The association between macronutrient intake and the metabolic syndrome and its components in type 1 diabetes

Identification of nutrition factors in the metabolic syndrome and its progression over time in older adults: analysis of the TUDA cohort

BACKGROUND

Nutrition is recognized as playing an important role in the metabolic syndrome (MetS), but the dietary components involved are unclear. We aimed to investigate nutrition factors in relation to MetS and its progression in older adults over a follow-up period of 5.4 years.

METHODS

Community-dwelling adults (≥ 60y) from the Trinity-Ulster-Department-of-Agriculture study, sampled at baseline (2008-12) and follow-up (2014-18; n 953), were classified as 'with MetS' by having three or more of: waist circumference (≥ 102 cm, males; ≥ 88 cm, females); HDL-cholesterol (< 1.0 mmol/L, males; < 1.3 mmol/L, females); triglycerides (≥ 1.7 mmol/L); blood pressure (systolic ≥ 130 and/or diastolic ≥ 85 mmHg); and hemoglobin A1c (≥ 39 mmol/mol).

RESULTS

MetS was identified in 67% of participants, increasing to 74% at follow-up. Predictors at baseline for the development of metabolic syndrome (MetS) at follow-up were higher waist circumference (odds ratio [95%CI]; 1.06 [1.01-1.11]), but not BMI, and increased triglyceride concentrations (2.01 [1.29-3.16]). In dietary analysis (at follow-up), higher protein (g/kg bodyweight/day) and monounsaturated fatty acid (g/day) intakes were each associated with lower risk of MetS (0.06 [0.02-0.20] and 0.88 [0.78-1.00], respectively), whilst higher protein was also associated with lower abdominal obesity (0.10 [0.02-0.51]) and hypertension (0.22 [0.00-0.80]). Furthermore, participants with, compared to without, MetS consumed less high-quality protein foods (P = 0.006) and more low-quality protein foods (P < 0.001), as defined by the protein digestibility-corrected amino acid score.

CONCLUSIONS

Dietary interventions targeting protein quantity and quality may have specific benefits in preventing or delaying the progression of MetS in at-risk older people, but this requires investigation in the form of randomized trials.

Metabolic syndrome in patients with type 1 diabetes mellitus at a tertiary centre in North India: A five year follow up study

BACKGROUND AND AIMS

Metabolic syndrome (MS) is prevalent in the Indian population and has been traditionally linked to Type 2 diabetes mellitus (T2DM). Its presence is now being increasingly recognized in patients with Type 1 diabetes mellitus (T1DM). Presence of MS may increase the risk of diabetes related complications. This study was designed to determine the prevalence of MS in a cohort of patients with T1DM at baseline and at 5 years of follow up.

METHODS

Longitudinal cohort study in a tertiary care center in North India. Patients with T1DM attending the Diabetes of the Young (DOY) Clinic from January 2015 to March 2016 included. Microvascular and macrovascular complications assessed. The cohort was followed after a period of 5 years.

RESULTS

We included 161 patients (males, 49.4%) with a median (IQR) age of 23 (18-34) years and median (IQR) diabetes duration of 12 (7, 17) years. At baseline, 31 (19.2%) patients had MS. Patients with MS were more likely to have microvascular complications: retinopathy (p = 0.003), neuropathy (p = 0.02) and nephropathy (p = 0.04). Independent predictors of MS: insulin sensitivity (IS) (adjusted OR (aOR) 0.02 [95% CI, 0.003-0.118]), body weight (aOR 1.05 [95% CI, 1.007-1.108]), diastolic blood pressure (aOR 1.08 [95% CI, 1.01-1.15]) and duration of diabetes (aOR 1.09 [95% CI, 1.02-1.16]). On follow-up (n = 100), 13 (13%) had MS.

CONCLUSIONS

One in 5 patients with T1DM suffers from MS, and is therefore predisposed to its attendant risks, calling for early identification and targeted interventions.

Dietary fat intake is associated with insulin resistance and an adverse vascular profile in patients with T1D: a pooled analysis

BACKGROUND

Insulin resistance (IR) increases vascular risk in individuals with Type 1 Diabetes (T1D). We aimed to investigate the relationship between dietary intake and IR, as well as vascular biomarkers in T1D.

METHODS

Baseline data from three randomised controlled trials were pooled. Estimated glucose disposal rate (eGDR) was used as an IR marker. Employing multivariate nutrient density substitution models, we examined the association between macronutrient composition and IR/vascular biomarkers (tumour necrosis factor-α, fibrinogen, tissue factor activity, and plasminogen activator inhibitor-1).

RESULTS

Of the 107 patients, 50.5% were male with mean age of 29 ± 6 years. Those with lower eGDR were older with a longer diabetes duration, higher insulin requirements, and an adverse vascular profile (p < 0.05). Patients with higher degrees of IR had higher total energy intake (3192 ± 566 vs. 2772 ± 268 vs. 2626 ± 395 kcal/d for eGDR < 5.1 vs. 5.1-8.6 vs. ≥ 8.7 mg/kg/min, p < 0.001) and consumed a higher absolute and proportional amount of fat (47.6 ± 18.6 vs. 30.4 ± 8.1 vs. 25.8 ± 10.4%, p < 0.001). After adjusting for total energy intake, age, sex, and diabetes duration, increased carbohydrate intake offset by an isoenergetic decrease in fat was associated with higher eGDR (β = 0.103, 95% CI 0.044-0.163). In contrast, increased dietary fat at the expense of dietary protein intake was associated with lower eGDR (β = - 0.119, 95% CI - 0.199 to - 0.040). Replacing fat with 5% isoenergetic amount of carbohydrate resulted in decreased vascular biomarkers (p < 0.05).

CONCLUSION

Higher fat, but not carbohydrate, intake is associated with increased IR and an adverse vascular profile in patients with T1D.

Dietary total, plant and animal protein intake in relation to metabolic health status in overweight and obese adolescents

Few studies have investigated dietary total protein intake and its subtypes in relation to metabolic health status. We explored the relation between dietary total, plant and animal protein intake with metabolic health status in Iranian overweight/obese adolescents. Overweight/obese adolescents (n = 203) were selected for this cross-sectional study by multistage cluster random-sampling method. A validated food frequency questionnaire was used to evaluate dietary intakes. Total, plant and animal protein intake were considered as percentage of energy intake. Anthropometric indices, blood pressure, lipid and glycemic profiles were collected. Participants were classified as metabolically healthy obese (MHO) or unhealthy obese (MUO) based on International Diabetes Federation (IDF) and IDF/Homeostasis Model Assessment Insulin Resistance (HOMA-IR) definitions. Subjects had a mean age of 13.98 years, and 50.2% of them were girls. Based on IDF criteria, adolescents in the top tertile of total (OR = 0.32; 95% CI 0.13–0.77), plant (OR = 0.30; 95% CI 0.10–0.91), and animal (OR = 0.20; 95% CI 0.08–0.54) protein intake had lower odds of being MUO compared to the reference category. Considering IDF/HOMA-IR criteria, subjects in the highest tertile of total (OR = 0.31; 95% CI 0.12–0.79) and animal (OR = 0.17; 95% CI 0.06–0.49) protein intake were less likely to be MUO. However, no substantial association was observed with plant protein intake. Also, an inverse association was observed between each SD increase in total and animal protein with MUO odds. We found inverse association between total, plant and animal protein intake and chance of being MUO in adolescents. Further prospective studies are needed to confirm the findings.

Effects of modified-Paleo and moderate-carbohydrate diets on body composition, serum levels of hepatokines and adipocytokines, and flow cytometric analysis of endothelial microparticles in adults with metabolic syndrome: a study protocol for a randomized clinical trial

Background

Metabolic syndrome is a combination of metabolic risk factors causing a pathological condition that increases the risk of non-communicable diseases, such as diabetes and cardiovascular diseases. A variety of dietary approaches have been examined to halt this rapid trend; however, the effects of modified-Paleo diet and medium-carbohydrate diet on inflammation, adipokines, hepatokines, and the profile of endothelial microparticles in individuals with metabolic syndrome have not been investigated in detail. The present study is designed to examine the effect of modified-Paleo and moderate-carbohydrate diet with two delivery modes: “fixed diet plan” vs “calorie counting” on weight, body composition, serum levels of some hepatokines and adipocytokines, and flow cytometric analysis of endothelial microparticles in adults with metabolic syndrome.

Methods

Eighty metabolic syndrome patients will be recruited in this study. They will be randomly allocated to one of the following 4 groups: (1) receiving a modified-Paleo diet with calorie counting, (2) receiving a modified-Paleo diet with a fixed diet plan, (3) receiving a medium-carbohydrate diet with calorie counting, and (4) receiving a medium-carbohydrate diet with a fixed diet plan for 10 weeks. Weight, height, waist circumference, and body composition will be assessed at the study baseline and at the end of the trial. Serum insulin, asprosin, chemerin, FGF-21, CTRP-1, PYY, ghrelin, plasma EMPs (CD31+/CD42b− and CD144+/CD42b−), lipid profile, glycemic indices, hs-CRP, leptin, vitamin C, creatinine and satiety, hunger, fullness, and desire to eat (via visual analog scales) will be measured at the study baseline and at the end of the trial. Insulin resistance and insulin sensitivity will be determined using the HOMA-IR and QUICKI equations.

Discussion

To the best of our knowledge, this is the first randomized controlled trial that will determine the effect of modified-Paleo and moderate-carbohydrate diet on weight, body composition, serum levels of some hepatokines and adipocytokines, and the profile of EMPs in adults with metabolic syndrome. Moreover, the effects of different diet delivery modes, including “fixed diet plan” and “calorie counting” will also be analyzed. The results of this trial can provide clinical witnesses on the effectiveness of carbohydrate-restricted diets in ameliorating metabolic status and prevent the development of chronic diseases.

Trial registration

Iranian Registry of Clinical Trials IRCT2016121925267N4. Registered on 26 July 2017

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05612-y.

Unveiling the Correlation between Inadequate Energy/Macronutrient Intake and Clinical Alterations in Volunteers at Risk of Metabolic Syndrome by a Predictive Model

Although lifestyle-based interventions are the most effective to prevent metabolic syndrome (MetS), there is no definitive agreement on which nutritional approach is the best. The aim of the present retrospective analysis was to identify a multivariate model linking energy and macronutrient intake to the clinical features of MetS. Volunteers at risk of MetS (F = 77, M = 80) were recruited in four European centres and finally eligible for analysis. For each subject, the daily energy and nutrient intake was estimated using the EPIC questionnaire and a 24-h dietary recall, and it was compared with the dietary reference values. Then we built a predictive model for a set of clinical outcomes computing shifts from recommended intake thresholds. The use of the ridge regression, which optimises prediction performances while retaining information about the role of all the nutritional variables, allowed us to assess if a clinical outcome was manly dependent on a single nutritional variable, or if its prediction was characterised by more complex interactions between the variables. The model appeared suitable for shedding light on the complexity of nutritional variables, which effects could be not evident with univariate analysis and must be considered in the framework of the reciprocal influence of the other variables.

Global prevalence of metabolic syndrome among patients with type I diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

The presence of metabolic syndrome among diabetes patients is frequent and is associated with an increased incidence of chronic complications and mortality. Despite several studies have been conducted, there is no overall estimation on the prevalence of metabolic syndrome among type 1 diabetic patients. Therefore, this study aimed to estimate the pooled prevalence of metabolic syndrome among patients with type 1 diabetes mellitus.

METHODS

Medline via PubMed, CINAHL, ScienceDirect, Ovid, Google Scholar, ResearchGate and African Journals Online were searched by limiting publication period from January 2005 to October 2020. Data were extracted with a standardized format prepared in Microsoft Excel and exported to Stata 16.0 for analyses. The I² statistic was used to check heterogeneity across the included studies. DerSimonian and Laird random-effects model was applied to estimate pooled prevalence and 95% confidence interval across studies. Funnel plot symmetry, Begg's test and Egger's regression test were used to determine the presence of publication bias. Subgroup and sensitivity analysis as well as meta-regression were conducted to explore the potential sources of heterogeneity. The study protocol is registered on PROSPERO with reference number: CRD42020213435.

RESULTS

In this meta-analysis, a total of 27 studies with 45,811 study participants were included. The pooled prevalence of metabolic syndrome was 23.7% with substantial heterogeneity (I² = 98.2%; P < 0.001). Geographical-based subgroup analysis revealed that the highest prevalence was observed in Australia (27.3%). As per meta-analysis of 17 studies, the pooled prevalence of metabolic syndrome in female type 1 diabetes patients (25.9%) was slightly higher than male T1DM patients (22.5%).

CONCLUSION

Nearly a quarter of the type 1 diabetes mellitus patients were affected by metabolic syndrome. Therefore, more attention should be paid to the prevention and control of the epidemic and for the reduction of the morbidity and mortality associated with metabolic syndrome among type 1 diabetes mellitus patients.

The contribution of proteins, fats, carbohydrates, and alcohol to the total energy value of the diet: a cross-sectional study

While eating, people receive energy, as well as the necessary nutrients. However, different food products contain different amounts of macro- and micronutrients, so their consumption can vary significantly depending on eating habits. The diets of 105 people, first-year students of the Peoples` Friendship University of Russia from six different regions of the Earth: CIS countries; Latin America; Central and South Africa; North Africa, the Middle East, and Central Asia; Central and South Asia; Iran and Azerbaijan - were analyzed. Nutrition was evaluated by the frequency method. The median calorie intake among all examined was 2756 kcal per day. At the same time, the proportion of proteins from the total calorie content was 15.3%, from fats – 37.5%, from carbohydrates – 47.1%, from alcohol – 0.5%. It was not possible to detect significant differences in the consumption of macronutrients or their contribution to the energy value of the diet between the regions. The exception was ethanol consumption: students coming from Central and South Africa consumed significantly more alcoholic drinks compared to students from Russia, Ukraine, and Moldova. Due to the extremely high level of dispersion within each of the studied groups, it was not possible to detect significant differences in the consumption of macronutrients, depending on the region of origin of the student. That is, intra-group differences turned out to be significantly more than inter-group differences. At the same time, the share of macronutrients in ensuring the total calorie content of the diet in this study turned out to be close to the data obtained in large cities of other countries and significantly differed from the results of the assessment of diets of rural residents. Probably, the student’s nutrition is formed largely under the influence of the urban environment and individual taste preferences; ethnic and cultural affiliation plays a much smaller role.

Association of Nutrient Patterns with Metabolic Syndrome and Its Components in Iranian Adults

We aimed to examine the association between nutrient patterns and metabolic syndrome (MetS) in Iranian adults. In a cross-sectional study of 850 self-certified healthy women and men aged 20-59 years old, dietary data were assessed using three 24-hour recall. Anthropometric measures were done and blood samples were collected to measure serum fasting serum glucose and lipid profile. The MetS was defined using the International Diabetes Federation. Major nutrient patterns were identified using principle competent analysis. In the first nutrient pattern, the individuals in the fifth quintile had a higher intake of vitamins B₁, B₂, B₃, B₅, B₆, B₁₂, zinc, iron, saturated fatty acids (SFAs), and protein. In the second nutrient pattern, individuals in the first quintile had lower consumption of zinc, SFAs, vitamin E, α-tocopherol, oleic acid, polyunsaturated fatty acids, β-carotene, linolenic acid, and monounsaturated fatty acids, compared to the fifth quintile. Furthermore, in the third nutrient pattern, the individuals in the fifth quintile had a higher intake of potassium, magnesium, phosphorous, calcium, protein, carbohydrate, vitamin C, and folate compared to other quintiles. We identified the second pattern had an indirect association with systolic and diastolic blood pressure, triglycerides, fasting blood sugar (p < 0.001 for all), and total cholesterol (p = 0.04) when it was controlled for body weight. Our findings showed that nutrient patterns may have an association with MetS components with mediating body weight.

Association of nutrient patterns and metabolic syndrome and its components in adults living in Tehran, Iran

Purpose

Identification of nutrient patterns (NPs) may be helpful to evaluate the overall quality of diet and its relation to metabolic syndrome (MetS). We investigated the association of major nutrient patterns with MetS and its components among apparently healthy adults living in Tehran.

Methods

We included 522 adults (24-83 years old) who referred to health centers in Tehran. Fasting blood samples were collected to measure glycemic indicators and lipid profile. Principal component analysis (PCA) based on the 26 nutrient items were applied. Metabolic syndrome was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (ATP III).

Results

Three major nutrient patterns were identified: "Mono and disaccharides pattern", "Macronutrient pattern" and "Antioxidant pattern". After controlling for potential confounders, serum HDL (p < 0.001) increased across tertiles of "Antioxidant pattern". A significant inverse association was observed between adherence to "Antioxidant pattern" and odds of MetS (OR: 2.36, 95% CI: 1.51, 3.69) in crude model which was disappeared after adjusting for age, sex, education, physical activity, smoking, marital status, energy and BMI. Moreover, we found that adherence to "Antioxidant pattern" was inversely related to odds of reduced levels of serum high density lipoprotein (HDL) (OR: 0.09, 95% CI: 0.02, 0.35). No association was found between "Mono and disaccharides pattern", "Macronutrient pattern", MetS and its components.

Conclusions

In general, adherence to "Antioxidant pattern "resulted in lower level of HDL concentrations. More studies are needed to investigate the possible causal relationship of these results.

Dietary fat intake and metabolic syndrome in adults: A systematic review

BACKGROUND AND AIMS

The metabolic syndrome (MetS) is a cluster of coexisting cardiovascular risk factors. The role of specific dietary fats was reemphasized by dietary recommendations. This systematic review aims to assess evidence for the effect of dietary fat intake on MetS occurrence and reversion in adults.

METHODS AND RESULTS

The MEDLINE database was used to search the existing literature. We included observational studies that analyzed dietary fat intake in adults with MetS and clinical trials that compared the effects of different dietary fat diets on MetS and/or its components. Thirty articles were selected (14 observational and 16 clinical trials), and we included information of dietary fat and fatty acids as well as MetS, body mass index, cholesterol, hypertension, and diabetes in adults. SFA intake was found to be positively associated with MetS components. Most of the observational reviewed studies found beneficial associations between MUFA and PUFA (including n-3 and n-6 subtypes) intake and MetS components. Clinical trials also supported the benefits of MUFA- or PUFA-enriched diets (including low-fat diets) in reducing MetS.

CONCLUSIONS

The effects of dietary SFAs on MetS will be influenced by other specific nutrients. Replacement of SFA by MUFA and PUFA has been associated with a decrease in MetS. Dietary recommendations should emphasize on different qualities of fat intake, not only to reduce total fat intake, to obtain health benefits in adults.

Dietary Fat Intake and Metabolic Syndrome in Older Adults

BACKGROUND

Metabolic Syndrome (MetS) is associated with higher rates of cardiovascular disease (CVD), type 2 diabetes mellitus, and cancer worldwide.

OBJECTIVE

To assess fat intake in older adults with or without MetS.

DESIGN

Cross-sectional nutritional survey in older adults living in the Balearic Islands (n = 477, 48% women, 55-80 years old) with no previous CVD.

METHODS

Assessment of fat (total fat, MUFA, PUFA, SFA, TFA, linoleic acid, α-linolenic acid, marine and non-marine ω-3 FA, animal fat and vegetable fat, cholesterol) and macronutrient intake using a validated food frequency questionnaire, and its comparison with recommendations of the US Institute of Medicine (IOM) and the Spanish Society of Community Nutrition (SENC).

RESULTS

Participants with MetS showed higher BMI, lower physical activity, higher total fat and MUFA intake, and lower intake of energy, carbohydrates, and fiber than participants without MetS. Men and women with MetS were below the Acceptable Macronutrient Distribution Range (AMDR) proposed by IOM for carbohydrates and above the AMDR for total fat and MUFAs, and women were below the AMDR proposed for α-linolenic acid (ALA) compared with participants without MetS.

CONCLUSIONS

Subjects with MetS were less likely to meet IOM and SENC recommendations for fat and macronutrient intakes as compared to non-MetS subjects.

Association between depressive symptoms and dietary intake in patients with type 1 diabetes

AIMS

Depressive mood negatively affects self-care practices, and thereby increases the risk of long-term complications. Not much is known about the association between depressive symptoms and dietary intake in patients with type 1 diabetes, a population with high risk of cardiovascular disease.

METHODS

Subjects (n = 976, 41% men, age 48 ± 14 years) were participants in the Finnish Diabetic Nephropathy Study. Depressive symptomatology was assessed with the Beck Depression Inventory (BDI). Dietary patterns were derived from food frequency questionnaire-entries by exploratory factor analysis. Energy and macronutrient intakes were calculated from food records. In the same record, participants also reported the results of their daily blood glucose monitoring. Associations between BDI score and self-care variables were analysed using generalized linear regression. For macronutrients, a substitution model was applied.

RESULTS

Two dietary patterns ("Fish and vegetables", and "Traditional") negatively associated with the BDI score. Instead, an increase in the "Sweet" pattern score was positively associated with depressive symptomatology. Of the macronutrients, favouring protein over carbohydrates or fats associated with lower depression scores. Higher blood glucose self-monitoring frequency and higher variability of the measurements were positively associated with the BDI score. However, no association was observed between depressive symptoms and the mean of the blood glucose measurements.

CONCLUSIONS

Depressive symptoms are reflected in the dietary intake and the self-monitoring of blood glucose, in type 1 diabetes. Whether depression, via compromised self-care practices, negatively affect long-term outcomes in this patient group has to be the subject of future studies.

Dietary Fiber Intake and Metabolic Syndrome Risk Factors among Young South African Adults

This study attempts to bridge the research gap regarding the importance of dietary fiber in reducing metabolic syndrome (MetS) risk factors in young rural South Africans. A total of 627 individuals (309 males and 318 females) aged 18–30 years participated in the study. Dietary intake was measured using a validated 24-h recall method. The consumption of different types of dietary fiber (total, soluble, and insoluble) was calculated and presented as grams. Anthropometrics, blood pressure, fasting blood glucose, and lipid profiles were measured according to standard protocols. According to the definition of the International Diabetes Federation (IDF), the prevalence of MetS was 23.1%. Overall, the total median [interquartile range (IQR)] values for total, insoluble, and soluble fiber consumed were 4.6 g [0.0–48.9], 0.0 g [0.0–18.0], and 0.0 g [0.0–15.0], respectively. Females had a higher median [IQR] intake of total (5.1 g [0.0–48.9] vs. 4.3 g [0.0–43.9]), insoluble (0.0 g [0.0–18.0] vs. 0.0 g [0.0–12.0]), and soluble fiber (0.0 g [0.0–14.9] vs. 0.0 g [0.0–7.3]) than males, respectively. The mean values for waist circumference, fasting blood glucose, and total cholesterol were higher in females than males (82.20 cm vs. 75.07 cm; 5.59 mmol/L vs. 5.44 mmol/L; and 4.26 mmol/L vs. 4.03 mmol/L, respectively), with significant differences observed for waist circumference and total cholesterol (p < 0.001 and p = 0.005, respectively). More than 97% of participants had fiber intakes below the recommended levels. After adjusting for all potential confounders (age, gender, and energy), log total fiber was inversely associated with fasting blood glucose (β = −0.019, 95% CI [−0.042 to 0.003], p < 0.05), systolic blood pressure (β = −0.002, 95% CI [−0.050 to 0.002], p < 0.05) and high-density lipoprotein cholesterol (β = −0.085, 95% CI [−0.173 to 0.002], p = 0.051) This study may be of public health relevance, providing a potential link between less dietary fiber intake and fasting blood glucose (FBG) and both systolic and diastolic blood pressure. Therefore, this observational data encourages public health policy measures to increase the consumption of dietary fiber in rural communities in order to lower the burden of MetS and its associated risk factors.

Dietary patterns reflecting healthy food choices are associated with lower serum LPS activity

Gram-negative bacteria-derived lipopolysaccharides (LPS) are associated with various negative health effects. Whether diet is associated with LPS, is an understudied phenomenon. We investigated the association between diet and serum LPS activity in 668 individuals with type 1 diabetes in the FinnDiane Study. Serum LPS activity was determined using the Limulus Amoebocyte Lysate assay. Diet was assessed with a food frequency questionnaire (FFQ) section of a diet questionnaire and a food record. The food record was used to calculate energy, macronutrient, and fibre intake. In a multivariable model, energy, macronutrient, or fibre intake was not associated with the LPS activity. Using factor analysis, we identified seven dietary patterns from the FFQ data (“Sweet”, “Cheese”, “Fish”, “Healthy snack”, “Vegetable”, “Traditional”, and “Modern”). In a multivariable model, higher factor scores of the Fish, Healthy snack, and Modern patterns predicted lower LPS activity. The validity of the diet questionnaire was also investigated. The questionnaire showed reasonable relative validity against a 6-day food record. The two methods classified participants into the dietary patterns better than expected by chance. In conclusion, healthy dietary choices, such as consumption of fish, fresh vegetables, and fruits and berries may be associated with positive health outcomes by reducing systemic endotoxaemia.