Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity

Unraveling patterns, causes, and nature-based remediation strategy for non-grain production on farmland in hilly regions

The surge in non-grain production on farmland (NGPF) poses significant threats to food security and land sustainability, particularly in hilly regions. However, there remains a lack of clarity on how to effectively balance grain and non-grain production in relation to land remediation. Using Wannian County as a case study, we investigate the evolution of this by leveraging high-precision land surveys and satellite imagery. Through the application of bootstrapped partial linear regression models, we identify key influencers behind each type of NGPF. In proposing land remediation solutions, we integrate the results of NGPF and land quality evaluations to identify mismatches between non-grain production and land attributes (i.e., topography, geology, soil, and land use). Our findings reveal a substantial growth in NGPF, expanding from 3838.72 ha to 5659.64 ha (2010-2020), and predominantly occurring on farmland with favorable natural conditions and connected locations such as proximity to roads, town centers, and industrial plants. Surprisingly, the basic farmland protection policy shows limited effectiveness in curbing NGPF, except for garden operations. We identify 1674 NGPF patches suitable for conversion to grain production and provide land remediation suggestions tailored to low-quality farmland with specific natural barriers, thus complementing the demand for regional non-grain production. This study thereby innovatively proposes nature-based land remediation strategies to address the non-grain production dilemma by tailoring NGPF and land quality, offering valuable insights for sustainable farmland management in China and beyond.

Dietary Flavonoid and Subclass Intakes are not Associated with Markers of Bone Health in U.S. Adults Age 50+ Years

BACKGROUND

Dietary flavonoid intakes have been associated with improved markers of bone health in Chinese and Scottish cohorts, but little data exist in middle aged to older adults in the United States.

OBJECTIVES

The objective of our research was to assess if dietary flavonoid intakes are associated with bone mineral density (BMD), bone mineral content (BMC), and bone area of the lumbar spine and femoral neck in a nationally representative population of middle aged to older U.S. adults. We further sought to investigate if relationships of the main flavonoid subgroups (i.e., anthocyanins, flavan-3-ols, flavanones, flavones, flavonols, and isoflavones) exist, as a secondary objective.

METHODS

Cross-sectional data from individuals aged 50+ years enrolled in the 2017-2018 National Health and Nutrition Examination Survey (NHANES) were used in our analyses (N = 2590). Weighted multivariate logistic regression models were used to investigate the relationship between quartiles of flavonoid intake and BMD, BMC, and bone area of the lumbar spine and femoral neck of participants.

RESULTS

Mean age of participants was 63.4 ± 0.52 years and 64.1 ± 0.52 years for men and women, respectively. Average total flavonoid intake was 217 ± 19.4 mg/day and 306 ± 26.9 mg/day for men and women, respectively. Total flavonoid intakes were not significantly associated with BMD, BMC, or bone area of the femoral neck or lumbar spine in male or female participants. Flavonoid subclass intakes were also not consistently associated with improved markers of bone health.

CONCLUSION

Although several limitations exist, this cross-sectional analysis of U.S. adults aged 50+ years provides contradictory evidence to the hypothesis that higher flavonoid and flavonoid subclass intakes beneficially impacts markers of bone health. Large prospective cohort investigations that better capture long-term dietary flavonoid intake and ascertain fractures the primary outcome, as well as randomized controlled trials, are needed to fully elucidate the effects flavonoids on bone health.

The global burden and trends analysis of early-onset colorectal cancer attributable to dietary risk factors in 204 countries and territories, 1990-2019: a secondary analysis for the global burden of disease study 2019

Background

Rising trends in early-onset colorectal cancer (CRC) burden have been observed, but the distribution and temporal patterns of early-onset CRC attributable to dietary risks remain unclear.

Objectives

This study aimed to estimate the burden of early-onset CRC attributable to dietary risk factors globally, regionally, and nationally, by age and sex, from 1990 to 2019.

Methods

The absolute number and age-specific rates (ASR) of diet-related early-onset CRC burden, as well as summary exposure value (SEV) of attributable dietary risk factors, were extracted from the Global Burden of Disease (GBD) Study 2019. The temporal changes in the burden between 1990 and 2019 were analyzed by calculating the percentage change in the absolute number of burden and the estimated annual percentage change (EAPC) in ASR of burden. The annualized rates of change (ARC) were calculated to evaluate the variation trend of SEV.

Results

In 2019, diet-related early-onset CRC caused 30,096 (95% UI: 23,148 to 36,091) death cases and 1,465,755 (95% UI: 1,126,489 to 1,761,661) DALYs worldwide, accounting for 34.8% deaths and 34.4% DALYs of overall early-onset CRC, respectively. Moreover, a diet low in milk (responsible for 16.5% [95% UI: 11.1 to 21.9%] of DALYs in 2019), low in whole grains (15.2% [95% UI: 5.9 to 19.9%]), low in calcium (14.3% [95% UI: 10.7 to 18.9%]), high in red meat (5.3% [95% UI: 1.7 to 9.5%]), high in processed meat (2.5% [95% UI: 0.9 to 4.0%]), and low in fiber (2.3% [95% UI: 0.9 to 4.2%]) were early-onset CRC attributable dietary risk factors. The age-specific DALYs rate of early-onset CRC attributable to each dietary risk factor generally showed an increasing trend globally between 1990 and 2019, except for low intake of fiber (EAPC = -0.57, 95% CI: -0.76 to -0.38). In addition, from 1990 to 2019, males have a higher burden than females and this gap may continue to widen due to the increasing difference between the sexes in most dietary risk factors. Furthermore, dietary risks-attributable early-onset CRC burden has shifted from regions with high socio-demographic index (SDI) to high-middle and middle SDI quintiles with uncontrolled dietary risks.

Conclusion

Early-onset CRC remains a concerning issue globally, and effective prevention and modification of dietary risk factors holds great promise to reduce early-onset CRC-related burden. Prioritizing diet improvement for males is critical and urgent for CRC control efforts, particularly for those living in developing countries with ongoing dietary pattern transition.

Understanding consumer food choices & promotion of healthy and sustainable Mediterranean diet and lifestyle in children and adolescents through behavioural change actions: the DELICIOUS project

Over the last decades, the abandonment of traditional dietary patterns, such as the Mediterranean diet, represents an important threat for human health and environmental safeguard. The DELICIOUS project aims to promote healthy lifestyles among children and adolescents by implementing activities and tools to increase the adherence to the Mediterranean Diet with an attention to the environmental impacts of the diet. This study protocol describes the DELICIOUS project as a single-arm, uncontrolled behavioural intervention providing formal and non-formal education activities, development of new snacks and recipe reformulation, web/mobile app development, and physical activities to school children and adolescents in five European countries. The project aims to increase awareness of the nutritional benefits and the sustainability aspects of the Mediterranean Diet and to promote consumers' empowerment through an online platform for sustainable and healthy meal planning in the school canteen.

Usefulness of triglyceride-glucose index and homeostatic model assessment for predicting coronary microvascular dysfunction

BACKGROUND

Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest Triglyceride-Glucose (TyG) index is a superior marker of IR that had a better accuracy to predict Type 2 Diabetes or cardiovascular outcomes than HOMA-IR.

OBJECTIVES

We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement.

METHODS

All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR ≤2.0 was defined as CMD.

RESULTS

TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (OR:1.38, 95 %CI:1.14-1.67, p = 0.001) but not TyG index(OR:1.48, 95 %CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95 %CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95 %CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF10:3507) but not for TyG index(BF10:0.66).

CONCLUSIONS

HOMA-IR, but not TyG index, is closely associated with CMD.

Living with obesity in Ireland: determinants, policy and future perspectives

Globally, the prevalence of those living with obesity (≥30 kg/m2) is rising, with this trend expected to continue if firm and decisive policy interventions are not introduced. Across Europe, despite many consecutive policies aiming to reverse rising trends in weight status over recent decades, no country is currently on track to halt and reverse current trends in the coming years. This is evident in Ireland too, whereby the reporting of nationally representative weight status data show that targets have not been achieved since reporting began. The aim of this review is to critically appraise recent evidence relating to the key determinants of obesity including weight status, diet quality and physical activity with an emphasis on socioeconomic inequalities. And to consider these in the context of respective policy measures and propose future-focused recommendations. Furthermore, as with the complex nature of obesity, multifaceted approaches that shift the focus from the individual and place responsibility at a societal level will be reviewed.

The burden of liver disease in Latin America

Liver disease poses a substantial burden in Latin America. This burden is primarily attributed to a high level of alcohol consumption and the increasing prevalence of risk factors associated with metabolic dysfunction-associated steatotic liver disease (MASLD), such as sedentary lifestyles, easy access to ultra-processed foods, obesity, and type 2 diabetes mellitus. These epidemiological trends are cause for concern, especially considering that there are significant challenges in addressing them due to disparities in access to liver disease screening and care. In this article, we aim to provide an overview of the current situation regarding liver disease in Latin America. We also discuss recent multinational proposals designed to address the growing MASLD burden via its integration into existing non-communicable diseases policies, at both local and global levels. Additionally, we emphasize the urgent need to establish effective public health policies that target both MASLD risk factors and excessive alcohol consumption. Furthermore, we discuss the development of liver transplantation programs, areas for improvement in medical education and research capabilities, and how the fostering of extensive collaboration among all stakeholders is crucial for addressing liver disease in the region.

Flavonoids, gut microbiota, and host lipid metabolism

Flavonoids are widely distributed in nature and have a variety of beneficial biological effects, including antioxidant, anti-inflammatory, and anti-obesity effects. All of these are related to gut microbiota, and flavonoids also serve as a bridge between the host and gut microbiota. Flavonoids are commonly used to modify the composition of the gut microbiota by promoting or inhibiting specific microbial species within the gut, as well as modifying their metabolites. In turn, the gut microbiota extensively metabolizes flavonoids. Hence, this reciprocal relationship between flavonoids and the gut microbiota may play a crucial role in maintaining the balance and functionality of the metabolism system. In this review, we mainly highlighted the biological effects of antioxidant, anti-inflammatory and antiobesity, and discussed the interaction between flavonoids, gut microbiota and lipid metabolism, and elaborated the potential mechanisms on host lipid metabolism.

Relationship of calcium and magnesium intakes with the dietary approaches to stop hypertension score and blood pressure: the International Study of Macro/micronutrients and Blood Pressure

OBJECTIVE

Research investigating calcium and magnesium intakes from the Dietary Approaches to Stop Hypertension (DASH) pattern and other sources in association with blood pressure is limited. We aimed to characterize sources/intake levels of calcium and magnesium in relation to overall diet quality (DASH-score) and determine modification effects with DASH score and blood pressure.

METHODS

Cross-sectional United States data (average dietary and supplement intake from four 24 h recalls and eight blood pressure measurements) from two separate visits, 2195 men and women (40-59 years) in the International Study of Macro/Micronutrients and Blood Pressure were analysed. Food-based adherence to the DASH diet was estimated. Linear models tested associations between each 1-point DASH score with blood pressure. Participants were stratified by adherence to sex-specific recommended allowance for magnesium and calcium intakes. Effect-modification was tested across DASH-score quintiles and median of urinary sodium.

RESULTS

DASH-score was inversely associated with SBP in fully adjusted models (-0.27; 95%CI: -0.38 to -0.15 mmHg). SBP was inversely associated with dietary calcium intake from DASH food groups: -1.54 (95% CI: -2.65 to -0.43) mmHg; calcium intake from other non-DASH food groups: -1.62 (95% CI: -2.94 to -0.29) mmHg. Dietary magnesium intake from DASH food groups (-1.59; 95% CI: -2.79, -0.40 mmHg) and from other non-DASH foods (-1.92; 95% CI: -3.31, -0.53 mmHg) was inversely associated with SBP.

CONCLUSION

A higher DASH score showed a consistent association with lower BP suggesting a relationship between intakes of calcium and Mg with BP regardless of whether the source is part of the DASH diet or not, even when adjusted for supplement intakes.The INTERMAP is registered as NCT00005271 at www.clinicaltrials.gov .

Association of healthy eating index and self-rated health in adults living in Tehran: a cross-sectional study

BACKGROUND

Self-rated health (SRH) has been identified in many studies as a valid predictor of mortality and healthcare utilization. There is limited research on SRH and dietary intake. This study aimed to investigate the association between healthy eating index (HEI) and SRH in adults living in Tehran.

METHODS

This cross-sectional study was carried out among 850 adult men and women aged 20-59 years who visited health centers in Tehran from 2021 to 2022. Dietary intake was assessed using a validated and reliable semiquantitative food frequency questionnaire with 168 food items, and SRH was assessed with one question: "In general, how do you rate your health?". We categorized SRH into excellent/very good, good, and fair/poor. In the descriptive statistics part, we used mean ± standard deviation or number (ratio) for quantitative and qualitative variables, respectively. The chi-squared test and one-way analysis of variance were used to calculate the percentage and mean for demographic characteristics across tertiles of SRH. An analysis of covariance was used to compare the means of energy, macronutrients, the HEI, and its component variables across the tertiles of SRH.

RESULTS

The final sample included 795 participants (68.2% female; mean ± standard deviation age: 44.81 ± 10.62 years) whose 40% reported excellent/very good SRH, and 30% reported good and fair/poor SRH separately. There was no association between body mass index, physical activity, education, health status, smoking, and sleep duration with SRH. After adjustment, the total HEI score and its component scores did not differ across the tertiles of SRH status. However, participants with good SRH had a higher intake of total energy (mean difference (MD): 180.33 Kcal, P value < 0.001), total fat (MD: 8.15 gr, P value = 0.002), and total carbohydrates (MD: 20.18 gr, P value = 0.004) than those with fair/poor SRH.

CONCLUSION

According to our findings, fair/poor SRH was associated with a lower consumption of total energy, total fat, and total carbohydrates in Iranian adults. Additional observational studies would be necessary to clarify these findings.

Metabolic risks remain a serious threat to cardiovascular disease: findings from the Global Burden of Disease Study 2019

Metabolic factors are major and controllable risk factors for cardiovascular diseases (CVD), and few studies have described this burden. We aim to assess it from 1990 to 2019 and predict the trends through 2034. Global Burden of Disease (GBD) provides data on sex, age, and socio-demographic index (SDI) levels. Numbers, age-standardized death rates (ASDR) and estimated annual percentage change (EAPC) were used. Future trends were estimated by NORDPRED model. The deaths cases of metabolic-related CVD increased from 8.61 million (95% UI: 7.91-9.29) to 13.71 million (95% UI: 12.24-14.94) globally. The ASDR continued to decline globally (EAPC = -1.36). The burden was heavier in male and middle-aged people and elderly people. CVD-related ASDR caused by high systolic blood pressure (SBP) had a downward trend globally (EAPC = -1.45), while trends of high body mass index (BMI) (EAPC = 1.29, 1.97, 0.92) and fasting plasma glucose (FPG) (EAPC = 0.95, 1.08, 0.46) were increasing in the middle, low-middle, and low SDI regions, respectively. Compared to 2015-2019, cumulative deaths will increase by 27.85% from 2030 to 2034, while ASDR will decrease 10.47%. The metabolic-related CVD burden remained high globally and deaths will continue to rise in the future. Men, middle-aged and elderly people were focus of concern. High SBP was globally well-managed over the past 30 years, but the CVD burden due to high BMI and FPG remained high. Exceptional initiatives are needed to regarding interventions targeting high BMI and FPG in middle and lower SDI regions.

Dietary Quality and Associated Factors among Women of Reproductive Age in Six Sub-Saharan African Countries

The burden of micronutrient malnutrition is high among women of reproductive age (WRA) in sub-Saharan Africa. We examined the dietary quality and associated factors for WRA in Cameroon, Côte d'Ivoire, Kenya, Nigeria, Senegal, and Tanzania. Data were collected from women aged 15-49 years using representative Diet Quality Questionnaire surveys. The Minimum Dietary Diversity for Women (MDD-W), All-5 (key food group) consumption, noncommunicable disease risk (NCD-Risk), and Global Dietary Recommendation (GDR) indicators were assessed. Participants included N = 16,584 women [Cameroon: N = 2073; Côte d'Ivoire: N = 242; Kenya: N = 864; Adamawa State (Nigeria): N = 1283; Benue State (Nigeria): N = 1047; Nasarawa State (Nigeria): N = 1151; Senegal: N = 7232; Tanzania: N = 2692]. The MDD-W ranged from 43.0% in Tanzania to 81.4% in Côte d'Ivoire and was higher in urban, compared to rural, areas in Cameroon, Kenya, Nasarawa, Senegal, and Tanzania (p < 0.001). Increased education and wealth were positively associated with MDD-W in Kenya, Benue, Senegal, and Tanzania. Fewer than half of all women attained All-5 consumption. NCD-Risk scores ranged from 1.13 (95% CI: 1.08, 1.17) in Tanzania to 2.28 (95% CI: 2.16, 2.40) in Nasarawa, and women's GDR scores ranged from 10.47 (95% CI: 10.40, 10.54) in Cameroon to 11.45 (95% CI: 11.25, 11.64) in Côte d'Ivoire. Our findings highlight key aspects of women's diets in sub-Saharan African settings to enable greater awareness and more targeted responses to the specific areas needing the most improvement.

Global, regional, and national burden and trends analysis of gallbladder and biliary tract cancer from 1990 to 2019 and predictions to 2030: a systematic analysis for the Global Burden of Disease Study 2019

Objectives

Our aim was to explore the disease burden caused by gallbladder and biliary tract cancer globally, regionally, and nationally, by age and sex.

Methods

The absolute number of cases and age-standardized rates (ASR) of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) due to gallbladder and biliary tract cancer were extracted from the Global Burden of Disease (GBD) Study 2019. We estimated the trends in disease burden by calculating the percentage change in the absolute number of cases and the estimated annual percentage change (EAPC) in ASR, by social development index (SDI), region, nation, sex, and age.

Results

From 1990 to 2019, the number of incident cases, prevalent cases, deaths, and DALYs worldwide significantly increased by 1.85-fold, 1.92-fold, 1.82-fold, and 1.68-fold, respectively. However, the age-standardized rates of incidence, prevalence, mortality, and DALYs tend to decrease globally over time. Nevertheless, heterogeneous disease burden patterns exist between geographic regions due to different geographical risk factors, distinct epidemiologically predominant gallbladder and biliary tract cancer subtypes, and potential genetic predispositions or ethnicity. Additionally, socioeconomic status mediates the regional variation in disease burden, with increasing SDI or HDI scores associated with downward trends in the age-standardized rates of incidence, prevalence, mortality, and DALYs. Older individuals and females are at higher risk of gallbladder and biliary tract cancer, but the increasing burden of early-onset gallbladder and biliary tract cancer is a cause for concern, especially for those living in lower SDI areas and males. High BMI is the primary risk factors underlying gallbladder and biliary tract cancer, accounted for 15.2% of deaths and 15.7% DALYs globally in 2019.

Conclusion

Our study comprehensively elucidated the distribution and dynamic trends of gallbladder and biliary tract cancer burden over the past three decades, from multiple dimensions. These findings emphasize the importance of promoting a healthy lifestyle as a population-level cancer prevention strategy and tailoring cancer control actions based on localized risk factors and the epidemic profiles of gallbladder and biliary tract cancer by anatomical subtype.

Aging Increases Global Annual Food Greenhouse Gas Emissions up to 300 Million Tonnes by 2100

The dietary preferences of the elderly population exhibit distinct variations from the overall averages in most countries, gaining increasing significance due to aging demographics worldwide. These dietary preferences play a crucial role in shaping global food systems, which will result in changed environmental impacts in the future such as greenhouse gas (GHG) emissions. We present a quantitative evaluation of the influence of population aging on the changes in GHG emissions from global food systems. To achieve this, we developed regional dietary coefficients (DCs) of the elderly based on the Global Dietary Database (GDD). We then reconciled the GDD with the dataset from the Food and Agriculture Organization of the United Nations (FAO) to calculate the food GHG emissions of the average population in each of the countries. By applying the DCs, we estimated the national food GHG emissions and obtained the variations between the emissions from aged and average populations. We employed a modified version of the regional integrated model of climate and the economy model (RICE) to forecast the emission trends in different countries based on FAO and GDD data. This integrated approach allowed us to evaluate the dynamic relationships among aging demographics, food consumption patterns, and economic developments within regions. Our results indicate that the annual aging-embodied global food GHG emissions will reach 288 million tonnes of CO2 equivalent (Mt CO2e) by 2100. This estimation is crucial for policymakers, entrepreneurs, and researchers as it provides insights into a potential future environmental challenge and emphasizes the importance of sustainable food production and consumption strategies to GHG emission mitigations associated with aging dietary patterns.

Estimating the carbon footprint of Mexican food consumption based on a high-resolution environmentally extended input-output model

Increased global attention is being paid to the food-health-climate trilemma. In this study, we evaluate the climate impacts of Mexico's food consumption patterns by creating a high-resolution (262 sectors) Environmentally Extended Input-Output (EEIO) model called MXEEIO. We focus on the differences between food away from home (FAFH) and food at home (FAH) and compare Mexico's results with those of the USA. The results show that the main components of food spending in Mexico were meat, baked products, and beverages, raising concerns about their potential negative health effects if consumed excessively. Mexico's total greenhouse gas (GHG) emissions from food consumption were estimated at 149 million metric tons (MMT) in 2013, as opposed to 797 MMT for the USA. Meat and dairy products were the main contributors to Mexico's food-related GHG emissions, accounting for 57% of total emissions. Mexico spent a much smaller proportion of food-related income on FAFH than the USA (13% vs. 52%), suggesting great potential for growth as Mexico's per capita GDP continues to rise. Detailed contribution analysis shows that reducing Mexico's food-related GHG emissions would benefit most from a transition to low-carbon cattle farming, but mitigation efforts in other sectors such as crop cultivation and electricity generation are also important. Overall, our study underscores the significance of food-related GHG emissions in Mexico, especially those from meat and dairy products, and the mitigation challenges these sectors face.

Dietary Behavior and Determinants of Diet Quality among Primary Health Care Patients in Poland

BACKGROUND

The aim of the present research was to determine the factors influencing the prevalence of eating behaviors, diet quality, and unhealthy eating among primary healthcare patients in Poland.

METHODS

The cross-sectional study included 896 adult primary care patients in Łódź. The study was conducted from January 2020 to December 2021 among thirty-four primary healthcare facilities. A survey recorded the sociodemographic data of the respondents as well as data regarding their health condition and diet.

RESULTS

The majority of the respondents (57.6%) had average dietary habits, while 40% had unhealthy eating habits. The univariable logistic regression found that primary care patients with medium/secondary education had a 1.5 times greater risk of unhealthy eating habits, and those with post-secondary vocational education had a 1.75 times greater risk of unhealthy eating habits than those with higher education (OR = 1.46; 95% CI: 1.08-1.97, p ≤ 0.01, and OR = 1.75; 95% CI: 1.04-2.94, p ≤ 0.05). The multivariable logistic regression confirmed that the level of education had a significant impact on dietary habits: for medium/secondary education, OR = 1.40; 95% CI: 1.03-1.91 (p ≤ 0.01); for post-secondary vocational education, OR = 1.69; 95% CI: 1.0-2.85 (p ≤ 0.05).

CONCLUSIONS

The education level was significantly correlated with the prevalence of unhealthy eating behaviors in the studied population. This factor should be considered in the promotion of healthy eating behaviors and nutritional counseling interventions conducted by family physicians in primary health care.

Investigating the Influence of Heavy Metals and Environmental Factors on Metabolic Syndrome Risk Based on Nutrient Intake: Machine Learning Analysis of Data from the Eighth Korea National Health and Nutrition Examination Survey (KNHANES)

This study delves into the complex interrelations among nutrient intake, environmental exposures (particularly to heavy metals), and metabolic syndrome. Utilizing data from the Korea National Health and Nutrition Examination Survey (KNHANES), machine learning techniques were applied to analyze associations in a cohort of 5719 participants, categorized into four distinct nutrient intake phenotypes. Our findings reveal that different nutrient intake patterns are associated with varying levels of heavy metal exposure and metabolic health outcomes. Key findings include significant variations in metal levels (Pb, Hg, Cd, Ni) across the clusters, with certain clusters showing heightened levels of specific metals. These variations were associated with distinct metabolic health profiles, including differences in obesity, diabetes prevalence, hypertension, and cholesterol levels. Notably, Cluster 3, characterized by high-energy and nutrient-rich diets, showed the highest levels of Pb and Hg exposure and had the most concerning metabolic health indicators. Moreover, the study highlights the significant impact of lifestyle habits, such as smoking and eating out, on nutrient intake phenotypes and associated health risks. Physical activity emerged as a critical factor, with its absence linked to imbalanced nutrient intake in certain clusters. In conclusion, our research underscores the intricate connections among diet, environmental factors, and metabolic health. The findings emphasize the need for tailored health interventions and policies that consider these complex interplays, potentially informing future strategies to combat metabolic syndrome and related health issues.

"Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review

"Food Is Medicine" (FIM) represents a spectrum of food-based interventions integrated into health care for patients with specific health conditions and often social needs. Programs include medically tailored meals, groceries, and produce prescriptions, with varying levels of nutrition and culinary education. Supportive advances include expanded care pathways and payment models, e-screening for food and nutrition security, and curricular and accreditation requirements for medical nutrition education. Evidence supports positive effects of FIM on food insecurity, diet quality, glucose control, hypertension, body weight, disease self-management, self-perceived physical and mental health, and cost-effectiveness or cost savings. However, most studies to date are quasiexperimental or pre/post interventions; larger randomized trials are ongoing. New national and local programs and policies are rapidly accelerating FIM within health care. Remaining research gaps require rigorous, iterative evaluation. Successful incorporation of FIM into health care will require multiparty partnerships to assess, optimize, and scale these promising treatments to advance health and health equity.

Nutritional status in patients with chronic pancreatitis and liver cirrhosis is related to disease conditions and not dietary habits

Malnutrition is a common complication of chronic pancreatitis (CP) and liver cirrhosis (LC). Inadequate food intake is considered a relevant driver of malnutrition in both entities. However, the contribution of habitual diet to impaired nutritional status is unclear. In a prospective, multicenter cross-sectional study, we recruited patients with confirmed CP or LC and healthy volunteers as a control group. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. We comprehensively investigated habitual dietary intake on nutrient, food group, and dietary pattern level applying two validated food frequency questionnaires. We included 144 patients (CP: n = 66; LC: n = 78) and 94 control subjects. Malnutrition was prevalent in 64% and 62% of patients with CP or LC, respectively. In both CP and LC, despite slightly altered food group consumption in malnourished and non-malnourished patients there were no differences in energy or nutrient intake as well as dietary quality. Compared to controls patients showed distinct dietary food group habits. Patients consumed less alcohol but also lower quantities of fruits and vegetables as well as whole grain products (p < 0.001, respectively). Nevertheless, overall dietary quality was comparable between patients and healthy controls. Nutritional status in CP and LC patients is rather related to disease than habitual dietary intake supporting the relevance of other etiologic factors for malnutrition such as malassimilation or chronic inflammation. Despite distinct disease-related differences, overall dietary quality in patients with CP or LC was comparable to healthy subjects, which suggests susceptibility to dietary counselling and the benefits of nutrition therapy in these entities.

Cross-country health inequalities of four common nutritional deficiencies among children, 1990 to 2019: data from the Global Burden of Disease Study 2019

BACKGROUND

Nutritional deficiencies remain serious medical and public health issues worldwide, especially in children. This study aims to analyze cross-country inequality in four common nutritional deficiencies (protein-energy malnutrition, dietary iron deficiency, vitamin A deficiency and iodine deficiency) among children from 1990 to 2019 based on Global Burden of Disease (GBD) 2019 data.

METHODS

Prevalence and disability-adjusted life years (DALYs) data as measures of four nutritional deficiency burdens in people aged 0 to 14 years were extracted from the GBD Results Tool. We analyzed temporal trends in prevalence by calculating the average annual percent change (AAPC) and quantified cross-country inequalities in disease burden using the slope index.

RESULTS

Globally, the age-standardized prevalence rates of dietary iron deficiency, vitamin A deficiency and iodine deficiency decreased, with AAPCs of -0.14 (-0.15 to -0.12), -2.77 (-2.96 to -2.58), and -2.17 (-2.3 to -2.03) from 1999 to 2019, respectively. Significant reductions in socio-demographic index (SDI)-related inequality occurred in protein-energy malnutrition and vitamin A deficiency, while the health inequality for dietary iron deficiency and iodine deficiency remained basically unchanged. The age-standardized prevalence and DALY rates of the four nutritional deficiencies decreased as the SDI and healthcare access and quality index increased.

CONCLUSIONS

The global burden of nutritional deficiency has decreased since 1990, but cross-country health inequalities still exist. More efficient public health measures are needed to reduce disease burdens, particularly in low-SDI countries/territories.

Decoding China's anthropogenic typical pollutant discharge patterns: Long-term dynamics and hotspot transitions driven by population, diet, and sanitation

Human activities have led to an alarming increase in pollution, resulting in widespread water contamination. A comprehensive understanding of the quantitative relationship between anthropogenic pollutant discharges and the escalating anthropogenic disturbances and environmental efforts is crucial for effective water quality management. Here we establish a Model for Estimating Anthropogenic pollutaNts diScharges (MEANS) and simulate the long-term dynamics of various types of anthropogenic discharges in China based on an unprecedented spatio-temporal dynamic parameter dataset. Our findings reveal that from 1980 to 2020, anthropogenic discharges exhibited an overall trend of initially increasing and subsequently decreasing, with the peak occurring around 2005. During this period, the dominant pollution sources in China shifted from urban to rural areas, thereby driving the transition of hotspot pollutants from nitrogen to phosphorus in the eastern regions. The most significant drivers of anthropogenic pollutant discharges gradually shifted from population size and dietary structure to wastewater treatment and agricultural factors. Furthermore, we observed that a significant portion of China's regions still exceed the safety thresholds for pollutant discharges, with excessive levels of total phosphorus (TP) being particularly severe. These findings highlight the need for flexible management strategies in the future to address specific pollution levels and hotspots in different regions. Our study underscores the importance of considering the complex interplay between anthropogenic disturbances, environmental efforts, and long-term anthropogenic pollutant discharges for effective water pollution control.

Aligning Santal Tribe Menu Templates with EAT-Lancet Commission's Dietary Guidelines for Sustainable and Healthy Diets: A Comparative Analysis

BACKGROUND

In the context of global shifts in food systems, this paper explores the unique dietary practices of the Santal tribe, an indigenous group in eastern India, to understand the health, nutrition, and sustainability aspects of their traditional food systems. This study evaluates the nutritional content of the Santal diet in comparison to the EAT-Lancet Commission's 2019 dietary guidelines for healthy and sustainable diets.

METHODS

The University of East Anglia, in collaboration with the NNEdPro Global Institute for Food, Nutrition and Health in Cambridge, PRADAN; colleagues in India and local Santal youth, conducted nutritional analyses of traditional Santal recipes. Two menu templates, Kanhu Thali and Jhano Thali, were selected for comparative analysis based on their representation of diverse dietary practices within the Santal community. Nutritional data, including energy as well as the distribution of macronutrients and micronutrients, were compiled and compared with the EAT-Lancet guidelines.

RESULTS

The Santal menu templates (nutritionally complete meals) demonstrated alignment with EAT-Lancet recommendations in aspects such as whole grains, starchy vegetables, vegetables, plant-based protein sources, unsaturated fats, and limited added sugars. However, notable deviations included the absence of animal-based protein sources and dairy. The Santal diet showed high protein intake, largely from plant-based sources, and emphasised the importance of whole grains. Seasonal variations in nutritional content were observed between the two templates.

CONCLUSIONS

While the Santal diet aligns with some aspects of global dietary guidelines, there are notable deviations that underscore the complexity of aligning traditional diets with universal recommendations. The findings emphasise the need for culturally sensitive dietary recommendations that respect traditional diets while promoting sustainability. Research needs to support tailored global guidelines enshrining core principles of nutritional adequacy which are inter-culturally operable in order to accommodate cultural diversity, local practices, and seasonal variations, crucial for fostering sustainable and healthy eating habits in diverse sociodemographic contexts.

Gender differences in the association between healthy eating index-2015 and hypertension in the US population: evidence from NHANES 1999-2018

BACKGROUND

Diet has long been recognized as an important modifiable risk factor for hypertension. Herein, our research goal was to decipher the association of healthy eating index-2015 (HEI-2015) with hypertension, and to explore potential gender differences.

METHODS

We collected the cross-sectional data of 42,391 participants of the National Health and Nutrition Examination Survey (NHANES) 1999-2018. The association of HEI-2015 with hypertension was estimated using weighted multivariate logistic regression, with restricted cubic spline (RCS) regression being adopted to examine the nonlinearity of this association in both genders, and the stability of the results were examined by sensitivity analysis. We also performed subgroup analysis to detect potential difference in the link between HEI-2015 and hypertension stratified by several confounding factors.

RESULTS

After eliminating potential confounding bias, the adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for hypertension across higher HEI-2015 quartiles were 0.93 (0.85-1.03), 0.84 (0.77-0.93), and 0.78 (0.72-0.86) compared to the lowest quartile, respectively. HEI-2015 was nonlinearly and inversely associated with hypertension in all participants. The gender-specific RCS curves presented a U-shaped correlation in males, while showed a linear and inverse correlation in females. Besides, subgroup analyses showed a lower risk of hypertension in participants who were females, younger than 40 years, Whites, obese, and diabetic patients.

CONCLUSIONS

We determined a nonlinear and inverse association between HEI-2015 and hypertension in the US general population, and revealed a remarkable gender difference when adhering to a HEI-2015 diet for preventing hypertension.

Do Global Dietary Nutrient Datasets Associate with Human Biomarker Assessments? A Regression Analysis

BACKGROUND

To assess the state and trends of global nutrition, our best tools are nationally representative assessments using human biomarker assays, yet these are expensive and logistically challenging. We instead often rely on more easily produced global nutrient datasets-measures of nutrients provided by the diet-as a proxy for nutritional intake and deficiency, due to their greater geographic and temporal coverage. However, the accuracy of global nutrient datasets is questionable.

OBJECTIVE

We aimed to test whether estimates of inadequate dietary intake derived from existing global nutrient datasets reliably associate with biophysical deficiency.

DESIGN

We performed linear regressions of estimates of inadequate dietary nutrient intake derived from three global nutrient datasets-Global Dietary Database, Global Nutrient Database, and Global Expanded Nutrient Supply (GENuS) model-against the existing suite of nationally representative biomarker survey data for three key nutrients of global concern in two vulnerable demographic groups: zinc, folate, and vitamin A in females of childbearing age; and zinc and vitamin A in children younger than 5 y.

RESULTS

We found significant associations (P < 0.1) for only 3 of 22 regressions between global nutrition datasets and biophysical deficiency: zinc for females of childbearing age from GENuS and Global Dietary Database, and zinc for children under 5 y from GENuS. Folate and vitamin A show no reliable relationship between nutrient datasets and independent biomarker surveys. Applying the successful models for zinc to the accompanying full datasets yield estimates of global zinc deficiency of 31%-37% for these demographic groups.

CONCLUSIONS

We found that few estimates of nutritional inadequacy from global dietary datasets are associated with more direct measures of biophysical deficiency from biomarker studies. Researchers and policymakers must be cautious when applying global nutrient datasets to questions of global health and use them for limited applications.

The Burden of Cardiovascular Diseases Attributed to Diet High in Sugar-Sweetened Beverages in 204 Countries and Territories From 1990 to 2019

This study examines the impact of sugar-sweetened beverage (SSB) consumption on cardiovascular diseases (CVDs) and aims to provide evidence for preventive measures. The analysis involved a comprehensive scrutiny of CVD-related data from 1990 to 2019. Temporal trends of ASMR and ASDR were assessed using the Estimated Annual Percentage Change (EAPC). Globally, there was an increase in deaths and DALYs from 1990 to 2019, despite decreasing ASMR and ASDR. In 2019, SSB-related CVDs accounted for approximately 193.1 thousand deaths and 3973.2 thousand DALYs. China had the highest number of deaths, Tajikistan had the highest ASMR, and Yemen had the highest ASDR in 2019. ASMR and ASDR increased with age and were higher in males. Deaths and DALYs increased overall, except in high Socio-demographic Index (SDI) regions. ASMR and ASDR declined across SDI regions, with the steepest decline in high SDI regions (EAPC: -2.8 for ASMR, -2.36 for ASDR). ASDR increased in low SDI countries but decreased in high SDI countries. This study provides comprehensive insights into the global burden of SSB-related CVDs. Urgent interventions and policies are needed to reduce SSB consumption and mitigate the impact on cardiovascular health.

Engaging with 'less affluent' communities for food system transformation: a community food researcher model (FoodSEqual project)

The UK food system is distorted by inequalities in access, failing the people most in need, yet it should provide access to safe, nutritious affordable food for all citizens. Dietary patterns are associated with socio-demographic characteristics, with high levels of diet-related disease mortality attributed to poor dietary habits. Disadvantaged UK communities face urgent public health challenges, yet are often treated as powerless recipients of dietary and health initiatives. The need for food system transformation has been illustrated within recent UK government policy drivers and research funding. The Food Systems Equality project is a research consortium that aims to 'co-produce healthy and sustainable food systems for disadvantaged communities'. The project focusses on innovating food products, supply chains and policies, placing communities at the centre of the change. Tackling the above issues requires new ways of working. Creative approaches in food research are known to empower a wider range of individuals to share their 'lived food experience' narratives, building relationships and corroborating co-production philosophies, thus promoting social justice, and challenging more traditional positivist/reductionist 'biomedical' approaches for nutrition and food studies. This review paper critiques the use of community-centric approaches for food system transformation, focusing on one, a community food researcher model() as an exemplar, to highlight their utility in advocating with rather than for less affluent communities. The potential for creative methods to lead to more equitable and lasting solutions for food system transformation is appraised, consolidating the need for community-driven systemic change to foster more progressive and inclusive approaches to strengthen social capital. The paper closes with practice insights and critical considerations offering recommendations for readers, researchers, and practitioners, enabling them to better understand and apply similar approaches.

Rural-urban disparities in fruit and vegetable consumption and cognitive performance in Brazil

OBJECTIVES

Rural residents are exposed to many risk factors for poor diet quality, such as low socioeconomic status and food insecurity. However, the differences between urban and rural residents regarding the association of fruit and vegetable consumption with cognitive performance have not been explored. The aim of this study was to investigate the association of fruit and vegetable consumption with cognitive performance in urban and rural areas in a nationally representative sample of Brazilian older adults.

METHODS

The sample included 9,412 adults aged 50 years or older from the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros [ELSI]). The association between consumption of fruits and vegetables and cognitive performance was evaluated using linear regression.

RESULTS

In 8,158 participants (mean age 61.6 ± 9.3 years, 54% women, 44% White, and 15% from rural areas), the mean frequency of fruit and vegetable consumption was 2.0 ± 1.3 times a day. Higher intake of fruits and vegetables was associated with better memory (ß = 0.031, 95%CI 0.014-0.049), verbal fluency (ß = 0.030, 95%CI 0.004-0.056), and global cognition (ß = 0.035, 95%CI 0.015-0.055) performance in urban, but not rural residents (p for interaction = 0.036).

CONCLUSIONS

Higher frequency of fruit and vegetable intake was associated with better cognitive performance in urban, but not in rural areas in Brazil.

Socioeconomic distribution of food outlet availability through online food delivery services in seven European countries: A cross-sectional study

This area-level cross-sectional study examined online food outlet availability through the most popular online food delivery service platforms (OFDS) across seven European countries, and explored how this online food outlet availability was socioeconomically distributed. Data collection of online food outlet availability was automated in England, Italy, Luxembourg, the Netherlands, Portugal, Spain and Switzerland. We used a geographic information system to join online food outlet availability to socio-demographic information. Median number of food outlets delivering through OFDS was highest in England and lowest in Italy, Portugal and Spain. We also found that high-income areas have the greatest online food outlet availability in most countries. In England, areas with a middle income had the least online food outlets available and no income data was available for Switzerland. Further work is needed to understand drivers of disparities in online food outlet availability, as well as possible implications for public health.

Food Is Medicine: A Presidential Advisory From the American Heart Association

Unhealthy diets are a major impediment to achieving a healthier population in the United States. Although there is a relatively clear sense of what constitutes a healthy diet, most of the US population does not eat healthy food at rates consistent with the recommended clinical guidelines. An abundance of barriers, including food and nutrition insecurity, how food is marketed and advertised, access to and affordability of healthy foods, and behavioral challenges such as a focus on immediate versus delayed gratification, stand in the way of healthier dietary patterns for many Americans. Food Is Medicine may be defined as the provision of healthy food resources to prevent, manage, or treat specific clinical conditions in coordination with the health care sector. Although the field has promise, relatively few studies have been conducted with designs that provide strong evidence of associations between Food Is Medicine interventions and health outcomes or health costs. Much work needs to be done to create a stronger body of evidence that convincingly demonstrates the effectiveness and cost-effectiveness of different types of Food Is Medicine interventions. An estimated 90% of the $4.3 trillion annual cost of health care in the United States is spent on medical care for chronic disease. For many of these diseases, diet is a major risk factor, so even modest improvements in diet could have a significant impact. This presidential advisory offers an overview of the state of the field of Food Is Medicine and a road map for a new research initiative that strategically approaches the outstanding questions in the field while prioritizing a human-centered design approach to achieve high rates of patient engagement and sustained behavior change. This will ideally happen in the context of broader efforts to use a health equity-centered approach to enhance the ways in which our food system and related policies support improvements in health.

The association between diet quality and chronic obstructive pulmonary disease: a case-control study

BACKGROUND

Previous investigations have primarily examined the relationship between various dietary patterns and the risk of chronic obstructive pulmonary disease (COPD); however, there have been limited studies that have evaluated the association between diet quality presented by Healthy Eating Index 2010 (HEI-2010) and COPD. The aim of this study was to investigate this association in Iranian population.

METHODS

This case-control study recruited 84 cases and 252 healthy controls who were randomly selected. Diet, smoking, and physical activity were assessed using validated questionnaires. The HEI-2010 score ranged from zero to hundred twenty, with zero indicating an unhealthy diet and hundred twenty indicating a healthy diet. Logistic regression models were utilized to analyze the association between HEI-2010 and the odds of COPD.

RESULTS

Results from logistic regression showed that individuals with higher HEI scores had a significantly lower odds of COPD (OR: 0.34; 95% CI: 0.16-0.72). After adjusting for confounders, individuals with the highest HEI score were 82% less likely to have COPD (OR: 0.18; 95% CI: 0.03-0.96). This association remained significant after adjusting for smoking and physical activity (OR: 0.08; 95% CI: 0.01-0.93) and with additional adjustment for BMI (OR: 0.08; 95% CI: 0.01-0.92).

CONCLUSIONS

This study found a significant association between a higher HEI-2010 score and a lower odd of COPD in the Iranian population. These results suggest that a healthy diet may play a crucial role in reducing the odds of COPD and in improving the function of the lungs. However, further prospective studies are warranted to elucidate this relationship.

Global and national prevalence of nonalcoholic fatty liver disease in adolescents: An analysis of the global burden of disease study 2019

BACKGROUND AND AIMS

NAFLD in adolescents is an increasing health crisis worldwide, but its exact global, continental, and national prevalence, its relationship with other metabolic conditions, and the human development index (HDI) globally are not known.

APPROACH AND RESULTS

We analyzed data from the Global Burden of Disease Study 2019 to compare global, continental, and national prevalence rates of adolescent NAFLD and associations with other metabolic conditions and HDI. The global NAFLD prevalence in adolescents increased from 3.73% in 1990 to 4.71% in 2019 (a relative increase of 26.27%). The prevalence for the male and female populations was 5.84% and 3.52% in 2019, respectively. The Oceanian and North American continents had the highest adolescent NAFLD prevalence (median: 6.54% and 5.64%, respectively), whereas Europe had the lowest prevalence (median: 3.98%). South America and North America had the highest relative increase in adolescent NAFLD prevalence from 1990 to 2019 (median: 39.25% and 36.87%, respectively). High body mass index and type 2 diabetes mellitus increased significantly in adolescents worldwide. However, only high body mass index and not type 2 diabetes mellitus correlated with NAFLD prevalence in adolescents globally. Countries with a higher HDI had larger increases in adolescent NAFLD prevalence from 1990 to 2019 although countries with the highest HDI (HDI: > 0.9) had the lowest NAFLD prevalence in 2019.

CONCLUSIONS

NAFLD in adolescents is an increasing health problem on all continents. Improving environmental factors, including lifestyle but also healthcare policies, can help to prevent NAFLD from developing in children and adolescents and help to improve outcomes in children and adolescents with NAFLD.

Global trends indicate increasing consumption of dietary sodium and fiber in middle-income countries: A study of 30-year global macrotrends

According to the Global Burden of Disease Study, 3 million deaths were attributable to high sodium intake and low intake of whole grains. With the rapid evolution of the food industry, we hypothesize that dietary intake of sodium has increased and that dietary intake of whole grains or fibers has decreased because of easier access to highly processed food. Country-level data on dietary factors and country income levels from 1990 to 2018 were collected from 3 public databases. The trend of dietary intake was modeled using the linear mixed model accounting for random effects of individual countries. The country-level differences in dietary factors between males and females were calculated, and the trends were also modeled accounting for the random effects of countries. Both males and females consumed increasing amounts of dietary sodium from 1990 to 2018 in high-income, middle- to high-, middle-, and low-income countries. Dietary fiber intake increased in low-to-middle, middle-, and middle-to-high income countries for both men and women over the past 3 decades. Men tend to consume more sodium and less fiber and whole grains in their diets than women, the trend of which is statistically significant in middle-income countries. Over the past 3 decades, the macrotrend of dietary sodium has increased around the globe. To reduce the sodium intake level, nutrition policy should emphasize sodium reduction, especially in high-income, middle- to high-income, middle-income, and low-income countries.

Developmental origins of health and disease knowledge is associated with diet quality in preconception young adult men and women

The Developmental Origins of Health and Disease (DOHaD) approach supports that nutritional exposures in early life affect an individual's later health and risk of disease. Dietary exposure during the preconception period may also influence individual, and inter- and transgenerational health and disease risk, in both men and women. This study aimed to describe knowledge of the DOHaD approach (DOHaDKNOWLEDGE) and diet quality in preconception young adults in Norway, to assess associations between DOHaDKNOWLEDGE and a Diet Quality Score (DQS), and to assess gender differences in those above. Data from 1362 preconception young adults was obtained from the PREPARED study baseline dataset. The sample had 88% women participants, a mean age of 27 years, 36% had overweight or obesity, and 77% had higher level of education. DOHaDKNOWLEDGE was assessed by the participants' agreement to five statements using a Likert scale. Diet quality was assessed using aspects of diet quality and a DQS derived from a dietary screener. We found moderate level of both DOHaDKNOWLEDGE (12/20 points) and diet quality (DQS: 60/100 points), indicating potential for improvements. Specifically, the greatest potential for diet quality improvements were observed for sugary foods, red and processed meats, legumes, and unsalted nuts and seeds. Gender differences were observed for both DOHaDKNOWLEDGE and diet quality. DOHaDKNOWLEDGE was positively associated with DQS, adjusted for sociodemographic factors, with little evidence of an interaction effect by gender. This study indicates that knowledge of the DOHaD approach is positively associated with diet quality in preconception young men and women. Future studies should consider incorporating pregnancy intentions, relationship status, and health literacy.

Ultra-processed food consumption in Argentina according to income level and its association with the intake of healthy foods

Ultra-processed foods (UPFs) are associated with unhealthy diets and chronic diseases. Hence, knowing the consumption pattern of UPFs in the general population is crucial to design policies to improve public health, such as the recently approved law for the Promotion of Healthy Eating in Argentina (Law N° 27.642). The aim of the study was to characterise the consumption of UPFs according to income level and to assess their association with the intake of healthy foods in the Argentinian population. Healthy foods were defined in this study as those non-UPF groups that have been shown to reduce the risk of non-communicable diseases and excluded certain natural or minimally processed foods such as red meat, poultry and eggs. We retrieved data from the 2018-2019 National Nutrition and Health Survey (ENNyS 2), a cross-sectional, nationally representative survey performed in Argentina, including 15 595 inhabitants. We classified the 1040 food items recorded by the degree of processing using the NOVA system. UPFs represented nearly 26% of daily energy. The intake of UPFs increased with income, with a difference of up to 5 percentage points between the lowest (24%) and the highest (29%) income levels (p < 0.001). Cookies, industrial pastries, cakes and sugar-sweetened beverages were the most consumed UPF items, accounting for 10% of daily energy intake. We found that UPF intake was associated with a decrease in consumption of healthy food groups, mainly fruits and vegetables, where a difference of -28.3 g/2000 kcal and -62.3 g/2000 kcal between tertile 1 and tertile 3 was estimated, respectively. Therefore, Argentina still maintains a UPF consumption pattern of a low- and middle-income country, where UPF intake increases with income, but these foods also compete with the intake of healthy foods.

Global squid contamination by halogenated polycyclic aromatic hydrocarbons and its trade induced risk transfer

Squid is traded globally as an important food resource. However, the occurrence of carcinogenic halogenated polycyclic aromatic hydrocarbons (HPAHs) in squid and the risk of their transfer through trade is little understood or recognized. Here, we comprehensively evaluated the occurrence and risk transfer by quantifying the congener-specific concentrations of HPAHs in 121 squid samples collected from the Pacific, Atlantic and Indian oceans. This was the first time that nine of the 36 target chlorinated and brominated PAH congeners had been detected in squid. The HPAHs exhibited growth-dilution effects in the squid. The lipid content of squid was the most significant factor influencing HPAH bioaccumulation, while differences in squid growth and local ocean contamination influenced by geographical distribution also affected HPAH bioaccumulation. The redistribution and risk transfers of HPAHs in squid as a food could be affected by international trading. The cancer risks from squid consumption in China and Mexico were increased by 50 % and 30 %, respectively, because of international squid trading.

Epidemiological Trends in Cardiovascular Disease Mortality Attributable to Modifiable Risk Factors and Its Association with Sociodemographic Transitions across BRICS-Plus Countries

BRICS-Plus countries (Brazil, Russia, India, China, South Africa, and 30 other countries) is a group of 35 countries with emerging economies making up more than half of the world's population. We explored epidemiological trends of cardiovascular disease (CVD) mortality attributable to modifiable risk factors and its association with period and birth cohort effects and sociodemographic index (SDI) across BRICS-Plus countries by using joinpoint regression and age-period-cohort modeling from 1990 to 2019. Between 1990 and 2019, the all-ages CVD deaths increased by 85.2% (6.1 million to 11.3 million) across BRICS-Plus countries. The CVD age-standardized mortality rate attributable to dietary risks and smoking significantly decreased across BRICS-Plus countries, with some exceptions. However, four-fifths of BRICS-Plus countries observed a remarkable increasing trend of high body mass-index (BMI)-related CVD deaths, in particular, among younger adults (25-49 years). Early birth cohorts and individuals aged greater than 50 years showed a higher risk of CVD mortality. Both the China-ASEAN FTA and Mercosur regions stand out for their successful sociodemographic transition, with a significant reduction in CVD mortality over the study period. Singapore and Brazil achieved great progress in CVD mortality reduction and the other BRICS-Plus countries should follow their lead in adopting public health policies and initiatives into practice.

Deep Learning-Based Near-Infrared Hyperspectral Imaging for Food Nutrition Estimation

The limited nutritional information provided by external food representations has constrained the further development of food nutrition estimation. Near-infrared hyperspectral imaging (NIR-HSI) technology can capture food chemical characteristics directly related to nutrition and is widely used in food science. However, conventional data analysis methods may lack the capability of modeling complex nonlinear relations between spectral information and nutrition content. Therefore, we initiated this study to explore the feasibility of integrating deep learning with NIR-HSI for food nutrition estimation. Inspired by reinforcement learning, we proposed OptmWave, an approach that can perform modeling and wavelength selection simultaneously. It achieved the highest accuracy on our constructed scrambled eggs with tomatoes dataset, with a determination coefficient of 0.9913 and a root mean square error (RMSE) of 0.3548. The interpretability of our selection results was confirmed through spectral analysis, validating the feasibility of deep learning-based NIR-HSI in food nutrition estimation.

Global meta-analysis shows reduced quality of food crops under inadequate animal pollination

Animal pollination supports the production of a wide range of food crops fundamental to maintaining diverse and nutritionally balanced diets. Here, we present a global meta-analysis quantifying the contribution of pollination to multiple facets of crop quality, including both organoleptic and nutritional traits. In fruits and vegetables, pollinators strongly improve several commercially important attributes related to appearance and shelf life, whereas they have smaller effects on nutritional value. Pollination does not increase quality in stimulant crops, nuts, and spices. We report weak signals of a pollination deficit for organoleptic traits, which might indicate a potential service decline across agricultural landscapes. However, the deficit is small and non-significant at the α = 0.05 level, suggesting that pollen deposition from wild and/or managed pollinators is sufficient to maximise quality in most cases. As producing commercially suboptimal fruits can have multiple negative economic and environmental consequences, safeguarding pollination services is important to maintain food security.

Assessment of Diet Quality in Children and Adolescents with Overweight or Obesity in Greece

The adoption of healthy nutritional habits constitutes one of the most important determinants of healthy growth and development in childhood. Few studies in Greece have examined children's diet quality using diet indices. The present study aimed to assess the diet quality of a large cohort of children and adolescents with overweight or obesity. Study participants (n = 1335), aged 2-18, were recruited through the Out-patient Clinic for the Prevention and Management of Overweight and Obesity in Childhood and Adolescence, Aghia Sophia Children's Hospital, Athens, Greece. Anthropometric, socio-demographic, and behavioral data were collected using standard methods and equipment. The Diet Quality Index (DQI), which includes four subcomponents (i.e., dietary diversity, dietary quality, dietary equilibrium, and meal index), was calculated to assess each subject's diet quality. According to the results of this study, children's total DQI score was 63.1%. It was observed that 66.7% of the children had at least moderate diet quality (total DQI ≥ 59.34%). Boys had higher values of the total DQI and certain components of the DQI (i.e., dietary equilibrium score and meal index) compared to girls. Three out of ten children with overweight/obesity had poor diet quality (i.e., DQI ≤ 59.33). Younger children (2-5 years old) were found to have the lowest values of dietary equilibrium compared to older children (6-9 and 12-18 years old). Moreover, boys had higher values of the total DQI score and of specific components of this index (i.e., dietary equilibrium and meal index) compared to girls. Children living in urban areas had higher values in the dietary quality score compared to those living in rural areas. Children with overweight had higher values of the dietary quality score and the total DQI score compared to children with obesity. The present study highlighted that children and adolescents with overweight or obesity have poor diet quality. Multilevel and higher intensity interventions should be designed specifically for this group to achieve tangible outcomes.

Epidemiological trend and age-period-cohort effects on cardiovascular disease mortality and disability-adjusted life years attributable to dietary risks and high body mass index at the regional and country level across China and Pakistan

Background

Modifiable risk factors are major drivers of cardiovascular disease (CVD). We aimed to determine the epidemiological trend and age-period-cohort effects on CVD burden attributable to dietary risks and high body mass index (BMI) across China and Pakistan from 1990 to 2019.

Methods

Data on the all-ages and age-specific CVD burden, age-standardized CVD mortality and disability-adjusted life years (DALYs) rates were obtained from the Global Burden of Disease Study 2019. Joinpoint regression analysis was conducted to find temporal trends and age-period-cohort (APC) modeling was used to estimate age, period, and cohort effects on CVD burden.

Results

Between 1990 and 2019, the all-ages CVD burden attributable to dietary risks and high BMI increased by ~2-3-fold in China and by 3-5-fold in Pakistan. The diet-related CVD age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate significantly decreased in China but increased in Pakistan. Both countries showed a marked increasing trend of CVD ASMR and the age-standardized DALYs rate attributable to high BMI. Taiwan in China showed a remarkable reduction in CVD burden. However, in Pakistan, all regions observed a significantly increasing trend of CVD burden attributable to modifiable risk factors. A higher risk ratio of premature CVD mortality (<70 years) was observed among Chinese attributable to high BMI and among Pakistani attributable to dietary risks. In China, early birth cohorts showed a higher risk ratio and recent birth cohorts experienced a lower risk ratio of CVD burden compared with Pakistan.

Conclusion

In conclusion, dietary risks and high BMI caused a huge CVD burden across China and Pakistan.

Toward an Integrated Consideration of 24 h Movement Guidelines and Nutritional Recommendations

While physical activity, sleep and sedentary behaviors are almost always considered independently, they should be considered as integrated human behaviors. The 24 h Movement approach proposes a concomitant consideration of these behaviors to promote overall health. Not only do these behaviors impact energy expenditure, but they have also been shown to separately impact energy intake, which should be further explored when considering the entire integration of these movement behaviors under the 24 h movement approach. After an evaluation of the prevalence of meeting the 24 h Movement and dietary recommendations, this review summarizes the available evidence (using English publications indexed in PubMed/MEDLINE) regarding the association between the 24 h Movement Guidelines and eating habits. Altogether, the results clearly show the beneficial impact of promoting the 24 h guidelines simultaneously, highlighting that the higher the number of respected movement recommendations, the better eating behaviors in both children and adults. Importantly, our results point out the importance of emphasizing the need to reach sedentary guidelines for better eating habits. Movement and dietary behaviors appear closely related, and giving recommendations on one might impact the other. Combining the 24 h Movement with dietary Guidelines might be more efficient than promoting them separately in public health strategies.

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents' physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world's child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15-19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.

The Impact of Free Sugar on Human Health-A Narrative Review

The importance of nutrition in human health has been understood for over a century. However, debate is ongoing regarding the role of added and free sugars in physiological and neurological health. In this narrative review, we have addressed several key issues around this debate and the major health conditions previously associated with sugar. We aim to determine the current evidence regarding the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood. We also present some predominant theories on mechanisms of action. The findings suggest a negative effect of excessive added sugar consumption on human health and wellbeing. Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health. Further research into individual effects of carbohydrate forms in diverse populations is needed to understand the complex relationship between sugar and health.

Adherence to Healthy and Sustainable Dietary Patterns and Long-Term Chronic Inflammation: Data from the EPIC-Potsdam Cohort

OBJECTIVES

We explored the prospective associations between adherence to a priori chosen dietary patterns, including EAT-Lancet (EAT-L) and Mediterranean (tMDS) diet with long-term inflammatory responses in a German population sample.

DESIGN AND SETTING

Prospective cohort study.

PARTICIPANTS

A subsample of 636 predominantly healthy participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study who were on average 51-years old at baseline.

MEASUREMENTS

Data was collected repeatedly between 1994/1998 - 2013. At baseline (1994/1998) and 6.8-years later (2001/2005), EAT-L and tMDS scores were derived from available food frequency questionnaires. Stable high, stable low, increasing, and decreasing adherence to EAT-L and tMDS were defined as scoring above/below baseline median at baseline and 6.8-years later. Long-term chronic inflammation was assessed based on the average values of repeated measurements of two inflammatory biomarkers - chemerin and high-sensitivity C-reactive protein (hs-CRP) - in plasma samples collected between 2010/2012 and 2013. Multivariable linear regression analysis adjusted for socio-demographic and lifestyle factors at baseline and in 2010/2012 was used to assess the association between diet adherence and long-term hs-CRP and chemerin concentrations.

RESULTS

Stable high or increasing adherence to EAT-L diet compared to stable low adherence was associated with slight reduction of long-term chemerin concentrations on the long run (stable high: -4.4%; increasing: -4.0%), not reaching statistical significance. Increasing adherence to tMDS compared to stable low adherence was also associated with a minor reduction in chemerin concentrations (-3.6%). Decreasing adherence to tMDS compared stable high adherence was associated with 2.7% higher chemerin. The associations were even less pronounced when hs-CRP was used as an outcome.

CONCLUSIONS

Adherence to healthy and sustainable dietary patterns defined using existing definitions for EAT-L and tMDS were associated with minor and not statistically significant reduction in the concentrations of inflammatory biomarkers on the long run. More research is needed to explore whether following these diets may represent a suitable approach for targeted prevention in the general population.

Dietary patterns and their association with cardiovascular risk factors in Ethiopia: A community-based cross-sectional study

Purpose

To identify the dietary patterns and their association with cardiovascular risk factors among adult people in urban and rural areas of Wolaita, southern Ethiopia.

Methods

A total of 2,483 participants aged 25-64 years were selected using a three-stage random sampling. Data for this study were collected using structured questionnaires, the previous 24-h dietary intake assessment, anthropometric, blood pressure, and biochemical measurements. We used factor analysis to identify dietary patterns. Factors associated with dietary patterns were analyzed using multiple linear regression models. The adjusted regression coefficients with their 95% CI were used to ascertain the association.

Result

We identified three major dietary patterns that explained 51% of the variance in food consumption. The western dietary pattern was characterized by the consumption of meat/organ meat, biscuits/sweets, chicken stew, pasta-macaroni recipes, butter, white wheat bread, egg recipe, and Ethiopian dish shiro-wet, and was positively associated with urban residence, obesity, hypertension, blood glucose, and total cholesterol levels. Adherence to the consumption of tubers, whole-grain maize products, coffee leaves-and-herbs beverage, legumes, and sweet potatoes featured the traditional dietary pattern. The traditional dietary pattern showed a positive relationship with rural residence, physical activity, and obesity, and it had a negative relationship with hypertension. The healthy dietary pattern was characterized by the intake of green leafy vegetables, green pepper, and whole-grain maize products, and negatively related to obesity, and hypertension, while positively related to urban residence.

Conclusion

The coexistence of western, traditional, and healthy dietary patterns in the present study indicates the transition to a new dietary pattern in the study area. All dietary patterns were associated with one or more cardiovascular risk factors, but the western dietary pattern was associated with most of these, while the traditional diet showed fewer such associations. Therefore, it might be useful to promote healthy and traditional dietary patterns along with physical activity. Interventions related to the current findings, if initiated early in life, may benefit the public in preventing cardiovascular risk factors such as obesity, hypertension, and type 2-diabetes.