Association between unhealthy plant-based diets and the metabolic syndrome in adult men and women: a population-based study in South Korea

A plant-based diet index to study the relation between diet and disease risk among adults: a narrative review

Plant-based diets (PBD) may offer various health benefits and contribute to a sustainable way of life, but, if not planned correctly, may also confer risks, e.g., by focusing on plant foods with low nutrient density, such as foods primarily consisting of refined carbohydrates. A plant-based diet index (PDI) differentiating between a healthful, unhealthful, and overall PBD, offers a promising approach to standardize and compare studies and integrate results. In this review we (1) summarize current evidence on the PDI and disease risk of relevance to public health, (2) discuss the methodology of the PDI and how it can be sensibly applied in further studies and (3) indicate areas with a lack of knowledge, such as vulnerable populations. In summary, our amalgamation shows, that adherence to a healthier plant-based diet is associated with an 8-68% lower risk for metabolic risk factors, diabetes, and cardiovascular disease, while adherence to an unhealthier plant-based diet is associated with a 10-63% higher risk. Although differences in calculation methods and underlying diet patterns between populations should be accounted for, the PDI can be a useful tool to assess adherence to different plant-based diet patterns and their association with health outcomes in cohort studies across cultures.

Association between plant-based diets and the risk of coronary heart disease predicted using the Framingham Risk Score in Korean men: data from the HEXA cohort study

OBJECTIVES

This study investigated the potential correlation between 4 plant-based diet indices and the predicted risk of coronary heart disease (CHD) in Korean men using the Framingham Risk Score.

METHODS

The study included 12,356 men participants (aged ≥40 years) from the Health Examinees Study. Dietary intake was estimated using a validated food frequency questionnaire. Four plant-based diet indices were measured, including the overall plant-based diet index, the healthy plant-based diet index (hPDI), the unhealthy plant-based diet index (uPDI), and the pro-vegetarian diet index. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the predicted 10-year risk of CHD.

RESULTS

The study found that individuals in the highest hPDI quintile had a 19% lower risk score for CHD based on the Framingham Risk Score (model 3: HR, 0.80; 95% CI, 0.69 to 0.93; p for trend=0.010). In stratified analyses, the highest pro-vegetarian diet index was associated with a lower risk score for CHD in physically active individuals (HR, 0.74; 95% CI, 0.59 to 0.93; p for interaction=0.020). Conversely, the highest uPDI was associated with the highest risk score for CHD in those with a body mass index of ≥25 kg/m2 and a waist circumference ≥90 cm.

CONCLUSIONS

This prospective cohort study highlights the positive role of adhering to a high hPDI diet in the prevention of CHD in Korean men. Further prospective studies are needed to determine the association between various plant-based diet indices and the risk of CHD in Asian populations with different dietary habits.

Effect of a plant-based diet on oxidative stress biomarkers in male footballers

Proper nutrition plays a vital role in modulating oxidative status. There is an increasing popularity of plant-based dietary patterns among athletes. Therefore, the present study aimed to determine the plant-based diet index (PDI) score among male footballers and their non-athlete controls, as well as its relationship with oxidative biomarkers by evaluating the urinary excretion of F2alpha-isoprostane (F2a-IP) and 8-hydroxy-2'-deoxyguanosine (8-OHdG). A group of footballers (n = 45) and a healthy non-athlete group (n = 45) were selected. The two groups were matched based on body mass index (BMI) and age. The mean (standard deviation (SD)) age of the subjects was 22.88 (2.41) years, and their BMI was 22.08 (1.35) kg/m2. Anthropometric indices were evaluated, and fasting morning urine samples were analyzed to measure oxidative biomarkers. The PDI, unhealthy plant-based diet index (uPDI), and healthy plant-based diet index (hPDI) were calculated using valid food frequency questionnaire data. Generalized estimating equation models were used for all analyses. Compared to the non-athlete group, the PDI score was significantly greater in the footballer group (β = 9.8; P < 0.001), while the differences between the two groups in uPDI and hPDI scores were not significant. Overall, footballers consumed more plant-based foods. By examining the relationship between dietary indices and oxidative biomarkers, only a negative association was observed between PDI score and F2a-IP level (β = -1.25; P = 0.03). Based on the results, footballers were more adherent to a plant-based diet than non-athletes. In addition, it seems that following plant-based diets (the higher PDI) may exert beneficial effects on lowering F2a-IP levels due to improving the body's antioxidant status.

The association between plant-based diet indices and metabolic syndrome: a systematic review and dose-response meta-analysis

Aim/introduction

The prevalence of metabolic syndrome (MetS) and its components have markedly increased worldwide. Among lifestyle factors introduced to lower the risk of MetS, healthy dietary patterns have gained considerable attention. This study aimed to assess the association between adherence to plant-based diet indices including O-PDI (overall plant-based diet index), H-PDI (healthy plant-based diet index), U-PDI (unhealthy plant-based diet index), and risk of MetS development.

Methods

To find related observational studies which assessed the association between Plant-based Diet indices and risk of MetS development, PubMed/Medline, Scopus, and Web of Science databases were searched from January 2016 to November 2023. A random effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (95% CI). To assess the heterogeneity of included studies, the I2 index was used.

Results

Nine studies including 34,953 participants from the initial 288 studies were recognized to include in this meta-analysis study. According to pooled analysis, there was a significant relationship between the adherence to H-PDI and the lower risk of MetS (ES: 0.81; 95% CI: 0.67, 0.97; I2 = 77.2%, p < 0.001), while greater adherence to U-PDI was associated with 27% increases in the risk of MetS (ES: 1.27; 95% CI: 1.05, 1.54; I2 = 76.8%, p < 0.001). According to our analysis of the association between adherence to PDIs and the risk of MetS components, greater adherence to O-PDI and H-PDI was significantly associated with a higher risk of elevated FBS and obesity, respectively. As well, greater adherence to U-PDI was significantly associated with a higher risk of obesity, hypertriglyceridemia, low HDL-C, and elevated FBS.

Conclusion

Our results highlighted the importance of food choices in the context of a plant-based dietary pattern, indicating that adherence to unhealthy plant-based dietary patterns rich in less healthful carbohydrates may induce the risk of MetS development.

Systematic review registration

PROSPERO CRD42023428981.

Scoping review of the association of plant-based diet quality with health outcomes

Introduction

The association of plant-based dietary patterns with health outcomes has traditionally been assessed without considering nutritional value. The plant-based dietary index (PDI), first published in 2016, overcomes this limitation with both a healthful PDI (hPDI) and an unhealthful PDI (uPDI), based on the quality of plant foods consumed plus the frequency of animal foods. We sought to summarize the breadth of research using the hPDI and uPDI to gain insight into how the quality of plant-based dietary patterns might be associated with health outcomes.

Methods

Scoping review of studies that used the PDI, hPDI, or uPDI to report associations with health outcomes. Multiple databases were searched from 2010 through April 2023 with 2 authors independently assessing eligibility and extracting data. In addition to assessing the association of the indices to health outcomes, we determined the frequency of concordant or discordant findings for hPDI versus PDI and for hPDI versus uPDI.

Results

We included 95 articles (54% longitudinal, 37% cross-sectional, and 9% case-control) with a median sample size of 3,646. Higher hPDI levels were associated with favorable health outcomes in 36% of comparisons (most often for obesity, mortality, diabetes, cardiovascular disease, and psychiatric disorders), compared to 25% for the PDI and only 2% for the uPDI. Conversely, higher levels of the uPDI were associated with unfavorable health outcomes in 33% of comparisons, in contrast to under 1% for the hPDI and 2% for the PDI. When the hPDI association to an outcome was discordant with the uPDI or PDI, the significance and directionality always favored the hPDI over the uPDI, and nearly always favored the hPDI over the PDI.

Discussion

Dietary indices that account for the quality of plant foods can show health benefits that might be missed by a generic plant-based index. A greater focus on the quality of plant foods could improve nutrition guidelines, raise awareness about the benefits of adding unrefined plant foods to the diet, and empower consumers to make incremental additions of such foods to displace unhealthy foods. We anticipate increasing use of indices that address food quality in future research.

The association of plant-based dietary pattern with general and abdominal obesity: a large cross-sectional study

Purpose

Only a few studies have studied the association between plant-based dietary index (PDI) and the prevalence of obesity. The purpose of this study was to investigate the association between PDI and the prevalence of general and abdominal obesity in a large sample of Iranian adults.

Methods

The current cross-sectional study was performed from 2010 to 2012 in Isfahan, Iran. This study comprised 6,724 adults between the ages of 18 and 55. We analyzed data from 6,724 participants who were classified as having general obesity and 5,203 individuals who were classified as having abdominal obesity. Dietary intake was assessed using a validated food frequency questionnaire. We determined the PDI by assigning plant foods positive scores and animal foods negative values using the method of Satija et al. General obesity was defined as having a body mass index (BMI) greater than 30 kg/m2, whereas abdominal obesity was classified as having a waist circumference (WC) greater than 88 cm for women and 102 cm for men. Data was examined using Chi-squared test and the analysis of variance (ANOVA and ANCOVA). Multivariable binary logistic regression analyses were performed to evaluate the association between PDI and risk of general as well as abdominal obesity.

Results

The mean age of the study participants was 36.8 ± 8.08 years, and 57% of them were female. General obesity prevalence was 9.6%, while abdominal obesity was 26.8%. In all the unadjusted and multivariable adjusted models of the total population, there was no significant association between highest vs. lowest adherence to the PDI and general obesity or abdominal obesity. No significant association was found when men and women were analyzed separately as well.

Conclusion

In the present study, no association was observed between PDI and general and abdominal obesity in the Iranian adult population.

Association between plant-based diets and metabolic syndrome in obese adults from Iran: a cross-sectional study

BACKGROUND

Metabolic syndrome (MetS) is a common chronic disease with several complications. Given that, studies on the association of plant-based diet indices (PDIs) with risk of MetS among adults with obesity, are limited, we aimed to examine the association between PDIs (including overall PDI, healthy PDI (hPDI), unhealthy PDI (uPDI)) and MetS in Iranian adults with obesity.

METHODS

In Tabriz, Iran, a total of 347 adults between the ages of 20 and 50 participated in this cross-sectional research study. We created an overall PDI, hPDI, and uPDI from validated semi-quantitative food-frequency questionnaire (FFQ) data. To investigate the association between hPDI, overall PDI, uPDI, and MetS and its components, a binary logistic regression analysis was performed.

RESULTS

The average age was 40.78 ± 9.23 years, and the average body mass index was 32.62 ± 4.80 kg/m². There was no significant association between overall PDI (OR: 0.87; 95% CI: 0.54-1.47), hPDI (OR: 0.82; 95% CI: 0.48-1.40), and uPDI (OR: 0.83; 95% CI: 0.87-2.46) with MetS, even after adjustment for confounders. Moreover, our findings showed that participants with the highest adherence to uPDI had a higher chance of hyperglycemia (OR: 2.50; 95% CI: 1.13-5.52). Also, this association was significant in the first (OR: 2.51; 95% CI: 1.04-6.04) and second (OR: 2.58; 95% CI: 1.05-6.33) models, after controlling for covariates. However, in both adjusted and crude models, we did not find a significant association between hPDI and PDI scores and MetS components such as high triglyceride, high waist circumference, low High-density lipoprotein cholesterol, raised blood pressure, and hyperglycemia. Moreover, those in the top tertile of uPDI had higher fasting blood sugar and insulin levels when compared with those in the first tertile, and subjects in the last tertile of hPDI compared with participants in the first tertile had lower weight, waist-to-hip ratio, and fat-free mass.

CONCLUSION

We found a direct significant association between uPDI and odds of hyperglycemia in the whole population of study. Future large-scale, prospective studies on PDIs and the MetS are necessary to confirm these findings.

Dietary phytochemical index is favorably associated with oxidative stress status and cardiovascular risk factors in adults with obesity

Phytochemicals are bioactive compounds found in plant-based foods. Consumption of phytochemical-rich foods has been associated with cardiovascular and metabolic diseases prevention in various populations. To quantify the phytochemical content of the diet, dietary phytochemical index (DPI) was established which is defined as the proportion of daily energy intake derived from foods rich in phytochemicals. The purpose of this study was to evaluate the association between the DPI and oxidative stress markers and cardiovascular risk factors in obese adults. In this cross-sectional study, a total of 140 adults aged 20-60 years and body mass index (BMI) of ≥ 30 kg/m² were included. A validated food frequency questionnaire (FFQ) was used to collect information on dietary intakes. The DPI was calculated based on the following formula: DPI = [daily energy obtained from foods rich in phytochemicals (kcal)/total daily energy intake (kcal) × 100]. There was an inverse association between DPI and serum concentrations of Malondialdehyde (MDA) (P = 0.004), triglyceride (TG) (P-trend = 0.003), high-sensitive C-reactive protein (hs-CRP) (P = 0.017), and erythrocyte superoxide dismutase (SOD) activity (P = 0.024). Total antioxidant capacity (TAC) was positively associated with DPI score (P = 0.045). No significant relationship was found between the DPI score and fasting blood sugar (FBS), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total oxidant status (TOS), glutathione peroxidase (GPx), catalase (CAT), and anthropometric parameters as well as systolic and diastolic blood pressure. The current study found that there was a significant inverse association between DPI and oxidative stress, inflammation, and hypertriglyceridemia as cardiovascular disease (CVD) risk factors in obese population. However, further research is needed to confirm these findings.

Association of plant-based dietary patterns with metabolic syndrome: baseline results from the Persian Kavar cohort study (PKCS)

Plant-based diets (PBDs) have gained a positive reputation among experts as a solution to combat the epidemic of MetS. A total of 2225 healthy Iranian individuals aged 35-70 years were considered eligible to be included in this cross-sectional investigation. Various dietary, anthropometric, and biochemical assessments were conducted using standard, valid methods/tools. Relevant PBD scores were calculated using three a posteriori indices, including the overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). Our findings showed that women with the highest adherence to hPDI had a lower chance of MetS. Also, participants in the top tertiles of hPDI were more likely to have a lower risk of low serum HDL-c and abnormal glucose homeostasis. Additionally, a significant increasing trend was observed for low serum HDL-c across tertiles of uPDI. Our observations suggest that healthful-rich plant foods may have a protective effect against MetS, especially in women.

The Association between Plant-Based Diet Indices and Metabolic Syndrome in Chinese Adults: Longitudinal Analyses from the China Health and Nutrition Survey

Objectives: To investigate the association between a plant-based diet and metabolic syndrome (MetS) among Chinese adults. Methods: Based on the data from the 2004–2015 China Health and Nutrition Survey and the corresponding edition of China Food Composition, we calculated the healthy plant-based diet indices (hPDI) and unhealthy plant-based diet indices (uPDI). The Cox proportional hazards regression model was used to estimate the hazard ratios (HRs) with 95% confidence intervals (CIs) for MetS. Mediation analysis was further conducted to explore the mediator role of Body Mass Index (BMI) in the association between hPDI and MetS. Results: We included 10,013 participants, and over a median follow-up of 5 years, 961 patients (9.60%) developed MetS. Compared to those in the lowest quintile of hPDI score, we found that those in the highest quintile of hPDI score had a 28% lower ([HR]: 0.72, 95% CI 0.56–0.93, Ptrend = 0.021) risk of developing MetS and had a 20% lower (hazard ratio [HR]: 0.80, 95% CI 0.70–0.92, Ptrend = 0.004) risk of developing abdominal obesity. No significant associations were observed between uPDI and the MetS, but those in the highest quintile of uPDI score had a 36% higher (hazard ratio [HR]: 1.36, 95% CI 1.20–1.64, Ptrend < 0.001) risk of developing abdominal obesity, compared to those in the lowest quintile of uPDI score. In exploratory analysis, we observed that BMI at baseline mediated 27.8% of the association between hPDI and incident MetS, and BMI at baseline mediated 29.7% of the association between hPDI and abdominal obesity. Conclusion: The current findings reveal a possible causal relationship between a healthy plant-based diet and a reduced risk of MetS, especially abdominal obesity. It is observed that BMI may mediate the relationship between hPDI score and MetS. Controlling early dietary patterns and BMI may help reduce the risk of MetS.

Higher Adherence to Plant-Based Diet Lowers Type 2 Diabetes Risk among High and Non-High Cardiovascular Risk Populations: A Cross-Sectional Study in Shanxi, China

This study aimed to investigate the association between the plant-based diet index (PDI) score and T2D risk among residents of Shanxi Province, China, and explore whether the association was influenced by different levels of cardiovascular risk. A total of 50,694 participants aged 35-75 years were recruited between 2017 and 2019, and they were further divided into the high cardiovascular risk population (HCRP; n = 17,255) and the non-high cardiovascular risk population (non-HCRP; n = 33,439). The PDI was calculated based on food frequency from a food frequency questionnaire (FFQ). Incident T2D was defined based on elevated plasma glucose (≥7 mmol/L) or hypoglycemic medicine use. We investigated the association of the PDI andT2D risk using a two-level generalized estimating equation and restricted cubic splines model. The results showed that quartile 4 of the PDI indicated significantly reduced T2D risk in the total population (OR: 0.83; 95% CI: 0.75-0.92), HCRP (OR: 0.80; 95% CI: 0.71-0.91), and non-HCRP (OR: 0.80; 95% CI: 0.74-0.87) compared with corresponding quartile 1 (OR = 1). In stratified analysis, the negative associations between PDI and T2D risk were stronger in the total population with the elderly (age > 60 years), BMI < 24, and men, and in the non-HCRP with men and BMI 24-28, and in the HCRP with the elderly and BMI < 24 than those with corresponding subgroups (p_interaction < 0.05). Linear curves were observed for the total population and non-HCRP, but an L-shaped association was observed for the HCRP. Therefore, our results suggest that higher PDI scores may effectively attenuate the T2D risk in the Chinese population and non-HCRP, and a beneficial association of PDI with T2D risk was observed in the HCRP at a certain threshold level. Longitudinal studies and intervention trials are required to validate our study findings.

Association of plant-based diets with adropin, atherogenic index of plasma, and metabolic syndrome and its components: A cross-sectional study on adults

Background

Little is known about the association of plant-based diet indices with metabolic syndrome (MetS) and its novel predictive biomarkers, including the atherogenic index of plasma (AIP) and adropin. We aimed to investigate the association of plant-based diets with adropin, atherogenic index of plasma, and MetS and its components in adults.

Methods

The present population-based cross-sectional study was conducted on a representative sample of adults aged 20-60 years in Isfahan, Iran. Dietary intake was obtained through a validated 168-item semi-quantitative food frequency questionnaire (FFQ). Peripheral blood was obtained after an overnight fast of at least 12 h from each participant. MetS was identified based on the Joint Interim Statement (JIS). AIP was calculated as a logarithmically transformed ratio of triglyceride (TG)/high-density lipoprotein cholesterol (HDL-c), and serum levels of adropin were measured by an ELISA kit.

Results

A total of 28.7% of subjects had MetS. No significant association was found between the overall plant-based diet index (PDI) and the healthful plant-based diet index (hPDI) with MetS. However, a non-linear association was observed between hPDI and MetS. Subjects in the third quartile of the unhealthful plant-based diet index (uPDI) had higher odds of MetS compared to the first quartile (OR: 2.39; 95% CI: 1.01, 5.66). The highest quartile of PDI (OR: 0.46; 95% CI: 0.21, 0.97) and the third quartile of hPDI (OR: 0.40; 95% CI: 0.18, 0.89) were associated with decreased odds of having high-risk AIP compared to the first quartile, after adjusting for potential confounders. No linear association was found between quartiles of plant-based diet indices and serum levels of adropin.

Conclusion

Plant-based diet index (PDI) and hPDI were not associated with the prevalence of MetS in adults, while moderate adherence to uPDI increased the prevalence of MetS. In addition, high adherence to PDI and moderate adherence to hPDI were associated with decreased odds of high-risk AIP. No significant association was found between plant-based diet indices and serum adropin levels. To confirm these findings, further studies with prospective designs are warranted.

Association between different types of plant-based diet and dyslipidaemia in Korean adults

This study investigated the association between the different types of plant-based diets and dyslipidaemia in Korean adults using data from the nationally representative sample. Using the 2012–2016 Korea National Health and Nutrition Survey data, a total of 14 167 adults (≥19 years old) participated in this study. Dietary intake was assessed by a semi-quantitative FFQ. Three different plant-based diet indices (overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), unhealthful plant-based diet index (uPDI)), were calculated. Dyslipidaemia and its components (hypertriacylglycerolaemia, hypercholesterolaemia, low HDL-cholesterol, high LDL-cholesterol, use of anti-hyperlipidaemia agent) were measured. Multivariable logistic regression analysis was used to examine the associations between plant-based diet and dyslipidaemia and individual lipid disorders. Totally, 47% of overall population had dyslipidaemia. Individual in the highest quintile of uPDI had 22% greater odds of dyslipidaemia (95 % CI 1·05, 1·41) and 48 % higher odds of hypertriacylglycerolaemia (95 % CI 1·21, 1·81) and 16% higher odds of low HDL-cholesterol (OR: 1·16, 95 % CI 1·00, 1·35) than those in the lowest quintile of uPDI. PDI was associated with 16 % higher odds of low HDL-cholesterol, and hPDI was associated with 25% lower odds of high LDL-cholesterol. However, neither PDI nor hPDI was significantly associated with the prevalence of dyslipidaemia. Greater adherence to unhealthful plant-based diets was associated with greater odds of the dyslipidaemia and its components suggesting the importance of the quality of plant-based diet in South Korean adults for dyslipidaemia prevention.

Positive association of unhealthy plant-based diets with the incidence of abdominal obesity in Korea: a comparison of baseline, most recent, and cumulative average diets

OBJECTIVES

Different approaches for analyzing repeated dietary measurements may yield differences in the magnitude and interpretation of findings. We aimed to compare 3 dietary measurements (baseline, most recent, and cumulative average) in terms of the association between plant-based diet indices (PDIs) and incident abdominal obesity in Korean adults aged 40-69 years.

METHODS

This study included 6,054 participants (54% women) free of abdominal obesity (defined as waist circumference ≥90 cm for men and ≥85 cm for women) at baseline. As exposures, baseline, most recent, and cumulative average measurements for PDI, healthy-PDI (hPDI), and unhealthy-PDI (uPDI) were created. A Cox proportional-hazard model was used to estimate the hazard ratios (HRs) for abdominal obesity.

RESULTS

During 45,818 person-years of follow-up (median, 9 years), we identified 1,778 incident cases of abdominal obesity. In the multivariable-adjusted analysis, a higher uPDI was associated with a higher risk of abdominal obesity in both total and stratified analyses. The findings were consistent across all approaches (Q5 vs. Q1: HRbaseline=1.70; 95% confidence interval [CI], 1.46 to 1.98; HRmost recent=1.52; 95% CI, 1.30 to 1.78; HRcumulative average=1.76; 95% CI, 1.51 to 2.06 in the total set). PDI showed no meaningful association with abdominal obesity risk in any analyses. hPDIaverage had a suggestive inverse association with abdominal obesity risk in men, and hPDIbaseline had a positive association with abdominal obesity risk in women.

CONCLUSIONS

Greater adherence to unhealthy plant-based diets may increase the risk of developing abdominal obesity in Korean adults. The findings were generally consistent across all approaches.

Cheese Intake Exhibits an Alteration of Glycolipid Profile and Impacts on Non-Alcoholic Fatty Liver in Bahraini Older Adults

Background: Metabolic syndrome (MetS) is a multifactorial condition characterized by a complex interrelation between genetic and environmental factors that heighten the risk of cardiovascular diseases and all-cause mortality. It is hypothesized that diet may play an important role in the regulation of metabolic syndrome factors and influence the process. Therefore, the main objective of this study was to investigate the specific dietary patterns associated with metabolic syndrome markers and quantify the possible effects of dietary patterns among Bahrain older adults. Methods: This is a cross-sectional study that included 151 Bahraini patients diagnosed with MetS, 89 (58.7%) were females and 62 (41.3%) males. Results: The prevalence of Non-Alcoholic Fatty Liver was 89%. Statistically significant correlations were found between dairy products with low fat and SBP (r = 0.182, p < 0.001) body mass index (BMI) (r = −0.195; p < −0.01). Higher chicken consumption was associated with reduction of BMI (r = −0.273; p < −0.01). A higher consumption of ricotta and cheddar cheese (high in fat) was associated with higher levels of triglycerides (p < 0.01). Higher frequent consumption of rice (basmati) was associated with lower glucose levels (r = −0.200; p < −0.01). Fatty liver has been associated with high consumption of cream cheese (p < 0.01). Conclusion: In older Bahraini adults with metabolic syndrome, higher frequency of food consumption of full-fat cheese was linked with a derangement of lipid profile and Non-Alcoholic Fatty Liver. Positive effects on BMI have been recorded with higher-frequency consumption of basmati rice and chicken.

Circulating Inflammatory Markers May Mediate the Relationship between Healthy Plant-Based Diet and Metabolic Phenotype Obesity in Women: A Cross-Sectional Study

BACKGROUND

It has been posited that both metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUHO) could be emergent from diet and inflammatory markers. Thus, we sought to investigate the influence of plant-based diet on MHO and MUHO phenotypes mediated by inflammatory markers in overweight and obese women.

METHODS

This cross-sectional study was conducted on 289 women aged ≥18 years, with a body mass index (BMI) ≥25 kg/m². Dietary intake was measured using 147 item food frequency questionnaire, as well as anthropometrics and biochemistry panel, in all participants. Metabolic health phenotypes were considered using Karelis score, while plant-based diet indices (PDI) were evaluated based on 18 food groups, where healthy and unhealthy PDI were identified.

RESULTS

Accordingly, 26.9% of women had MHO and 73.1% had MUHO phenotypes. After adjusting for potential confounders, TGF-β1 had a significant inverse association with hPDI (β: -0.28; 95% CI: 452.99, -85.25; P: 0.004). Moreover, we found that women with higher hPDI had lower odds of MUHO (OR: 0.95; 95% CI: 0.39, 2.30; P: 0.03). Regarding the mediatory effect of the inflammatory markers, TGF-β1 (P: 0.73), IL-β1 (P: 0.14), and MCP1 (P: 0.51) played a role in decreasing the odds of MUHO among hPDI tertiles.

CONCLUSION

There was a significant inverse relationship between adherence to hPDI and MUHO phenotype in overweight and obese Iranian women. This association appeared to be mediated by TGF-β1, IL-β1, and MCP1.

Reproducibility of a food frequency questionnaire: Korea Nurses' Health Study

BACKGROUND/OBJECTIVES

This study aimed to examine the reproducibility of food frequency questionnaires (FFQs) designed for young female nurses in the Korea Nurses' Health Study.

SUBJECTS/METHODS

The reproducibility of web-based, self-administered FFQs was evaluated among 243 Korean female nurses. The first FFQ (FFQ1) was administered from March 2014 to February 2019 and the second FFQ (FFQ2) from November 2019, with a mean interval of 2.8 years between the FFQs (range, 9 months–5.6 years). Pearson and Spearman correlation coefficients (r values) and quartile agreements between FFQ1 and FFQ2 were calculated for intakes of energy, nutrients, and foods.

RESULTS

Pearson correlation coefficients ranged from 0.41 to 0.55 (median r = 0.51) for energy and raw nutrients and from 0.16 to 0.46 (median r = 0.36) for energy-adjusted nutrients. Spearman correlation coefficients ranged from 0.25 to 0.72 (median r = 0.41) for food items. The percentages of women who were classified into the same or adjacent quartile were 77% to 84% (median = 82%) for raw nutrients and 69% to 86% (median = 78%) for foods.

CONCLUSIONS

The results indicated that the web-based FFQ used in the Korea Nurses' Health Study has acceptable reproducibility.

The Association of Dietary Phytochemical Index with Metabolic Syndrome in Adults

In this study, we assessed the association between the dietary phytochemical index (DPI) and metabolic syndrome (MetS) among adults in a cross-sectional study. We enrolled 850 adult men and women aged 18–65 years who had been referred to health centers in Tehran, Iran. The DPI was calculated based on 8 components including fruits, vegetables, legumes, whole grains, soy products, nuts, seeds, olive, and olive oil. The odds ratio (OR) and 95% confidence interval (CI) of the MetS across quartiles of the DPI were calculated using the logistic regression analysis, adjusting for age, energy intake, marital status, education status, occupation, smoking status, physical activity, and body mass index. The mean age of participants was 44.7 ± 10.7, of whom 69% were women. The prevalence of MetS was 30.5%. The mean score of DPI in women and men was 36.2 ± 26.8 and 33.7 ± 24.7, respectively. There was no significant association between DPI and odds of MetS in men (OR_{fourth vs. first quartile},1.57; 95% CI, 0.64–3.84) and women (OR_{fourth vs. first quartile}, 0.86; 95% CI, 0.50–1.49) in the fully adjusted model. There was an inverse association between DPI and increased risk of central obesity in women (OR_{fourth vs. first quartile}, 0.54; 95% CI, 0.29–1.00; p trend = 0.03). There was no significant association between DPI and other components of the MetS in men and women. Finally, we observed no significant association between the DPI and the odds of MetS. However, the finding suggests that having a phytochemical-rich diet can be inversely associated with abdominal obesity.

The association between plant-based diet indices and metabolic syndrome in Iranian older adults

BACKGROUND

We investigated the association between plant-based diets indices - an overall plant-based diet index; a healthful plant-based diet index; and an unhealthful plant-based diet index - and metabolic syndrome among Iranian older adults.

AIM

We aimed to examine the relationship between plant-based diet indices and metabolic syndrome.

METHODS

This cross-sectional study included 178 older adults (51 men and 127 women), with a mean age of 67.04 (60-83) who were referred to health centers in Tehran, Iran. Blood and urine samples were collected to measure serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides. We created an overall plant-based diet index, healthful plant-based diet index, and unhealthful plant-based diet index from semi-quantitative food-frequency questionnaire data. Anthropometric measures were done.

RESULTS

Our crude model results showed that triglycerides, systolic and diastolic blood pressure, fasting blood sugar, high-density lipoprotein cholesterol, and waist circumference did not significantly differ between tertiles of plant-based diet index and healthful plant-based diet index; also triglycerides, systolic and diastolic blood pressure, fasting blood sugar, and waist circumference did not significantly differ between tertiles of unhealthful plant-based diet index, but high-density lipoprotein cholesterol significantly differed between tertiles of unhealthful plant-based diet index. After adjusting for confounders the results remained non-significant for plant-based diet index but high-density lipoprotein cholesterol was significant for healthful and unhealthful plant-based diet indices. There was also no significant association between plant-based diet index (OR: 1.11; 95% CI: 0.53-2.33), healthful plant-based diet index (OR: 0.81; 95% CI: 0.39-1.68), and unhealthful plant-based diet index (OR: 0.81; 95% CI: 0.38-1.72) with metabolic syndrome, even after adjustment for confounders.

CONCLUSIONS

Our findings showed that plant-based diets are not significantly associated with risk of metabolic syndrome in older adults. To confirm the veracity of these findings, more studies should be conducted.

COVID-19 Pandemic Is a Call to Search for Alternative Protein Sources as Food and Feed: A Review of Possibilities

The coronavirus disease 2019 (COVID-19) pandemic is a global health challenge with substantial adverse effects on the world economy. It is beyond any doubt that it is, again, a call-to-action to minimize the risk of future zoonoses caused by emerging human pathogens. The primary response to contain zoonotic diseases is to call for more strict regulations on wildlife trade and hunting. This is because the origins of coronaviruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), SARS-CoV, Middle East respiratory syndrome coronavirus (MERS-CoV), as well as other viral pathogens (e.g., Ebola, HIV) are traceable to wild animals. Although COVID-19 is not related to livestock animals, the pandemic increased general attention given to zoonotic viral infections—the risk of which can also be associated with livestock. Therefore, this paper discusses the potential transformation of industrial livestock farming and the production of animal products, particularly meat, to decrease the risks for transmission of novel human pathogens. Plant-based diets have a number of advantages, but it is unrealistic to consider them as the only solution offered to the problem. Therefore, a search for alternative protein sources in insect-based foods and cultured meat, important technologies enabling safer meat production. Although both of these strategies offer a number of potential advantages, they are also subject to the number of challenges that are discussed in this paper. Importantly, insect-based foods and cultured meat can provide additional benefits in the context of ecological footprint, an aspect important in light of predicted climate changes. Furthermore, cultured meat can be regarded as ethically superior and supports better food security. There is a need to further support the implementation and expansion of all three approaches discussed in this paper, plant-based diets, insect-based foods, and cultured meat, to decrease the epidemiological risks and ensure a sustainable future. Furthermore, cultured meat also offers a number of additional benefits in the context of environmental impact, ethical issues, and food security.