Whole grains and human health

Aligning front-of-pack labelling with dietary guidelines: including whole grains in the health star rating

PURPOSE

Front-of-pack labelling systems, such as the Health Star Rating (HSR), aim to aid healthy consumer dietary choices and complement national dietary guidelines. Dietary guidelines aim to be holistic by extending beyond the individual nutrients of food, including other food components that indicate diet quality, including whole grains. We aimed to test the feasibility of including whole grains in the HSR algorithm, to better inform dietary guidance in Australia coherent with existing dietary guidelines.

METHODS

We assigned whole-grain points as a favourable component of the HSR based on the whole-grain content of foods. We compared the original, and three modified HSR algorithms (including altered thresholds for star ratings) using independent-samples median tests. Finally, we used Spearman's correlation to measure the strength of association between an item's nutritional composition (all components of the HSR algorithm including all favourable and unfavourable components) and their HSR using each algorithm.

RESULTS

Up to 10 points were added for products with ≥ 50% whole-grain content, with no points for products with < 25%. Adjusting the HSR score cut-off by 3 points for grain products created the greatest difference in median HSR between refined and whole-grain items (up to 2 stars difference), compared to the original algorithm (a maximum of 1 star).

CONCLUSIONS

The addition of whole grains to the HSR algorithm improved the differentiation of refined and whole-grain items, and therefore better aligned with dietary guidelines. Holistic approaches to food guidance systems are required to provide consistent messaging and inform positive food choices.

Healthy Eating beyond Whole Grains-Insight on Associations between Diet Quality and Arterial Stiffness in the Brisighella Heart Study Cohort

Although whole grains have well-recognized protective effects against the development of cardiometabolic diseases, whole grain foods are poorly consumed by the general population. The aim of our study was to establish, at a population level, the vascular impact of a low intake of whole grain foods. From the initial cohort of the Brisighella Heart Study, we identified a population sample of 1503 individuals-including 720 men (47.9%) and 783 women (52.1%)-who overall largely consumed refined grain products. Diet quality was estimated by the Short Healthy Eating Index (sHEI), and women were found to have an eating pattern that was overall healthier than men (44.1 ± 8.5 vs. 36.3 ± 8.1, p < 0.001). The development of an age- and blood pressure (BP)-adjusted multiple linear regression model found that carotid-femoral pulse wave velocity (cfPWV) was significantly predicted by the estimated glomerular filtration rate (eGFR, B = -0.148, 95% Confidence Interval (CI) -0.259--0.038, p < 0.001), serum uric acid (SUA, B = 0.220, 95%CI 0.095-0.320, p = 0.001) and sHEI (B = -0.231, 95%CI -327--0.089, p < 0.001) in men, and by eGFR (B = -0.152, 95%CI -0.266--0.052, p < 0.001), body mass index (BMI, B = 0.174, 95%CI 0.111-0.331, p = 0.002), SUA (B = 0.278, 95%CI 0.158-0.354, p < 0.001) and sHEI (B = -0.218, 95%CI -308--0.115, p < 0.001) in women. Ultimately, a low sHEI score was a significant predictor of arterial stiffness also in a population cohort with a high consumption of refined grain products.

Association between Whole-Grain Intake and Obesity Defined by Different Anthropometric Indicators and Dose-Response Relationship Analysis among U.S. Adults: A Population-Based Study

Existing research shows an inconsistent correlation between whole-grain intake and obesity risk, with limited study on the dose-response relationship. Here, we aimed to examine this association and dose-response relationship among U.S. adults who participated in a NHANES (2003-2018). The intake of whole grain was collected and calculated from two rounds of 24 h dietary recall. Obesity was categorized based on body mass index (BMI) and waist circumference (WC). Weighted multivariable logistic regression models were used to calculate the odds of obesity according to whole-grain intake, and the dose-response relationship was modeled by restricted cubic spline regression. Among the 27,862 participants, 38.3% had general obesity, while 58.3% had abdominal obesity. After multivariate adjustment of potential confounders, the participants in the highest quintile of whole-grain intake had a lower prevalence of general obesity (OR 0.79; 95% CI 0.72-0.88) and abdominal obesity (OR 0.80; 95% CI 0.73-0.89) compared with those in the lowest category. Spline regression showed an inversely linear dose-response association between whole-grain intake and the prevalence of general obesity and abdominal obesity. In conclusion, a higher whole-grain intake was associated with lower odds of obesity, both general and abdominal. Our findings highlight the importance of increasing the whole-grain intake to prevent and manage obesity.

Development and validity testing of the Canadian Food Scoring System (CFSS), a nutrient profile model based on the recommendations of Canada's Food Guide 2019

Canada's food guide (CFG) 2019 provides dietary guidance for all Canadians; however, there is no tool available to help Canadians easily determine how individual foods align with CFG. Therefore, the objectives of this study were (1) to develop a nutrient profile model, Canadian Food Scoring System (CFSS), to rank the healthfulness of individual foods according to the recommendations of CFG; and (2) to assess its validity. The CFSS was developed based on CFG, leveraging existing Canadian labelling regulations to set quantitative criteria for the CFG recommendations. The CFSS included three main steps: (1) classifying foods into the nutritious food categories and assigning points based on the alignment with the recommendations of CFG; (2) deducting points based on the levels of saturated fat, sugars, and sodium using thresholds from Canadian front-of-pack labelling regulations; and (3) calculating the final score from the first two steps to classify foods into one of five categories: "very poor," "poor," "fair," "good," or "excellent" choice. Convergent validity was assessed by examining the alignment of the CFSS with Health Canada's CFG-Food Classification System using a national food composition database and the Healthy Eating Food Index-2019 using nationally representative dietary intake survey data. The CFSS showed strong correlation with the CFG-Food Classification System (ρ = 0.782, p < 0.001) and moderate correlation with the Healthy Eating Food Index-2019 (r = 0.636, p < 0.001), indicating good convergent validity both at the food and dietary level. The newly developed CFSS can assess the alignment of individual foods with CFG, which can be used to help Canadians more easily make healthy food choices.

[Bioactive components of whole grain and their effect on health]

Introduction

Non-communicable diseases represent a global health burden with increasing prevalence. To prevent or improve this type of diseases, dietary strategies based on healthy foods have been suggested. Cereals are the most consumed foods in the world and preventive effects of whole grains on health have been described. The germ and bran of cereals are abundant in bioactive compounds, including phytochemicals, vitamins, minerals and fibers, and these compounds are effective in preventing and improving non-communicable diseases. This review analyzes the content and distribution of the primary components of whole grains (wheat, barley, oats, rice and black wheat) and their fractions, focusing on the mechanisms by which phenolic acids and dietary fiber contribute to reducing the risk of metabolic and cardiovascular diseases and cancer. There is clear evidence of the broad cellular and physiological effects of bioactive compounds in whole grains, supporting the health value of a diet rich in whole grains.

Comprehensive Strategies for Metabolic Syndrome: How Nutrition, Dietary Polyphenols, Physical Activity, and Lifestyle Modifications Address Diabesity, Cardiovascular Diseases, and Neurodegenerative Conditions

Several hallmarks of metabolic syndrome, such as dysregulation in the glucose and lipid metabolism, endothelial dysfunction, insulin resistance, low-to-medium systemic inflammation, and intestinal microbiota dysbiosis, represent a pathological bridge between metabolic syndrome and diabesity, cardiovascular, and neurodegenerative disorders. This review aims to highlight some therapeutic strategies against metabolic syndrome involving integrative approaches to improve lifestyle and daily diet. The beneficial effects of foods containing antioxidant polyphenols, intestinal microbiota control, and physical activity were also considered. We comprehensively examined a large body of published articles involving basic, animal, and human studie, as well as recent guidelines. As a result, dietary polyphenols from natural plant-based antioxidants and adherence to the Mediterranean diet, along with physical exercise, are promising complementary therapies to delay or prevent the onset of metabolic syndrome and counteract diabesity and cardiovascular diseases, as well as to protect against neurodegenerative disorders and cognitive decline. Modulation of the intestinal microbiota reduces the risks associated with MS, improves diabetes and cardiovascular diseases (CVD), and exerts neuroprotective action. Despite several studies, the estimation of dietary polyphenol intake is inconclusive and requires further evidence. Lifestyle interventions involving physical activity and reduced calorie intake can improve metabolic outcomes.

Sex differences in the relationships between macronutrients and all-cause mortality in individuals with metabolically unhealthy overweight/obesity

This study investigates sex differences in the effects of macronutrient quantity, quality, and timing on mortality in metabolically unhealthy overweight/obesity (MUO) populations. The study included 18,345 participants, including 9204 men and 9141 women. The Cox proportional risk model and isocaloric substitution effects were used to examine the association of macronutrient intake and subtype with all-cause mortality in the MUO populations. After adjusting for the potential covariates, The risk of all-cause mortality was elevated in men in the highest 25% percentile of poor-quality carbohydrates compared with men in the lowest quartile (odds ratio [OR]: 2.04; 95% confidence interval [CI], 1.40-2.98). Compared with women in the lowest quartile, the risk of all-cause mortality for women in the highest 25% percentile for high-quality carbohydrates (OR: 0.74; 95% CI, 0.55-0.99) and unsaturated fatty acids (OR: 0.54; 95% CI, 0.32-0.93) were decreased. In women, replacing low-quality carbohydrates with high-quality carbohydrates on an isocaloric basis reduces the risk of all-cause mortality by approximately 9%. We find that different macronutrient consumption subtypes are associated with all-cause mortality in MUO populations, with differential effects between men and women, and that the risk of all-cause mortality is influenced by macronutrient quality and meal timing.

Associations between whole grains intake and new-onset hypertension: a prospective cohort study

IMPORTANCE

Epidemiological evidences regarding the association between whole grain intake and the risk of new-onset hypertension are still controversial.

OBJECTIVE

We aimed to investigate the relationship between whole grain intake and new-onset hypertension and examine possible effect modifiers in the general population.

METHODS

A total of 10,973 participants without hypertension from the China Health and Nutrition Survey were enrolled, with follow-up beginning in 1997 and ending in 2015. Whole grain intake was assessed by 3 consecutive 24-h dietary recalls combined with a household food inventory. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression model after adjusting for potential risk factors.

RESULTS

During a median follow-up of 7.0 years, 3,733 participants developed new-onset hypertension. The adjusted HRs (95% CIs) were as follows: for quartile 2 (HR: 0.52; 95% CI: 0.47-0.57), quartile 3 (HR: 0.46; 95% CI: 0.42-0.51), and quartile 4 (HR: 0.35; 95% CI: 0.31-0.38), compared with quartile 1. Different types of whole grain types, including wheat (adjusted HR, 0.35; 95% CI, 0.32-0.39), maize (adjusted HR, 0.50; 95% CI, 0.42-0.59), and millet (adjusted HR, 0.38; 95% CI, 0.30-0.48), showed significant associations with a reduced risk of hypertension. The association between whole grain intake and new-onset hypertension was stronger in individuals with older age (P for interaction < 0.001) and higher BMI (P for interaction < 0.001).

CONCLUSION

Higher consumption of whole grains was significantly associated with a lower risk of new-onset hypertension. This study provides further evidence supporting the importance of increasing whole grain intake for hypertension prevention among Chinese adults.

Exploring Chitosan Lactate as a Multifunctional Additive: Enhancing Quality and Extending Shelf Life of Whole Wheat Bread

The shelf life of whole wheat bread (WWB) significantly impacts its freshness and overall quality. This research investigated the impact of chitosan lactate (CL) on various characteristics influencing the shelf life of WWB, including its physical, chemical, textural, antimicrobial, and sensory attributes. These characteristics were evaluated by conducting various experiments such as physical inspection, moisture, impedance, swelling, color, texture, FTIR, microbiological, and sensory analysis. CL with different concentrations was incorporated into WWB formulations: P0.0 (0.0% w/w CL, control), P0.5 (0.5% w/w CL), P1.0 (1.0% w/w CL), P2.0 (2.0% w/w CL), and P3.0 (3.0% w/w CL). The inclusion of CL promoted the Maillard reaction (MR) compared to P0.0. The promotion of MR resulted in the formation of a shinier crust, which increased as the CL content was increased. P0.5 comprised large-sized pores and exhibited increased loaf height. CL-containing WWB formulations showed an increased moisture content and decreased impedance values compared to the control. FTIR analysis of P0.5 demonstrated the enhanced interaction and bonding of water molecules. P0.5 demonstrated optimal textural, colorimetric, and antimicrobial properties compared to other formulations. The sensory attributes of WWBs remain unchanged despite CL addition. In conclusion, P0.5 exhibited optimal characteristics associated with better quality and prolonged shelf life.

Chromatographic Methods for the Determination of Glyphosate in Cereals Together with a Discussion of Its Occurrence, Accumulation, Fate, Degradation, and Regulatory Status

The European Union's recent decision to renew the authorization for the use of glyphosate until 15 December 2033 has stimulated scientific discussion all around the world regarding its toxicity or otherwise for humans. Glyphosate is a chemical of which millions of tons have been used in the last 50 years worldwide to dry out weeds in cultivated fields and greenhouses and on roadsides. Concern has been raised in many areas about its possible presence in the food chain and its consequent adverse effects on health. Both aspects that argue in favor of toxicity and those that instead may indicate limited toxicity of glyphosate are discussed here. The widespread debate that has been generated requires further investigations and field measurements to understand glyphosate's fate once dispersed in the environment and its concentration in the food chain. Hence, there is a need for validated analytical methods that are available to analysts in the field. In the present review, methods for the analytical determination of glyphosate and its main metabolite, AMPA, are discussed, with a specific focus on chromatographic techniques applied to cereal products. The experimental procedures are explained in detail, including the cleanup, derivatization, and instrumental conditions, to give the laboratories involved enough information to proceed with the implementation of this line of analysis. The prevalent chromatographic methods used are LC-MS/MS, GC-MS/SIM, and GC-MS/MS, but sufficient indications are also given to those laboratories that wish to use the better performing high-resolution MS or the simpler HPLC-FLD, HPLC-UV, GC-NPD, and GC-FPD techniques for screening purposes. The concentrations of glyphosate from the literature measured in wheat, corn, barley, rye, oats, soybean, and cereal-based foods are reported, together with its regulatory status in various parts of the world and its accumulation mechanism. As for its accumulation in cereals, the available data show that glyphosate tends to accumulate more in wholemeal flours than in refined ones, that its concentration in the product strictly depends on the treatment period (the closer it is to the time of harvesting, the higher the concentration), and that in cold climates, the herbicide tends to persist in the soil for a long time.

Association between Whole Grain Intake and Chronic Kidney Disease

BACKGROUND

The relationship between whole grain intake and chronic kidney disease (CKD) remains uncertain.

OBJECTIVE

This study aimed to evaluate the association between whole grain intake and risk of CKD in Chinese adults.

METHODS

The present cross-sectional study used data from the China Health and Nutrition Survey conducted in 2009. Whole grain intake was measured using 3 consecutive 24-h dietary recalls and a household food inventory. A multivariable logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for risk of CKD. In addition, a restricted cubic spline was used to investigate the dose‒response relationship between whole grain and risk of CKD.

RESULTS

A total of 6747 participants were included, 728 of whom had CKD. Compared with those in the lowest whole grain intake group, those in the higher grain intake group had an inverse association with risk of CKD (Q2: adjusted OR 0.70, 95% CI: 0.54, 0.89; Q3: adjusted OR 0.54, 95% CI: 0.42, 0.69; and Q4: adjusted OR 0.29, 95% CI: 0.21, 0.41). The association between whole grain intake and CKD seems to be stronger for individuals who were male (P for interaction = 0.008) or smokers (P for interaction = 0.013). In addition, the restricted cubic spline suggested an obvious L-shaped correlation.

CONCLUSIONS

Increased whole grain intake was associated with a decreased risk of CKD in Chinese adults.

Effect of Flour Particle Size on the Glycemic Index of Muffins Made from Whole Sorghum, Whole Corn, Brown Rice, Whole Wheat, or Refined Wheat Flours

The unique properties of sorghum are increasingly being studied for potential health benefits, with one area of emphasis being the impact of sorghum consumption on mitigating type 2 diabetes. The glycemic index (GI) of muffins made from whole grain sorghum flour ground to three different particle sizes (fine, intermediate, coarse) was tested on eight healthy volunteers (ages 18-40) and compared to the glycemic index of whole grain corn, wheat, and rice flours produced using a similar product formula. Sorghum flour ground through a 0.5 mm screen ("fine") had an overall similar particle size to that of the brown rice flour ground using a 0.5 mm screen. The range of GI values was 32 to 56, with only the GI of intermediate milled sorghum flour being lower than that of corn, rice, or wheat (p < 0.05). The lowest glycemic index (32 +/- 17) was found when using sorghum flour with an intermediate particle size (167 +/- 4 μm). Muffins made using brown rice had the next lowest glycemic index at 37 +/- 17. All GI values calculated had large standard deviations, which is common for these types of studies. These results can assist in the product development process to advance the quality of healthy, gluten-free sorghum-based foods for consumers. Further research should investigate if these results can be duplicated and the possible reason for the lower GI of intermediate particle size sorghum flour.

Nutrition policy critical to optimize response to climate, public health crises

The effects of unanticipated crises on health care and first-responder systems are reflected in climate-fueled environmental emergencies, to which human resilience is diminished by our chronic disease epidemic. For example, people who depend on specialized medications, like refrigerated insulin for diabetes, will likely face additional challenges in receiving treatment and care during extreme heat, floods, disasters, and other adverse events. These circumstances may be compounded by staff and equipment shortages, lack of access to fresh food, and inadequate healthcare infrastructure in the wake of a disaster. Simply put, our health care and first-response systems struggle to meet the demands of chronic disease without such crises and may be fundamentally unable to adequately function with such crises present. However, nutrition's primacy in preventing and controlling chronic disease directly enhances individual and public resilience in the face of existential threats. Highlighting the shared diet-related etiology clearly demonstrates the need for a national policy response to reduce the disease burden and potentiate mitigation of the sequelae of climate risks and capacity limits in our food and health care systems. Accordingly, this article proposes four criteria for nutrition policy in the Anthropocene: objective government nutrition recommendations, healthy dietary patterns, adequate nutrition security, and effective nutrition education. Application of such criteria shows strong potential to improve our resiliency despite the climate and public health crises.

Nordic diet and its benefits in neurological function: a systematic review of observational and intervention studies

Introduction

Neurological disorders have been considered the major contributors to global long-term disability and lower quality of life. Lifestyle factors, such as dietary patterns, are increasingly recognized as important determinants of neurological function. Some dietary behaviors, such as Nordic diet (ND) were likely to have protective effects on brain function. However, an understanding of the effectiveness of the ND pattern to improve neurological function and brain health is not fully understood. We review the current evidence that supports the ND pattern in various aspects of neurological function and addresses both proven and less established mechanisms of action based on its food ingredients and biochemical compounds.

Methods

In this systematic review, PubMed, Web of Science, and Scopus databases were searched from inception to February 2023. Observational and intervention studies were included.

Results

Of the 627 screened studies, 5 observational studies (including three cohorts and two cross-sectional studies) and 3 intervention studies investigating the association between ND and neurological function. Observational studies investigated the association of ND with the following neurological functions: cognition, stroke, and neuropsychological function. Intervention studies investigated the effects of ND on cognition and depression.

Discussion

Despite the limited literature on ND and its association with neurological function, several aspects of ND may lead to some health benefits suggesting neuroprotective effects. The current state of knowledge attributes the possible effects of characteristic components of the ND to its antioxidant, anti-inflammatory, lipid-lowering, gut-brain-axis modulating, and ligand activities in cell signaling pathways. Based on existing evidence, the ND may be considered a recommended dietary approach for the improvement of neurological function and brain health.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/], identifier [CRD2023451117].

Fifty shades of grain - Increasing whole grain consumption through daily messages

Despite numerous health benefits, the majority of consumers, in particular young adults, show low levels of whole grain consumption behaviour (WGCB). In order to increase WGCB, this pre-registered experimental study investigates the effect of a two weeks message intervention. Participants (n = 329) received either information about health benefits, recipe suggestions, a combination of both, or about a control topic. We evaluated WGCB at three time points: prior to, immediately after (post), and one month after the intervention (follow-up). Our findings show that participants read the message on most of the days and on average, evaluate the health-only message most positively. Furthermore, we found that health messages, but not recipe suggestions significantly increase WGCB at the follow-up measure. This effect was serially mediated by attitudes and behavioural intentions at the post-intervention measure, with more positive attitudes and higher intentions leading to more WGCB. Although health messages are an effective tool to influence WGCB, the effect is small in magnitude and consumption levels remain rather low. We discuss implications for future research and for the communication of whole grain related health benefits among different stakeholders in the health sector.

Evaluation of nutritional and functional properties of anatomical parts of two sorghum (Sorghum bicolor) varieties

Compositional differences exist among grain varieties as well as in the content of respective fractions. The proximate composition, amino acids, mineral contents, and functional properties of white and brown sorghum and its anatomical parts (dehulled and bran) were studied. The results showed that the bran had higher crude protein, crude fat, crude fibre, and ash contents for both sorghum varieties than the whole grain and dehulled samples. Likewise, significantly (p ≤ 0.05) higher essential and non-essential amino acids and minerals, particularly calcium, zinc, potassium were recorded for the bran samples compared to the whole grains or dehulled ones. With regard to the functional properties, the hydration capacity, hydration index, water, and oil absorption capacities of the dehulled samples were significantly (p ≤ 0.05) lower than the other investigated samples, except for bulk density, which was significantly (p ≤ 0.05) higher. In contrast, none of the swelling capacities differed significantly in any of the samples. In conclusion, sorghum bran has significant potential in the food industry and could be an excellent material for formulating high-fibre foods and serving as a nutritionally-rich food ingredient.

Diet is Linked to Colorectal Cancer Risk among Asian Adults: A Scoping Review

This review aimed to map current evidence on the association between dietary factors and colorectal cancer (CRC) risk in Asia. This review was conducted based on Arksey and O'Malley methodological framework. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow diagram was used to record the review process. For the purpose of searching for articles, three electronic databases namely PubMed, EBSCOHost and ScienceDirect were employed. The inclusion criteria for articles selection were articles with association analysis between diet and CRC risk among Asians, had adults as participants, articles were written in English, open-accessed and published between years 2009 and 2021. Thus, 35 out of 369 screened articles were eventually included in this review which covered 28 case-control studies, six prospective cohort studies and one randomised clinical trial. Foods such as meats, alcohol and westernised diet have been shown to be associated with increase of CRC risk while fruits, vegetables and traditional meals decreased the risk of CRC. Only a few interventional and dietary patterns studies were identified. Specific single foods and nutrients and dietary patterns have been found to increase the risk but also protected the Asian population against CRC. The findings of this review will guide health professionals, researchers and policy makers to conduct a suitable study design and topic for future research.

Dietary Patterns of Patients with Prediabetes and Type 2 Diabetes

Given the worldwide high prevalence of type 2 diabetes, the prevention and control of this disease has become an urgent priority. In this research, we report the results from a cross-sectional study conducted in the counties of Suceava and Iasi, northeast of Romania, on 587 patients with type 2 diabetes and 264 patients with prediabetes. By employing a factor analysis (principal component) on 14 food groups followed by varimax orthogonal rotation, three dietary patterns were identified for each group. In prediabetes, a low adherence to a specific dietary pattern (1 and 2) was associated with lower fasting plasma glucose, blood pressure and serum insulin, compared to increased adherence. In patients with diabetes, a low adherence to Pattern 1 was associated with lower systolic blood pressures, while a low adherence to Pattern 3 was associated with a lower HbA1c, compared to high adherence. Statistically significant differences between the groups were observed for fats and oils, fish and fish products, fruit, potatoes, sugars, preserves and snacks intake. The study demonstrated that certain food patterns are associated with increased blood pressure, fasting blood glucose and serum insulin.

Measures of carbohydrate quality and their association with diet quality and cardiometabolic health outcomes in Singapore middle-aged and older adults

BACKGROUND AND AIMS

Carbohydrate quality may play a key role in cardiometabolic health and disease risk. This study aimed to assess the dietary carbohydrate quality of the free-living middle-aged and older adults in Singapore, and its association with overall diet quality and cardiometabolic health.

METHODS AND RESULTS

This cross-sectional study examined the diet and cardiometabolic disease risk indicators of middle-aged and older adults in Singapore (n = 104). Dietary carbohydrate quality was assessed as the pass and fail rate of the population to four measures of carbohydrate quality: (i) dietary fiber recommended daily allowance (RDA), (ii) whole-grain recommendation, (iii) free sugar recommendation, and (iv) carbohydrate metrics. The association between each carbohydrate quality measure and diet quality, as well as cardiometabolic health, was assessed. Except for free sugar recommendation, the carbohydrate quality of the population was found to be poor with a low adherence (20-36%) to three measures. Subjects meeting these measures had generally higher intakes of fiber, protein, and most micronutrients compared with subjects who failed. Meeting different variants of the carbohydrate metrics was associated with 60% lower odds of pre-hypertensive blood pressure (p = 0.037; p = 0.047), and meeting the dietary fiber RDA was associated with lower waist circumference (p = 0.021).

CONCLUSION

An improvement in carbohydrate quality is warranted among free-living middle-aged and older adults in Singapore. Not all measures of carbohydrate quality were equally effective in preserving overall diet quality; the carbohydrate metrics and dietary fiber RDA can be identified as effective measures in relation to cardiometabolic disease risk.

CLINICAL TRIAL REGISTRATION

https://clinicaltrials.gov/ CLINICAL TRIAL REGISTRATION: NCT03554954, 13 Sept. 2018.

Impact of a Low-Insulin-Stimulating Bread on Weight Development-A Real Life Randomised Controlled Trial

The impact on body weight development is usually analysed by comparing different diet types. Our approach was to change only one component, namely bread, common to most diets. In a single-centre triple-blind randomised controlled trial the effects of two different breads on body weight were analyzed without further lifestyle modification. Overweight adult volunteers (n = 80) were randomised 1:1 to exchange previously consumed breads for either a rye bread from milled whole grain (control) or a medium-carbohydrate, low-insulin-stimulating bread (intervention). Pre-tests demonstrated that the two bread types strongly differed in the glucose and insulin response elicited, but had similar energy content, texture and taste. The primary endpoint was the estimated treatment difference (ETD) in change of body weight after 3 months of treatment. Whereas body weight remained unchanged in the control group (-0.1 ± 2.0 kg), significant weight reduction was observed in the intervention group (-1.8 ± 2.9 kg), with an ETD of -1.7 ± 0.2 kg (p = 0.007), that was more pronounced in participants ≥ 55 years (-2.6 ± 3.3 kg), paralleled by significant reductions in body mass index and hip circumference. Moreover, in the intervention group, the percentage of participants with significant weight loss (≥1 kg) was twice as high as in the control group (p < 0.001). No other statistically significant changes in clinical or lifestyle parameters were noted. Simply exchanging a common insulinogenic bread for a low-insulin-stimulating bread demonstrates potential to induce weight loss in overweight persons, especially those at older age.

An Insight into Wheat Germ Oil Nutrition, Identification of Its Bioactive Constituents and Computer-Aided Multidimensional Data Analysis of Its Potential Anti-Inflammatory Effect via Molecular Connections

Wheat germ oil (WGO) is the richest source of unexplored antioxidants and anti-inflammatory compounds. In this study, we identified the constituents of WGO by gas chromatography-mass spectrometry (GC-MS). The physicochemical and pharmacokinetic behaviors were evaluated for the top 12 constituents with the common target FABP4. Three fatty acids with significant anti-inflammatory activity were evaluated for their interaction with FABP4 by molecular docking. The molecular mechanisms involved in anti-inflammatory responses were analyzed by various in-silico analytical tools and multidimensional data analysis. WGO showed anti-inflammatory activities via FABP4 interacting physically with target genes (77.84%) and by co-expressing with 8.01% genes. Primary targets for inflammatory pathways were PPARα, PPARγ, LPL, LEP, and ADIPOQ, as depicted by gene network enrichment analysis. The key pathways implicated were the metabolism of lipids, PPAR signaling, cellular response to alcohol, oxygen and nitrogen pathway, inflammatory response pathway, and regulation of the inflammatory pathway. The common transcription factors implicated were HNF1, AP2α, CEBP, FOX, STATS, MYC, Zic, etc. In this study, we found that WGO possesses anti-inflammatory potential via FABP4 binding to PPARα, PPARγ, LPL, LEP, and ADIPOQ gene expression by regulatory transcription factors HNF, AP2α, and CEPB.

Nutrition Patterns of Polish Esports Players

The aim of this study was to quantify the dietary patterns (DPs) of Polish esports players aged 18-26 years. Data were obtained via questionnaires that assessed dietary habits and frequency of food consumption. Dietary patterns were derived using Principal Component Analysis (PCA) and Factor Analysis (FA). In total, nine distinct DPs were identified. Eight DPs were considered unhealthy; 'fast food', 'High-processed food, meat and confectionery', 'Sweet', 'Fat-diary products', 'Vegetable-fruit', 'Spices and additives', 'Fats' and 'Cereal'; and only one was deemed healthy. E-athletes presented mostly poor dietary habits, which included: irregular eating of meals, frequent snacking, at least three meals a day and composition of snacks, frying of meat dishes and sweetening of hot drinks. Healthy dietary habits included proper hydration during the day and consumption of mainly non-sparkling water. The unbalanced and largely unhealthy dietary habits of esports players raise health concerns for these e-athletes, particularly when combined with a sedentary lifestyle. Future research could assess the nutritional knowledge of this group as it relates to national guidelines, investigate interventions designed to introduce healthier eating options into their lifestyle and examine the relationship between DPs and health or cognitive performance.

Personalized breast cancer onset prediction from lifestyle and health history information

We propose a method to predict when a woman will develop breast cancer (BCa) from her lifestyle and health history features. To address this objective, we use data from the Alberta's Tomorrow Project of 18,288 women to train Individual Survival Distribution (ISD) models to predict an individual's Breast-Cancer-Onset (BCaO) probability curve. We show that our three-step approach-(1) filling missing data with multiple imputations by chained equations, followed by (2) feature selection with the multivariate Cox method, and finally, (3) using MTLR to learn an ISD model-produced the model with the smallest L1-Hinge loss among all calibrated models with comparable C-index. We also identified 7 actionable lifestyle features that a woman can modify and illustrate how this model can predict the quantitative effects of those changes-suggesting how much each will potentially extend her BCa-free time. We anticipate this approach could be used to identify appropriate interventions for individuals with a higher likelihood of developing BCa in their lifetime.

Health Effects of Whole Grains: A Bibliometric Analysis

Whole grains have been recommended in the diet in most countries, with numerous publications focusing on their health effect. A systematic analysis of these publications on different research methods, regions and perspectives will contribute to an understanding of the innovation pattern in this field. This bibliometric study analyzes the global publication characteristics, hotspots and frontiers of whole grain health benefit research, and discusses the trends and prospects of this topic. The overall number of publications is on the rise, with the United States contributing the most publications. The most cited literature shows that observational studies, systematic reviews and meta-analysis are the most widely used methods. The main focus in this area is on dietary fiber and bioactive substances, while the latter has received increased attention in recent years in particular. With the increasingly prominent problems of hidden hunger and chronic disease, the development of whole grain foods and their optimum intake have gradually become hot topics. In addition to the need to reveal the mechanism of whole grain health effects, consensus needs to be reached on standards and definitions for whole grain foods, and attention should be paid to the retention of taste and healthy nutrients in processing.

Dietary Intakes and Eating Behavior between Metabolically Healthy and Unhealthy Obesity Phenotypes in Asian Children and Adolescents

Diet plays a critical role in the development of obesity and obesity-related morbidities. Our study aimed to evaluate the dietary food groups, nutrient intakes and eating behaviors of metabolically healthy and unhealthy obesity phenotypes in an Asian cohort of children and adolescents. Participants (n = 52) were asked to record their diet using a 3-day food diary and intakes were analyzed using a nutrient software. Eating behavior was assessed using a validated questionnaire. Metabolically healthy obesity (MHO) or metabolically unhealthy obesity (MUO) were defined based on criteria of metabolic syndrome. Children/adolescents with MUO consumed fewer whole grains (median: 0.00 (interquartile range: 0.00-0.00 g) vs. 18.5 g (0.00-69.8 g)) and less polyunsaturated fat (6.26% kcal (5.17-7.45% kcal) vs. 6.92% kcal (5.85-9.02% kcal)), and had lower cognitive dietary restraint (15.0 (13.0-17.0) vs. 16.0 (14.0-19.0)) compared to children/adolescents with MHO. Deep fried food, fast food and processed convenience food were positively associated with both systolic (β: 2.84, 95%CI: 0.95-6.62) and diastolic blood pressure (β: 4.83, 95%CI: 0.61-9.04). Higher polyunsaturated fat intake (OR: 0.529, 95%CI: 0.284-0.986) and cognitive dietary restraint (OR: 0.681, 95%CI: 0.472-0.984) were associated with a lower risk of the MUO phenotype. A healthier diet composition and positive eating behavior may contribute to favorable metabolic outcomes in children and adolescents with obesity.

Dietary contributors to fermentable carbohydrate intake in healthy American college students

OBJECTIVE

The study explored food items that contribute most toward increased fermentable carbohydrate (FC) intake and its association with diet quality in college students.

METHOD

This cross-sectional study included 571 consented college students (≥18 years) with reported energy intakes (500-3500 kcal/day for women; 800-4000 kcal/day for men). FC intake and healthy eating index-2015 (HEI-2015) scores were assessed by diet history questionnaire-II. Data were analyzed by unadjusted bivariate linear regression and Pearson correlation tests.

RESULTS

The mean intakes of total FC (β = 1.24; 95% Confidence Interval: 1.02, 1.47) significantly predicted HEI-2015 scores. Positive correlations were found between FC intake and red and orange vegetables (r = 0.62), whole fruits (r = 0.63), and dark green vegetables (r = 0.58). Conclusions: Higher FC intake was associated with higher diet quality; vegetables and fruits are primary contributors to FC content. Efforts are required to promote these food items to improve diet quality and FC intake to shape eating choices in college students.

α-Glucosidase inhibitors from brown rice bound phenolics extracts (BRBPE): Identification and mechanism

Brown rice bound phenolics extracts (BRBPE) have been reported to possess α-glucosidase inhibitory effects, the specific enzyme inhibitors involved in this process were unknown. Here, α-glucosidase inhibitors in BRBPE were screened using bioaffinity ultrafiltration methods, and seven phenolic compounds - three monomers (p-coumaric acid, ferulic acid and methyl ferulate), three dimers (8-5', 5-5' and 8-O-4' diferulic acid) and a trimer (5-5'/8-O-4″ dehydrotriferulic acid) were identified as exact inhibitors, among which 5-5'/8-O-4″ dehydrotriferulic acid and 5-5'diferulic acid exhibited the best inhibitory activity. Enzyme kinetic analysis suggested that the inhibitory mechanism of these seven inhibitors including competitive, noncompetitive, uncompetitive and mixed manner. Molecular docking analysis revealed that the seven inhibitors bind with α-glucosidase mainly by hydrogen bonding interaction, hydrophobic force and ionic bond. Molecular dynamics simulation further explored the structure and molecular property of phenolic-glucosidase complex. This work provided a deep insight into brown rice bound phenolics acting as potent α-glucosidase inhibitors.

Overview of the Composition of Whole Grains’ Phenolic Acids and Dietary Fibre and Their Effect on Chronic Non-Communicable Diseases

Chronic non-communicable diseases are the major cause of death globally. Whole grains are recommended in dietary guidelines worldwide due to increasing evidence that their consumption can improve health beyond just providing energy and nutrients. Epidemiological studies have suggested that the incorporation of whole grains, as part of a healthy diet, plays a key role in reducing one’s risk for cardiovascular diseases (CVDs), obesity, type 2 diabetes (T2D) and cancer. Phenolic acids and dietary fibre are important components found in whole grains that are largely responsible for these health advantages. Both phenolic acids and dietary fibre, which are predominantly present in the bran layer, are abundant in whole-grain cereals and pseudo-cereals. Several studies indicate that whole grain dietary fibre and phenolic acids are linked to health regulation. The main focus of this study is two-fold. First, we provide an overview of phenolic acids and dietary fibres found in whole grains (wheat, barley, oats, rice and buckwheat). Second, we review existing literature on the linkages between the consumption of whole grains and the development of the following chronic non-communicable diseases: CVDs, obesity, T2D and cancer. Altogether, scientific evidence that the intake of whole grains reduces the risk of certain chronic non-communicable disease is encouraging but not convincing. Based on previous studies, the current review encourages further research to cover the gap between the emerging science of whole grains and human health.

Whole- and Refined-Grain Consumption and Longitudinal Changes in Cardiometabolic Risk Factors in the Framingham Offspring Cohort

BACKGROUND

Greater whole grain (WG) consumption is associated with reduced risk of cardiovascular disease (CVD); however, few prospective studies have examined WG or refined grain (RG) intake and intermediate cardiometabolic risk factors.

OBJECTIVES

We examined the longitudinal association between WG and RG intake on changes in waist circumference (WC); fasting HDL cholesterol, triglyceride, and glucose concentrations; and blood pressure.

METHODS

Subjects were participants in the Framingham Offspring cohort study [n = 3121; mean ± SD baseline age: 54.9 ± 0.2 y; BMI (kg/m2) 27.2 ± 0.1]. FFQ, health, and lifestyle data were collected approximately every 4 y over a median 18-y follow-up. Repeated measure mixed models were used to estimate adjusted mean changes per 4-y interval in risk factors across increasing categories of WG or RG intake.

RESULTS

Greater WG intake was associated with smaller increases in WC (1.4 ± 0.2 compared with 3.0 ± 0.1 cm in the highest compared with the lowest category, respectively; P-trend < 0.001), fasting glucose concentration (0.7 ± 0.4 compared with 2.6 ± 0.2 mg/dL; P-trend < 0.001), and systolic blood pressure (SBP; 0.2 ± 0.5 compared with 1.4 ± 0.3 mm Hg; P-trend < 0.001) per 4-y interval. When stratified by sex, a stronger association with WC was observed among females than males. Higher intake of WG was associated with greater increases in HDL cholesterol and declines in triglyceride concentrations; however, these differences did not remain significant after adjustment for change in WC. Conversely, greater RG intake was associated with greater increases in WC (2.7 ± 0.2 compared with 1.8 ± 0.1 cm, P-trend < 0.001) and less decline in triglyceride concentration (-0.3 ± 1.3 compared with -7.0 ± 0.7 mg/dL, P-trend < 0.001).

CONCLUSIONS

Among middle- to older-age adults, replacing RG with WG may be an effective dietary modification to attenuate abdominal adiposity, dyslipidemia, and hyperglycemia over time, thereby reducing the risk of cardiometabolic diseases.

PROTOCOL: The association between whole-grain dietary intake and noncommunicable diseases: A systematic review and meta-analysis

Our primary research questions are: (1) What is the association between whole grains (WG) intake and the prevalence of NCDs (i.e., type 2 diabetes, cardiovascular disease, obesity, cancer, mortality) and their biomarkers? (2) Which biomarker(s) has/have the greatest association with WG intake when combining multiple biomarkers together in the same analysis? Our secondary research question is: (3) Are there dose-response relationships between WG intake and biomarkers and prevalence of NCDs which could help inform a universal recommendation for WG intake?

Associations of Whole Grain and Refined Grain Consumption With Metabolic Syndrome. A Meta-Analysis of Observational Studies

Background: The associations of whole grain and refined grain consumption with metabolic syndrome (MetS) has been evaluated in several epidemiological studies with conflicting results. This meta-analysis was therefore employed to further investigate the above associations. Method: We searched the PubMed, Web of Science and Embase database until March 2021 (without restriction for inclusion time), for observational studies on the associations of whole grain and refined grain consumption with MetS. The pooled relative risk (RR) of MetS for the highest vs. lowest category of whole grain and refined grain consumption, as well as their corresponding 95% confidence interval (CI) were calculated. Results: A total of 14 observational studies, which involved seven cross-sectional and seven prospective cohort studies, were identified. Specifically, nine studies were related to whole grain consumption, and the overall multi-variable adjusted RR demonstrated that the whole grain consumption was inversely associated with MetS (RR = 0.80, 95%CI: 0.67-0.97; P = 0.021). With regard to refined grain consumption, 13 studies were included. The overall multi-variable adjusted RR indicated that refined grain consumption was positively associated with MetS (RR = 1.37, 95%CI: 1.02-1.84; P = 0.036). Conclusions: The existing evidence suggests that whole grain consumption is negatively associated with MetS, whereas refined grain consumption is positively associated with MetS. Our result might be helpful to better consider the diet effect on MetS. However, more well-designed prospective cohort studies are needed to elaborate the concerned issues further.

Comprehensive review of water management and wastewater treatment in food processing industries in the framework of water-food-environment nexus

Food processing is among the greatest water-consuming industries with a significant role in the implementation of sustainable development goals. Water-consuming industries such as food processing have become a threat to limited freshwater resources, and numerous attempts are being carried out in order to develop and apply novel approaches for water management in these industries. Studies have shown the positive impact of the new methods of process integration (e.g., water pinch, mathematical optimization, etc.) in maximizing water reuse and recycle. Applying these methods in food processing industries not only significantly supported water consumption minimization but also contributed to environmental protection by reducing wastewater generation. The methods can also increase the productivity of these industries and direct them to sustainable production. This interconnection led to a new subcategory in nexus studies known as water-food-environment nexus. The nexus assures sustainable food production with minimum freshwater consumption and minimizes the environmental destructions caused by untreated wastewater discharge. The aim of this study was to provide a thorough review of water-food-environment nexus application in food processing industries and explore the nexus from different aspects. The current study explored the process of food industries in different sectors regarding water consumption and wastewater generation, both qualitatively and quantitatively. The most recent wastewater treatment methods carried out in different food processing sectors were also reviewed. This review provided a comprehensive literature for choosing the optimum scenario of water and wastewater management in food processing industries.

Nutritional Properties of Rice Varieties Commonly Consumed in Italy and Applicability in Gluten Free Diet

Gluten-free diets are often characterized by an inadequate intake of nutrients and are generally monotonous for the limited number of products celiac patients can use. As rice is the most used cereal by celiac consumers, studying rice varieties nutritional characteristics is of interest to manage diet quality and variety. Proteins, total carbohydrates and amylose content of six rice varieties (Ribe, Vialone Nano, Carnaroli, Arborio, Basmati, and Fragrance) were analyzed. Analyses were performed in raw products and after boiling, stewing, and microwaving. A decrease of proteins and total carbohydrates amount was observed in cooked rice. The same was reported for amylose content with boiling showing the highest loss (average retained amylose 53%). Considering amylose percentage with respect to total carbohydrates, each variety showed either an increase or a decrease depending on cooking method. The highest values were obtained with stewing above all for Basmati rice and Arborio rice. However, exceptions can be underlined as Carnaroli rice, showing the highest percentage when boiled. In this context, nutritional characteristics of cooked rice varieties appear to be of great importance to increase specific nutritional knowledge to better manage gluten-free diets.

Determinants of US University Students' Willingness to Include Whole Grain Pasta in Their Diet

College students’ lifestyle and eating habits strongly affect their health. Among many healthy eating behaviors, including whole grain food in the diet is known as providing health benefits such as maintaining a steady blood sugar, lower cholesterol, and since it is rich in fiber and minerals, it is essential for the well-being. However, consumers’ intakes of whole grain products remain below recommendation, including college students. This study aims to evaluate determinant factors contributing to college students’ willingness to include whole grain pasta in their diets. A sample of 499 students enrolled in a US college participated in this study. Most students perceived whole grain pasta as healthy and filling and somewhat tasty. Availability and price were not barriers for consumption. Logistic regression results suggested that factors affecting students’ willingness to consume whole grain pasta in the future were the desire to eat, cognitive and affective attitudes, perception of whole grain pasta, as well as having already chosen pasta thanks to its availability at the dining. Two student segments were identified according to their healthy eating perception: Uninvolved and Health-conscious. Cognitive attitudes such as beneficial and essential had positive effects on consumption in both segments, suggesting that information provision covering specific health/nutritional benefits of whole grains for students is crucial.

Whole grain intake favorably affects blood glucose and serum triacylglycerols in overweight and obese children: A randomized controlled crossover clinical trial

OBJECTIVES

The aim of this study was to determine the effects of whole grain consumption on the metabolic profiles of overweight or obese children.

METHODS

This was a randomized crossover clinical trial with 44 overweight or obese girls. After a 2-wk run-in period, girls were randomly assigned to either intervention or control groups. Participants in the intervention group were asked to obtain 50% of their grain servings from whole grain foods each day for 6 wk. Those in the control group were asked not to consume any of these foods. A 4-wk washout period was applied following which participants were crossed over to the alternate arm. Fasting blood samples were taken before and after each phase of study.

RESULTS

Mean (± SD) age and body mass index was 11.2 ± 1.49 y and 23.5 ± 2.5 kg/m², respectively. Mean whole grain intake in intervention and control groups throughout the study was 26.5 and 3.7 g/d, respectively (P = 0.01). Whole grain consumption resulted in lower concentrations of plasma glucose (changes from baseline in intervention group: -0.10 versus 0.21 mmol/L in control group, P = 0.01), serum triacylglycerols (changes from baseline in intervention group: -0.18 versus 0.08 mmol/L in control group, P = 0.01) and higher concentrations of serum high-density lipoprotein cholesterol (changes from baseline in intervention group: 0.16 versus -0.14 mmol/L in control group, P = 0.05) after 6 wk of intervention. No effects of whole grain intake on serum concentrations of total- and low-density lipoprotein cholesterol or on blood pressure were found.

CONCLUSION

This study provided evidence supporting the beneficial effects of whole grain foods on serum concentrations of glucose, triacylglycerols and high-density lipoprotein cholesterol in overweight children.

The association between plant-based dietary patterns and risk of breast cancer: a case-control study

Limited data are available, linking the plant-based diets to breast cancer (BC). We examined the association of overall plant-based diet index (PDI), hypothesized healthful (hPDI) and unhealthful versions of a plant-based diet index (uPDI) with BC in Iranian women. This population-based case–control study included 350 cases with newly diagnosed BC and 700 age-matched apparently healthy controls. We collected dietary data using a validated, Willett-format semi-quantitative food frequency questionnaire. Using these data, we generated a PDI by dedicating positive scores to plant foods, and reverse scores to animal foods, hPDI by assigning positive scores to healthy plant foods and reverse scores to less healthy plant foods and animal foods, and finally uPDI in which positive scores were assigned to less healthy plant foods and reverse scores to healthy plant foods and animal foods. After controlling for potential confounders, individuals in the highest quartile of PDI had 67% lower odds of BC than those in the lowest quartile (OR 0.33; 95% CI 0.22–0.50). Individuals with the greatest adherence to hPDI were 36% less likely to have BC than those with the lowest adherence, in the fully adjusted model (OR 0.64; 95% CI 0.43–0.94). In terms of uPDI, women in the top quartile had a 2.23 times greater chance of BC than those in the bottom quartile (OR 2.23; 95% CI 1.48–3.36). Greater adherence to PDI and hPDI was inversely associated with the risk of BC, whereas uPDI was associated with an increased risk.

The effects of whole grain intake on anthropometric measures in overweight and obese children: a crossover randomised clinical trial

Whole-grain foods have been reported to affect body weight and satiety. However, we are aware of no study in this regard among children. The present study aimed to determine the effects of whole grain consumption on anthropometric measures in overweight or obese children. In this randomised crossover clinical trial, forty-four overweight or obese girls participated. After a 2-week run-in period, subjects were randomly assigned to either intervention (n 44) or non-intervention (n 44) groups. Subjects in the intervention group were given a list of whole-grain foods and were asked to obtain half of their grain servings from these foods each day for 6 weeks. Individuals in the non-intervention group were asked not to consume any of these foods. A 4-week washout period was applied. Then, participants were crossed over to the alternate arm. The measurements were done before and after each phase. Mean age, weight and BMI of participants were 11·2 (sd 1·49) years, 51·2 (sd 10·2) kg and 23·5 (sd 2·5) kg/m2, respectively. Despite the slight reduction in weight and BMI, there were no significant differences in changes in these anthropometric measures. We found a significant effect of whole grain intake on waist circumference (−2·7 v. 0·3 cm, P = 0·04). No significant changes in hip circumference were observed. Changes in the prevalence of overweight, obesity and abdominal obesity were not significantly different. This study indicated a beneficial effect of whole-grain foods on waist circumference in overweight children; however, these foods did not influence weight and BMI.

Premenopausal breast cancer is a health challenge: nutritional habits show potential to prevent this disease

Background:

The incidence of breast cancer had increased around the world. More premenopausal women suffer from this condition with great economic and social impact. The objective of this study is to establish possible associations between lifestyle and the presence of breast cancer in premenopausal women.

Methods:

The study population was composed of 330 premenopausal patients younger than 55 years with breast disease, cared between 2013 and 2017 at the University Hospital Mayor Méderi. Two comparison groups were formed. Patients with a tumor diagnosed as malignant considering cases and control group of patients with a tumor diagnosed as benign. With factors associated significantly in the bivariate analysis (P < .10), the hierarchically organized multiple regression model controlled by the confounding variables was constructed. The logistic regression model was adjusted by the age variable, to avoid residual confounder.

Results:

The population included 330 premenopausal women with benign and malignant breast disease: 134 cases and 196 controls. From the multivariate analysis, it was identified that the whole-grain consumption was inversely associated with presence of breast cancer (odds ratio [OR] = 0.579; 95% confidence interval [CI]: 0.339, 0.991; P = .046). On the other hand, consumption of fish was associated with the presence of breast malignancy (OR = 2.560; 95% CI: 1.200, 5.460; P = .015).

Conclusions:

Considering the epigenetic and multiomics individual profiles in the development of premenopausal breast cancer and its social and economic impact can be useful in development of modern clinical strategies with crucial interventions at the primary, secondary, and tertiary prevention levels for this disease.

Knowledge, attitudes and practices related to WG consumption among college students: a cross-sectional study in Chongqing, China

OBJECTIVES

This work aimed to investigate WG (WG)-related knowledge, attitudes, practices (KAPs) and factors affecting WG consumption among college students in Chongqing, China.

STUDY DESIGN

A cross-sectional study was performed among 2500 students from six universities using a self-administered questionnaire.

METHODS

The chi-squared test and binary logistic regression were used for data analysis.

RESULTS

Only 14.7% of the participants were aware of WG, 57.1% supported the consumption of WG, and only 8.5% consumed WG regularly in the last month. Participants with poor knowledge of WG were about 2 times more likely to not concern about chronic diseases (CDs) than concern about CDs (odds ratio [OR] = 2.241, 95% confidence interval [CI], 1.030-4.877). Women were less likely to have a poor attitude to WG compared with men (OR = 0.682, 95% CI, 0.529-0.878), whereas women were more likely to have a poor WG practice (OR = 2.335, 95% CI, 1.327-4.111).

CONCLUSIONS

Although results showed low levels of WG knowledge and practices, this study still supports positive attitudes to acquire WG-related knowledge among college students in Chongqing, China.

Whole Grains, Refined Grains, and Cancer Risk: A Systematic Review of Meta-Analyses of Observational Studies

PubMed, Web of Science, and the Cochrane Database of Systematic Reviews were searched for meta-analyses that provided risk estimates (±95% confidence intervals) for associations between intakes of whole and refined grains and risk of total and site-specific cancer. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Only meta-analyses that included whole grains and refined grains as separate food groups, and not as part of dietary patterns, were included. A total of 17 publications were identified that met inclusion criteria. Within these, results from a total of 54 distinct meta-analyses were reported for whole grains and 5 meta-analyses for refined grains. For total cancer mortality, 7 meta-analyses of cohort studies indicated that whole grain intake was associated with 6% to 12% lower risk in comparison of highest vs. lowest intake groups, and 3% to 20% lower risk for doses ranging from 15 to 90 g/day. For site-specific cancers, meta-analyses indicated that whole grain intake was consistently associated with lower risks of colorectal, colon, gastric, pancreatic, and esophageal cancers. Limited data were available for refined grains, with only 4 publications providing risk estimates, and only 1 of the meta-analyses included more than 3 studies. High intake of refined grains was associated with increased risk of colon and gastric cancer. By contrast, in the only dose-response meta-analysis, each 90 g/day consumption of refined grains was associated with a 6% lower risk of total cancer. In addition to the limited number of published meta-analyses on refined grains, results were also weakened due to the fact that refined grains were frequently defined to include both staple grain foods and indulgent grain foods, and the majority of studies included in the meta-analyses provided no specific definition of refined grains. Overall, meta-analyses of cohort and case-control studies consistently demonstrate that whole grain intake is associated with lower risk of total and site-specific cancer, and support current dietary recommendations to increase whole grain consumption. By contrast, the relationship between refined grain intake and cancer risk is inconclusive.

Dietary Habits and Risk of Early-Onset Dementia in an Italian Case-Control Study

Risk of early-onset dementia (EOD) might be modified by environmental factors and lifestyles, including diet. The aim of this study is to evaluate the association between dietary habits and EOD risk. We recruited 54 newly-diagnosed EOD patients in Modena (Northern Italy) and 54 caregivers as controls. We investigated dietary habits through a food frequency questionnaire, assessing both food intake and adherence to dietary patterns, namely the Greek-Mediterranean, the Dietary Approaches to Stop Hypertension (DASH), and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diets. We modeled the relation between dietary factors and risk using the restricted cubic spline regression analysis. Cereal intake showed a U-shaped relation with EOD, with risk increasing above 350 g/day. A high intake (>400 g/day) of dairy products was also associated with excess risk. Although overall fish and seafood consumption showed no association with EOD risk, we found a U-shaped relation with preserved/tinned fish, and an inverse relation with other fish. Similarly, vegetables (especially leafy) showed a strong inverse association above 100 g/day, as did citrus and dry fruits. Overall, sweet consumption was not associated with EOD risk, while dry cake and ice-cream showed a positive relation and chocolate products an inverse one. For beverages, we found no relation with EOD risk apart from a U-shaped relation for coffee consumption. Concerning dietary patterns, EOD risk linearly decreased with the increasing adherence to the MIND pattern. On the other hand, an inverse association for the Greek-Mediterranean and DASH diets emerged only at very high adherence levels. To the best of our knowledge, this is the first study that explores the association between dietary factors and EOD risk, and suggests that adherence to the MIND dietary pattern may decrease such risk.