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Maghoul A, Khonsari NM, Asadi S, Abdar ZE, Ejtahed HS, Qorbani M. Dietary carbohydrate quality index and cardio-metabolic risk factors. INT J VITAM NUTR RES 2024; 94:377-393. [PMID: 38009678 DOI: 10.1024/0300-9831/a000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Introduction: Improving the quality of diet is known as one of the practical ways to reduce cardio-metabolic risk factors (CMRFs). The carbohydrate quality index (CQI) is a relatively new index to evaluate diet quality. It is calculated based on the ratio of solid carbohydrates to total carbohydrates, dietary fibre intake, glycemic index and the ratio of whole grains to total grains. This systematic review and meta-analysis was designed to investigate the association between dietary CQI and CMRFs. Methods: In this systematic review, some international databases, including Scopus, PubMed, EMBASE, Web of Science, and Google Scholar up to July 2022, were searched according to appropriate keywords. All observational studies with an English full text assessing the association between the dietary CQI and CMRFs were included. Two researchers independently extracted the data and assessed the quality of the articles with the Newcastle-Ottawa Scale. Random/fixed-effect meta-analysis was used to pool standardized mean difference (SMD) as an effect size. Results: 11 studies with a total of 63962 subjects were found to be eligible and included in the qualitative synthesis; only BMI, WC and metabolic syndrome reached the threshold of 3 reports with the same effect size and thus only 5 were included in the meta-analysis. The main finding of the included studies was that there were inverse associations between CQI and CMRFs, mainly obesity, glucose metabolism indices, and blood pressure. In the five studies included in the random effect meta-analysis, the association between CQI and body mass index (SMD: 0.45, 95%CI: -0.12, 1.01), waist circumference (SMD: -0.09, 95%CI: -0.34, 0.15) and metabolic syndrome (SMD: 0.63, 95%CI: -0.01, 1.28) was not statistically significant. Conclusion: Although the qualitative findings support the positive association of CQI with CMRFs, the evidence is insufficient to conclude robust findings. Further observational and interventional studies are needed to clearly elucidate this association.
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Affiliation(s)
- Arman Maghoul
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Sasan Asadi
- Department of Community Medicine, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Kurdistan Province, Iran
| | - Zahra Esmaeili Abdar
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Hanieh-Sadat Ejtahed
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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2
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Pehlivan M, Saleki N, Sezer FE, Özyürek F, Delice B, Hızlı Güldemir H. Water and beverage consumption habits of adults in Turkey by gender and BMI: a cross-sectional survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024; 34:1910-1925. [PMID: 36739539 DOI: 10.1080/09603123.2023.2172385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
The study aims to determine water and beverage consumption status and related factors in daily nutrition of adults living in Turkey. This study was conducted with 6332 adults aged 18-65 years across Turkey. Demographics and anthropometric data of subjects, their daily water and beverage consumption habits were explored using the retrospective 24-hour recall method. Water and black tea were the most consumed beverages (1801.38 ± 11.06 mL/day, 455 ± 6.10 mL/day, respectively). Increased BMI was associated with a significantly decreased rate of insufficient fluid intake among the participants. Underweight individuals were found to be consuming less (by 0.558 times) fluid compared to those with normal BMI, while obese individuals appeared to have greater energy intake from daily fluid consumption (by 1.111 times). This study showed a relationship between water and beverage intake and anthropometric measurements, suggesting that further research on personalized water intake strategies is beneficial in weight management.
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Affiliation(s)
- Merve Pehlivan
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Neda Saleki
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Fatma Elif Sezer
- Department of Nutrition and Dietetics, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Fatmanur Özyürek
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Büşranur Delice
- Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Hilal Hızlı Güldemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Anadolu University, Eskisehir, Turkey
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3
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Grech A, Sui Z, Rangan A, Simpson SJ, Coogan SCP, Raubenheimer D. Macronutrient (im)balance drives energy intake in an obesogenic food environment: An ecological analysis. Obesity (Silver Spring) 2022; 30:2156-2166. [PMID: 36321270 PMCID: PMC9828743 DOI: 10.1002/oby.23578] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The protein leverage hypothesis (PLH) postulates that strong regulation of protein intake drives energy overconsumption and obesity when human diets are diluted by fat and carbohydrates. The two predictions of the PLH are that humans (i) regulate intake to maintain protein within a narrow range and that (ii) energy intake is an inverse function of percentage energy from protein because absolute protein intake is maintained within narrow limits. METHODS Multidimensional nutritional geometry was used to test the predictions of the PLH using dietary data from the Australian National Nutrition and Physical Activity Survey. RESULTS Both predictions of the PLH were confirmed in a population setting: the mean protein intake was 18.4%, and energy intake decreased with increasing energy from protein (L = -0.18, p < 0.0001). It was demonstrated that highly processed discretionary foods are a significant diluent of protein and associated with increased energy but not increased protein intake. CONCLUSIONS These results support an integrated ecological and mechanistic explanation for obesity, in which low-protein highly processed foods lead to higher energy intake because of the biological response to macronutrient imbalance driven by a dominant appetite for protein. This study supports a central role for protein in the obesity epidemic, with significant implications for global health.
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Affiliation(s)
- Amanda Grech
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- School of Life and Environmental ScienceUniversity of SydneySydneyNew South WalesAustralia
| | - Zhixian Sui
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- School of Life and Environmental ScienceUniversity of SydneySydneyNew South WalesAustralia
| | - Anna Rangan
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- School of Life and Environmental ScienceUniversity of SydneySydneyNew South WalesAustralia
| | - Stephen J. Simpson
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- School of Life and Environmental ScienceUniversity of SydneySydneyNew South WalesAustralia
| | - Sean C. P. Coogan
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- School of Life and Environmental ScienceUniversity of SydneySydneyNew South WalesAustralia
| | - David Raubenheimer
- Charles Perkins CentreUniversity of SydneySydneyNew South WalesAustralia
- School of Life and Environmental ScienceUniversity of SydneySydneyNew South WalesAustralia
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The Origins of the Obesity Epidemic in the USA–Lessons for Today. Nutrients 2022; 14:nu14204253. [PMID: 36296935 PMCID: PMC9611578 DOI: 10.3390/nu14204253] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
The obesity epidemic appeared in the USA in 1976–1980 and then spread across Westernized countries. This paper examines the most likely causes of the epidemic in the USA. An explanation must be consistent with the emergence of the epidemic in both genders and in all age groups and ethnicities at about the same time, and with a steady rise in the prevalence of obesity until at least 2016. The cause is closely related to changes in the American diet. There is little association with changes in the intake of fat and carbohydrate. This paper presents the opinion that the factor most closely linked to the epidemic is ultra-processed foods (UPFs) (i.e., foods with a high content of calories, salt, sugar, and fat but with very little whole foods). Of particular importance is sugar intake, especially sugar-sweetened beverages (SSBs). There is strong evidence that consumption of SSBs leads to higher energy intake and more weight gain. A similar pattern is also seen with other UPFs. Factors that probably contributed to the increased intake of UPFs include their relatively low price and the increased popularity of fast-food restaurants. Other related topics discussed include: (1) the possible importance of Farm Bills implemented by the US Department of Agriculture; (2) areas where further research is needed; (3) health hazards linked to UPFs; and (4) the need for public health measures to reduce intake of UPFs.
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Majdi M, Imani H, Bazshahi E, Hosseini F, Djafarian K, Lesani A, Akbarzade Z, Shab-Bidar S. Habitual- and Meal-Specific Carbohydrate Quality Index and Their Relation to Metabolic Syndrome in a Sample of Iranian Adults. Front Nutr 2022; 9:763345. [PMID: 35433797 PMCID: PMC9011184 DOI: 10.3389/fnut.2022.763345] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/07/2022] [Indexed: 12/16/2022] Open
Abstract
Aim Most studies on diet quality have focused on the habitual and overall intake of foods without considering intakes at specific eating occasions. This study aimed to assess the association between habitual- and meal-specific carbohydrate quality index (CQI) and metabolic syndrome (MetS) in Iranian adults. Methods In this cross-sectional study, data from 850 participants were analyzed. Dietary information was obtained from a 3-day nonconsecutive 24 h recall. CQI was calculated from three criteria: dietary fiber, glycemic index, and solid carbohydrate/total carbohydrate ratio. The association between CQI and MetS was assessed by logistic regression. Results The prevalences of MetS in the lowest and highest tertile of CQI were 30.1 and 33.7, respectively (P = 0.6). In habitual diet and all the three meals, we failed to find any significant association between tertiles of CQI and MetS either before or after adjustment for covariates. However, in the habitual meals [odds ratio (OR): 0.69, 95% CI: 0.47–0.96] and lunch meals (OR: 0.66; 95% CI: 0.47–0.94), the highest CQI in comparison to the lowest one, significantly decreased the low high-density lipoprotein (HDL). In addition, the trend of low-HDL with CQI in habitual meal and lunch meal was statistically significant. Conclusion The results of this study showed that CQI was not associated with MetS and its components. Further investigations into the mechanisms underlying the role of carbohydrate quality in developing metabolic disorders are warranted.
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Affiliation(s)
- Maryam Majdi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Imani
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Bazshahi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hosseini
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Lesani
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Akbarzade
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- *Correspondence: Sakineh Shab-Bidar
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Hur S, Oh B, Kim H, Kwon O. Associations of Diet Quality and Sleep Quality with Obesity. Nutrients 2021; 13:nu13093181. [PMID: 34579058 PMCID: PMC8466020 DOI: 10.3390/nu13093181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/12/2022] Open
Abstract
Short sleep duration or poor sleep quality has been associated with an increased risk of obesity. Although the underlying mechanism remains unclear, one proposed pathway is poor diet quality. This cross-sectional study investigated whether diet quality modifies the association between sleep status and obesity in Korean adults. We used the baseline data and samples of 737 men and 428 women (n = 1165) aged 19–64, who participated in the prospective Ewha–Boramae cohort study. Sleep duration was dichotomized into ≥7 h (adequate) and <7 h (insufficient). Pittsburgh Sleep Quality Index (PSQI) values, reflecting sleep quality, were dichotomized into >5 (poor quality) and ≤5 (good quality). Diet quality was evaluated by the Recommended Food Score (RFS). Obesity was associated with higher rates of insufficient sleep and poor sleep quality in women, but not in men. After adjustment for covariates, women with poor sleep quality had a higher risk of obesity than women with good sleep quality (OR = 2.198; 95% CI = 1.027–4.704); this association occurred only in the group with RFS ≤ median score. Our findings support a significant association between sleep quality and obesity, and this association has been potentially modified by dietary quality in women.
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Affiliation(s)
- Soohee Hur
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea;
- System Health & Engineering Major in Graduate School, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
| | - Bumjo Oh
- Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, Korea;
| | - Hyesook Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea;
- System Health & Engineering Major in Graduate School, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
- Correspondence: (H.K.); (O.K.); Tel./Fax: +82-2-3277-6860 (O.K.)
| | - Oran Kwon
- Department of Nutritional Science and Food Management, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea;
- System Health & Engineering Major in Graduate School, Ewha Womans University, 52, Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea
- Correspondence: (H.K.); (O.K.); Tel./Fax: +82-2-3277-6860 (O.K.)
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7
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Unveiling the Correlation between Inadequate Energy/Macronutrient Intake and Clinical Alterations in Volunteers at Risk of Metabolic Syndrome by a Predictive Model. Nutrients 2021; 13:nu13041377. [PMID: 33923923 PMCID: PMC8072695 DOI: 10.3390/nu13041377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/15/2021] [Accepted: 04/17/2021] [Indexed: 01/02/2023] Open
Abstract
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.
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8
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Associations of fat and carbohydrate intake with becoming overweight and obese: an 11-year longitudinal cohort study. Br J Nutr 2020; 124:715-728. [PMID: 32378502 DOI: 10.1017/s0007114520001579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The effects of macronutrient intake on obesity are controversial. This research aims to investigate the associations between macronutrient intake and new-onset overweight/obesity. The relationship between the consumption of carbohydrate and total fat and obesity was assessed by the multivariable Cox model in this 11-year cohort, which included 6612 adults (3291 men and 3321 women) who were free of overweight and obesity at baseline. The dietary intake was recorded using a 24-h recall method for three consecutive days. Moreover, substitution models were developed to distinguish the effects of macronutrient composition alteration from energy intake modification. During 7·5 person years (interquartile range 4·3, 10·8) of follow-up, 1807 participants became overweight or obese. After adjusting for risk factors, the hazard ratio (HR) of overweight/obesity in extreme quintiles of fat was 1·48 (quintile 5 v. quintile 1, 95 % CI 1·16, 1·89; Ptrend = 0·02) in women. Additionally, replacing 5 % of energy from carbohydrate with equivalent energy from fat was associated with an estimated 4·3 % (HR 1·043, 95 % CI 1·007, 1·081) increase in overweight/obesity in women. Moreover, dietary carbohydrate was inversely associated with overweight/obesity (quintile 5 v. quintile 1, HR 0·70, 95 % CI 0·55, 0·89; Ptrend = 0·02) in women. Total fat was related to a higher risk of overweight/obesity, whereas high carbohydrate intake was related to a lower risk of overweight/obesity in women, which was not observed in men.
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9
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Huang J, Liao LM, Weinstein SJ, Sinha R, Graubard BI, Albanes D. Association Between Plant and Animal Protein Intake and Overall and Cause-Specific Mortality. JAMA Intern Med 2020; 180:1173-1184. [PMID: 32658243 PMCID: PMC7358979 DOI: 10.1001/jamainternmed.2020.2790] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Although emphasis has recently been placed on the importance of high-protein diets to overall health, a comprehensive analysis of long-term cause-specific mortality in association with the intake of plant protein and animal protein has not been reported. OBJECTIVE To examine the associations between overall mortality and cause-specific mortality and plant protein intake. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study analyzed data from 416 104 men and women in the US National Institutes of Health-AARP Diet and Health Study from 1995 to 2011. Data were analyzed from October 2018 through April 2020. EXPOSURES Validated baseline food frequency questionnaire dietary information, including intake of plant protein and animal protein. MAIN OUTCOMES AND MEASURES Hazard ratios and 16-year absolute risk differences for overall mortality and cause-specific mortality. RESULTS The final analytic cohort included 237 036 men (57%) and 179 068 women. Their overall median (SD) ages were 62.2 (5.4) years for men and 62.0 (5.4) years for women. Based on 6 009 748 person-years of observation, 77 614 deaths (18.7%; 49 297 men and 28 317 women) were analyzed. Adjusting for several important clinical and other risk factors, greater dietary plant protein intake was associated with reduced overall mortality in both sexes (hazard ratio per 1 SD was 0.95 [95% CI, 0.94-0.97] for men and 0.95 [95% CI, 0.93-0.96] for women; adjusted absolute risk difference per 1 SD was -0.36% [95% CI, -0.48% to -0.25%] for men and -0.33% [95% CI, -0.48% to -0.21%] for women; hazard ratio per 10 g/1000 kcal was 0.88 [95% CI, 0.84-0.91] for men and 0.86 [95% CI, 0.82-0.90] for women; adjusted absolute risk difference per 10 g/1000 kcal was -0.95% [95% CI, -1.3% to -0.68%] for men and -0.86% [95% CI, -1.3% to -0.55%] for women; all P < .001). The association between plant protein intake and overall mortality was similar across the subgroups of smoking status, diabetes, fruit consumption, vitamin supplement use, and self-reported health status. Replacement of 3% energy from animal protein with plant protein was inversely associated with overall mortality (risk decreased 10% in both men and women) and cardiovascular disease mortality (11% lower risk in men and 12% lower risk in women). In particular, the lower overall mortality was attributable primarily to substitution of plant protein for egg protein (24% lower risk in men and 21% lower risk in women) and red meat protein (13% lower risk in men and 15% lower risk in women). CONCLUSIONS AND RELEVANCE In this large prospective cohort, higher plant protein intake was associated with small reductions in risk of overall and cardiovascular disease mortality. Our findings provide evidence that dietary modification in choice of protein sources may influence health and longevity.
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Affiliation(s)
- Jiaqi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Stephanie J Weinstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Rashmi Sinha
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Barry I Graubard
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Demetrius Albanes
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
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10
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Obesity and adiposity: the culprit of dietary protein efficacy. Clin Sci (Lond) 2020; 134:389-401. [DOI: 10.1042/cs20190583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/24/2020] [Accepted: 02/10/2020] [Indexed: 12/14/2022]
Abstract
AbstractObesity and increased body adiposity have been alarmingly increasing over the past decades and have been linked to a rise in food intake. Many dietary restrictive approaches aiming at reducing weight have resulted in contradictory results. Additionally, some policies to reduce sugar or fat intake were not able to decrease the surge of obesity. This suggests that food intake is controlled by a physiological mechanism and that any behavioural change only leads to a short-term success. Several hypotheses have been postulated, and many of them have been rejected due to some limitations and exceptions. The present review aims at presenting a new theory behind the regulation of energy intake, therefore providing an eye-opening field for energy balance and a potential strategy for obesity management.
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Taylor RM, Haslam RL, Burrows TL, Duncanson KR, Ashton LM, Rollo ME, Shrewsbury VA, Schumacher TL, Collins CE. Issues in Measuring and Interpreting Diet and Its Contribution to Obesity. Curr Obes Rep 2019; 8:53-65. [PMID: 30877574 DOI: 10.1007/s13679-019-00336-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This review summarises the issues related to the measurement and interpretation of dietary intake in individuals with overweight and obesity, as well as identifies future research priorities. RECENT FINDINGS Some aspects of the assessment of dietary intake have improved through the application of technology-based methods and the use of dietary biomarkers. In populations with overweight and obesity, misreporting bias related to social desirability is a prominent issue. Future efforts should focus on combining technology-based dietary methods with the use of dietary biomarkers to help reduce and account for the impact of these biases. Future research will be important in terms of strengthening methods used in the assessment and interpretation of dietary intake data in the context of overweight and obesity.
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Affiliation(s)
- Rachael M Taylor
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Rebecca L Haslam
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Kerith R Duncanson
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Lee M Ashton
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Vanessa A Shrewsbury
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
| | - Tracy L Schumacher
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia
- Faculty of Health and Medicine, Department of Rural Health, University of Newcastle, Tamworth, NSW, 2340, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Level 3 ATC Building, Callaghan, NSW, 2308, Australia.
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12
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The trends in total energy, macronutrients and sodium intake among Japanese: findings from the 1995-2016 National Health and Nutrition Survey. Br J Nutr 2018; 120:424-434. [PMID: 29860946 DOI: 10.1017/s0007114518001162] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Monitoring nutritional status of the population is essential in the development and evaluation of national or local health policies. In this study, we aimed to demonstrate analysis on the trends in dietary intake of energy and macronutrients, as well as Na, in Japanese population using the data of series of cross-sectional national surveys - the National Nutrition Survey (NNS) and the National Health Nutrition Survey (NHNS) - during the period from 1995 to 2016. The NNS and NHNS participants aged 20-79 years were included in the analysis. Dietary intake was estimated using 1-d household-based dietary record. The trend in total energy intake, energy intake from macronutrients (fat and protein), Na intake and energy-adjusted Na intake were analysed using regression models adjusted to 2010 age distribution and anthropometry status. A total of 94 270 men and 107 890 women were included the analysis. Total energy intake showed a decreasing trend in both men and women. Similarly, energy intake from protein decreased, but energy intake (%) from fat increased in both sexes. Energy-adjusted Na intake showed a decreasing trend in both men and women. This study identified the decrease in total energy intake and energy intake from protein, whereas there were inverse trends in energy intake from fat among Japanese adults. Continued monitoring of trends in dietary intake will be needed, and there should be efforts to increase the accuracy of current survey procedures.
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Knapik JJ, Redmond JE, Grier TL, Sharp MA. Secular Trends in the Physical Fitness of United States Army Infantry Units and Infantry Soldiers, 1976–2015. Mil Med 2018; 183:e414-e426. [DOI: 10.1093/milmed/usx093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/08/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Joseph J Knapik
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA
- Henry M Jackson Foundation, 6720A Rockledge Dr, Bethesda, MD
| | - Jan E Redmond
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA
| | - Tyson L Grier
- US Army Public Health Center, 5158 Blackhawk Rd, Aberdeen Proving Ground, MD
| | - Marilyn A Sharp
- US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA
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Zhao J, Su C, Wang H, Wang Z, Wang Y, Zhang B. Secular Trends in Energy and Macronutrient Intakes and Distribution among Adult Females (1991-2015): Results from the China Health and Nutrition Survey. Nutrients 2018; 10:E115. [PMID: 29364176 PMCID: PMC5852691 DOI: 10.3390/nu10020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/09/2018] [Accepted: 01/12/2018] [Indexed: 01/18/2023] Open
Abstract
With rapid nutrition transition in China, dietary intake and nutritional status of women has gained more and more attention in the past decades. This study aimed to investigate temporal trends of total energy and macronutrient intakes among Chinese adult females. The longitudinal data are from the Chinese Health and Nutrition Survey (CHNS, 1991-2015). Information on the intake of energy and macronutrient was obtained from consecutive three-day dietary recall techniques and compared with the Chinese Dietary Reference Intakes (DRI). Mixed-effect models were performed to evaluate temporal trends of total energy and macronutrient intake. From 1991 to 2015, a significant reduction in daily energy, protein and carbohydrate intakes was seen among all adult females (p < 0.001). Daily fat intake, the proportion of energy from fat, the proportion of females consuming more than 30% of energy from fat and less than 50% of energy from carbohydrate were observed significant increment in the present study (p < 0.001). In 2015, the proportion met the DRI for energy and protein intakes were 47.0% and 48.0%, respectively; the proportion with lower carbohydrate and higher fat intakes compare with the DRI were 45.5% and 66.9%, respectively. Further nutritional education and policy interventions still needed to improve nutrition status for Chinese females.
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Affiliation(s)
- Jian Zhao
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Chang Su
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Huijun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Zhihong Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Yun Wang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
| | - Bing Zhang
- National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
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Knapik JJ, Sharp MA, Steelman RA. Secular Trends in the Physical Fitness of United States Army Recruits on Entry to Service, 1975-2013. J Strength Cond Res 2017; 31:2030-2052. [PMID: 28403029 DOI: 10.1519/jsc.0000000000001928] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Knapik, JJ, Sharp, MA, and Steelman, RA. Secular trends in the physical fitness of United States Army recruits on entry to service, 1975-2013. J Strength Cond Res 31(7): 2030-2052, 2017-A systematic literature search was conducted to identify and analyze articles that reported on physical fitness of new US Army recruits. The National Library of Medicine's PubMed and the Defense Technical Information Center were searched using the keywords (military personnel OR trainee OR recruit OR soldier) AND (physical fitness OR strength OR endurance OR flexibility OR balance OR coordination OR muscle contraction OR running OR exercise OR physical conditioning). Reference lists of obtained articles and contact with authors enhanced the search. Studies were selected if they involved recruits in Basic Combat Training or One-Station Unit Training, provided a quantitative assessment of at least one fitness measure, and the fitness measure(s) were obtained early in training. Average values for each fitness measure were obtained, plotted by the year of data collection, and fitted to linear regression models (fitness measure × year). Fifty-three articles met the review criteria. Regression analysis indicated little temporal change in height, but body weight, body mass index, body fat, and fat-free mass increased over time. Limited V[Combining Dot Above]O2max data suggested no temporal change in male recruits, but those in female recruits V[Combining Dot Above]O2max seem to have slightly improved. Apparently contradicting the V[Combining Dot Above]O2max findings, performance on endurance runs (1- and 2-mile) declined, possibly because of the increase in body weight. Muscular endurance (push-ups, sit-ups) demonstrated little systematic change over time. Limited but multiple measures of muscular strength suggest a temporal increase in strength. Specific components of US Army recruit fitness seem to have changed over time.
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Affiliation(s)
- Joseph J Knapik
- 1US Army Research Institute of Environmental Medicine, Natick, Massachusetts; 2US Army Public Health Center, Aberdeen Proving Ground, Maryland; 3Oak Ridge Institute for Science and Education, Belcamp, Maryland; and 4Defense Health Agency, Falls Church, Virginia
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Elmadfa I, Meyer AL. The Debate Goes on: New Evidence for the Role of Macronutrient Distribution on Body Weight Development: A Commentary on "Effects of Macronutrient Distribution on Weight and Related Cardiometabolic Profile in Healthy Non-Obese Chinese: A 6-month, Randomized Controlled-Feeding Trial" by Wan et al., EBioMedicine 2017, 22, 200-207. EBioMedicine 2017; 24:32-33. [PMID: 28939486 PMCID: PMC5652134 DOI: 10.1016/j.ebiom.2017.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Ibrahim Elmadfa
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Austria, Althanstrasse 14, 1090 Vienna, Austria.
| | - Alexa L Meyer
- Department of Nutritional Sciences, Faculty of Life Sciences, University of Vienna, Austria, Althanstrasse 14, 1090 Vienna, Austria
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Safe S, Li X. Endocrine disruption: Relevance of experimental studies in female animals to human studies. CURRENT OPINION IN TOXICOLOGY 2017. [DOI: 10.1016/j.cotox.2017.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Song M, Fung TT, Hu FB, Willett WC, Longo V, Chan AT, Giovannucci EL. Association of Animal and Plant Protein Intake With All-Cause and Cause-Specific Mortality. JAMA Intern Med 2016; 176:1453-1463. [PMID: 27479196 PMCID: PMC5048552 DOI: 10.1001/jamainternmed.2016.4182] [Citation(s) in RCA: 389] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
IMPORTANCE Defining what represents a macronutritionally balanced diet remains an open question and a high priority in nutrition research. Although the amount of protein may have specific effects, from a broader dietary perspective, the choice of protein sources will inevitably influence other components of diet and may be a critical determinant for the health outcome. OBJECTIVE To examine the associations of animal and plant protein intake with the risk for mortality. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study of US health care professionals included 131 342 participants from the Nurses' Health Study (1980 to end of follow-up on June 1, 2012) and Health Professionals Follow-up Study (1986 to end of follow-up on January 31, 2012). Animal and plant protein intake was assessed by regularly updated validated food frequency questionnaires. Data were analyzed from June 20, 2014, to January 18, 2016. MAIN OUTCOMES AND MEASURES Hazard ratios (HRs) for all-cause and cause-specific mortality. RESULTS Of the 131 342 participants, 85 013 were women (64.7%) and 46 329 were men (35.3%) (mean [SD] age, 49 [9] years). The median protein intake, as assessed by percentage of energy, was 14% for animal protein (5th-95th percentile, 9%-22%) and 4% for plant protein (5th-95th percentile, 2%-6%). After adjusting for major lifestyle and dietary risk factors, animal protein intake was not associated with all-cause mortality (HR, 1.02 per 10% energy increment; 95% CI, 0.98-1.05; P for trend = .33) but was associated with higher cardiovascular mortality (HR, 1.08 per 10% energy increment; 95% CI, 1.01-1.16; P for trend = .04). Plant protein was associated with lower all-cause mortality (HR, 0.90 per 3% energy increment; 95% CI, 0.86-0.95; P for trend < .001) and cardiovascular mortality (HR, 0.88 per 3% energy increment; 95% CI, 0.80-0.97; P for trend = .007). These associations were confined to participants with at least 1 unhealthy lifestyle factor based on smoking, heavy alcohol intake, overweight or obesity, and physical inactivity, but not evident among those without any of these risk factors. Replacing animal protein of various origins with plant protein was associated with lower mortality. In particular, the HRs for all-cause mortality were 0.66 (95% CI, 0.59-0.75) when 3% of energy from plant protein was substituted for an equivalent amount of protein from processed red meat, 0.88 (95% CI, 0.84-0.92) from unprocessed red meat, and 0.81 (95% CI, 0.75-0.88) from egg. CONCLUSIONS AND RELEVANCE High animal protein intake was positively associated with cardiovascular mortality and high plant protein intake was inversely associated with all-cause and cardiovascular mortality, especially among individuals with at least 1 lifestyle risk factor. Substitution of plant protein for animal protein, especially that from processed red meat, was associated with lower mortality, suggesting the importance of protein source.
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Affiliation(s)
- Mingyang Song
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Teresa T. Fung
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Simmons College, Boston, MA, USA
| | - Frank B. Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Walter C. Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
| | - Valter Longo
- Longevity Institute, School of Gerontology, and Department of Biological Sciences, University of Southern California, Los Angeles, CA, USA
- IFOM, FIRC Institute of Molecular Oncology, Milano, Italy
| | - Andrew T. Chan
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Edward L. Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA, USA
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McCrory MA, Shaw AC, Lee JA. Energy and Nutrient Timing for Weight Control: Does Timing of Ingestion Matter? Endocrinol Metab Clin North Am 2016; 45:689-718. [PMID: 27519140 DOI: 10.1016/j.ecl.2016.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Over the past 40 years, meal skipping and snacking in US adults have increased, and currently most eating occasions occur later in the day than previously. Whether these changes have played a causal role in the obesity epidemic is poorly understood. Observational studies are largely inconclusive due to methodological limitations. Experimental evidence does not support a causal role for eating frequency or breakfast skipping in weight control. Emerging evidence suggests that eating irregularity and eating later in the day may be detrimental for weight control, but more studies are needed. This article summarizes studies and highlights areas needing attention.
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Affiliation(s)
- Megan A McCrory
- Department of Nutrition, Georgia State University, PO Box 3995, Atlanta, GA 30302-3995, USA.
| | - Ayla C Shaw
- Department of Nutrition, Georgia State University, PO Box 3995, Atlanta, GA 30302-3995, USA
| | - Joy A Lee
- Department of Nutrition, Georgia State University, PO Box 3995, Atlanta, GA 30302-3995, USA
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Ter Borg S, Verlaan S, Mijnarends DM, Schols JMGA, de Groot LCPGM, Luiking YC. Macronutrient Intake and Inadequacies of Community-Dwelling Older Adults, a Systematic Review. ANNALS OF NUTRITION & METABOLISM 2015; 66:242-255. [PMID: 26183836 DOI: 10.1159/000435862] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/03/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anorexia of ageing may predispose older adults to under-nutrition and protein energy malnutrition. Studies, however, report a large variation in nutrient inadequacies among community-dwelling older adults. SUMMARY This systematic review provides a comprehensive overview of the energy and macronutrient intakes and possible inadequacies in community-dwelling older adults. PubMed and EMBASE were screened up to December 2013; data from national nutrition surveys were added. Forty-six studies were included, following the PRISMA guideline. KEY MESSAGES Mean daily energy intake was 8.9 MJ in men and 7.3 MJ in women. Mean daily carbohydrate and protein intakes were 46 and 15 En% in men and 47 and 16 En% in women, respectively. Mean daily total fat, saturated fatty acid (SFA), mono-unsaturated fatty acid (MUFA) and poly-unsaturated fatty acid intakes were respectively 34, 13, 13 and 5-6 En%. The carbohydrates and MUFA intakes are below the acceptable macronutrient distribution ranges (AMDR). Fat intake is relatively high, and SFA intake exceeds the upper-AMDR. Based on the estimated average requirement (EAR) cut-point method, 10-12% of older adults do not meet the EAR for protein. To interpret a possible energy imbalance additional information is needed on physical activity, energy expenditure and body weight changes. This systematic review indicates a suboptimal dietary macronutrient distribution and a large variation in nutrient intakes among community-dwelling older adults.
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Carbohydrate quality, weight change and incident obesity in a Mediterranean cohort: the SUN Project. Eur J Clin Nutr 2014; 69:297-302. [PMID: 25226822 DOI: 10.1038/ejcn.2014.187] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/01/2014] [Accepted: 08/04/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES To evaluate the association between the carbohydrate quality index (CQI) and weight change or incident overweight/obesity (body mass index ⩾25 kg/m(2)) in the 'Seguimiento Universidad de Navarra (SUN)' cohort. SUBJECTS/METHODS A total of 8741 participants who were initially free of overweight/obesity were followed up for a median of 7.9 years. We evaluated at baseline the CQI according to four criteria: dietary fiber intake, glycemic index, whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Subjects were classified into quintiles according to CQI. Weight was recorded at baseline and updated every 2 years during follow-up. RESULTS Increasing CQI of diet was not significantly associated with lower weight gain, although participants in the highest quintile had the lowest average crude weight gain (+211 g/year). We observed 1862 incident cases of overweight/obesity during follow-up. CQI was significantly associated (P for trend 0.006) with a lower risk of overweight/obesity; adjusted odds ratio for the fourth and fifth quintiles were 0.81 (95% confidence interval (CI): 0.66-0.99) and 0.74 (95% CI: 0.60-0.92), respectively. CONCLUSIONS In this Mediterranean cohort, CQI showed a significant inverse association with the incidence of overweight/obesity, which highlights that carbohydrate intake guidelines related to obesity prevention should be focused on improving the CQI of the diet.
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