Total Energy Intake: Implications for Epidemiologic Analyses

Associations of the intake of individual and multiple fatty acids with depressive symptoms among adults in NHANES 2007-2018

BACKGROUND

Previous studies have mainly focused on the effects of individual fatty acids on depressive symptoms, while the combined effect of fatty acids on the risk of depressive symptoms has not yet been extensively reported. This study evaluate the associations between individual and multiple fatty acids with depressive symptoms in U.S. adults.

METHODS

Data sets were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 cycles. Both males and females aged above 18 years with complete information about dietary fatty acids intake, depression symptoms, and covariates were included. Weighted linear regression models were conducted to evaluate the relationships between individual fatty acid intake and depressive symptoms, and restricted cubic spline (RCS) models were utilized to explore the corresponding dose-response relationships. Additionally, we implemented the weighted quantile sum (WQS) regression and quantile g-computation (QGC) models to estimate the mixed effects of 19 fatty acids and identify the predominant types.

RESULTS

After multivariable adjustments, an increase of one unit in Linoleic acid (LA), Alpha-Linolenic Acid (ALA), Arachidonic acid (AA), Docosapentaenoic acid(DPA), Docosahexaenoic acid(DHA), was associated with a decrease in depressive scores by -0.021 (95 % CI: -0.039,-0.003, p = 0.021),-0.028 (95 % CI: -0.045,-0.011, p = 0.002),-0.026 (95 % CI: -0.044,-0.008, p = 0.005), -0.026 (95 % CI: -0.042,-0.009, p = 0.003), and - 0.022 (95 % CI: -0.041,-0.003, p = 0.022), respectively. However, a per unit increase in Hexanoic acid and Octanoic acid was associated with an increase in depressive scores of 0.020 (95 % CI: 0.002,0.038, p = 0.029) and 0.026 (95 % CI: 0.004,0.048, p = 0.020), respectively. Meanwhile, significant dose-response relationships were supported by the RCS models. As for the mixed effects, both WQS and QGC models demonstrated that the mixture of polyunsaturated fatty acids (PUFAs) was inversely related to depressive symptoms, and ALA and DPA were the most critical contributors. DHA was negatively correlated with depressive symptoms in WQS analysis, but positively correlated with depressive symptoms in QGC analysis.

LIMITATIONS

The cross-sectional design limits our ability to establish causality, and 24-hour dietary recall can lead to potential inaccuracies reflecting participants' true eating habits.

CONCLUSION

Our study suggests that the single effects of each PUFA were inversely associated with depressive symptoms, except for octadecatetraenoic acid. Moreover, higher combined intake of dietary PUFAs is inversely associated with depressive symptoms in U.S. adults. Among the mixed effects of PUFAs, ALA and DPA may play predominant roles. However, DHA mixed with other fatty acids may have different effects on depressive symptoms, and further study is needed.

Ultraprocessed food consumption and risk of gallstone disease: analysis of 3 prospective cohorts

BACKGROUND

Majority of dietary intake in United States adults comes from ultraprocessed foods (UPFs), which have been linked to several adverse health outcomes. Gallstone disease is highly prevalent and constitutes a significant burden to the United States health system but remains understudied.

OBJECTIVES

This study aimed to investigate the association between UPF consumption and incident gallstone disease risk.

METHODS

In this analysis, 44,149 males in the Health Professionals' Follow-up Study (HPFS: 1986-2022), 71,145 females in the Nurses' Health Study (NHS: 1986-2021), and 90,932 females in the NHS II (1991-2021) were prospectively followed. Dietary intake was quadrennially assessed with semiquantitative food frequency questionnaires and used to identify UPFs. The primary outcome was defined as cholecystectomy. Cox proportional hazards model was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

RESULTS

Baseline median age was 54 y in HPFS, 53 y in NHS, and 36 y in NHS II. We identified 32,374 incident gallstone disease cases over 5,077,059 person-years. Participants in the highest UPF quintile had a higher incidence of gallstone disease than those in the lowest quintile (aHR: 1.29; 95% CI: 1.24, 1.36; P < 0.001). Incremental risk of incident gallstone disease was 2.8% per daily serving (95% CI: 2.4%, 3.2%; P < 0.001). This risk was driven by sugar-sweetened beverages and artificially sweetened beverages on UPF subgroup analyses. The proportion of risk mediated by obesity was 12.8% (95% CI: 7.7%, 20.5%; P < 0.001) in HPFS, 14.3% (95% CI: 10.4%, 19.4%; P < 0.001) in NHS, and 39.4% (95% CI: 31.2%, 48.1%; P < 0.001) in NHS II. The partial population attributable risk was estimated at 15.9% (95% CI: 13.4%, 18.3%).

CONCLUSIONS

UPF consumption is associated with a higher risk of gallstone disease, particularly consumption of sugar-sweetened beverages and artificially sweetened beverages. A substantial proportion of this risk is potentially mediated by obesity in younger females.

Dietary Carbohydrates, Genetic Susceptibility, and Gout Risk: A Prospective Cohort Study in the UK

This study aimed to investigate the associations between carbohydrate intake and gout risk, along with interactions between genetic susceptibility and carbohydrates, and the mediating roles of biomarkers. We included 187,387 participants who were free of gout at baseline and completed at least one dietary assessment in the UK Biobank. Cox proportional hazard models were used to estimate the associations between carbohydrate intake and gout risk. Over a median follow-up of 11.69 years, 2548 incident cases of gout were recorded. Total carbohydrate intake was associated with a reduced gout risk (Q4 vs. Q1: HR 0.67, 95% CI 0.60-0.74), as were total sugars (0.89, 0.80-0.99), non-free sugars (0.70, 0.63-0.78), total starch (0.70, 0.63-0.78), refined grain starch (0.85, 0.76-0.95), wholegrain starch (0.73, 0.65-0.82), and fiber (0.72, 0.64-0.80), whereas free sugars (1.15, 1.04-1.28) were associated with an increased risk. Significant additive interactions were found between total carbohydrates and genetic risk, as well as between total starch and genetic risk. Serum urate was identified as a significant mediator in all associations between carbohydrate intake (total, different types, and sources) and gout risk. In conclusion, total carbohydrate and different types and sources of carbohydrate (excluding free sugars) intake were associated with a reduced risk of gout.

Cross-sectional analyses of metabolites across biological samples mediating dietary acid load and chronic kidney disease

Chronic kidney disease (CKD) is a major public health burden, with dietary acid load (DAL) and gut microbiota playing crucial roles. As DAL can affect the host metabolome, potentially via the gut microbiota, we cross-sectionally investigated the interplay between DAL, host metabolome, gut microbiota, and early-stage CKD (TwinsUK, n = 1,453). DAL was positively associated with CKD stage G1-G2 (Beta (95% confidence interval) = 0.34 (0.007; 0.7), p = 0.046). After adjusting for covariates and multiple testing, we identified 15 serum, 14 urine, 8 stool, and 7 saliva metabolites, primarily lipids and amino acids, associated with both DAL and CKD progression. Of these, 8 serum, 2 urine, and one stool metabolites were found to mediate the DAL-CKD association. Furthermore, the stool metabolite 5-methylhexanoate (i7:0) correlated with 26 gut microbial species. Our findings emphasize the gut microbiota's therapeutic potential in countering DAL's impact on CKD through the host metabolome. Interventional and longitudinal studies are needed to establish causality.

Maternal nutrition during mid-pregnancy and children's body composition at 7 years of age in the SELMA study

Optimal nutrition during pregnancy is vital for both maternal and child health. Our objective was to explore if prenatal diet is associated with children's height and body fat. Nutrient intake was assessed through a FFQ from 808 pregnant women and summarised to a nutrition index, 'My Nutrition Index' (MNI). The association with children's height and body fat (bioimpedance) was assessed with linear regression models. Secondary analysis was performed with BMI, trunk fat and skinfolds. Overall, higher MNI score was associated with greater height (β = 0·47; (95 % CI 0·00, 0·94), among both sexes. Among boys, higher MNI was associated with 0·15 higher BMI z-scores, 0·12 body fat z-scores, 0·11 trunk fat z-scores, and larger triceps, and triceps + subscapular skinfolds (β = 0·05 and β = 0·06; on the log2 scale) (P-value < 0·05). Among girls, the opposite associations were found with 0·12 lower trunk fat z-scores, and smaller subscapular and suprailiac skinfolds (β = -0·07 and β = -0·10; on the log2 scale) (P-value < 0·05). For skinfold measures, this would represent a ± 1·0 millimetres difference. Unexpectedly, a prenatal diet in line with recommended nutrient intake was associated with higher measures of body fat for boys and opposite to girls at a pre-pubertal stage of development.

Is the association between sleep and socio-emotional development mediated by weight in toddlers aged 12 to 36 months?

Introduction

Childhood is an important stage for socio-emotional development. Understanding the associations of lifestyle habits with the healthy development of social and emotional skills is crucial for better interventions early in life. This study aims to analyze the association between sleep and socio-emotional development in toddlers aged 12 to 36 months and examine whether weight mediated these associations.

Methods

This study is part of a cluster randomized controlled trial developed in Portuguese childcare centers. A sample of 344 children (176 females) enrolled in the study. Participants' anthropometrics were measured while at childcare centers using standardized procedures. Body mass index (BMI) was computed as the body weight/height2 (kg/m2) ratio. Sleep quality was collected with the Tayside Children's Sleep Questionnaire, a 10-item scale that evaluates the child's ability to initiate and maintain sleep. Two additional questions regarding sleep duration were added. Parental questionnaires assessed the child's sex and date of birth, socioeconomic status, and total energy intake (TEI). Motor (fine and gross) was assessed using Bayley-III scales and socio-emotional (SE) by the Greenspan Social-Emotional Growth Chart questionnaire. Linear regression models were used to examine the associations between sleep (duration and quality) and SE with adjustments for sex, age, BMI, mothers' education, motor development, and TEI. Mediation analysis was conducted using path analysis.

Results

SE development was significantly associated with nighttime sleep duration even when adjusted for confounders (β = 0.223; 95% CI: 0.001, 0.004 and β = 0.168; 0.0003, 0.003; respectively). Sleep quality was not significantly associated with SE development, and the weight did not explain the associations between sleep and SE development.

Conclusion

This study supports that sleep duration is directly associated with SE development in toddlers. From a public health perspective, sleep duration should be prioritized in intervention programs to improve socio-emotional development early in life.

Adherence to the dietary approaches to stop hypertension and bone health in the Chinese elderly

INTRODUCTION

Many studies have demonstrated the relationship between diet and bone health, but research on the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and bone health across populations is rare. The purpose of this study was to examine associations between the DASH dietary pattern and bone health outcomes in Chinese elders, to verify whether higher adherence to the DASH was associated with better bone health in elderly populations.

MATERIALS AND METHODS

A total of 839 Chinese adults aged 50 years and above participated in this cross-sectional study. Bone mineral density (BMD) at calcaneus was measured via ultrasonic bone densitometer. A semiquantitative food frequency questionnaire (FFQ) was used to assess the usual dietary intake in the past 12 months. The DASH score was calculated based on energy-adjusted intakes of nine dietary components, including whole grains, beans, vegetables, fruits, dairy, red meat, total fat, sodium, and sugar-sweetened beverages.

RESULTS

In postmenopausal women, DASH score was significantly and positively correlated with BMD T-score after controlling potential covariates (β: 0.027 ± 0.012, P = 0.031) in multivariable linear regression models. In binary logistic regression analysis, male participants in the highest tertile of DASH score had lower risk of osteoporosis than those in the lowest tertile (odds ratio = 0.499; 95% confidence interval, 0.262-0.951; P = 0.035) after adjusting potential covariates.

CONCLUSION

Adherence to the DASH dietary pattern was associated with better bone health in Chinese elderly adults.

Diet composition, nutrient substitutions and circulating fatty acids in relation to ectopic and visceral fat depots

BACKGROUND & AIMS

Short-term randomized trials have demonstrated that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) causes a reduction or prevention of liver fat accumulation, but population-based studies on diet and body fat distribution are limited. We investigated cross-sectional associations between diet, circulating fatty acids and liver fat, visceral adipose tissue (VAT), intermuscular adipose tissue (IMAT) and other fat depots using different energy-adjustment models.

METHODS

Sex-stratified analyses of n = 9119 (for serum fatty acids) to 13 849 (for nutrients) participants in UK Biobank were conducted. Fat depots were assessed by MRI, circulating fatty acids by NMR spectroscopy and diet by repeated 24-h recalls. Liver fat, VAT and IMAT were primary outcomes; total adipose tissue (TAT) and abdominal subcutaneous adipose tissue (ASAT) were secondary outcomes. Three a priori defined models were constructed: the all-components model, standard model and leave-one-out model (main model including specified nutrient substitutions). Imiomics (MRI-derived) was used to confirm and visualize associations.

RESULTS

In women, substituting carbohydrates and free sugars with saturated fat (SFA) was positively associated with liver fat (β (95% CI) = 0.19 (0.02, 0.36) and β (95% CI) = 0.20 (0.05-0.35), respectively) and IMAT (β (95% CI) = 0.07 (0.00, 0.14) and β (95% CI) = 0.08 (0.02, 0.13), respectively), whereas substituting animal fat with plant fat was inversely associated with IMAT, ASAT and TAT. In the all-components and standard models, SFA and animal fat were positively associated with liver fat, IMAT and VAT whereas plant fat was inversely associated with IMAT in women. Few associations were observed in men. Circulating polyunsaturated fatty acids (PUFA) were inversely associated with liver fat, IMAT and VAT in both men and women, whereas SFA and monounsaturated fatty acids were positively associated.

CONCLUSIONS

Type of dietary fat may be an important determinant of ectopic fat in humans consuming their habitual diet. Plant fat and PUFA should be preferred over animal fat and SFA. This is corroborated by circulating fatty acids and overall consistent through different energy adjustment models.

TWITTER SUMMARY

In UK Biobank, intake of saturated- and animal fat were positively whereas biomarkers of polyunsaturated fat were inversely associated with liver-, visceral- and intermuscular fat. Type of dietary fat may be a determinant of ectopic fat, a risk factor for cardiometabolic disease.

Associations of specific dietary unsaturated fatty acids with risk of overweight/obesity: population-based cohort study

Background

The role of specific unsaturated fatty acids (FAs) in the development of overweight/obesity remains unclear in the general population. Here, we aimed to explore the associations of different types of unsaturated FAs with overweight/obesity risk among the Chinese population.

Methods

Eight thousand seven hundred forty-two subjects free of overweight/obesity at entry in the China Health and Nutrition Survey (CHNS) were followed up until 2015. Dietary unsaturated FAs were assessed by 3-day 24-h recalls with a weighing method in each wave. Cox regression models were used to obtain the hazard ratios (HRs) and 95% confidence intervals (CIs) for overweight/obesity risk associated with unsaturated FAs.

Results

During a median follow-up of 7 years, 2,753 subjects (1,350 males and 1,403 females) developed overweight/obesity. Consuming more monounsaturated FAs (MUFAs) was associated with a lower risk of overweight/obesity (highest vs. lowest quartile: HR 0.80, 95% CI 0.67-0.96; P-trend = 0.010). Similar inverse associations were observed for plant-MUFAs (HR_Q4vsQ1 0.83, 95% CI: 0.73-0.94; P-trend = 0.003) and animal-MUFAs (HR_Q4vsQ1 0.77, 95% CI: 0.64-0.94; P-trend = 0.004), total dietary oleic acid (OA) (HR_Q4vsQ1 0.66, 95% CI: 0.55-0.79; P-trend <0.001), plant-OA (HR_Q4vsQ1 0.73, 95% CI: 0.64-0.83; P-trend <0.001) and animal-OA (HR_Q4vsQ1 0.68, 95% CI: 0.55-0.84; P-trend <0.001). In addition, the intakes of n-3 polyunsaturated FAs (PUFAs) (HR_Q4vsQ1 1.24, 95% CI: 1.09-1.42; P-trend = 0.017) and α-linolenic acid (ALA) (HR_Q4vsQ1 1.22, 95% CI: 1.07-1.39; P-trend = 0.039) but not marine n-3 PUFAs were positively linked to overweight/obesity risk. Consumption of n-6 PUFAs (HR_Q4vsQ1 1.13, 95% CI: 0.99-1.28; P-trend = 0.014) and linoleic acid (LA) (HR_Q4vsQ1 1.11, 95% CI: 0.98-1.26; P-trend = 0.020) had marginal and positive relationships with the incidence of overweight/obesity. N-6/n-3 PUFA ratio ranging from 5.7 to 12.6 was related to higher risk of overweight/obesity.

Conclusion

Higher dietary intake of MUFAs was associated with lower overweight/obesity risk, which was mainly driven by dietary OA from either plant or animal sources. Intakes of ALA, n-6 PUFAs and LA were related to higher risk of overweight/obesity. These results support consuming more MUFAs for maintaining a healthy body weight among the Chinese population.

Association of Salt Intake with Muscle Strength and Physical Performance in Middle-Aged to Older Chinese: The Guangzhou Biobank Cohort Study

Older people have higher amounts of sodium accumulation in skeletal muscles than younger people, indicating the possible role of salt intake on muscular and physical function. This large population-based cross-sectional study examined the association of salt intake with muscle strength and physical performance in 4867 participants with an average age of 60.4 (standard deviation = 7.7) years. Information on salt intake was collected from self-reports. Absolute and relative grip strength (AGS and RGS), timed up-and-go test (TUGT), and falls were considered the indicators of muscle strength and physical performance. Linear and logistic regression were used to examine the associations of salt intake with AGS, RGS, TUGT score, and falls, adjusting for demographic and lifestyle factors, body mass index, self-rated health, and self-reported hypertension. Higher salt intake was independently associated with lower grip strength and a higher TUGT score. Versus light salt intake, the adjusted β (95% confidence interval (CI)) of AGS_max, RGS_max, and TUGT scores in those with salty taste were -0.53 (-0.97, -0.08) kg, -0.04 (-0.06, -0.02) kg per kg/m², and 0.08 (0.02, 0.14) s, respectively. A non-significant association was found between salt intake and falls. In sex-stratification analysis, the association remained in women but became non-significant in men. Our results suggest that avoiding high-salt diets may play a role in preserving muscle strength and physical function in the elderly, especially in women.

Reproducibility and Validity of a Semi-Quantitative Food Frequency Questionnaire for Assessing Dietary Intake of Vegetarians and Omnivores in Harbin, China

This study aims to evaluate the reproducibility and validity of a semi-quantitative food frequency questionnaire (SQFFQ) developed for vegetarians and omnivores in Harbin, China. Participants (36 vegetarians and 64 omnivores) administered SQFFQ at baseline (SQFFQ1) and six months later (SQFFQ2) to assess the reproducibility. The 24 h recalls (24 HRs) for three consecutive days were completed between the administrations of two SQFFQs to determine the validity. For reproducibility, Pearson correlation coefficients between SQFFQ1 and SQFFQ2 for vegetarians and omnivores were 0.45~0.88 and 0.44~0.84, respectively. For validity, unadjusted Pearson correlation coefficients were 0.46~0.83 with an average of 0.63 and 0.43~0.86 with an average of 0.61, respectively; energy-adjusted Pearson correlation coefficients were 0.43~0.82 with an average of 0.61 and 0.40~0.85 with an average of 0.59, respectively. Majority of the correlation coefficients for food groups and macronutrients decreased or remained unchanged after energy adjustment. Furthermore, all correlations were statistically significant (p < 0.05). Bland−Altman plots also showed reasonably acceptable agreement between the two methods. In conclusion, the SQFFQ developed in this study has reasonably acceptable reproducibility and validity.