Global Improvement in Dietary Quality Could Lead to Substantial Reduction in Premature Death

Comparison of food intake pattern of diabetic patients and healthy individuals in a sample of Saudi population: a case-control study

BACKGROUND

There has been a significant rise in the number of individuals diagnosed with type 2 diabetes mellitus (T2DM), with the condition reaching epidemic proportions globally. This study examined the dietary pattern of a sample of Saudi Arabian adults with T2DM compared to control non-diabetics.

METHODS

Data from 414 participants, 207 control and 207 T2DM was analyzed. Anthropometric measurements, foods intake such as vegetables, fruits, whole grains, fried foods, sweetened juice, sweets, and pastries consumption as well as physical activity were obtained by an interview-survey.

RESULTS

The consumption of vegetables, green and leafy vegetables, starchy vegetables, fruits, proteins, and milk was significantly higher in the diabetics (p< 0.0001 for all and p<0.01 for starchy vegetables). Of the case group, 79.7% of them consumed whole-wheat bread while 54.6% of them consumed low fat milk (p<0.0001). There was a significant decrease in the percentage of cases who consumed discretionary foods and sweetened juices and soft drinks (24.1%), avoided sweets (75.8%) and pastries (37.1%), (p<0.0001). There were also significant increases in the percentages of participants who use healthy fat (as olive oil) in the case group (78.7%) (p<0.001). There was a significant increase in the percentage of diabetics who followed a diet to lose weight (15%) (p<0.05). The majority of the two study groups were physically inactive (control 95.2% & case 94.2%).

CONCLUSIONS

The results of this study provide insight on that diabetics generally follow a healthy diet, yet their engagement in physical activity may not be optimal.

Perspective: Beyond the Mediterranean Diet-Exploring Latin American, Asian, and African Heritage Diets as Cultural Models of Healthy Eating

The Mediterranean diet is a well-studied cultural model of healthy eating, yet research on healthy models from other cultures and cuisines has been limited. This perspective article summarizes the components of traditional Latin American, Asian, and African heritage diets, their association with diet quality and markers of health, and implications for nutrition programs and policy. Though these diets differ in specific foods and flavors, we present a common thread that emphasizes healthful plant foods and that is consistent with high dietary quality and low rates of major causes of disability and deaths. In this perspective, we propose that nutrition interventions that incorporate these cultural models of healthy eating show promise, though further research is needed to determine health outcomes and best practices for implementation.

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 Insecurity and Premature Mortality and Life Expectancy in the US

Importance

Food insecurity has been linked to multiple causes of disease and premature mortality; however, its association with mortality by sex and across racial and ethnic groups remains unknown in the US.

Objective

To investigate the associations of the entire range of food security with all-cause premature mortality and life expectancy across racial and ethnic and sex groups in US adults.

Design, Setting, and Participants

This cohort study included adults (aged ≥18 years) who participated in the National Health and Nutrition Examination Survey from 1999 to 2018, with linkage to the National Death Index through December 31, 2019. Data analysis was performed from August to November 2023.

Exposures

Levels of food security were assessed with the US Department of Agriculture Adult Food Security Survey Module (full, marginal, low, and very low).

Main Outcomes and Measures

All-cause premature mortality (death that occurs before age 80 years) and life expectancy.

Results

The study included 57 404 adults (weighted mean [SE] age, 46.0 [0.19] years; 51.8% female; 12 281 Black individuals [21.4%]; 10 421 Mexican individuals [18.2%]; 4627 Other Hispanic individuals [8.1%]; 24 817 White individuals [43.2%]; and 5258 individuals of other races, including multiracial [9.2%]). During a median (IQR) of 9.3 (5.0-14.3) years of follow-up, 4263 premature deaths were documented. Compared with the full food security group, the adjusted hazard ratios were 1.50 (95% CI, 1.31-1.71), 1.44 (95% CI, 1.24-1.68), and 1.81 (95% CI, 1.56-2.10) across marginal, low, and very low food security groups, respectively (P < .001 for trend). The corresponding life expectancy at age 50 years in each group was 32.5 (95% CI, 32.4-32.6), 29.9 (95% CI, 28.9-30.9), 30.0 (95% CI, 28.9-31.0), and 28.0 (95% CI, 26.8-29.2) years. Equivalently, adults with marginal, low, or very low food security lived on average 2.6 (95% CI, 1.5-3.7), 2.5 (95% CI, 1.4-3.7), or 4.5 (95% CI, 3.2-5.8) fewer years at age 50 years, respectively, compared with those with full food security. The associations appeared to be stronger in women than in men (hazard ratios comparing very low food security with full food security, 2.29 [95% CI, 1.83-2.86] in women and 1.46 [95% CI, 1.19-1.78] in men; P = .009 for interaction) and stronger in White adults than in Black adults (hazard ratios comparing very low food security with full food security, 2.07 [95% CI, 1.70-2.53] in White adults and 1.33 [95% CI, 1.01-1.75] in Black adults; P < .001 for interaction) or in Hispanic adults (hazard ratios comparing very low food security with full food security, 1.06 [95% CI, 0.71-1.58]; P < .001 for interaction).

Conclusions and Relevance

In this cohort study, although the association of food security and life expectancy varied across sex and racial and ethnic groups, overall, lower levels of food security were associated with a higher risk of premature mortality and a shorter life expectancy. The findings of this study highlight the potential importance of improving food security in promoting population health and health equity.

Association between adherence to the EAT-Lancet sustainable reference diet and cardiovascular health among European adolescents: the HELENA study

BACKGROUND

The EAT-Lancet Commission proposed a global reference diet to promote healthy diets within planetary boundaries. Studies evaluating the associations between the reference diet with health outcomes among adolescents are scarce. Thus, our aim was to assess the association between adherence to the EAT-Lancet diet and cardiovascular health among European adolescents.

METHODS

Data from the HELENA study were used. Usual dietary intake was assessed using two 24-h dietary recalls and adherence to the EAT-Lancet diet was assessed using the Planetary Health Diet Index (PHDI), a 16-component index that ranges from 0 to 150 points. Cardiovascular health was assessed through the seven-component Ideal Cardiovascular Health (ICH) score: never smoked, eutrophic body mass index, moderate-to-vigorous physical activity, healthy dietary pattern, low blood pressure, low fasting plasma glucose, and low total cholesterol. Total ICH score was categorized into ideal (5-7) and non-ideal (0-4).

RESULTS

A 10-point increment in the PHDI was associated with a lower probability of a non-ideal ICH status (OR 0.84, [95% CI: 0.75, 0.94]) among European adolescents, after adjusting for age, sex, socio-economic status, and total energy intake. Furthermore, a 10-point increment in the PHDI was associated with lower probability of high blood pressure (OR: 0.87 [0.79, 0.96]) and a lower probability of high blood cholesterol (OR: 0.88 [0.78, 0.99]).

CONCLUSION

Our study suggests that a higher PHDI may be associated with a better cardiovascular health status among European adolescents.

The evolution and scope of Medicaid Section 1115 demonstrations to address nutrition: a US survey

Poor nutrition and food insecurity are drivers of poor health, diet-related diseases, and health disparities in the U.S. State Medicaid Section 1115 demonstration waivers offer opportunities to pilot food-based initiatives to address health outcomes and disparities. Several states are now leveraging 1115 demonstrations, but the scope and types of utilization remain undefined. To fill this gap, we conducted a systematic analysis of state Medicaid Section 1115 applications and approvals available on Medicaid.gov through July 1, 2023. We found that 19 approved and pending 1115 waivers address nutrition, with 11 submitted or approved since 2021. Fifteen states provide or propose to provide screening for food insecurity, referral to food security programs, and/or reporting on food security as an evaluation metric. Thirteen provide or propose to provide coverage of nutrition education services. Ten provide or propose to provide direct intervention with healthy food. The primary target populations of these demonstrations are individuals with chronic diet-sensitive conditions, mental health or substance use disorders, and/or who are pregnant or post-partum. Since 2021, state utilization of Medicaid 1115 demonstrations to address nutrition has accelerated in pace, scope, and population coverage. These findings and trends have major implications for addressing diet-related health and healthy equity in the United States.

A review of the impact of social disruptions on food security and food choice

At times of severe social disruption, be that war, conflict, pandemic, or economic downturn, both the availability and consumption of healthy dietary patterns can be adversely affected with any effects often outlasting the initial social disruption. For instance, when the COVID-19 pandemic hit and lockdown restrictions followed, households were reported to consume unhealthy diets. In some cases, this seemed to be a response to the situation and a coping mechanism. In contrast, in other cases, it was a consequence of limited food availability or access, with some communities finding that fresh foods became difficult to source due to the disruption in global supply chains. The example presented by the impact of conflict in Ukraine, which has also disrupted global food supply chains, at a macrolevel, food systems and at a microlevel, individual and community shows that food choices may respond to different global events in similar ways. Therefore, in this review, a range of events/disruptions are considered, beyond pandemics and wars, including climate disasters (e.g., fire, famine, and floods) that have been shown to impact food supply and consequently, food security. The importance of this can be seen as inadequate and nutritionally poor diets have a concomitant effect on health, which extends beyond the initial period of societal stress and disruption of food supply chains. Hence, the impact of such disruptions on consumer behavior which includes food choice needs to be corroborated. Therefore, this review aims to discuss the impact of such disruptions on consumer behavior and food choices. Additionally, this review provides some practical strategies that can be used to ensure the availability of healthy diets.

Determinants of Diet Quality in Adolescents: Results from the Prospective Population-Based EVA-Tyrol and EVA4YOU Cohorts

(1) Background: Unhealthy dietary behaviors are estimated to be one of the leading causes of death globally and are often shaped at a young age. Here, we investigated adolescent diet quality and its predictors, including nutrition knowledge, in two large Central European cohorts. (2) Methods: In 3056 participants of the EVA-Tyrol and EVA4YOU prospective population-based cohort studies aged 14 to 19 years, diet quality was assessed using the AHEI-2010 and DASH scores, and nutrition knowledge was assessed using the questionnaire from Turconi et al. Associations were examined utilizing multivariable linear regression. (3) Results: The mean overall AHEI-2010 score was 42%, and the DASH score was 45%. Female participants (60.6%) had a significantly higher diet quality according to the AHEI-2010 and DASH score. AHEI-2010 and DASH scores were significantly associated (p < 0.001) with sex, school type, smoking, and total daily energy intake. The DASH score was additionally significantly associated (p < 0.001) with age, socioeconomic status, and physical activity. Participants with better nutrition knowledge were more likely to be older, to attend a general high school, to live in a high-income household, to be non-smokers, and to have a higher diet quality according to the AHEI-2010 and DASH score. (4) Conclusions: Predictors of better diet quality included female sex, physical activity, educational level, and nutrition knowledge. These results may aid focused interventions to improve diet quality in adolescents.

Feasibility pilot study of a Japanese teaching kitchen program

Background

This pilot study examined the feasibility of a new lifestyle modification program involving a "Teaching Kitchen" in Japan. Our goal was to explore (1) feasibility of the program; (2) acceptability for class frequency (weekly vs. bi-weekly); and (3) changes in biometrics, dietary intakes, and lifestyle factors.

Methods

A total of 24 employees with obesity in a Japanese company were recruited. Participants were randomly divided into two groups (weekly or bi-weekly group), each attending the program consisting of four two-hour classes (lectures on nutrition, exercise, mindfulness, and culinary instructions). Participants were observed for changes in dietary intakes, biometrics, and health related quality of life over the subsequent 3 months. We tested the between-group differences in changes using linear mixed-effect models.

Results

The program completion rates were 83.3% in total (91.7% for weekly group and 75.0% for bi-weekly group). From baseline to post-intervention, significant decreases were observed in weight (p < 0.001), body mass index (p < 0.001), diastolic blood pressure (p = 0.03), body fat mass (p < 0.001), and dietary intakes in total fat (p = 0.03) and sodium (p = 0.008) among 17 participants who were available for measurements. Improvements in biometrics remained significant 1 month after the intervention (all p ≤ 0.03 in 14 participants). Participants' health related quality of life was significantly improved in bodily pain, general health, vitality, and mental component score (all p ≤ 0.047).

Conclusions

The new Japanese Teaching Kitchen program is feasible with high program completion rates in Japanese office workers with obesity. While this was a small feasibility study, significant multiple improvements in dietary intakes, biometrics, and health related quality of life suggest that this line of inquiry warrants further exploration to address obesity and obesity-related diseases in Japan.

Multiple socioeconomic circumstances and trajectories of fruit and vegetable consumption: the Helsinki Health Study

AIMS

Fruit and vegetable consumption is essential in disease prevention. Socioeconomic differences in consumption have been observed but evidence from longitudinal studies incorporating multiple socioeconomic indicators is lacking. We examined long-term fruit and vegetable consumption trajectories and multiple socioeconomic circumstances as their determinants.

METHODS

We used survey data from the Helsinki Health Study (phase 1 in 2000-2002, N=8960, response rate 67%; phases 2-4 in 2007, 2012 and 2017) among initially 40- to 60-year-old employees of City of Helsinki, Finland. Fruit and vegetable consumption was measured by a food frequency questionnaire and consumption times per month were calculated. Childhood (parental education, economic difficulties), conventional (own education, occupational class, household income) and material (housing tenure, wealth, current economic difficulties) socioeconomic circumstances were included. We used group-based trajectory modelling for identifying fruit and vegetable consumption trajectories and multinomial logistic regression for examining associations between socioeconomic circumstances and the trajectories.

RESULTS

Four fruit and vegetable consumption trajectories were identified: increasing higher (12%), decreasing higher (10%), stable moderate (43%) and stable low (35% of participants). Childhood, conventional and material socioeconomic circumstances were all associated with the trajectories: belonging to a lower socioeconomic group was associated with belonging to the stable low and moderate trajectories. In multivariate models, the strongest associations were found for occupational class and household wealth.

CONCLUSIONS

Disadvantageous childhood and adulthood socioeconomic circumstances were associated with lower long-term fruit and vegetable consumption. Socioeconomic circumstances should be considered in attempts to promote fruit and vegetable consumption, and people with disadvantageous circumstances need to be targeted in future interventions.

Ultra-processed foods consumption and diet quality among preschool children and women of reproductive age from Argentina

OBJECTIVE

To assess the association between the consumption of ultra-processed foods (UPF) and diet quality among preschool children and women of reproductive age from Argentina.

DESIGN

Cross-sectional and nationally representative survey. The food items were classified according to the NOVA system. Consumption of fruits, vegetables, legumes, nuts, seeds and wholegrains was estimated, and the energy and nutrients related to non-communicable disease (NCD) intake. Linear regression was used to assess the associations.

SETTING

Argentina.

PARTICIPANTS

Children aged 2-5 years (n 7022), female adolescent aged 10-19 years (n 2165) and women aged 20-49 years (n 4414).

RESULTS

UPF represented more than a quarter of total energy intake, 27 % in children, 31 % in female adolescents and 26 % in women. Across all age groups, the major contributors to UPF consumption were cookies and pastries (about 6·0-7·0 %), soft drinks (about 2·7-3·7 %), candies (about 1·8-4·6 %), and juices (about 1·3-1·7 %). The consumption of fresh vegetables, fresh fruits and legumes was negatively associated with UPF consumption. A significant positive association was found between the dietary share of UPF and the dietary content of NCD-promoting nutrients such as free sugars and total saturated and trans-fats. In contrast, a significant negative association was found with the content of NCD-protective such as fibre and protein.

CONCLUSIONS

UPF were associated with lower consumption of healthy foods and higher intake of nutrients related to NCD in children and women of reproductive age in Argentina. It is necessary to design food policies that simultaneously reduce the consumption of UPF while promoting the intake of fresh and whole foods to improve the dietary quality.

The Child and Adult Care Food Program and young children's health: a systematic review

CONTEXT

The Child and Adult Care Food Program (CACFP) is a federal nutrition program that supports young children's nutrition. Its potential impacts on child well-being have not been summarized.

OBJECTIVE

The objective of this review was to summarize the evidence for the impact of CACFP on children's diet quality, weight status, food insecurity, and cognitive development.

DATA SOURCES

Databases searched included MEDLINE, CAB Abstracts, Web of Science Core Collection, ERIC, PsycInfo, Dissertations & Theses Global (Proquest), EconLit, NBER, and the USDA's Economic Research Service (ERS), from database inception to November 12, 2021. Studies were included if the sample drew from child care programs serving children between the ages of 2 years and 18 years and if a comparison group of nonparticipating programs was included.

DATA EXTRACTION

Two reviewers independently extracted data on study design, year(s) of data collection, region, sample size, participant demographics, outcomes, and risk of bias.

DATA ANALYSIS

Due to the heterogeneity of the studies, a narrative synthesis was used.

RESULTS

Nineteen articles were reviewed, most of which had been published since 2012. Seventeen used cross-sectional designs. Twelve evaluated foods and beverages served; 4 evaluated dietary intake; 4 evaluated the child care nutrition environment; 2 evaluated food insecurity, 1 evaluated weight status; none evaluated cognitive outcomes. Studies typically found either a small beneficial association with CACFP or no significant association.

CONCLUSION

Currently, evidence for an association between CACFP and children's health is inconclusive, though it is slightly suggestive of a benefit for some dietary quality outcomes. More research, with stronger study designs, is needed.

SYSTEMATIC REVIEW REGISTRATION

A protocol for this systematic review was registered with the PROSPERO systematic review protocol registry (PROSPERO 2021 CRD42021254423).

Relative validity of the Planetary Health Diet Index by comparison with usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet among European adolescents: the HELENA study

PURPOSE

The EAT-Lancet Commission proposed an evidence-based global reference diet to improve human health within planetary boundaries. Recently, the Planetary Health Diet Index (PHDI) was developed based on the EAT-Lancet recommendations and validated among Brazilian adults. However, the relative validity of the PHDI in adolescents has yet to be assessed. Thus, we aimed to evaluate the relative validity of the PHDI in European adolescents.

METHODS

We used cross-sectional data from 1804 adolescents (12.5-17.5 years) enrolled in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study. The PHDI (0-150 points) was calculated based on dietary intake data from two non-consecutive 24-h dietary recalls. Associations between the PHDI and usual nutrient intakes, plasma food consumption biomarkers, and adherence to the Mediterranean diet were evaluated using multivariable-adjusted mixed-effects linear regression models.

RESULTS

Higher PHDI score was associated with greater intakes of nutrients predominantly from plant-source foods, such as vegetable protein, vitamin E, and folate and with lower intake of nutrients predominately from animal-source foods, such as total and saturated fat, cholesterol, and animal protein. Furthermore, a higher PHDI score was also positively associated with plasma β-carotene, vitamin C, vitamin D, folate, and ferritin concentrations, while negatively associated with trans-fatty acids concentration. Moreover, higher PHDI was related to a greater adherence to the Mediterranean dietary pattern.

CONCLUSIONS

The PHDI showed good relative validity among adolescents in the HELENA study. Hence, future research should assess adherence to the PHDI and long-term health outcomes.

Greater adherence to the Dietary Guidelines for Americans is associated with lower diet-related greenhouse gas emissions but higher costs

Introduction

Few studies have evaluated the sustainability of popular diet patterns in the US, which limits policy action and impedes consumer efficacy to make sustainable dietary changes. This study filled this gap by evaluating the relationship between diet quality, greenhouse gas emissions (GHGE), and diet cost for plant-based, restricted carbohydrate, low grain, low fat, and time restricted diet patterns.

Methods

Dietary data were retrieved from the National Health and Nutrition Examination Survey (2011-2018, n = 8,146) and linked with data on GHGE and food prices from publicly available databases. Diet quality was measured using the Healthy Eating Index-2015. The present study (1) compared the mean diet quality, GHGE, and diet cost between diet patterns, (2) evaluated the association of diet quality to GHGE and diet cost for each diet pattern, and (3) estimated the contribution of food sources to GHGE and diet cost for each diet pattern.

Results

Higher diet quality was associated with lower GHGE for the general population and for most diet patterns (p < 0.01) except for the plant-based and time restricted diet patterns (p > 0.05). Higher diet quality was associated with higher cost for the general population and for all dietary patterns (p < 0.01) except the time restricted diet pattern (p > 0.05). Protein foods, mostly beef, accounted for the largest share of GHGE (29-40%) and diet cost (28-47%) for all diet patterns except plant-based.

Discussion

Higher diet quality was associated with lower GHGE but was often accompanied by higher diet cost. These sustainability trade-offs can help inform major policy discussions in the US and shed light on further research needs in the area of food systems transformation.

Food Appreciation Scale Development and Dimensionality Assessment

Food appreciation has been associated with favorable dietary and food waste behaviors. However, no validated food appreciation assessment currently exists. This study aimed to develop and validate a food appreciation scale (FAS) using data from two independent US-based samples recruited online. The 29-item FAS was based on existing literature regarding appreciation as a psychological construct, mindful eating, and epicurean tendencies. In Study 1, 311 participants completed the FAS, and exploratory factor analysis (EFA) was conducted. In Study 2, 300 participants completed the FAS, and confirmatory factor analysis (CFA) was conducted to determine whether the factor structure remained consistent. The EFA indicated a good model fit for a four-factor structure after excluding six items that loaded on multiple or no factors (TLI 0.95, CFI 0.97, SRMR 0.03, RMSEA 0.05), and Cronbach's alpha indicated excellent reliability (Cronbach's alpha values 0.82-0.9). The CFA confirmed the four-factor structure (TLI 0.97, CFI 0.98, SRMR 0.08, RMSEA 0.05) and acceptable factor loadings with a simple structure. The factors assessed active food appreciation, reflective food appreciation, mindful epicurean tendencies, and food-related rituals. The validated FAS could allow researchers to assess food appreciation, measure changes in food appreciation over time, and compare food appreciation among different study populations.

Diet and Food and Nutrition Insecurity and Cardiometabolic Disease

Poor nutrition is the leading cause of poor health, health care spending, and lost productivity in the United States and globally, which acts through cardiometabolic diseases as precursors to cardiovascular disease, cancer, and other conditions. There is great interest in how the social determinants of health (the conditions in which people are born, live, work, develop, and age) impact cardiometabolic disease. Food insecurity is an example of a powerful social determinant of health that impacts health outcomes. Nutrition insecurity, a distinct but related concept to food insecurity, is a direct determinant of health. In this article, we provide an overview of how diet in early life relates to cardiometabolic disease and then continue to focus on the concepts of food insecurity and nutrition insecurity. In the discussions herein we make important distinctions between the concepts of food insecurity and nutrition insecurity and provide a review of their concepts, histories, measurement and assessment devices, trends and prevalence, and links to health and health disparities. The discussions here set the stage for future research and practice to directly address the negative consequences of food and nutrition insecurity.

Personal, behavioural and socio-environmental correlates of emerging adults' sustainable food consumption in a cross-sectional analysis

OBJECTIVE

Describe how dietary intake patterns of US young adults align with the EAT-Lancet Planetary Health Diet (PHD) sustainable diet goals and identify personal, behavioural, and socio-environmental correlates of sustainable intake.

DESIGN

Data on past-year dietary intake were captured using a FFQ. The PHD was applied to specific food groups, and a total PHD score was calculated. Linear regression models were used to identify associations between personal, behavioural and socio-environmental factors and PHD scores.

SETTING

This cross-sectional analysis uses data from the second wave of EAT 2010-2018 (Eating and Activity over Time), a population-based longitudinal study recruited in Minnesota.

PARTICIPANTS

Ethnically/racially diverse group of participants (n 1308) with a mean age of 22·1 (sd 2·0) years.

RESULTS

The mean PHD score was 4·1 (sd 1·4) on a scale of 0-14, with 14 representing the most sustainable. On average, participants consumed fewer whole grains, fish, legumes, soya, and nuts than ideal for a sustainable diet, and an excess of eggs, added sugar, and meat. The PHD score was higher for participants with higher socio-economic status (SES) and greater educational attainment. Higher home availability of healthy food (β = 0·24, P < 0·001) and less frequent fast-food consumption (β = -0·26, P < 0·001) were the strongest correlates of PHD scores.

CONCLUSIONS

Results suggest that a high percentage of participants may not be achieving the sustainable diet goals defined by the PHD. Reductions in meat consumption and increases in plant-based foods are necessary to increase the sustainability of US young adults' diets.

Greenhouse gas emissions, cost, and diet quality of specific diet patterns in the United States

BACKGROUND

Major policy agendas are calling for accelerated investment in research that addresses the impact of diet patterns on multiple domains of sustainability.

OBJECTIVE

To evaluate the comparative greenhouse gas emissions, diet cost, and diet quality of plant-based, low grain, restricted carbohydrate, low fat, and time restricted diet patterns on a daily per capita basis.

DESIGN

Dietary data from the National Health and Nutrition Examination Survey (2013-2016, n=4,025) were merged with data on greenhouse gas emissions (GHGE) and food prices from multiple databases. The Healthy Eating Index-2015 was used to measure diet quality.

RESULTS

The plant-based diet pattern had the lowest GHGE (3.5 kg CO2eq, 95% CI: 3.3, 3.8 kg CO2eq) and among the lowest diet cost ($11.51, 95% CI: $10.67, $12.41), but diet quality (45.8, 95% CI: 43.3, 48.5) was similar (P>0.005) to most other diet patterns. All of the sustainability impacts of the low grain diet pattern were intermediate. The restricted carbohydrate diet pattern had the highest diet cost ($18.46, 95% CI: $17.80, $19.13) but intermediate diet quality (46.8, 95% CI: 45.7, 47.9) and moderate-to-high GHGE (5.7 kg CO2eq, 95% CI: 5.4, 5.9 kg CO2eq). The low fat diet pattern had the highest diet quality (52.0, 95% CI: 50.8, 53.1) and intermediate GHGE (4.4 kg CO2eq, 95% CI: 4.1, 4.6 kg CO2eq) and diet cost ($14.53, 95% CI: $13.73, $15.38). The time restricted diet pattern had among the lowest diet quality score (42.6, 95% CI: 40.8, 44.6), had GHGE similar to most other diet patterns (4.6 kg CO2eq, 95% CI: 4.2, 5.0 kg CO2eq), and low-to-moderate diet cost ($12.34, 95% CI: $11.38, $13.40).

CONCLUSIONS

Most diet patterns were associated with sustainability trade-offs. The nature of those trade-offs can help inform discussions on food and nutrition policy in the US, including the National Strategy on Hunger, Nutrition, and Health, and future Dietary Guidelines for Americans.

Macular pigment is inversely related to circulating C-reactive protein concentrations in school-aged children

Xanthophyll carotenoids (i.e., lutein and zeaxanthin) are plant pigments that selectively deposit in the macula of the eye and provide retinal tissue with protection against photooxidative stress. Although having greater xanthophylls in various tissues is related to lower inflammation in adulthood and infancy, this relationship is underinvestigated in childhood. Thus, this study aimed to elucidate the relationships between macular xanthophyll status and inflammation in school-aged children. We hypothesized that greater macular pigment would be associated with lower systemic concentrations of C-reactive protein (CRP). Forty children (aged 7-12 years) from the East-Central Illinois area were recruited. Data were collected in a convenience sample over multiple visits to the laboratory that occurred over 1 month, including all individuals who provided adequate blood samples for analyses. Macular pigment optical density (MPOD) was assessed using customized heterochromatic flicker photometry. Dietary lutein and zeaxanthin were determined using 7-day diet records. Capillary dried blood spot samples were analyzed for CRP concentrations via enzyme-linked immunosorbent assay. Whole-body percentage fat (%Fat) was measured using dual-energy x-ray absorptiometry. Two-step hierarchical linear regression modelling was used to assess relationships between MPOD and CRP, following adjustment of pertinent covariates and the removal of outliers (N = 3). MPOD was negatively associated with CRP concentrations, after controlling for a priori covariates of age, sex, %Fat, and dietary lutein and zeaxanthin (β = -0.58, ΔR² = 0.22, P = .004). Age, sex, dietary lutein and zeaxanthin, and %Fat did not significantly contribute to the model. This study provides novel evidence that macular pigment and peripheral inflammation are inversely related in childhood.

Dried Fruits, Nuts, and Cancer Risk and Survival: A Review of the Evidence and Future Research Directions

Dried fruits and nuts contain high amounts of nutrients and phytochemicals-all of which may have anticarcinogenic, anti-inflammatory, and antioxidant properties. This narrative review summarizes the evidence for dried fruits and nuts and cancer incidence, mortality, and survival and their potential anticancer properties. The evidence for dried fruits in cancer outcomes is limited, but existing studies have suggested an inverse relationship between total dried fruit consumption and cancer risk. A higher consumption of nuts has been associated with a reduced risk of several site-specific cancers in prospective cohort studies, including cancers of the colon, lung, and pancreas, with relative risks per 5 g/day increment equal to 0.75 (95% CI 0.60, 0.94), 0.97 (95% CI 0.95, 0.98), and 0.94 (95% CI 0.89, 0.99), respectively. A daily intake of total nuts of 28 g/day has also been associated with a 21% reduction in the rate of cancer mortality. There is also some evidence that frequent nut consumption is associated with improved survival outcomes among patients with colorectal, breast, and prostate cancer; however, further studies are needed. Future research directions include the investigation of additional cancer types, including rare types of cancer. For cancer prognosis, additional studies with pre- and postdiagnosis dietary assessment are warranted.

Adherence to the EAT-Lancet sustainable reference diet and cardiometabolic risk profile: cross-sectional results from the ELSA-Brasil cohort study

PURPOSE

The EAT-Lancet Commission released a reference sustainable diet to improve human health and respect the planetary boundaries. The Planetary Health Diet Index (PHDI) was developed with the purpose of evaluate the adherence to this reference diet. The aim of the present study was to evaluate the association between adherence to the EAT-Lancet diet with cardiometabolic risk profile.

METHODS

We used the cross-sectional baseline data from 14,155 participants of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter ongoing cohort study. Dietary data were collected using a 114-item validated food frequency questionnaire. The PHDI was used to assess the adherence to the EAT-Lancet diet. It consists of 16 components and the total score can range from 0 to 150 points. Linear, logistic and quasi-Poisson regression models were built to evaluate the associations between PHDI and the outcomes.

RESULTS

Individuals with higher adherence to EAT-Lancet diet (PHDI, 5th quintile) had lower values for systolic blood pressure (β - 0.84; 95% CI - 1.66: - 0.01), diastolic blood pressure (β - 0.70; 95% CI - 1.24: - 0.15), total cholesterol (β - 3.15; 95% CI - 5.30: - 1.01), LDL-c (β - 4.10; 95% CI - 5.97: -  2.23), and non-HDL-cholesterol (β - 2.57; 95% CI - 4.62: - 0.52). No association was observed for HDL-c, triglycerides and HOMA-IR.

CONCLUSIONS

Our results indicate that higher adherence to the EAT-Lancet diet is associated with lower levels of blood pressure, total cholesterol, LDL-c, and non-HDL-c.

Canadians Adults Fail Their Dietary Quality Examination Twice

For many years, dietary quality among Canadians has been assessed using an index that gives criticized scores and does not allow for comparison with Americans. In Canadians aged ≥19 years, we aimed to (1) determine the dietary quality by using a more widely used evidence-based index that has shown associations with health outcomes, the alternative Healthy Eating Index (aHEI-2010); (2) assess changes in aHEI-2010 score and its components between 2004 and 2015; and (3) identify factors associated with aHEI-2010 score. We relied on the Canadian Community Health Survey 2004 (n = 35,107) and 2015 (n = 20,487). We used adjusted linear models with a time effect to compare the total aHEI-2010 score and its components. The overall aHEI-2010 score increased from 36.5 (95%CI: 36.2-36.8) in 2004 to 39.0 (95%CI: 38.5-39.4) in 2015 (p < 0.0001). Participants with less than a high school diploma showed the lowest score and no improvement from 2004 to 2015 (34.8 vs. 35.3, p = 0.4864). In each period, higher scores were noted among immigrants than non-immigrants (38.3 vs. 35.9 in 2004, p < 0.0001; 40.5 vs. 38.5 in 2015 p < 0.0001), and lower scores were observed in current smokers (33.4 vs. 37.1 in 2004, p < 0.0001; 34.5 vs. 39.9 in 2015, p < 0.0001). The use of the aHEI-2010 tool suggests a lower score among Canadians than the previous index, more comparable to the score among Americans.

Incremental monounsaturated to saturated fat ratio and fibre consumption is associated with a reduction in a composite score of modifiable cardiovascular risk factors: Prospective results from the Moli-sani study

BACKGROUND/OBJECTIVES

Unsaturated fats, fibre-rich foods and polyphenols are distinctive features of a traditional Mediterranean diet and have pleiotropic properties possibly contributing to reduce the long-term risk of non-communicable diseases and mortality associated with this diet. We aimed to evaluate whether changes over time in dietary fats, fibre and polyphenols consumption are associated with modifications in cardiovascular disease (CVD) risk factors.

METHODS

The analytic sample consists of a sub-cohort of 2023 men and women enrolled in the Moli-sani Study (n = 24,325). Dietary and health data were obtained both at baseline (2005-2010) and at re-examination (2017-2020). The exposures were changes in dietary fats, fibre and polyphenols consumption measured after 12.7 years (median), and the outcome was change in a composite score including 13 modifiable CVD risk factors (e.g., blood lipids, C-reactive protein), measured both at enrolment and after the 12.7 years period.

RESULTS

In multivariable-adjusted analysis including lifestyles, sociodemographic and clinical factors, an incremental intake of the ratio of monounsaturated to saturated fats or of fibre was associated with a reduction in the composite score of CVD risk factors (β = -0.086; 95%CI -0.150, -0.021 and β = -0.051; 95%CI -0.091, -0.012, respectively). Change in polyphenol intake was not associated with a substantial variation in the CVD risk score (p = 0.15).

CONCLUSIONS

An incremental consumption over time of monounsaturated versus saturated fats and of fibre was associated with an improvement in modifiable CVD risk factors as reflected by a composite score.

Health and environmental impacts of plant-rich dietary patterns: a US prospective cohort study

BACKGROUND

Diets that are rich in animal-based foods threaten planetary and human health, but plant-rich diets have varied health and environmental effects. We aimed to characterise a healthy dietary index and three plant-based indices by their environmental impacts and associations with risk of cardiovascular disease.

METHODS

In this prospective cohort study, we used data from a food-frequency questionnaire in the US-based Nurses' Health Study II. Participants were categorised by quintiles of four dietary indices, including the alternative healthy eating index-2010 (AHEI), plant-based diet index (PDI), unhealthy PDI, and healthy PDI. We calculated environmental impacts (greenhouse gas emissions and irrigation water, nitrogenous fertiliser, and high-quality cropland needs), and relative risks (RRs) of cardiovascular disease from 1991-2017, comparing quintiles.

FINDINGS

We included 90 884 participants in the health-impact analysis and 65 625 participants in the environmental-impact analysis. Comparing the top and bottom quintiles, higher AHEI scores were associated with a decreased cardiovascular disease risk (relative risk 0·77 [95% CI 0·66-0·89]); 30% lower greenhouse gas emissions (Q5 2·6 kg CO₂ equivalent vs Q1 3·7 kg CO₂ equivalent); and lower fertiliser, cropland, and water needs (all p_trends<0·0001). Similarly, the highest healthy PDI and PDI quintiles were associated with a decreased cardiovascular disease risk (healthy PDI 0·71 [0·60-0·83] and PDI 0·74 [0·63-0·85]) and lower environmental impacts (PDI water needs p_trend=0·0014; all other p_trends<0·0001). Conversely, the highest unhealthy PDI quintile had a higher cardiovascular disease risk compared with the lowest unhealthy PDI quintile (1·15 [1·00-1·33]; p_trend=0·023) and required more cropland (p_trend<0·0001) and fertiliser (p_trend=0·0008).

INTERPRETATION

Dietary patterns that are associated with better health had lower greenhouse gas emissions and nitrogenous fertiliser, cropland, and irrigation water needs. Not all plant-based diets conferred the same health and environmental benefits. US dietary guidelines should include nuanced consideration of environmental sustainability.

FUNDING

US National Institutes of Health.

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

Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.

Sociodemographic and dietary influences on perceptions of eating habits in Jamaica

Objective.

To evaluate how sociodemographic factors and food intake affect survey respondents’ perceptions of the quality of their diet.

Methods.

This cross-sectional analysis is based on a nonprobability sample of 374 participants in Jamaica aged ≥18 years. The three-stage process used a simple random sample to select three parishes; the main commercial areas of each parish were chosen for sampling. To ensure the inclusion of a cross-section that was as representative as possible, the sample included both public and private sector businesses, such as those in retail, hospitality and tourism as well as nongovernmental organizations. Employees and patrons completed a questionnaire regarding their food consumption and their perception of their own diet. Multiple correspondence analysis was used to evaluate the nonlinear relationships among the variables. The results of the analysis guided the specification of a multivariate logistic regression model that was used to estimate the relationship between sociodemographic factors, food intake and perceived eating patterns.

Results.

The average predicted probability of perceiving a diet as unhealthy was reduced when the respondent was male, economically active, in good health, and married or in a common-law relationship. The probability of perceiving a diet as unhealthy was increased for respondents with a college degree and those living in a household that had a male as the sole head. Consuming healthful food and drink reduced the perception of having a poor diet and vice versa, indicating there are possibly connections between food intake, the perception of diet quality and actual diet quality.

Conclusions.

This exploratory analysis established links between perceived diet quality, eating habits and sociodemographic factors. The impact on the perception of diet quality can be negative or positive, depending on the variable under consideration.

Dietary Catering: The Perfect Solution for Rational Food Management in Households

The problem of food waste is a global phenomenon. Food waste occurs at all stages of the food chain. Households, especially in developed countries, produce the most food waste. In order to effectively prevent consumers from throwing food away, it is important to understand the factors that determine these behaviors in the household. The aim of this study was to define the goal of using dietary catering in Polish society as a form of consumption of wholesome meals with a specific calorific value and distribution of macronutrients in the aspect of reducing losses related to food waste. The research was carried out online in the years 2020–2022 among the clients of a catering company. The survey respondents were residents of the Małopolskie Voivodeship in Poland. The research tool was an original anonymous questionnaire in the form of a shortened nutritional interview. On the basis of the obtained results, it can be concluded that factors such as age and gender influence consumer behavior. The reasons for the decision to choose dietary catering were mainly indicated as wasting and throwing away food, as well as inadequate management of food supplies and preparing too large portions of meals.

Dietary Change and Global Sustainable Development Goals

Food production for human consumption is a leading cause of environmental damage in the world and yet over two billion people suffer from malnutrition. Several studies have presented evidence that changes in dietary patterns across the world can lead to win-win outcomes for environmental and social sustainability and can complement ongoing technological and policy efforts to improve the efficiency of agricultural production. However, the existing evidence have been compiled in “silos” by a large range of researchers across several disciplines using different indicators. The aim of this quantitative review is to bring together the existing knowledge on heterogeneity of current dietary patterns across the world and how a transition toward healthy diets in different countries can aid in progress toward multiple global Sustainable Development Goals (SDGs). We first summarize the nutritional quality, economic cost, and environmental footprint of current diets of over 150 countries using multiple indicators. Next, we review which shifts in dietary patterns across different world regions can help toward achievement of SDG2 (Zero hunger), SDG3 (Good health and wellbeing), SDG 6 (Clean water and sanitation), SDG13 (Climate action), SDG14 (Life below water), and SDG15 (Life on land). Finally, we briefly discuss how to enable the shift toward sustainable dietary patterns and identify the research and data gaps that need to be filled through future efforts. Our analysis reveals that dietary change is necessary in all countries as each one has unique priorities and action items. For regions such as Sub-Saharan Africa and South Asia, increased intake of nutrient dense foods is needed to address deficiency of essential nutrients like folate, potassium, and vitamin A. For North America and Europe, shifting toward more plant-based diets would be healthier and simultaneously reduce the per capita environmental footprints. The results can be useful for policymakers in designing country-specific strategies for adoption of sustainable dietary behaviors and for food industry to ensure the supply of sustainable food items customized with regions' need.

[Intake of energy and critical nutrients according to the NOVA classification in Argentina, time trend and differences according to income]

Growing evidence of the global transition in food systems exists, affecting the availability, accessibility, affordability, and convenience of highly processed foods. This study aimed to evaluate the apparent consumption of energy, saturated fat, added sugars, and sodium according to the degree of food processing in Argentina from 1996 to 2018 and according to income level. This is a descriptive and cross-sectional study with data on food and beverage expenditures and income from the National Household Expenditure Survey for years 1996-1997, 2004-2005, 2012-2013, and 2017-2018, including more than 20,000 households in each period. The apparent daily consumption of energy, saturated fat, added sugars, and sodium per adult for: (1) minimally processed foods; (2) processed culinary ingredients; (3) processed foods; and (4) ultra-processed products, was calculated for each period and according to per capita income quintile in each household. Descriptive statistical analysis was performed. Reductions in the proportion of energy and all nutrients evaluated from minimally processed foods, culinary ingredients and processed foods were observed, as well as an increase in the consumption of ultra-processed products. One also observes a greater share from ultra-processed foods as household income increases but with decreasing differences over time. Therefore, future strategies in Argentina should promote the consumption of minimally processed foods and discourage the availability and accessibility of ultra-processed ones, especially for the most vulnerable groups.

Trends in dietary macronutrient composition and diet quality among US adults with diagnosed and undiagnosed elevated glycemic status: a serial cross-sectional study

BACKGROUND

Knowledge of glycemic status may affect dietary intake for subjects with diabetes and prediabetes.

OBJECTIVES

We aimed to determine whether trends of macronutrient intake and dietary quality differed by diagnosis of glycemic status among US adults with diabetes and prediabetes.

METHODS

Data from NHANES 1999-2016 were analyzed. Diagnosed cases were established by self-report, and undiagnosed cases were defined by laboratory criteria (glycated hemoglobin ≥ 5.7%, fasting plasma glucose ≥ 100 mg/dL, or 2-h oral-glucose-tolerance test ≥ 140 mg/dL). A difference-in-differences model was used to compare the temporal trends between the 2 groups.

RESULTS

There were 7502 diagnosed and 12,974 undiagnosed cases with elevated glycemic status included in the study. During 1999-2016, the intake of low-quality carbohydrates was lower, whereas intakes of high-quality carbohydrates, animal protein, plant protein, and unsaturated fat and the Healthy Eating Index 2015 (HEI-2015) score were higher, among the diagnosed cases than among the undiagnosed cases (P < 0.001 for all). However, in the trend analyses from 1999 to 2016, the increase in intake of high-quality carbohydrates was smaller among the diagnosed cases than among the undiagnosed cases (difference: -1.16%; 95% CI: -1.82%, -0.50%; P = 0.001). Moreover, the decrease in low-quality carbohydrate intake was smaller (difference: 0.79%; 95% CI: 0.01%, 1.57%; P = 0.05) and the increase in saturated fat intake was larger (difference: 0.44%; 95% CI: 0.08%, 0.79%; P = 0.02) among the diagnosed cases than among the undiagnosed cases. A significant difference of temporal trends in the HEI-2015 score between the diagnosed and undiagnosed cases was also observed, in favor of the undiagnosed cases (difference: -2.56; 95% CI: -3.71, -1.41; P < 0.001).

CONCLUSIONS

Although dietary habits among adults with diagnosed diabetes and prediabetes were better than those among the undiagnosed cases, these advantages have been diminishing during the past 2 decades.

Health and Sustainability Co-Benefits of Eating Behaviors: Towards a Science of Dietary Eco-Wellness

Two of the greatest challenges of our times - climate change and the linked epidemics of obesity, diabetes, and cardiovascular disease - are fueled in part by the over-consumption of carbon-intensive high calorie foodstuffs. Converging evidence from hundreds of studies has confirmed that transitioning from diets high in meat and dairy to largely plant-based diets not only is necessary for climate change mitigation but will also lead to substantive reductions in morbidity and mortality. Nevertheless, there are only the faintest beginnings of a robust science of behavioral eco-wellness, defined here as the study of how individual choices, behaviors, and habits impact both personal health and environmental sustainability. This paper focusses on the sub-field of dietary eco-wellness, which looks at health and sustainability impacts of food production, procurement, preparation, and consumption. To advance this crucial agenda, investigators will need to invent, develop, and assess approaches aimed at helping people transition towards healthier and more sustainable diets. In order to accurately and reliably assess appropriate outcomes, existing assessment methods will need to be refined, new techniques will need to be advanced, and all measurement methods will need to be validated. Local conditions will influence the effectiveness of various approaches, and so it is important that scientists and communities share their stories of success and challenge for others to learn from. This paper reviews emerging evidence from relevant studies in dozens of countries, suggesting next steps, potential pathways, and a framework for interpretation.

Cardiovascular disease burden attributable to dietary risk factors from 1990 to 2019: A systematic analysis of the Global Burden of Disease study

BACKGROUND AND AIMS

Dietary risks have always been a major risk factor for cardiovascular diseases (CVDs), especially in young people. This article aimed to provide an updated and comprehensive view of the spatial, temporal and sexual heterogeneity in diet-attributable CVD burdens from 1990 to 2019.

METHODS AND RESULTS

Data on diet-attributable CVD burdens were extracted from the Global Burden of Disease (GBD) Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs) and corresponding estimated annual percentage change (EAPC) were determined. Globally, the number of diet-attributable CVD deaths and DALYs in 2019 were 6.9 million and 153.2 million, marking 43.8% and 34.3% increases since 1990, respectively. However, ASRs of death and DALYs have declined over time. The regions with the highest ASRs of diet-related CVD deaths and DALYs were in Central Asia, whereas the lowest ASRs of CVD deaths and DALYs were observed in the high-income Asia Pacific region. Globally, men suffered higher death and DALY burdens than women. Ischemic heart disease and stroke were the leading causes of CVD deaths and DALYs, globally. Regarding the specific diet group, diets low in whole grains, high in sodium, low in fruits, low in nuts and seeds, low in vegetables and low in seafood omega-3 fatty acids contributed to CVD deaths and DALYs the most. Dietary risks accounted for a higher proportion in people aged less than 65 years old.

CONCLUSIONS

Diet-attributable CVDs threaten public health, particularly in low SDI countries and younger generations. As diet-related CVDs are nation-specific, the prioritization of public health interventions should be evidence-based.

The health, environmental, and economic dimensions of future dietary transitions in Argentina

Diets link human health with environmental sustainability, offering promising pressure points to enhance the sustainability of food systems. We investigated the health, environmental, and economic dimensions of the current diet in Argentina and the possible effects of six dietary change scenarios on nutrient adequacy, dietary quality, food expenditure, and six environmental impact categories (i.e., GHG emissions, total land occupation, cropland use, fossil energy use, freshwater consumption, and the emission of eutrophying pollutants). Current dietary patterns are unhealthy, unsustainable, and relatively expensive, and all things being equal, an increase in income levels would not alter the health dimension, but increase environmental impacts by 33-38%, and costs by 38%. Compared to the prevailing diet, the six healthier diet alternatives could improve health with an expenditure between + 27% (National Dietary Guidelines) to -5% (vegan diet) of the current diet. These dietary changes could result in trade-offs between different environmental impacts. Plant-based diets showed the lowest overall environmental impact, with GHG emissions and land occupation reduced by up to 79% and 88%, respectively, without significant changes in cropland demand. However, fossil energy use and freshwater consumption could increase by up to 101% and 220%, respectively. The emission of eutrophying pollutants could increase by up to 54% for all healthy diet scenarios, except for the vegan one (18% decrease). We conclude that the health and environmental crisis that Argentina (and other developing countries) currently face could be mitigated by adopting healthy diets (particularly plant-based), bringing in the process benefits to both people and nature.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11625-021-01087-7.

Flavonoid-Amyloid Fibril Hybrid Hydrogels for Obesity Control via Construction of Gut Microbiota

Innovative precise clinical approaches to protect humans from the alarming global growth of epidemics of chronic diseases, such as metabolic syndrome (MetS), are urgently needed. Here, we introduce protein hydrogels...

Quality and environmental footprints of diets by socio-economic status in Argentina

Food consumption and production plays a major role on human health and environmental sustainability. In addition, socio-economic status (SES) could be an important determinant on these impacts. Here we investigated the quality and environmental footprints of diets of different SES in Argentina. Dietary data was obtained from a recent national-wide representative survey (21,547 households), and individual intake was estimated by applying the Adult-Male Equivalent (AME) approach. Dietary quality was assessed by comparing the apparent consumption of foods and nutrients with the level of intake associated with the lowest risk of mortality, and applying the Alternate Healthy Eating Index 2010 (AHEI-2010). The environmental footprints were assessed with a set of six environmental indicators: greenhouse gas (GHG) emissions, total land occupation, cropland demand, fossil energy use, freshwater consumption and eutrophying emissions. Per capita total expenditure was utilized as an indicator of SES. We found a suboptimal intake of healthy and excess of unhealthy foods and nutrients in all SES, as well as a low AHEI-2010 score (34.7 ± 3.56 over 100). Regarding environmental footprints per AME, we estimated 8.91 ± 2.49 kg CO₂-eq/day for GHG emissions, 9.30 ± 2.93 MJ/day for fossil energy use, 54.2 ± 14.8 m²/day for total land occupation, 7.07 ± 1.90 m²/day for cropland demand, 205 ± 65.3 L/day for freshwater consumption and 19.8 ± 6.43 g PO₄-eq/day for eutrophying emissions. The Argentinian diet was found to be both unhealthy and unsustainable in all socio-economic levels.

2021 Dietary Guidance to Improve Cardiovascular Health: A Scientific Statement From the American Heart Association

Poor diet quality is strongly associated with elevated risk of cardiovascular disease morbidity and mortality. This scientific statement emphasizes the importance of dietary patterns beyond individual foods or nutrients, underscores the critical role of nutrition early in life, presents elements of heart-healthy dietary patterns, and highlights structural challenges that impede adherence to heart-healthy dietary patterns. Evidence-based dietary pattern guidance to promote cardiometabolic health includes the following: (1) adjust energy intake and expenditure to achieve and maintain a healthy body weight; (2) eat plenty and a variety of fruits and vegetables; (3) choose whole grain foods and products; (4) choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms); (5) use liquid plant oils rather than tropical oils and partially hydrogenated fats; (6) choose minimally processed foods instead of ultra-processed foods; (7) minimize the intake of beverages and foods with added sugars; (8) choose and prepare foods with little or no salt; (9) if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and (10) adhere to this guidance regardless of where food is prepared or consumed. Challenges that impede adherence to heart-healthy dietary patterns include targeted marketing of unhealthy foods, neighborhood segregation, food and nutrition insecurity, and structural racism. Creating an environment that facilitates, rather than impedes, adherence to heart-healthy dietary patterns among all individuals is a public health imperative.

Development and Validity of a General Nutrition Knowledge Questionnaire (GNKQ) for Chinese Adults

Nutrition knowledge refers to understanding concepts and processes related to nutrition and health, proven to be an essential determinant of healthy eating. However, partially due to the lack of nutrition knowledge and unhealthy eating patterns, more and more Chinese people face overweight, obesity, and a high risk of suffering from various chronic diseases. This study aimed to develop a general nutritional knowledge questionnaire (GNKQ) in a Chinese context to diagnose and improve nutrition knowledge education for Chinese people. The newly adapted questionnaire was based on the Turkey version of GNKQ, and absorbed dietary recommendations in a Chinese context. It was first validated by four nutrition experts, then tested by eleven volunteers (one public nutritionist, one preventive medicine graduate student, and nine psychology graduate students). Finally, the questionnaire was tested by 278 participants, including 175 adults, to determine internal consistency, content validity, and convergent validity. Moreover, the construct validity was evaluated by comparing the differences between 50 students in nutrition-related majors and 53 students in nutrition-unrelated majors. The final Chinese version of GNKQ kept 32 questions with 68 items after deleting some questions based on item difficulty and discrimination. The data showed that the overall internal consistency coefficient was 0.885, and the test-retest reliability was 0.769, p < 0.001. Students majoring in nutrition had larger scores than in nutrition-unrelated majors. The convergent validity for each demographic variable was consistent with previous studies, such as larger nutrition knowledge scores for females and those with a higher education. Therefore, the revised Chinese version of GNKQ showed good reliability and validity, indicating that it could be an effective tool to assess the nutrition knowledge of Chinese adults.

Implementation of food-based dietary guidelines: conceptual framework and analysis of the Brazilian case

OBJECTIVE

This study aimed to develop a conceptual framework of the process of food-based dietary guidelines (FBDG) implementation and analyse Brazil's employed measures to implement dietary guidelines for the Brazilian population (2014).

DESIGN

Qualitative research.

SETTING

Aiming to develop the conceptual framework, a literature review on FBDG implementation was carried out. Both documents scoped within the macropolitical sphere and scientific articles were reviewed. In the case study, measures took in Brazil were identified through a search on institutional websites and technical management reports of government sectors were responsible for FBDG implementation in the country.

PARTICIPANTS

This study does not involve humans.

RESULTS

The new conceptual framework frames FBDG implementation as a part of a larger set of intersectoral public policies to promote healthy eating and highlights two main implementation ways: educational materials and public policies. Brazil has a range of policies to promote healthy eating guided by the perspective of food as a right. Most of the implemented measures focussed on the concept of 'FBDG as educational materials,' although the recommendations have also been implemented in public policies.

CONCLUSION

The FBDG implementation should be carried out in an integrated manner with multi-sector involvement. The Brazilian's case analysis can be helpful to decision makers in food policy across the globe be inspired by the Brazilian efforts, considering that the Brazilian FBDG was one of the firsts to have adopted a multidimensional paradigm of healthy eating, including diet sustainability.

Development of an EAT-Lancet index and its relation to mortality in a Swedish population

BACKGROUND

Current global food systems threaten human health and environmental sustainability. In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both areas, but there is no consensus on how to quantify the EAT-Lancet reference diet as a diet index, and its relation to mortality has not been widely studied.

OBJECTIVES

We sought to develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large, population-based Swedish cohort. We also examined food components included in the index and their individual associations with mortality.

METHODS

We used the Malmö Diet and Cancer cohort (n = 22,421; 45-73 years old at baseline). Dietary data were collected using a modified diet history method. The EAT-Lancet index was developed based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0-3 points per component; 0-42 points in total). Associations with mortality were examined based on registers during a mean of 20 years of follow-up and were adjusted for potential confounders.

RESULTS

Divided into 5 adherence groups, the highest adherence to the EAT-Lancet diet (≥23 points) was associated with lower all-cause mortality (HR, 0.75; 95% CI, 0.67-0.85), cancer mortality (HR, 0.76; 95% CI, 0.63-0.92), and cardiovascular mortality (HR, 0.68; 95% CI, 0.54-0.84) than the lowest adherence (≤13 points). Several food components included in the index contributed to the observed reductions in mortality.

CONCLUSIONS

We developed a new dietary index to investigate adherence to the EAT-Lancet diet. The findings indicate a 25% lower risk of mortality among those with the highest adherence to the EAT-Lancet diet, as defined using our index, which adds to the evidence base for the development of sustainable dietary guidelines.

The Global Diet Quality Score is Associated with Higher Nutrient Adequacy, Midupper Arm Circumference, Venous Hemoglobin, and Serum Folate Among Urban and Rural Ethiopian Adults

BACKGROUND

Nutritionally inadequate diets in Ethiopia contribute to a persisting national burden of adult undernutrition, while the prevalence of noncommunicable diseases (NCDs) is rising.

OBJECTIVES

To evaluate performance of a novel Global Diet Quality Score (GDQS) in capturing diet quality outcomes among Ethiopian adults.

METHODS

We scored the GDQS and a suite of comparison metrics in secondary analyses of FFQ and 24-hour recall (24HR) data from a population-based cross-sectional survey of nonpregnant, nonlactating women of reproductive age and men (15-49 years) in Addis Ababa and 5 predominately rural regions. We evaluated Spearman correlations between metrics and energy-adjusted nutrient adequacy, and associations between metrics and anthropometric/biomarker outcomes in covariate-adjusted regression models.

RESULTS

In the FFQ analysis, correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B12 adequacy were 0.32 in men and 0.26 in women. GDQS scores were inversely associated with folate deficiency in men and women (GDQS Quintile 5 compared with Quintile 1 OR in women, 0.50; 95% CI: 0.31-0.79); inversely associated with underweight (OR, 0.63; 95% CI: 0.44-0.90), low midupper arm circumference (OR, 0.61; 95% CI: 0.45-0.84), and anemia (OR, 0.59; 95% CI: 0.38-0.91) in women; and positively associated with hypertension in men (OR: 1.77, 95% CI: 1.12-2.80). For comparison, the Minimum Dietary Diversity-Women (MDD-W) was associated more positively (P < 0.05) with overall nutrient adequacy in men and women, but also associated with low ferritin in men, overweight/obesity in women, and hypertension in men and women. In the 24HR analysis (restricted to women), the MDD-W was associated more positively (P < 0.05) with nutrient adequacy than the GDQS, but also associated with low ferritin, while the GDQS was associated inversely with anemia.

CONCLUSIONS

The GDQS performed capably in capturing nutrient adequacy-related outcomes in Ethiopian adults. Prospective studies are warranted to assess the GDQS' performance in capturing NCD outcomes in sub-Saharan Africa.

The Global Diet Quality Score Is Inversely Associated with Nutrient Inadequacy, Low Midupper Arm Circumference, and Anemia in Rural Adults in Ten Sub-Saharan African Countries

BACKGROUND

Key nutrient deficits remain widespread throughout sub-Saharan Africa (SSA) whereas noncommunicable diseases (NCDs) now cause one-third of deaths. Easy-to-use metrics are needed to track contributions of diet quality to this double burden.

OBJECTIVES

We evaluated comparative performance of a novel food-based Global Diet Quality Score (GDQS) against other diet metrics in capturing nutrient adequacy and undernutrition in rural SSA adults.

METHODS

We scored the GDQS, Minimum Dietary Diversity-Women (MDD-W), and Alternative Healthy Eating Index-2010 (AHEI-2010) using FFQ data from rural men and nonpregnant, nonlactating women of reproductive age (15-49 y) in 10 SSA countries. We evaluated Spearman correlations between metrics and energy-adjusted nutrient intakes, and age-adjusted associations with BMI, midupper arm circumference (MUAC), and hemoglobin in regression models.

RESULTS

Correlations between the GDQS and an energy-adjusted aggregate measure of dietary protein, fiber, calcium, iron, zinc, vitamin A, folate, and vitamin B-12 adequacy were 0.34 (95% CI: 0.30, 0.38) in men and 0.37 (95% CI: 0.32, 0.41) in women. The GDQS was associated (P < 0.05) with lower odds of low MUAC [GDQS quintile (Q) 5 compared with Q1 OR in men: 0.44, 95% CI: 0.22, 0.85; women: 0.57, 95% CI: 0.31, 1.03] and anemia (Q5/Q1 OR in men: 0.56, 95% CI: 0.32, 0.98; women: 0.60, 95% CI: 0.35, 1.01). The MDD-W correlated better with some nutrient intakes, though associated marginally with low MUAC in men (P = 0.07). The AHEI-2010 correlated better with fatty acid intakes, though associated marginally with low MUAC (P = 0.06) and anemia (P = 0.14) in women. Overweight/obesity prevalence was low, and neither the GDQS, MDD-W, nor AHEI-2010 were predictive.

CONCLUSIONS

The GDQS performed comparably with the MDD-W in capturing nutrient adequacy-related outcomes in rural SSA. Given limited data on NCD outcomes and the cross-sectional study design, prospective studies are warranted to assess GDQS performance in capturing NCD outcomes in SSA.

Higher-diet quality is associated with higher diet costs when eating at home and away from home: National Health and Nutrition Examination Survey, 2005-2016

OBJECTIVES

To evaluate the association between diet quality and cost for foods purchased for consumption at home and away from home.

DESIGN

Cross-sectional analysis. Multivariable linear regression models evaluated the association between diet quality and cost for all food, food at home (FAH) and food away from home (FAFH).

SETTING

Daily food intake data from the National Health and Nutrition Examination Survey (2005-2016). Food prices were derived using data from multiple, publicly available databases. Diet quality was assessed using the Healthy Eating Index-2015 and the Alternative Healthy Eating Index-2010.

PARTICIPANTS

30 564 individuals ≥20 years with complete and reliable dietary data.

RESULTS

Mean per capita daily diet cost was $14·19 (95 % CI (13·91, 14·48)), including $6·92 (95 % CI (6·73, 7·10)) for FAH and $7·28 (95 % CI (7·05, 7·50)) for FAFH. Diet quality was higher for FAH compared to FAFH (P < 0·001). Higher diet quality was associated with higher food costs overall, FAH and FAFH (P < 0·001 for all comparisons).

CONCLUSIONS

These findings demonstrate that higher diet quality is associated with higher costs for all food, FAH and FAFH. This research provides policymakers, public health professionals and clinicians with information needed to support healthy eating habits. These findings are particularly relevant to contemporary health and economic concerns that have worsened because of the COVID-19 pandemic.

Sustainability analysis of Finnish pre-schoolers' diet based on targets of the EAT-Lancet reference diet

Purpose

The EAT-Lancet reference diet is a healthy plant-based diet produced within planetary boundaries. To inform the food system transformation, we compared Finnish pre-schoolers’ food consumption with the reference diet’s food group targets.

Methods

Food record data for 3- to 6-year-old pre-schoolers were collected in the cross-sectional DAGIS survey. Ingredients of composite dishes were available in the data. In addition, we manually decomposed industrial products such as sausages and biscuits by estimating the shares of ingredients. We also estimated the consumption of added sugars and converted the consumption of dairy products into milk equivalents. We used usual intake modelling to estimate the mean consumption and the proportion of children who met the reference diet’s targets. We set the target amounts separately for 3- to 4-year-olds and 5- to 6-year-olds in grams by proportioning the published target amounts (assuming a 2500 kcal diet) to the children’s mean reported energy intake.

Results

For both age groups (3- to 4-year-olds, n = 460; 5- to 6-year-olds, n = 402), the daily mean consumption of whole grains, vegetables, legumes, nuts, and unsaturated oils was below targets, whereas the consumption of red meat, dairy foods, tubers, and added sugars was above targets. The consumption of fruit and fish was in line with targets.

Conclusion

To comply with the reference diet’s targets, major changes in the diets of Finnish children are needed. The key food groups targeted for higher consumption are whole grains and legumes and targeted for lower consumption red meat and dairy products.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00394-021-02672-3.

Effects of a Brazilian cardioprotective diet and nuts on cardiometabolic parameters after myocardial infarction: study protocol for a randomized controlled clinical trial

Background

Nut consumption has been related to improvements on cardiometabolic parameters and reduction in the severity of atherosclerosis mainly in primary cardiovascular prevention. The objective of this trial is to evaluate the effects of the Brazilian Cardioprotective Diet (DIetaCArdioprotetoraBrasileira, DICA Br) based on consumption of inexpensive locally accessible foods supplemented or not with mixed nuts on cardiometabolic features in patients with previous myocardial infarction (MI).

Methods

DICA-NUTS study is a national, multicenter, randomized 16-week follow-up clinical trial. Patients over 40 years old with diagnosis of previous MI in the last 2 to 6 months will be recruited (n = 388). A standardized questionnaire will be applied to data collection and blood samples will be obtained. Patients will be allocated in two groups: Group 1: DICA Br supplemented with 30 g/day of mixed nuts (10 g of peanuts, 10 g of cashew, 10 g of Brazil nuts); and Group 2: only DICA Br. The primary outcome will consist of LDL cholesterol means (in mg/dL) after 16 weeks of intervention. Secondary outcomes will consist of other markers of lipid profile, glycemic profile, and anthropometric data.

Discussion

It is expected that DICA Br supplemented with mixed nuts have superior beneficial effects on cardiometabolic parameters in patients after a MI, when compared to DICA Br.

Trial registration

ClinicalTrials.gov Identifier NCT03728127. First register: November 1, 2018; Last update: June 16, 2021. World Health Organization Universal Trial Number (WHO-UTN): U1111-1259-8105.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05494-0.