION

A higher dietary potential acid load was associated with higher risk of RC incidence and mortality in American adults.

Influence of Microbial Transglutaminase on the Formation of Physico-Chemical Properties of Meat Analogs

With growing environmental and health concerns surrounding meat consumption, meat analogs have emerged as sustainable and health-conscious alternatives. A major challenge in developing these products is replicating the fibrous, elastic texture of meat, where microbial transglutaminase (MTG) has shown significant potential. MTG catalyzes protein cross-linking, enhancing the structural integrity of meat analogs. This study aimed to evaluate the effects of MTG concentrations (0%, 0.5%, and 1%) and incubation times (0, 1.5, and 3 h) on the quality and rheological properties of meat analogs. Analogs were tested for pH, protein content, dry matter, fat retention, and thermal loss. Textural properties, including hardness, cohesiveness, gumminess, springiness, and chewiness, were determined using texture profile analysis, while leakage parameters were evaluated through water and fat content tests. Results revealed that higher MTG concentrations and longer incubation times improved protein content (14.34% to 15.55%), dry matter (29.61% to 32.53%), and reduced total leakage (1.262% to 0.634%). Textural properties, including hardness (57.08 N to 83.14 N), gumminess (19.40 N to 30.00 N), and chewiness (17.60 N × mm to 29.58 N × mm), also significantly improved with increasing MTG levels. Thermal loss ranged from 98.37% to 100.9%, showing enhanced retention at higher MTG concentrations. These results support the role of MTG in creating meat analogs with improved meat-like textures, achieved through enhanced protein cross-linking and moisture retention.

Diet and Cancer Metabolism

Diet and exercise are modifiable lifestyle factors known to have a major influence on metabolism. Clinical practice addresses diseases of altered metabolism such as diabetes or hypertension by altering these factors. Despite enormous public interest, there are limited defined diet and exercise regimens for cancer patients. Nevertheless, the molecular basis of cancer has converged over the past 15 years on an essential role for altered metabolism in cancer. However, our understanding of the molecular mechanisms that underlie the impact of diet and exercise on cancer metabolism is in its very early stages. In this work, we propose conceptual frameworks for understanding the consequences of diet and exercise on cancer cell metabolism and tumor biology and also highlight recent developments. By advancing our mechanistic understanding, we also discuss actionable ways that such interventions could eventually reach the mainstay of both medical oncology and cancer control and prevention.

Effect of carnosine on nitrosamine formation in gastric-simulated aqueous and lipid environments

BACKGROUND

Nitrite salts are frequently utilized as meat additives to improve the quality and safety of processed meat products. However, these salts are associated with the formation of carcinogenic nitrosamines. Given its potential regulating effect on the formation of intermediate molecules, such as nitric oxide, it is hypothesized that carnosine, a meat constituent possessing antioxidant activity and other multiple health benefits, could dampen the formation of nitrosamines. The current study therefore assessed the effect of carnosine on nitrosamine formation in both a monophasic aqueous system and a biphasic water-lipid system simulating a gastric environment.

RESULTS

In the monophasic system, relatively high levels of carnosine were required to significantly reduce the formation of different species of nitrosamine compared with the control (no carnosine). While higher levels of some nitrosamines were generated in both phases of the biphasic system, low carnosine concentrations significantly suppressed nitrosamine formation in the aqueous phase, while in the lipid phase, intermediate levels of carnosine were required. At higher carnosine levels, further reduction in nitrosamines was observed in the lipid phase.

CONCLUSIONS

This study demonstrates the capacity of carnosine to reduce nitrosamine formation in aqueous and lipid environments and suggests the potential of dietary carnosine to lower the risks associated with the consumption of processed meat products. © 2024 His Majesty the King in Right of Canada and The Author(s). Journal of the Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. Reproduced with the permission of the Minister of Agriculture and Agri-Food Canada.

Common questions and misconceptions about protein supplementation: what does the scientific evidence really show?

Protein supplementation often refers to increasing the intake of this particular macronutrient through dietary supplements in the form of powders, ready-to-drink shakes, and bars. The primary purpose of protein supplementation is to augment dietary protein intake, aiding individuals in meeting their protein requirements, especially when it may be challenging to do so through regular food (i.e. chicken, beef, fish, pork, etc.) sources alone. A large body of evidence shows that protein has an important role in exercising and sedentary individuals. A PubMed search of "protein and exercise performance" reveals thousands of publications. Despite the considerable volume of evidence, it is somewhat surprising that several persistent questions and misconceptions about protein exist. The following are addressed: 1) Is protein harmful to your kidneys? 2) Does consuming "excess" protein increase fat mass? 3) Can dietary protein have a harmful effect on bone health? 4) Can vegans and vegetarians consume enough protein to support training adaptations? 5) Is cheese or peanut butter a good protein source? 6) Does consuming meat (i.e., animal protein) cause unfavorable health outcomes? 7) Do you need protein if you are not physically active? 8) Do you need to consume protein ≤ 1 hour following resistance training sessions to create an anabolic environment in skeletal muscle? 9) Do endurance athletes need additional protein? 10) Does one need protein supplements to meet the daily requirements of exercise-trained individuals? 11) Is there a limit to how much protein one can consume in a single meal? To address these questions, we have conducted a thorough scientific assessment of the literature concerning protein supplementation.

Transforming plant proteins into plant-based meat alternatives: challenges and future scope

The global transition towards sustainable living has led to a growing demand for innovative food products that enhance environmental sustainability. Traditional meat production is known for its high energy consumption and significant carbon emissions, necessitating alternative approaches. Plant-based meat (PBM) offers a promising solution to reduce the ecological footprint of animal agriculture. This paper examines various challenges in PBM development, including nutritional equivalence, industrial scalability, organoleptic properties, and digestibility. Addressing these challenges requires interdisciplinary collaboration to ensure consumer acceptance, regulatory compliance, and environmental stewardship. Advanced technologies like nanotechnology, fermentation, and enzymatic hydrolysis, along with automation and repurposing cattle farms, offer solutions to enhance PBM's quality and production efficiency. By integrating these innovations, PBM has the potential to revolutionize the food industry, offering sustainable and nutritious alternatives that meet global dietary needs while significantly reducing environmental impact.

Graphical abstract

Spatiotemporal trends in the burden of colorectal cancer incidence and risk factors at country level from 1990 to 2019

BACKGROUND AND AIM

Worldwide, the incidence of colorectal cancer (CRC) continues to rise and remains a major public health concern. This study aimed to analyze the temporal and spatial trends in CRC incidence and related risk factors at the country level.

METHODS

Data on CRC and related risk factors were obtained from the Global Burden of Disease Study (GBD) 2019 study. Temporal trends were evaluated using estimated annual percentage change while spatial trends were analyzed using spatial autocorrelation and autoregression. Additionally, linear mixed-effects models were employed to identify risk factors linked to CRC incidence.

RESULTS

Globally, from 1990 to 2019, the incidence cases of CRC increased by 157.23%. At the national level, the incidence of CRC increased in most countries, with the highest increases of age-standardized incidence rate (ASIR) in Equatorial Guinea, Vietnam, and China. In both 1990 and 2019, global spatial clustering of CRC ASIR highlighted hotspots in Europe, characterized by elevated CRC ASIR levels. A comparative analysis of risk factors between hotspot countries and others indicated that gender and alcohol use exerted greater influence in hotspots than elsewhere.

CONCLUSION

Although from 1990 to 2019, the highest growth in ASIR of CRC has been observed in African, Asian, and Latin American countries, the hotspots are still concentrated in Europe. In the identified hotspots, gender and alcohol use exert a more significant impact on CRC incidence compared with other countries. Thus, we should pay attention to countries where the CRC incidence is increasing and these risk factors.

Effects of sodium tripolyphosphate on the quality and digestion properties of PSE pork

This study aimed to examine the impact of sodium tripolyphosphate (STPP) on the quality and digestive characteristics of PSE pork. The results showed a notable decrease in cooking loss of PSE pork from 29.11% to 25.67% with increasing STPP concentration (P < 0.05). Additionally, the gastric digestibility of PSE pork decreased significantly from 52.01% to 45.81% (P < 0.05). The particle size of digesta decreased significantly after gastrointestinal digestion (P < 0.05). These changes were primarily due to the enhanced cross-linking of proteins through ionic interactions, hydrogen bonds and hydrophobic interactions, and resulted in the embedding of hydrophobic groups and endogenous fluorophores. Furthermore, denser network was formed. These findings give a new insight into considering the impact of STPP on meat nutrition when used to enhance texture and water holding capacity.

Adults' beliefs related to reducing red meat consumption: An exploratory study in the province of Quebec, Canada

A significant consumption of red meat is associated with various issues (e.g. public health, sustainability, animal welfare). This exploratory study aims to identify the perceived advantages and disadvantages, perceived approval and disapproval by important others, and perceived barriers and facilitators pertaining to reducing red meat consumption among adults. An online questionnaire based on the Theory of Planned Behaviour was used to elicit the salient beliefs of 55 red meat eaters living in the province of Quebec (Canada). A content analysis performed by two independent coders revealed that the predominant themes (modal beliefs) included health, environment, saving money, food preferences, social influence, perceptions of the alternatives of meat, and efforts related to change. This study can inform the development of interventions aimed at promoting the reduction of red meat consumption.

Bread Consumption and Cancer Risk: Systematic Review and Meta-Analysis of Prospective Cohort Studies

Because bread can contain potential carcinogens such as acrylamide, and is widely consumed, we conducted a systematic review and meta-analysis to determine whether bread consumption is associated with increased cancer risk. PubMed and Medline databases were searched up to 1 March 2024, for studies that provided hazard ratios (HRs) (or similar) for bread consumption and cancer incidence or mortality. Only prospective cohort studies were included. We used the Preferred Reporting Items of Systematic reviews and Meta-Analyses checklist. Meta-analysis was performed with Cochrane's RevMan 5.4.1 software using a DerSimonian-Laird random-effects model. Heterogeneity was assessed with Cochrane's Q (χ2) and I 2 statistics, and publication bias was assessed with Egger's test. Twenty-four publications met inclusion criteria, including 1,887,074 adults, and were included in the systematic review. Ten publications that provided HRs were included in the meta-analysis for highest compared with lowest intakes, and an additional 7 publications that provided mortality or incident rate ratios or relative risks were included in supplemental meta-analyses. Of 108 reported HRs (or similar), 97 (79%) were either not statistically significant (n = 86) or indicated lower cancer risk (n = 11) associated with the highest intakes of bread. The meta-analysis indicated that bread intake was not associated with site-specific cancer risk [HR: 1.01; 95% confidence interval (CI): 0.89, 1.14; P = 0.92; 8 publications] or total cancer mortality (HR: 0.90; 95% CI: 0.73, 1.11; P = 0.32; 2 publications). Supplemental meta-analyses using all risk estimates in addition to HRs confirmed these findings. Whole-grain bread was associated with a lower site-specific cancer risk, mainly because of reduced colorectal cancer risk. Results of the systematic review and meta-analysis indicate that bread consumption is not associated with increased site-specific cancer risk, whereas high whole-grain/nonwhite bread consumption is associated with lower total cancer mortality and colorectal cancer risk. This study was registered at Clinical Trials Registry of PROSPERO as registration number CRD42023414156.

The role of ultra-processed foods in plant-based diets: associations with human health and environmental sustainability

PURPOSE

Investigate the associations of ultra-processed foods (UPF) in healthful (hPDI) and unhealthful (uPDI) plant-based diets with all-cause mortality, greenhouse gas emissions (GHGE), and blue water consumption (BWC).

METHODS

Analyses were based on 35,030 participants (20-70 years; 74% females) from the EPIC-NL cohort who were followed up from 1993 to 1997 through 2014. Plant-based diet indices (hPDI and uPDI) and UPF consumption were calculated from a validated FFQ, assessed at baseline. Cox proportional hazard and multiple linear regression models were used to estimate associations between combined quartiles of the PDI indices and UPF consumption.

RESULTS

With lower hPDI and higher UPF diets as the reference, we observed the following. Risk estimates of all-cause mortality were 0.98 (95% CI: 0.83, 1.16) for lower UPF consumption, 0.86 (95% CI: 0.68, 1.08) for higher hPDI, and 0.78 (95% CI: 0.66, 0.89) for combined higher hPDI and lower UPF consumption. Results with the uPDI were inconclusive. Mean differences in GHGE and BWC were 1.4% (95% CI: 0.3, 2.4) and 1.6% (95% CI: -0.5, 3.7) for lower UPF consumption, -7.4% (95% CI: -8.6, -6.4) and 9.6% (95% CI: 7.2, 12.0) for higher hPDI, and - 6.8% (95% CI: -7.4, -6.1) and 13.1% (95% CI: 11.6, 14.8) for combined higher hPDI and lower UPF consumption. No apparent conflict between environmental impacts was observed for the uPDI; GHGE and BWC were lower for higher uPDI scores.

CONCLUSION

Mortality risk and environmental impacts were mostly associated with the amount of plant-based foods and to a lesser extent UPF in the diet. Shifting to a more healthful plant-based diet could improve human health and reduce most aspects of environmental impact (GHGE, but not BWC) irrespective of UPF consumption.

Making Sense of the Relationship Between Ultra-Processed Foods, Obesity, and Other Chronic Diseases

Ultra-processed foods (UPFs) is a food category within the NOVA system. The key feature of UPFs are foods that have been highly processed and contain various additives, especially those that are industrially produced. It is claimed that UPFs are inherently unhealthy. The classification system is highly controversial. This paper critically evaluates the evidence. In stark contrast to conventional systems for food classification, the NOVA system disregards the nutritional values of foods. As a result, many foods generally considered to be healthy are included as UPFs, whereas many unhealthy foods are excluded. Epidemiological studies, mainly prospective cohort studies, have consistently reported an association between the intake of UPFs and risk of obesity, cardiovascular disease (CVD), type 2 diabetes, common mental disorders (especially depression), and all-cause mortality. A similar association has been reported for cancer and hypertension, but the supporting evidence is weaker. The most plausible explanation for this is that the associations are largely due to a limited number of unhealthy foods, such as processed meat and sugar-sweetened beverages. Studies of the relationship between UPFs and obesity present a different picture. There is much evidence that suggests that UPFs play a major causal role in obesity. The high contents of fat, sugar, carbohydrates, and sodium commonly present in UPFs makes these foods hyperpalatable. In addition, UPFs typically have a high energy density. As a result of these two features of UPFs, most people consume an excessive energy intake when presented with UPFs. Because UPFs include a wide range of foods, many of which are healthy, it is likely that while many UPFs are obesogenic, many others are not.

Dietary and Nutritional Interventions for the Management of Endometriosis

Endometriosis is a chronic, complex, systemic inflammatory condition that impacts approximately 190 million girls and women worldwide, significantly impacting their quality of life. The effective management of endometriosis requires a multi-disciplinary and holistic approach, one that includes surgical and medical management, such as a laparoscopy and a chronic medical management plan, as well as dietary, nutritional, and lifestyle adjunct interventions, such as pelvic pain physiotherapy and acupuncture. There is growing evidence to support the role of dietary and nutritional interventions in the adjunct management of endometriosis-related pain and gastrointestinal symptoms. However, the implementation of these interventions is often not regulated, as patients with endometriosis often adopt self-management strategies. Diet and nutrition can modulate key players integral to the pathophysiology of endometriosis, such as, but not limited to, inflammation, estrogen, and the microbiome. However, it is unclear as to whether diet plays a role in the prevention or the onset of endometriosis. In this review, we discuss three key players in the pathogenesis of endometriosis-inflammation, estrogen, and the microbiome-and we summarize how diet and nutrition can influence their mechanisms, and consequently, the progression and manifestation of endometriosis. There is a major need for evidence-based, non-invasive adjunct management of this debilitating disease, and diet and nutritional interventions may be suitable.

A global analysis of portion size recommendations in food-based dietary guidelines

Objective

Since large food portion sizes (PS) lead to overconsumption, our objective was to review PS recommendations for commonly consumed food groups reported in Food-Based Dietary Guidelines (FBDGs) globally and to assess variation in PS across countries and regions.

Methods

Consumer-oriented FBDGs from the Food and Agriculture Organization (FAO) online repository were used to evaluate dietary recommendations, PS and number of portions for common food groups. Guidelines were classified for each group as qualitative, quantitative, or missing. A standardized approach was applied to convert PS recommendations given as household measures, cup equivalents, pieces and other measures into grams for cross comparison. Variation of recommended PS of common food groups within and across regions was examined.

Results

Among 96 FBDGs, variations were found both across and within regions. At a regional level, the highest median PS recommendations were seen in Europe for Meat, Fish and Pulses, in the Near East for Dairy products, and in Africa for most grain-based foods. Recommendations for Fruits and Vegetables showed the highest consistency across FBDGs worldwide, whereas guidance on Meat, fish & eggs and Cooked cereals/grains showed discrepancies in the classification of foods into categories, as well as in the number of portions per day.

Discussion

While some variation in PS recommendations across countries can be expected due to cultural and regional dietary practices, inconsistent definitions to refer to a portion and varied derivation methods may further produce discrepancies. Harmonizing development methods for FBDG could help establish more consistent reference portion sizes and therefore provide clearer guidance to consumers.