Prediction of metabolic syndrome by a high intake of energy-dense nutrient-poor snacks in Iranian children and adolescents

Association between modified youth healthy eating index and nutritional status among Iranian children in Zabol city: a cross-sectional study

Diet quality in childhood and adolescence can affect health outcomes such as physical and cognitive growth and preventing chronic diseases in adulthood. This study aimed to evaluate the relationship between diet quality using the modified youth healthy eating index (MYHEI) with socioeconomic factors and nutrition status in 7-12-year-old children in Iran. This descriptive-cross-sectional study was performed on 580 students in Zabol, Iran, selected through multistage cluster sampling. The diet was assessed through the 168-item food frequency questionnaire (FFQ) and eating behaviors. Then, the MYHEI scoring system was used to calculate the diet quality. In addition, we used the WHO growth indices, such as weight to age, height to age, and body mass index (BMI) to age ratios, to evaluate nutrition status. The mean total MYHEI score in children was 56.3 ± 11.2. Among children with the highest MYHEI score quartile, the number of girls was significantly higher than boys (p = 0.001). The prevalence of underweight, stunting, and wasting was 25.3%, 17.4%, and 21.7%, respectively. The prevalence of underweight (OR: 2.2; 95% CI  1.26, 3.90, p = 0.001) and stunting (OR: 3.2; 95% CI   1.65, 6.14, p = 0.006) were significantly lower in the higher MYHEI score quartile compared to the lower quartile. The overall diet quality of most children should be modified. Therefore, to improve the children's health and nutrition status, it is necessary to perform nutritional interventions such as training and promotional programs, especially in schools.

Association of ultra-processed foods consumption with risk of cardio-cerebrovascular disease: A systematic review and meta-analysis of cohort studies

AIMS

The epidemiological evidence regarding the impact of ultra-processed foods (UPFs) on the risk of cardio-cerebrovascular diseases (CCVDs) is controversial. The aim of this systematic review and meta-analysis is to examine the association between UPF consumption and the risk of CCVDs within cohort studies.

DATA SYNTHESIS

A systematic literature search was conducted across multiple databases, including PubMed/Medline, Embase, Web of Science, Scopus, and the Cochrane Library databases, covering the inception of these databases up until January 1st, 2023. A total of 39 cohort studies involving 63,573,312 human participants were deemed eligible according to the inclusion criteria. Utilizing random-effects models, risk ratios (RRs) were estimated to determine the pooled results. Our findings indicate a significant association between a higher consumption of UPF and an increased likelihood of CCVDs (RR: 1.08, 95% CI: 1.01-1.16, I2 = 89%; p < 0.01) compared to individuals who either abstain from or consume lesser amounts of UPF. Nonlinear dose-response meta-analyses showed that a consistent high intake of UPFs was associated with an elevated risk of developing CCVDs (p non-linearity <0.001). Notably, the risk of CCVDs escalated by approximately 7% with an UPF intake of up to 1 serving per day. Subgroup analysis further revealed a significant augmentation in the risk of total CVD and hypertension with increased UPF consumption.

CONCLUSIONS

A higher intake of UPF significantly increases the risk of developing CCVDs. Prospective studies controlling for confounding factors are needed to validate the relationship between UPF intake and the development of CCVDs.

Prevalence of metabolic syndrome and its association with oral health: First results from the Kurdish cohort study

Aims

Investigate the association between oral and dental health (ODH) and metabolic syndrome (MetS) in adults aged 35-70 years.

Methods

The study utilized data from the enrollment phase of Dehgolan prospective cohort study in the west of Iran. A cross-sectional assessment was conducted on a total of 3996 participants, involving a comprehensive oral examination and the assessment of their oral hygiene behavior (ODH). MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III. Logistic regression used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for sociodemographic characteristics.

Results

MetS was more prevalent among those who not daily brushing and flossing. Participants with missing teeth (MT) show higher prevalent of MetS. Being female, lower age, illiteracy, family history of diabetes, low physical activity, and salt at table were independently associated with increase odds of MetS (p < 0.05). Odds of MetS were significantly decreased with use flossing (OR = 0.75; CI = 0.60-0.93), decayed (OR = 0.83; CI = 0.72-0.97), filled (OR = 0.84; CI = 0.71-0.99), and increased with MT (OR = 1.45; CI = 1.16-1.81) as long as adjusted for ODH factors. When other potential confounder such as sociodemographic, personal and nutritional habits were adjusted, daily flossing was the only factor that still statistically decreased (OR = 0.79; CI = 0.62-0.99) the odds of MetS.

Conclusion

Daily flossing was the only factor that independently associated with MetS. Relationship of other ODH factors with Mets were confounded by sociodemographic characteristics of the participants.

Nutrient patterns in relation to metabolic health status in overweight and obese adolescents

The association between dietary nutrient patterns (NPs) and metabolic health status has not been investigated in adolescents. This study aimed to evaluate the relationship between NPs and metabolic health status in Iranian adolescents with overweight and obesity. In this cross-sectional study, 203 obese/overweight adolescents were selected using a multistage mass random sampling method. To assess usual dietary intakes, a validated food frequency questionnaire was applied. Data of anthropometric and blood pressure were collected. Insulin, lipid profile, and glucose levels were determined using fasting blood samples. Two approaches [International Diabetes Federation (IDF) and a combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR)] were applied to identify metabolically healthy obese and metabolically unhealthy obese (MUO) adolescents. Participants had a mean age of 13.9 ± 1.61 years and 52.2% of them were girls. Three NPs were identified and labeled as "high minerals and vitamins" (NP1), "high carbohydrate" (NP2) and "high fat and sodium" (NP3). After adjustments for all potential confounders, no significant association was observed between higher adherence to NP1 and NP2 and odds of MUO; however, greater adherence to "high fat and sodium" NP was associated with higher odds of being MUO based on IDF (OR = 3.12; 95% CI 1.19, 8.09) and IDF/HOMA-IR (OR = 2.81; 95% CI 1.02, 7.74) definitions. Stratified analysis revealed that these associations were stronger in boys (versus girls) and obese (versus overweight) adolescents. In conclusion, high adherence to a "high fat and sodium" nutrient pattern was related to elevated chance of being MUO in Iranian adolescents, especially in boys and obese individuals. Therefore, less consumption of trans fatty acids, saturated fatty acids and sodium could be recommended to prevent MUO prevalence especially in boys with obesity.

Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies

BACKGROUND

Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease.

OBJECTIVE

To inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers.

METHODS

PubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure).

RESULTS

Of 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty).

CONCLUSIONS

No definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.

The Association of Dietary Pattern with the Risk of Prehypertension and Hypertension in Jiangsu Province: A Longitudinal Study from 2007 to 2014

Hypertension is the most common chronic disease and the primary risk factor for cardiovascular diseases. Prehypertension is closely related to a variety of cardiovascular disease risk factors during the development of hypertension. The objective of this study was to explore the relationship between dietary patterns and hypertension in Jiangsu Province. Specifically, we included the participants from 2007 and then followed up in 2014 in the Jiangsu Province of China and collected information from food frequency questionnaires, anthropometric measurements, and disease self-reports. A total of 1762 women and men were included in the final analysis. We extracted four dietary patterns using factor analysis, calculated the pattern-specific factor scores, and divided the scores into quartiles, which increased from Q1 to Q4. Compared with participants in Q1, an increased risk of high diastolic blood pressure was found in Q4 of the snack dietary pattern. Additionally, participants in Q2–Q4 of the frugal dietary pattern were found to have a positive association with abnormal blood pressure. However, the results found in the frugal dietary pattern vanished after adjusting more confounders in Q4 of high systolic blood pressure. We found that some food items were associated with hypertension and prehypertension. The overconsumption of salt and alcohol are risk factors for both prehypertension and hypertension. Added sugar and saturated fatty acids are risk factors for hypertension, which may provide suggestions for the residents in China to change dietary habits to prevent prehypertension and hypertension.

Fructose Intake, Hypertension and Cardiometabolic Risk Factors in Children and Adolescents: From Pathophysiology to Clinical Aspects. A Narrative Review

Arterial hypertension, dyslipidemia, alterations in glucose metabolism and fatty liver, either alone or in association, are frequently observed in obese children and may seriously jeopardize their health. For obesity to develop, an excessive intake of energy-bearing macronutrients is required; however, ample evidence suggests that fructose may promote the development of obesity and/or metabolic alterations, independently of its energy intake. Fructose consumption is particularly high among children, because they do not have the perception, and more importantly, neither do their parents, that high fructose intake is potentially dangerous. In fact, while this sugar is erroneously viewed favorably as a natural nutrient, its excessive intake can actually cause adverse cardio-metabolic alterations. Fructose induces the release of pro-inflammatory cytokines, and reduces the production of anti-atherosclerotic cytokines, such as adiponectin. Furthermore, by interacting with hunger and satiety control systems, particularly by inducing leptin resistance, it leads to increased caloric intake. Fructose, directly or through its metabolites, promotes the development of obesity, arterial hypertension, dyslipidemia, glucose intolerance and fatty liver. This review aims to highlight the mechanisms by which the early and excessive consumption of fructose may contribute to the development of a variety of cardiometabolic risk factors in children, thus representing a potential danger to their health. It will also describe the main clinical trials performed in children and adolescents that have evaluated the clinical effects of excessive intake of fructose-containing drinks and food, with particular attention to the effects on blood pressure. Finally, we will discuss the effectiveness of measures that can be taken to reduce the intake of this sugar.

Energy-dense nutrient-poor snacks and risk of non-alcoholic fattyliver disease: a case-control study in Iran

OBJECTIVE

The purpose of the present study was to determine the association between energy-dense nutrient-poor snacks intake and the risk of non-alcoholic fatty liver disease (NAFLD) in Iranian adults. For this purpose, a total of 143 cases with a newly confirmed diagnosis of NAFLD and 471 controls free of the disease were studied. Dietary intake was assessed using a food frequency questionnaire.

RESULTS

The percentage of calories from total energy-dense nutrient-poor snacks was 6.08% and 5.04%, in patients and controls, respectively (P = 0.036). Compared with subjects in the lowest quartile of total energy-dense nutrient-poor snacks intake, the risk of NAFLD for those in the top quartile of consumption increased by about two times, in both crude (OR: 1.94; 95% CIs 1.16-3.26; P for trend = 0.015) and adjusted (OR: 2.27; 95%CIs 1.19-4.31; P for trend = 0.001) models. The relative odds of NAFLD increased significantly in the fourth quartile of dietary cake and biscuit (OR: 1.21, P for trend = 0.037) and soft drinks (OR: 1.64, P for trend = 0.005) intake compared with the lowest corresponding quartiles, after adjustment for age, sex, body mass index, physical activity, alcohol, energy intake. Our results indicate that there might be a moderate positive association between energy-dense nutrient-poor snacks intake and risk of NAFLD.

Important Food Sources of Fructose-Containing Sugars and Incident Hypertension: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Background Sugar-sweetened beverages are associated with hypertension. We assessed the relation of important food sources of fructose-containing sugars with incident hypertension using a systematic review and meta-analysis of prospective cohort studies. Methods and Results We searched MEDLINE, EMBASE, and Cochrane (through December week 2, 2018) for eligible studies. For each food source, natural log-transformed risk ratios (RRs) for incident hypertension were pooled using pair-wise meta-analysis and linear and nonlinear dose-response meta-analyses. Certainty in our evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. We identified 26 reports, including 15 prospective cohorts (930 677 participants; 363 459 cases). Sugar-sweetened beverages showed harmful (RRper-355-mL, 1.10 [95% CI, 1.08, 1.12]) whereas fruit (RRper-240-g, 0.94 [95% CI, 0.96, 0.99]) and yogurt showed protective associations (RRper-125-g, 0.95 [95% CI, 0.94, 0.97]) with incident hypertension throughout the dose range. One hundred percent fruit juice showed a protective association only at moderate doses (RRat-100-mL, 0.97 [95% CI, 0.94, 0.99]). The pair-wise protective association of dairy desserts was not supported by linear dose-response analysis. Fruit drinks or sweet snacks were not associated with hypertension. Certainty of the evidence was "low" for sugar-sweetened beverages, 100% fruit juice, fruit, and yogurt and "very low" for fruit drinks, sweet snacks, and dairy desserts. Conclusions The harmful association between sugar-sweetened beverages and hypertension does not extend to other important food sources of fructose-containing sugars. Further research is needed to improve our estimates and better understand the dose-response relationship between food sources of fructose-containing sugars and hypertension. Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02702375.

The association of dietary patterns and adherence to WHO healthy diet with metabolic syndrome in children and adolescents: Tehran lipid and glucose study

BACKGROUND

The optimal dietary pattern for reducing the extent of metabolic syndrome (MetS) has not been well established yet. The aim of this study was to evaluate dietary patterns and adherence to WHO healthy diet in children and adolescents and their associations with MetS.

METHODS

Subjects of this cohort study were selected from among children and adolescents of the Tehran Lipid and Glucose Study participants, aged 6-18 years (n = 424). Dietary measurements were collected using a valid and reliable food frequency questionnaire. MetS was defined as the existence of at least 3 risk factors according to the Cook criteria. Diet was assessed based on dietary components of the WHO healthy diet. Dietary patterns were defined by principal component analysis.

RESULTS

The mean ± SD age of participants (42% boys and 57% girls) was 13.5 ± 3.7 years. The most consistency with the WHO healthy diet was observed for cholesterol, free sugar and protein consumption in both genders, and the least was for n-3 poly-unsaturated fatty acid, trans-fatty acid and salt. Intake of SFA up to 12% of energy intake (third quartile) reduced the risk of MetS, compared to the first quartile. Subjects in the third quartile of n-6 poly-unsaturated fatty acid intake (6.2% of energy) showed the lowest odds ratio of MetS compared to the first quartile (OR: 0.18, CI: 0.04-0.66). In the adjusted model, the risk of MetS reduced across quartiles of MUFA intake by 60% (OR: 1, 0.40, 0.40, 0.42; P trend = 0.05). No significant trends were observed in the risk of MetS components across quartiles of the WHO healthy diet components. Three major dietary patterns were identified, the healthy, unhealthy and cereal/meat. An increased risk of MetS was observed in the highest quartile of unhealthy dietary pattern score compared to the lowest quartile (OR: 1, 0.81, 0.93, 2.49; P trend = 0.03).

CONCLUSIONS

Our results demonstrated that the majority of our population did not meet some components of WHO healthy diet recommendations. The quality and quantity of fatty acid intakes were associated with risk of MetS. Adherence to unhealthy dietary pattern was associated with two-fold increase in MetS risk.

Association of nuts and unhealthy snacks with subclinical atherosclerosis among children and adolescents with overweight and obesity

Background

The process of atherosclerosis begins early in childhood and usually remains asymptomatic until later in life. Carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis could identify early vascular alterations. Unhealthy snacks consumption is associated with obesity and other CVD risk factors in children and adolescents. The aim of this study is to investigate the association of different snack substitution and cIMT among overweight and obesity children and adolescents.

Methods

A total of 339 participants aged 6 to 13 years with the body mass index Z score ≥ 1 based on WHO criteria enrolled in this study. We measured food intakes of participants by validate and reliable food frequency questionnaire (FFQ). Carotid intima media thickness was measured in the common carotid artery with high-resolution ultrasonography.

Results

After controlling for confounders, intake of nuts had a negative relationship with cIMT (β = 0.135 mm P value = 0.009). Moreover, participants in the last tertile of nuts intake had 59% lower risk of high cIMT in comparison with those who consumed less than 0.64 serving/wk./1000Kcal of nuts (P for trend = 0.010). Substituted of nuts intake with sweet unhealthy snacks had a negative relationship with cIMT (β = 0.15 mm). There was no other significant association between energy-dense nutrient-poor solid snacks and cIMT.

Conclusions

Our findings emphasize the impact of nuts consumption as a healthy snack on subclinical stages atherosclerosis. Clinical trial studies could examine the effect of different kinds of nuts consumption on cIMT and complications of CVD risk factors.

Electronic supplementary material

The online version of this article (10.1186/s12986-019-0350-y) contains supplementary material, which is available to authorized users.

Breakfast Skipping Is Associated with Increased Risk of Type 2 Diabetes among Adults: A Systematic Review and Meta-Analysis of Prospective Cohort Studies

Background

Epidemiologic studies have indicated that breakfast skipping is associated with risk of type 2 diabetes. However, the shape of the dose-response relation and the influence of adiposity on this association have not been reported.

Objective

We investigated the association between breakfast skipping and risk of type 2 diabetes by considering the influence of the body mass index (BMI).

Methods

In this systematic review and meta-analysis, PubMed and Web of Science were searched up to August 2017. Prospective cohort studies on breakfast skipping and risk of type 2 diabetes in adults were included. Summary RRs and 95% CIs, without and with adjustment for BMI, were estimated with the use of a random-effects model in pairwise and dose-response meta-analyses.

Results

In total 6 studies, based on 96,175 participants and 4935 cases, were included. The summary RR for type 2 diabetes comparing ever with never skipping breakfast was 1.33 (95% CI: 1.22, 1.46, n = 6 studies) without adjustment for BMI, and 1.22 (95% CI: 1.12, 1.34, n = 4 studies) after adjustment for BMI. Nonlinear dose-response meta-analysis indicated that risk of type 2 diabetes increased with every additional day of breakfast skipping, but the curve reached a plateau at 4-5 d/wk, showing an increased risk of 55% (summary RR: 1.55; 95% CI: 1.41, 1.71). No further increase in risk of type 2 diabetes was observed after 5 d of breakfast skipping/wk (P for nonlinearity = 0.08).

Conclusions

This meta-analysis provides evidence that breakfast skipping is associated with an increased risk of type 2 diabetes, and the association is partly mediated by BMI.

Nutrition and Cardio-Metabolic Risk Factors: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

Genetic and environmental factors contribute to the incidence of metabolic syndrome (MetS). This study aimed to review all findings of studies conducted in framework of the Tehran lipid and glucose study (TLGS) regarding the association of dietary factors with cardio-metabolic risk factors.

EVIDENCE ACQUISITION

All English-language studies were searched using PubMed and Scopus databases from 2000 to 2017. Finally, 105 relevant papers were included in this review.

RESULTS

Whole grains, legumes, nuts and healthy dietary patterns (DPs) reduced risk of MetS, while white rice, salty/sweet snacks increased this. The western DP had a significant interaction with APOC3, APOA1 and MC4R polymorphisms in relation to MetS. After 6.5 years of follow-up, odds of reaching menarche ≤ 12 years was significantly higher in girls with higher intakes of milk, calcium, magnesium, and phosphorous. Among children and adolescents, higher adherence to the dietary approaches to stop hypertension (DASH)-style diet decreased the risk of abdominal obesity, whereas increased adherence to the western DP could contribute to general and abdominal obesity. A three-year follow-up of adult participants showed that higher intakes of phytochemical-rich foods were inversely related to development of insulin resistance. Higher adherence to the healthy DPs was associated with the reduced risk of hyperlipidemia and hypertention. Nutrition interventions postponed rise in the prevalence of MetS. The DASH diet resulted in weight reduction compared to control diet.

CONCLUSIONS

Higher adherence to healthy food choices was associated with reduced odds of MetS, abdominal obesity, dyslipidemia and hypertension. The western DP accentuated the association of polymorphisms with MetS.

Modified Healthy Eating Index and Incidence of Metabolic Syndrome in Children and Adolescents: Tehran Lipid and Glucose Study

OBJECTIVE

To assess the relationship between modified healthy eating index (mHEI) with the development of metabolic syndrome (MetS) among children and adolescents.

STUDY DESIGN

Dietary data were collected using a food frequency questionnaire among 424 healthy subjects, aged 6-18 years. The components of mHEI were grains, vegetables and fruits, dairy, red to white meat ratio, butter, sweet snacks, sweetened beverages, salty snacks, and fast food. Multivariable logistic regression models were used to estimate the incidence of MetS after 3.6 years of follow-up in each quartile of the mHEI score, adjusted for baseline age, sex, total energy intake, physical activity, and body mass index.

RESULTS

The mean ± SD age and mHEI scores of participants were 13.6 ± 3.7 years and 55.9 ± 10.0, respectively, at baseline. MetS developed in 11% of the participants at the end of follow-up. After adjustment for confounders, the occurrences of MetS decreased in the highest quartile compared with the lowest quartile of the mHEI score (OR = 0.35, 95% CI 0.13-0.98, P for trend = .025). In addition, higher scores of mHEI components including fruits, salty snacks, and fast food were associated with lower risk of MetS.

CONCLUSIONS

Higher scores of mHEI as an indicator of diet quality may hinder the development of MetS among children and adolescents.

Sweetened beverages, snacks and overweight: findings from the Young Lives cohort study in Peru

Objective

To determine the association between consumption of snacks and sweetened beverages and risk of overweight among children.

Design

Secondary analysis of the Young Lives cohort study in Peru.

Setting

Twenty sentinel sites from a total of 1818 districts available in Peru.

Subjects

Children in the younger cohort of the Young Lives study in Peru, specifically those included in the third (2009) and the fourth (2013) rounds.

Results

A total of 1813 children were evaluated at baseline; 49·2 % girls and mean age 8·0 (sd 0·3) years. At baseline, 3·3 (95 % CI 2·5, 4·2) % reported daily sweetened beverage consumption, while this proportion was 3·9 (95 % CI 3·1, 4·9) % for snacks. Baseline prevalence of overweight was 22·0 (95 % CI 20·1, 23·9) %. Only 1414 children were followed for 4·0 (sd 0·1) years, with an overweight incidence of 3·6 (95 % CI 3·1, 4·1) per 100 person-years. In multivariable analysis, children who consumed sweetened beverages and snacks daily had an average weight increase of 2·29 (95 % CI 0·62, 3·96) and 2·04 (95 % CI 0·48, 3·60) kg more, respectively, than those who never consumed these products, in approximately 4 years of follow-up. Moreover, there was evidence of an association between daily consumption of sweetened beverages and risk of overweight (relative risk=2·12; 95 % CI 1·05, 4·28).

Conclusions

Daily consumption of sweetened beverages and snacks was associated with increased weight gain v. never consuming these products; and in the case of sweetened beverages, with higher risk of developing overweight.