Dietary Guidelines for Americans, 2020-2025: Understanding the Scientific Process, Guidelines, and Key Recommendations

Common questions and misconceptions about caffeine supplementation: what does the scientific evidence really show?

Caffeine is a popular ergogenic aid that has a plethora of evidence highlighting its positive effects. A Google Scholar search using the keywords "caffeine" and "exercise" yields over 200,000 results, emphasizing the extensive research on this topic. However, despite the vast amount of available data, it is intriguing that uncertainties persist regarding the effectiveness and safety of caffeine. These include but are not limited to: 1. Does caffeine dehydrate you at rest? 2. Does caffeine dehydrate you during exercise? 3. Does caffeine promote the loss of body fat? 4. Does habitual caffeine consumption influence the performance response to acute caffeine supplementation? 5. Does caffeine affect upper vs. lower body performance/strength differently? 6. Is there a relationship between caffeine and depression? 7. Can too much caffeine kill you? 8. Are there sex differences regarding caffeine's effects? 9. Does caffeine work for everyone? 10. Does caffeine cause heart problems? 11. Does caffeine promote the loss of bone mineral? 12. Should pregnant women avoid caffeine? 13. Is caffeine addictive? 14. Does waiting 1.5-2.0 hours after waking to consume caffeine help you avoid the afternoon "crash?" To answer these questions, we performed an evidence-based scientific evaluation of the literature regarding caffeine supplementation.

Ketone monoester attenuates oxygen desaturation during weighted ruck exercise under acute hypoxic exposure but does not impact cognitive performance

Acute ingestion of exogenous ketone supplements in the form of a (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (R-BD R-βHB) ketone monoester (KME) can attenuate declines in oxygen availability during hypoxic exposure and might impact cognitive performance at rest and in response to moderate-intensity exercise. In a single-blind randomized crossover design, 16 males performed assessments of cognitive performance before and during hypoxic exposure with moderate exercise [2 × 20 min weighted ruck (∼22 kg) at 3.2 km/h at 10% incline] in a normobaric altitude chamber (4572 m, 11.8% O2). The R-BD R-βHB KME (573 mg/kg) or a calorie- and taste-matched placebo (∼50 g maltodextrin) were co-ingested with 40 g of dextrose before exposure to hypoxia. The R-βHB concentrations were rapidly elevated and sustained (>3 mM; P < 0.001) by KME. The decline in oxygen saturation during hypoxic exposure was attenuated in KME conditions by 2.4%-4.2% (P < 0.05) compared with placebo. Outcomes of cognitive performance tasks, in the form of the Defense Automated Neurobehavioral Assessment (DANA) code substitution task, the Stroop color and word task, and a shooting simulation, did not differ between trials before and during hypoxic exposure. These data suggest that the acute exogenous ketosis induced by KME ingestion can attenuate declining blood oxygen saturation during acute hypoxic exposure both at rest and during moderate-intensity exercise, but this did not translate into differences in cognitive performance before or after exercise in the conditions investigated. HIGHLIGHTS: What is the central question of this study? Can exogenous ketosis act as a countermeasure to declines in blood oxygen saturation and cognitive performance during acute hypoxic exposure while performing a weighted ruck exercise? What is the main finding and its importance? Acute exogenous ketosis via ingestion of a drink containing the (R)-3-hydroxybutyl (R)-3-hydroxybutyrate ketone monoester prior to acute hypoxic exposure attenuated hypoxia-induced declines in blood oxygen saturation but had no effect on cognitive performance during exercise.

Ketone monoester attenuates declines in cognitive performance and oxygen saturation during acute severe hypoxic exposure under resting conditions

Exogenous ketone supplements are a potential augmentation strategy for cognitive resilience during acute hypoxic exposure due to their capacity to attenuate the decline in oxygen (O2) availability, and by providing an alternative substrate for cerebral metabolism. Utilizing a single-blind randomized crossover design, 16 male military personnel (age, 25.3 ± 2.4 year, body mass, 86.2 ± 9.3 kg) performed tests of cognitive performance at rest in three environments: room air (baseline), normoxia (20 min; 0 m; 20.9% O2) and hypoxia (20 min; 6096 m, 9.7% O2) using a reduced O2 breathing device (ROBD). (R)-3-Hydroxybutyl (R)-3-hydroxybutyrate (R-BD R-βHB) ketone monoester (KME; 650 mg/kg, split dose given at 30 min prior to each exposure) or taste-matched placebo (PLA) was ingested prior to normoxia and hypoxic exposure. Blood R-βHB and glucose concentrations, cognitive performance and O2 saturation (S p O 2 ${{S}_{{\mathrm{p}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ ) were collected throughout. KME ingestion increased blood R-βHB concentration, which was rapid and sustained (>4 mM 30 min post; P < 0.001) and accompanied by lower blood glucose concentration (∼20 mg/dL; P < 0.01) compared to PLA. Declines in cognitive performance during hypoxic exposure, assessed as cognitive efficiency during a Defense Automated Neurobehavioral Assessment (DANA) code substitution task, were attenuated with KME leading to 6.8 (95% CL: 1.0, 12.6) more correct responses per minute compared to PLA (P = 0.018). The decline inS p O 2 ${{S}_{{\mathrm{p}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ during hypoxic exposure was attenuated (6.40%S p O 2 ${{S}_{{\mathrm{p}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ ; 95% CL: 0.04, 12.75; P = 0.049) in KME compared to PLA (KME, 76.8 ± 6.4%S p O 2 ${{S}_{{\mathrm{p}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ ; PLA, 70.4 ± 7.4%S p O 2 ${{S}_{{\mathrm{p}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ ). Acute ingestion of KME attenuated the decline in cognitive performance during acute severe hypoxic exposure, which coincided with attenuation of declines in O2 saturation. HIGHLIGHTS: What is the central question of this study? Can exogenous ketosis act as a countermeasure to declines in blood oxygen saturation and cognitive performance during acute severe hypoxic exposure at rest? What is the main finding and its importance? Acute exogenous ketosis via ingestion of a drink containing the (R)-3-hydroxybutyl (R)-3-hydroxybutyrate ketone monoester prior to acute severe hypoxic exposure attenuated hypoxia-induced declines in blood oxygen saturation and cognitive performance at rest.

The contribution of dietary advanced glycation end-products and genetic risk in the development of inflammatory bowel disease: a prospective cohort study

BACKGROUND

Dietary advanced glycation end products (AGEs) may promote oxidative stress and inflammation in the gastrointestinal tract.

AIMS

The aim of this study is to investigate the association between dietary AGE intake and the risk of inflammatory bowel disease (IBD).

METHODS

We included 121,978 participants without IBD at baseline from the UK Biobank. We estimated consumption of three common AGEs (Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1)) by matching 24-h dietary questionnaires to a validated dietary AGE database. We used Cox proportional hazards regression models to calculate the hazard ratio (HR) and 95% CI of the association between dietary AGEs and IBD risk.

RESULTS

During a median follow-up of 13.72 years, 671 participants developed IBD (192 with Crohn's disease (CD) and 478 with ulcerative colitis (UC)). Among the assessed dietary AGEs, only CEL was associated with an increased risk of IBD (HR = 1.09, 95% CI: 1.01-1.18, p = 0.020) and CD (HR = 1.18, 95% CI: 1.03-1.36, p = 0.014), particularly for participants who were overweight, physically inactive, and non-smokers. Among participants at a high genetic risk of CD, HRs (95% CI) of CD were 1.26 (1.00-1.57) for CML, 1.41 (1.12-1.77) for CEL, and 1.28 (1.01-1.62) for MG-H1 (p < 0.05 for each). However, none of the dietary AGEs was significantly associated with UC risk, irrespective of genetic predisposition.

CONCLUSIONS

Dietary CEL was associated with an increased risk of IBD and CD, but not UC. Further interventional studies are required to support the potential benefit of AGE restriction, especially for individuals at a high genetic risk of CD.

Community-based diet and obesity-related policy, system, and environmental interventions for obesity prevention during the first 1000 days: A scoping review

Community-based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community-based diet and obesity-related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60-69%) occurred in the prenatal period and early infancy (0-3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.

General Dietary Recommendations for People with Down Syndrome

Down syndrome (DS) is caused by trisomy of chromosome 21 and is associated with characteristic features of appearance, intellectual impairment to varying degrees, organ defects, and health problems typical of this syndrome. Studies on the frequency of consumption of food products in this group show many irregularities, in particular too low consumption of vegetables and fruits, wholegrain cereal products and dairy products, and excessive consumption of meat products and sweets. It is necessary to correct eating habits. The diets of people with trisomy 21 should be consistent with the recommendations of rational nutrition for the general population and take into account specific dietary modifications related to the occurrence of diseases and health problems characteristic of this syndrome.

The impact of medium-chain triglycerides on weight loss and metabolic health in individuals with overweight or obesity: A systematic review and meta-analysis

BACKGROUNDS

The efficacy of medium-chain triglycerides (MCTs) for weight management and mitigating metabolic disorders among individuals with overweight and obesity remains a topic of ongoing discussion. Notably, there is a gap in the distinction between pure MCTs and medium-long-chain triglycerides (MLCTs).

METHODS

This meta-analysis investigates the efficacy of MCTs on weight loss and glucolipid metabolism in these populations, explicitly evaluating the differential effects of pure MCTs and MLCTs. We performed a random-effects meta-analysis on relevant studies examining weight loss and glucolipid parameters, incorporating a subgroup analysis conducted based on intervention types, pure MCTs versus MLCTs.

RESULTS

Our findings revealed diets enriched with MCTs are more effective in achieving weight reduction (WMD: -1.53%; 95% CI: -2.44, -0.63; p < 0.01), particularly those containing pure MCTs (WMD: -1.62%; 95% CI: -2.78, -0.46; p < 0.01), compared to long-chain fatty acids (LCTs) enriched diets. However, our subgroup analysis indicates that an MLCTs-enriched diet did not significantly reduce weight loss. Additionally, MCTs-enriched diets were associated with significant reductions in blood triglyceride levels and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) scores, compared to LCTs-enriched diets.

CONCLUSIONS

Hence, the authors recommend incorporating pure MCTs in dietary interventions for individuals with overweight and obesity, particularly those with comorbidities such as dyslipidemia and impaired glucose metabolism.

Adding more beans to the US typical dietary pattern can lead to greater intake of shortfall nutrients and a higher diet quality in younger and older adults

INTRODUCTION

Data on nutrient and diet quality outcomes when additional beans are consumed as part of the typical American dietary pattern are scarce. The purpose of this study was to assess the effect of increased bean consumption, in the typical American dietary pattern, on the intake of shortfall nutrients and overall diet quality.

METHODS

Using data from the US National Health and Nutrition Examination Survey, 2001-2018, the current analyses modeled the addition of one and two servings of canned and dried beans in all adults (N = 44,574; ≥19 y), younger adults (N = 23,554; 19-50 y) and older adults (N = 21,020; ≥51 y). The beans considered were kidney beans, black beans, chickpeas, and pinto beans.

RESULTS

The modeling of beans to the typical American dietary pattern resulted in significant increases in the intake of several shortfall nutrients, including dietary fiber, potassium, magnesium, iron, folate, and choline (p's < 0.0001). Modeling 1 and 2 servings of beans daily to the US typical dietary pattern significantly increased overall diet quality in all adult age groups considered. Total diet quality, as measured by Healthy Eating Index-2015 scores, was 15-16 % greater with an additional serving of beans and 19-20 % higher with 2 servings of beans relative to the US typical dietary pattern (p values<0.0001).

CONCLUSIONS

Dietary patterns that are rich in beans are associated with significantly higher diet quality scores and greater intake of shortfall nutrients, including nutrients of public health concern. Dietary guidance should consider the health benefits associated with the promotion of increased consumption of canned and dry beans in dietary patterns as benefits seen in younger adults continue to older adulthood.

Factors Associated with Participation in Community Supported Agriculture (CSA) among Low-Income Households: A Scoping Review

Households with limited financial resources often struggle with inadequate access to healthy, affordable food. Community supported agriculture (CSA) has the potential to improve access to fresh fruits and vegetables, yet low-income households seldom participate due to cost and other barriers. Cost-offset (or subsidized) CSA reduces financial barriers, yet engagement varies widely among those who enroll. This scoping review explored factors associated with CSA participation among low-income households in the United States. Eighteen articles met the inclusion criteria, quantitative and qualitative data were extracted, the evidence was synthesized, and themes were developed. The findings suggested that women may be more likely than men to enroll in CSA. A lack of familiarity with CSA may hinder enrollment, whereas more education and self-efficacy for food preparation may facilitate participation. In terms of share contents, high-quality produce, a variety of items, more fruit, a choice of share contents, and a choice of share sizes may facilitate participation. In terms of CSA operations, a low price, good value, acceptance of Supplemental Nutrition Assistance Program (SNAP) benefits, close pick-up locations on existing travel routes, delivery of shares, clear communication, fostering a sense of belonging and trust, and educational support may support participation. Together these findings support 13 recommendations for cost-offset CSA implementation to engage low-income households.

The Relationship between Lifestyle Behaviors and Mental Illness in Women in College

Women, particularly those in college, have the highest prevalence of any mental illness (MI), which negatively impacts social connection, academic performance, and health. Research into alternative treatment methods suggests that lifestyle behaviors are safer and more effective than medication at reducing MI symptoms. This study explores the relationship between lifestyle behaviors and MI in college women through an online survey. The survey included a food frequency questionnaire (Diet History Questionnaire II) and questions about lifestyle behaviors, symptoms of MI, and sociodemographic information. Diet quality was calculated using the Healthy Eating Index (HEI), and MI was assessed using the Depression, Anxiety, and Stress Scale-21. Independent sample t-tests, ANOVA, and chi-square analyses were conducted. A total of 222 women completed the survey. Overall, diet quality was poor, with a mean HEI of 62.6 ± 10.4. No significant differences or associations were found between MI groups for total HEI score, sleep, or tobacco use. However, alcohol use was significantly associated with MI (p = 0.049). Individuals with fewer concurrent unhealthy lifestyle behaviors had less severe symptoms of depression (p = 0.009) and anxiety (p < 0.001) compared to those with more unhealthy lifestyle behaviors. In this study, alcohol use was the only independent lifestyle behavior associated with symptoms of MI. We also found an association between the number of concurrent unhealthy lifestyle behaviors and depression and anxiety symptoms. Future research should explore the benefits of a healthy lifestyle on MI in a more diverse sample of women.

Longitudinal changes in Mediterranean diet adherence and perceived benefits and barriers to its consumption in US university students

Objective

The Dietary Guidelines for Americans has recommended consumption of a Mediterranean diet (MD) for overall health and wellbeing, and the US News & World Report has ranked the MD as the top diet overall for the past six consecutive years. However, it is uncertain if university students in the United States (US) have increased their adoption of this dietary approach over these past six years.

Design

Longitudinal cross-sectional survey conducted in three cohorts (2018, 2020, 2022) utilizing regression models to assess MD Adherence and other relevant outcomes variables.

Setting

University in the southern US.

Participants

Students (n = 761) enrolled in undergraduate introductory nutrition course.

Results

Survey respondents were 83% female, 91% white, and 97% ages 18-24. Predictors of MD adherence were older age, female gender, and health-related qualifications. MD adherence was lowest in 2022. The 2022 group perceived less MD health benefits, weight loss, ethical concerns, natural content, and sensory appeal compared to the 2018 group. During the COVID-19 pandemic, changes in eating behavior were examined in the 2020 and 2022 groups. We observed that participants in the 2022 group had a greater frequency of snacking and a lower frequency of eating out compared to 2020 group.

Conclusion

MD adherence did not increase over time in US university students. These findings underscore the need for targeted interventions and education to promote healthier eating habits in university students.

Is Adherence to the Saudi Healthy Plate Dietary Guidelines Associated with Eating Concerns Symptoms among Saudi Young Females?

BACKGROUND

Food-based dietary guidelines (FBDGs) offer broad recommendations based on scientific evidence, focusing on food groups rather than nutrients that should be included in the diet. Emerging adulthood (18-30 years) is a critical period for poor dietary quality and mental health. Eating habits (EHs) are formed early in life and are influenced by various factors, such as emotional state, which can lead to either binge or restricted eating, ultimately increasing the risk of eating disorders (EDs). This cross-sectional study aimed to investigate the extent of adherence to the Saudi Healthy Plate Dietary Guidelines (SHPDGs) and its potential association with Eating Concerns (ECs) among Saudi females (aged 18-30 years) from all provinces in the Kingdom of Saudi Arabia.

METHODS

A validated online questionnaire was used to assess eating behaviors (EBs) using the Starting The Conversation (STC) instrument and EC symptoms using the Eating Disorders Screen for Primary Care (ESP) screening tool.

RESULTS

The total sample size was 1092 participants with a mean age of 23.02 ± 3.47. Only 0.7% of the participants adhered to the SHPDGs and were free of EC symptoms. Conversely, 50.4% of participants who exhibited EC symptoms had poor adherence to the SHPDGs. Across Saudi Arabian provinces, high adherence to the SHPDGs was more prominent in both the Eastern and Western provinces (37.5%) than in the Central and Southern provinces (0%). The most striking result was that the Central province exhibited a high percentage of poor adherence to the SHPDGs (25.6%). Moreover, high adherence to SHPDGs was not associated with the probability of ECs.

CONCLUSIONS

The present study revealed a trend of poor adherence to SHPDGs among Saudi females, with a large proportion also experiencing EC symptoms. Accordingly, the authors recommend increasing awareness within the Saudi community about SHPDGs using educational campaigns on social media platforms to enhance the importance of adopting a healthy diet, especially among females, and demonstrate that the impact on their health and well-being is that they are experiencing multiple phases that involve pregnancy and giving birth involves specific nutritional requirements.

Dietary Patterns Among US Children: A Cluster Analysis

BACKGROUND

Most children in the United States consume low-quality diets. Identifying children's dietary patterns and their association with sociodemographic characteristics is important for designing tailored youth dietary interventions.

OBJECTIVE

This study's objective was to use cluster analysis to investigate children's dietary patterns and these patterns' associations with sociodemographic characteristics.

DESIGN

Data from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey were evaluated to examine dietary patterns.

PARTICIPANTS AND SETTING

Participants included 3,044 US youth aged 2 to 11 years who completed at least 1 valid 24-hour diet recall.

MAIN OUTCOME MEASURES

The main outcome measures were Healthy Eating Index (HEI) 2015 component and composite scores.

STATISTICAL ANALYSES PERFORMED

A cluster analysis was performed on standardized scores of 11 components of the HEI-2015 to identify dietary patterns. One logistic analysis combined the two higher-HEI score clusters and the 2 lower-HEI score clusters to form a 3-category variable of higher-, medium-, and lower-HEI score clusters. Another logistic analysis contrasted 2 higher- and then the 2 lower-HEI clusters with each other to examine sociodemographic factors contributing to cluster membership.

RESULTS

Five clusters were identified, each displaying a distinct dietary pattern. Older, non-Hispanic Black, and overweight children had higher odds of being in the higher-HEI clusters than the medium-HEI cluster. Being older and non-Hispanic Black were linked to higher odds of being in the lower-HEI clusters than the medium-HEI cluster. Conversely, being Mexican American and living with a college-educated reference person were associated with lower odds of being in the lower-HEI clusters compared with the medium-HEI cluster. Among the higher-HEI clusters, Mexican American and Asian American children had higher odds of being in the Pescatarian cluster. Among the lower-HEI clusters, children who were racially or ethnically minoritized had lower odds of being in the Excess Sugar cluster.

CONCLUSIONS

Children in this study displayed different dietary patterns, with key sociodemographic variation.

The Association Between Overall, Healthy, and Unhealthy Plant-Based Diet Index and Risk of Prediabetes and Type 2 Diabetes Mellitus: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies

CONTEXT

The global incidence of prediabetes and type 2 diabetes mellitus (T2DM) has increased substantially in recent years. Among the established, modifiable lifestyle factors associated with favorable prediabetes and T2DM risk, healthy dietary patterns have attracted considerable attention.

OBJECTIVE

The association between adherence to plant-based dietary pattern indices (PDIs), including the overall PDI (O-PDI), healthy PDI (H-PDI), and unhealthy PDI (U-PDI), and the risk of prediabetes and T2DM was investigated in this study.

DATA SOURCES

A literature search was conducted of the PubMed/Medline, Scopus, and Web of Sciences databases from their inception to February 2024. A systematic review and meta-analysis were conducted using random effects models and dose-response analyses. The Cochran Q test and the I2 statistic were used to evaluate heterogeneity between studies.

DATA EXTRACTION

A total of 16 publications, with data on a total of 721 012 participants, were identified for the meta-analysis.

DATA ANALYSIS

According to a pooled analysis, compared with the lowest category of O-PDI and H-PDI adherence, the highest category was associated with a 14% and 19% reduction in T2DM risk, respectively, for O-PDI (effect size [ES] = 0.86; 95%CI, 0.82-0.90; I2 = 57.7) and H-PDI (ES = 0.81; 95%CI, 0.75-0.88; I2 = 82.6). Greater adherence to U-PDI was significantly associated with an 10% increase in the risk of T2DM (ES = 1.10; 95%CI, 1.04-1.16). Consistent associations were found within the predetermined subgroups. As well, there was a nonlinear inverse association between O-PDI, H-PDI, and T2DM risk. No significant association was found between adherence to O-PDI (ES = 0.87; 95%CI, 0.75-1.01; I2 = 68%), H-PDI (ES = 0.99; 95%CI, 0.87-1.13; I2 = 0.0%), and U-PDI (ES = 1.09; 95%CI, 0.94-1.21; I2 = 22.9%) and risk of prediabetes.

CONCLUSION

These findings underscore the importance of dietary selections within the framework of a plant-based dietary pattern, particularly when incorporating healthful, plant-based foods, which may have potential benefits in reducing the T2DM risk.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023459851.

Determination of Flavonoids and Phenolic Acids in the Liver of Wistar Rats after a Dietary Enrichment with Corinthian Currant (Vitis vinifera L., var. Apyrena): A Liquid Chromatography-Tandem Mass Spectrometry Study

Corinthian currants are dried fruits produced from Vitis vinifera L. var. Apyrena grape. This study investigated the distribution of phenolic compounds in male Wistar rat livers following two distinct Corinthian currant long-term dietary intake protocols (3 and 10% w/w). Method optimization, comparing fresh and lyophilized tissues, achieved satisfactory recoveries (>70%) for most analytes. Enzymatic hydrolysis conditions (37 °C, pH 5.0) minimally affected phenolics, but enzyme addition showed diverse effects. Hydrolyzed lyophilized liver tissue from rats consuming Corinthian currants (3 and 10% w/w) exhibited elevated levels of isorhamnetin (20.62 ± 2.27 ng/g tissue and 33.80 ± 1.38 ng/g tissue, respectively), along with similar effects for kaempferol, quercetin, and chrysin after prolonged Corinthian currant intake. This suggests their presence as phase II metabolites in the fasting-state liver. This study is the first to explore phenolic accumulation in rat liver, simulating real conditions of dried fruit consumption, as seen herein with Corinthian currant.

Diet quality and anxiety: a critical overview with focus on the gut microbiome

Anxiety disorders disproportionally affect females and are frequently comorbid with eating disorders. With the emerging field of nutritional psychiatry, focus has been put on the impact of diet quality in anxiety pathophysiology and gut microbiome underlying mechanisms. While the relationship between diet and anxiety is bidirectional, improving dietary habits could better facilitate the actions of pharmacological and psychological therapies, or prevent their use. A better understanding of how gut bacteria mediate and moderate such relationship could further contribute to develop personalized programs and inform probiotics and prebiotics manufacturing. To date, studies that look simultaneously at diet, the gut microbiome, and anxiety are missing as only pairwise relationships among them have been investigated. Therefore, this study aims at summarizing and integrating the existing knowledge on the dietary effects on anxiety with focus on gut microbiome. Findings on the effects of diet on anxiety are critically summarized and reinterpreted in relation to findings on (i) the effects of diet on the gut microbiome composition, and (ii) the associations between the abundance of certain gut bacteria and anxiety. This novel interpretation suggests a theoretical model where the relationship between diet and anxiety is mediated and/or modulated by the gut microbiome through multiple mechanisms. In parallel, this study critically evaluates methodologies employed in the nutritional field to investigate the effects of diet on anxiety highlighting a lack of systematic operationalization and assessment strategies. Therefore, it ultimately proposes a novel evidence-based approach that can enhance studies validity, reliability, systematicity, and translation to clinical and community settings.

Cancer Incidence Rates in the US in 2016-2020 with Respect to Solar UVB Doses, Diabetes and Obesity Prevalence, Lung Cancer Incidence Rates, and Alcohol Consumption: An Ecological Study

This article reports the results of an ecological study of cancer incidence rates by state in the US for the period 2016-2020. The goals of this study were to determine the extent to which solar UVB doses reduced cancer risk compared to findings reported in 2006 for cancer mortality rates for the periods 1950-1969 and 1970-1794 as well as cancer incidence rates for the period 1998-2002 and to determine which factors were recently associated with cancer risk. The cancer data for non-Hispanic white (European American) men and women were obtained from the Centers for Disease Control and Prevention. Indices were obtained for solar UVB at the surface for July 1992, and alcohol consumption, diabetes, and obesity prevalence near the 2016-2020 period. Lung cancer incidence rates were also used in the analyses as a surrogate for smoking, diet, and air pollution. The cancers for which solar UVB is significantly associated with reduced incidence are bladder, brain (males), breast, corpus uteri, esophageal, gastric, non-Hodgkin's lymphoma, pancreatic, and renal cancer. Lung cancer was significantly associated with colorectal, laryngeal, and renal cancer. Diabetes was also significantly associated with breast, liver, and lung cancer. Obesity prevalence was significantly associated with breast, colorectal, and renal cancer. Alcohol consumption was associated with bladder and esophageal cancer. Thus, diet has become a very important driver of cancer incidence rates. The role of solar UVB in reducing the risk of cancer has been reduced due to people spending less time outdoors, wearing sunscreen that blocks UVB but not UVA radiation, and population increases in terms of overweight and obese individuals, which are associated with lower 25-hydroxyvitamin D concentrations and the generation of systemic inflammation, which is a risk factor for cancer. A dietary approach that would reduce the risk of diabetes, obesity, lung cancer, and, therefore, cancer, would be one based mostly on whole plants and restrictions on red and processed meats and ultraprocessed foods. Solar UVB exposure for a few minutes before applying sunscreen and taking vitamin D supplements would also help reduce the risk of cancer.

Prevalence and predictive features of metabolic dysfunction-associated steatotic liver disease in type 1 diabetes

AIMS/HYPOTHESIS

The prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in type 1 diabetes remain unclear. Therefore, we investigated the prevalence and severity of MASLD in type 1 diabetes and assessed which clinical features are most important in predicting MASLD severity.

METHODS

A total of 453 individuals with type 1 diabetes (41.6 ± 15.0 years, 64% female, body mass index [BMI] 25.4 ± 4.2 kg/m2, and HbA1c 55.6 ± 12 mmol/mol) underwent vibration-controlled transient elastography (VCTE), with a controlled attenuation parameter (CAP) score for steatosis (≥280.0 dB/m) and a liver stiffness measurement (LMS) for fibrosis (≥8.0 kPa). A machine learning Extra-Trees classification model was performed to assess the predictive power of the clinical features associated with type 1 diabetes with respect to steatosis and fibrosis.

RESULTS

The prevalence of hepatic steatosis and fibrosis was 9.5% (95% CI, 6.8-12.2) and 3.5% (95% CI, 1.8-5.2). Higher LMS was associated with a longer duration of type 1 diabetes (median 30.5 [IQR 18.0-39.3] years vs 15.0 [IQR 6.0-27.0] years), and individuals were older, had a higher BMI (mean 27.8 ± 5.2 vs 25.3 ± 4.1 kg/m2), and a higher CAP score (mean 211.4 ± 51.7 dB/m vs 241.4 ± 75.6 dB/m). The most important predictive features of fibrosis were duration of type 1 diabetes, age, and systolic blood pressure, with a mean ± SD area under the curve of 0.73 ± 0.03.

CONCLUSION

Individuals with type 1 diabetes and high blood pressure, older age, higher BMI, and longer duration of disease could be considered at high-risk for developing MASLD.

Long-term exposure to ambient fine particulate matter and risk of liver cancer in the NIH-AARP Diet and Health Study

BACKGROUND

Fine particulate matter (PM2.5) exposure has been associated with liver cancer incidence and mortality in a limited number of studies. We sought to evaluate this relationship for the first time in a U.S. cohort with historical exposure assessment.

METHODS

We used spatiotemporal prediction models to estimate annual average historical PM2.5 concentrations (1980-2015) at residential addresses of 499,729 participants in the NIH-AARP Diet and Health Study, a cohort in 6 states (California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania) and 2 metropolitan areas (Atlanta, Georgia, and Detroit, Michigan) enrolled in 1995-1996 and followed up through 2017. We used a time-varying Cox model to estimate the association for liver cancer and the predominant histologic type, hepatocellular carcinoma (HCC), per 5 µg/m3 increase in estimated outdoor PM2.5 levels, incorporating a 5-year average, lagged 10 years prior to cancer diagnosis and adjusting for age, sex, race/ethnicity, education level and catchment state. We also evaluated PM2.5 interactions with hypothesized effect modifiers.

RESULTS

We observed a non-significantly increased risk of liver cancer associated with estimated PM2.5 exposure (Hazard ratio [HR] = 1.05 [0.96-1.14], N = 1,625); associations were slightly stronger for HCC, (84 % of cases; HR = 1.08 [0.98-1.18]). Participants aged 70 or older at enrollment had an increased risk of liver cancer versus other age groups (HR = 1.50 [1.01-2.23]); p-interaction = 0.01) and risk was elevated among participants who did not exercise (HR = 1.81 [1.22-2.70]; p-interaction = 0.01). We found no evidence of effect modification by sex, smoking status, body mass index, diabetes status, or alcohol consumption (p-interaction > 0.05).

CONCLUSIONS

Our findings in this large cohort suggest that residential ambient PM2.5 levels may be associated with liver cancer risk. Further exploration of the variation in associations by age and physical activity are important areas for future research.

Omega-3 fatty acids in primary and secondary prevention of cardiovascular diseases

Even with substantial progress in primary and secondary prevention, cardiovascular disease (CVD) persists as a major cause of mortality and morbidity globally. Omega-3 polyunsaturated fatty acids (Ω-3 PUFAs) have gained considerable attention for their ability to improve CV health and prognosis. Metanalyses of randomized controlled trials have demonstrated Ω-3 PUFAs' positive impact on CVD outcomes for both primary and secondary prevention endpoints. Marine Ω-3 PUFAs also improve CVD risk factors including blood pressure, lipids, and inflammation; however, many physicians do not recommend Ω-3 PUFAs, largely due to inconsistent results in randomized trials. In this comprehensive review article, we evaluate both historic and current data concerning primary and secondary prevention of CVD with use of Ω-3 PUFAs, delve into the potential causes for the varied results, and examine the most current recommendations on the usage of Ω-3 PUFAs.

The Impact of Curcumin, Resveratrol, and Cinnamon on Modulating Oxidative Stress and Antioxidant Activity in Type 2 Diabetes: Moving beyond an Anti-Hyperglycaemic Evaluation

Research indicates that up to half of the population resorts to dietary supplements for managing diseases such as type 2 diabetes rather than changing their nutritional habits. These supplements not only aim to have an anti-hyperglycaemic effect but also seek to reduce oxidative stress to prevent diabetes complications. This systematic literature systematic review aims to evaluate the efficacy of curcumin, resveratrol, and cinnamon in modulating oxidative stress and antioxidant activity in individuals with type 2 diabetes. Data were collected from PubMed, Web of Sciences, and Scopus databases regarding the impact of curcumin, resveratrol, and cinnamon on total antioxidant capacity (TAC), malondialdehyde (MDA), tumour necrosis factor α (TNF-α), interleukin 6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) levels for this review. Effect sizes for each study were calculated using Cohen's or Hedges's d coefficient. Parameters of oxidative stress and inflammatory status, such as TAC, MDA, TNF-α, IL-6, and hs-CRP, improved following phytochemicals. Additionally, curcumin, resveratrol, and cinnamon exhibited regulatory effects on carbohydrate metabolism by reducing glucose, insulin, and glycated haemoglobin concentrations and lipid metabolism by lowering total cholesterol (TC), low-density lipoprotein (LDL), and triglycerides (TG) and increasing high-density lipoprotein (HDL). Incorporating curcumin, resveratrol, and cinnamon into diets may be beneficial for maintaining organism homeostasis and improving metabolic control in individuals with type 2 diabetes. However, the conflicting results reported in the literature highlight the need for further detailed investigations into the effectiveness of phytochemical use for type 2 diabetes.

Recent Insights and Recommendations for Preventing Excessive Gestational Weight Gain

Recommendations for weight gain during pregnancy are based on pre-pregnancy body mass index (BMI). Pregnancy is a risk factor for excessive weight gain and many endocrine problems, making it difficult to return to pre-pregnancy weight and increasing the risk of postpartum obesity and, consequently, type 2 diabetes and metabolic syndrome. Both excessive gestational weight gain (EGWG) and obesity are associated with an increased risk of gestational hypertension, pre-eclampsia, gestational diabetes, cesarean section, shoulder dystocia, and neonatal macrosomia. In the long term, EGWG is associated with increased morbidity and mortality, particularly from diabetes, cardiovascular disorders, and some cancers. This study aims to present recommendations from various societies regarding weight gain during pregnancy, dietary guidance, and physical activity. In addition, we discuss the pathophysiology of this complication and the differential diagnosis in pregnant women with EGWG. According to our research, inadequate nutrition might contribute more significantly to the development of EGWG than insufficient physical activity levels in pregnant women. Telehealth systems seem to be a promising direction for future EGWG prevention by motivating women to exercise. Although the importance of adequate pre-pregnancy weight and weight gain during pregnancy is well known, an increasing number of women gain excessive weight during pregnancy.

Primary, secondary and tertiary prevention of food allergy: current practices and future directions

The incidence of food allergies has risen around the globe, and experts have been exploring methods of preventing such allergies in young children to ease the burden of disease and reduce the morbidity and mortality caused by anaphylaxis to food allergens. Such preventative measures can be categorised as primary, secondary and tertiary prevention, which are discussed in detail in this review. Primary prevention is defined as the prevention of becoming sensitised towards specific allergens. The evidence suggests that avoiding common allergenic foods during pregnancy and breastfeeding is not protective against food allergies, and guidelines recommend weaning from 4 to 6 months of age, with recent studies supporting the early introduction of peanuts at 4 months to prevent peanut allergy. Secondary prevention targets patients who are already sensitised and aims to halt the progression of sensitisation, with evidence for high rates of success and safety in trials of early introduction to milk and peanuts using oral immunotherapy in sensitised infants. Tertiary allergy prevention focuses on reducing the risk of a patient having anaphylaxis, with oral immunotherapy being the most common method of promoting tolerance in allergic children. Several studies have demonstrated successful reintroduction for milk, egg and peanut; however, no such guidelines are recommended for other foods. Finally, dietary advancement therapy in the form of milk and egg ladders has been employed as a method of primary, secondary and tertiary prevention of allergies, particularly in Ireland, the UK and Canada.

Eggs and a Fiber-Rich Diet Are Beneficially Associated with Lipid Levels in Framingham Offspring Study Adults

Background

For many years, United States' dietary policy recommended limiting egg intake to no more than 3/wk in the belief that restricting dietary cholesterol would lower plasma cholesterol levels and thereby reduce the risk of cardiovascular disease. The evidence supporting these recommendations is controversial.

Objectives

To examine the impact of eggs, a major contributor to dietary cholesterol intake, on lipid levels and to determine whether these egg effects are modified by other healthy dietary factors in adults.

Methods

Males and females aged 30-64 y with available 3-d diet record data, without cardiovascular disease and not taking lipid- or glucose-lowering medications in the prospective Framingham Offspring cohort were included (n = 1852). Analysis of covariance models were used to compare mean follow-up lipid levels adjusting for age, sex, BMI, and dietary factors. Cox proportional hazard's models were used to estimate risk for elevated lipid levels.

Results

Consuming ≥5 eggs/wk was not adversely associated with lipid outcomes. Among men, consuming ≥5 (compared with <0.5) eggs/wk was associated with an 8.6 mg/dL lower total cholesterol level and a 5.9 mg/dL lower LDL cholesterol level, as well as lower triglycerides. Overall, higher egg intake combined with higher dietary fiber (compared with lower intakes of both) was associated with the lowest total cholesterol, LDL cholesterol, and LDL cholesterol-to-HDL cholesterol ratio. Finally, diets with higher (compared with lower) egg intakes in combination with higher total fish or fiber intakes, respectively, were associated with lower risks of developing elevated (>160 mg/dL) LDL cholesterol levels (hazard ratio: 0.61; 95% confidence interval: 0.44, 0.84; and HR: 0.70; 95% confidence interval: 0.49, 0.98, respectively).

Conclusions

Higher egg intakes were beneficially associated with serum lipids among healthy adults, particularly those who consumed more fish and dietary fiber.

Effect of alcohol consumption on risk of hypertension based on alcohol-related facial flushing response: From the health examinees study

BACKGROUND

Alcohol consumption is a significant public health concern in Korea, with many individuals engaging in risky drinking behaviors. This study aims to analyze the association between facial flushing responses and the progression of hypertension in Korean adults, stratified by gender, using a large-scale prospective cohort study.

METHODS

This study included 39,868 participants (males 10,868 and females 29,000) from the health examinees cohort. Participants were divided into two groups according to their weekly drinking patterns (moderate and heavy) and facial flushing responses (non-flusher and flusher) for statistical analysis. A multivariate Cox proportional hazards regression model was used to calculate hazard ratios and 95% confidence intervals between flushing response after alcohol consumption and hypertension risk.

RESULTS

In males, the flusher group with a moderate alcohol intake pattern had a decreased risk of incident hypertension compared with non-flushers. In females, the flusher group had relatively higher risk of pre-hypertension and hypertension compared to the non-flusher group.

CONCLUSION

The association between facial flushing and hypertension varies depending on the level of alcohol consumption and should be considered in relation to gender differences. Further research is needed to understand the relationship between facial flushing response and the risk of hypertension based on alcohol consumption levels.

Daily olive oil intake is feasible to reduce trigeminal neuralgia facial pain: A pilot study

Extra virgin olive oil (EVOO) is thought to contribute to neuroprotection and, thus, may influence pain symptoms experienced by adults with demyelination-related trigeminal neuralgia (TN). This study aimed to determine the feasibility of daily intake of EVOO and its potential to alleviate facial pain of TN. Adults, self-reporting as female and affected by TN, were enrolled in a 16-week nonblinded, parallel study. After a 4-week baseline, participants were randomized to 60 mL/day EVOO or control (usual diet and no supplemental EVOO) for 12 weeks. Participants completed a daily questionnaire on pain intensity and compliance, the Penn Facial Pain Scale weekly, the 36-Item Short Form Survey monthly, and dietary assessment during baseline and intervention. Participants (n = 52; 53.3 ± 12.9 years) were recruited nationally; 42 completed the study. The EVOO group, with 90% intake compliance, showed significant decreases in the Penn Facial Pain Scale items of interference with general function, interference with orofacial function, and severity of pain from baseline, whereas the control group showed no improvements. EVOO benefit, compared with control, trended for the interference with orofacial function (P = .05). The 36-Item Short Form Survey items of role limitations resulting from emotional problems and role limitations from physical health favored EVOO. The EVOO group significantly improved their Healthy Eating Index 2015 component scores of fatty acids (primarily from increased oleic acid), sodium, and refined grains. EVOO intake of 60 mL/day was feasible for participants experiencing TN and may mitigate pain and improve quality of life. This trial was registered at clinicaltrials.gov (NCT05032573).

Preoperative nutritional optimization for adult spinal deformity: Review

PURPOSE

The main objective of this review article is to examine the role that nutrition has on adult spinal deformity. The information presented in this review aims to provide spine surgeons with a broad overview of screening, assessment, and interventional strategies that may be used for presurgical nutritional optimization.

METHODS

A comprehensive literature review utilizing three biomedical databases was performed to generate articles of interest. Published articles related to nutrition, adult spinal deformity, spine surgery and orthopaedics were reviewed for the composition of this article. Nutrition may play a role in optimizing postoperative outcomes following adult spinal deformity surgeries, such as limiting delirium, length of stay, blood transfusion, and other medical complications. The use of screening tools, such as the PNI and CONUT score can assess preoperative nutritional status and may provide some utility in evaluating nutrition status in patients undergoing deformity surgery. Balancing both macronutrients and micronutrients, notably, carbohydrates, protein, albumin, and vitamin D can play a role in preoperative optimization.

CONCLUSION

Adult spinal deformity patients are at an increased risk for malnutrition. These patients should be assessed for nutrition status to prime them for surgery, minimize complications, and maximize their outcomes. However, further studies are needed to determine how nutrition ultimately affects adult spinal deformity patients in the postoperative period and to establish specific nutritional recommendations for this unique population.

Multimodal machine learning for modeling infant head circumference, mothers' milk composition, and their shared environment

Links between human milk (HM) and infant development are poorly understood and often focus on individual HM components. Here we apply multi-modal predictive machine learning to study HM and head circumference (a proxy for brain development) among 1022 mother-infant dyads of the CHILD Cohort. We integrated HM data (19 oligosaccharides, 28 fatty acids, 3 hormones, 28 chemokines) with maternal and infant demographic, health, dietary and home environment data. Head circumference was significantly predictable at 3 and 12 months. Two of the most associated features were HM n3-polyunsaturated fatty acid C22:6n3 (docosahexaenoic acid, DHA; p = 9.6e-05) and maternal intake of fish (p = 4.1e-03), a key dietary source of DHA with established relationships to brain function. Thus, using a systems biology approach, we identified meaningful relationships between HM and brain development, which validates our statistical approach, gives credence to the novel associations we observed, and sets the foundation for further research with additional cohorts and HM analytes.

Advancing nutrition risk assessment in middle-aged and older individuals with diverse food cultures: A data-driven personalized approach to predict incident hypertension, diabetes and mortality

BACKGROUND

Personalized nutrition risk assessment is crucial in addressing the association between healthy dietary habits across the life course and the development of disease, functional capacity, and healthy aging, as specific dietary pattern recommendations may not be suitable for diverse food cultures.

OBJECTIVE

To develop a data-driven, personalized nutrition risk assessment algorithm linked to incident hypertension, diabetes, and all-cause mortality utilizing the food frequency questionnaire among middle-aged and older individuals.

METHODS

A retrospective, population-based cohort study conducted between 1999 and 2015 utilized the nationally representative Taiwan Longitudinal Study on Aging (TLSA) survey to examine personalized dietary risk clusters and their associations with health outcomes. Latent class analysis was performed to derive the dietary diversity clusters among community-dwelling middle-aged and older individuals. Outcomes were defined as new-onset hypertension, diabetes mellitus and all-cause mortality at 4-, 8-, 12- and 16-year follow-ups.

RESULTS

Data from 1,811 participants (58.14% males, 43.90% aged 50-64 years) showed that around one-third of participants reported being illiterate, 21.98% widowed, and 51.46% engaging in regular physical exercise. Four dietary diversity clusters were identified: "least diverse", "fish and meat", "dairy, fruit, and vegetable", and "most diverse". The "most diverse" cluster was characterized by a high consumption of protein-rich foods, while the "dairy, fruit, and vegetable" cluster had the highest consumption of dairy products and beans/legumes. The "least diverse" cluster had the lowest intake of protein-rich foods, and dark-colored vegetables and fruits. The "most diverse" cluster had a significantly lower risk of hypertension development at the 4-year (aOR 0.58; p < 0.02) and 8-year (aOR 0.57; p < 0.01) follow-up and diabetes at the 4-year (aOR 0.44; p < 0.03) follow-up. Participants in the "most diverse" clusters exhibited lower risks of 8-year, 12-year, and 16-year mortality than those in the "least diverse" cluster (aOR 0.67, p < 0.05; 0.67, p < 0.03; and 0.50, p < 0.01, respectively).

CONCLUSION

The personalized nutrition risk assessment algorithm from the food frequency questionnaire can effectively stratify personal health risks among diverse middle-aged and older individuals, making it a valuable tool in lifestyle modification and intervention studies.

Evaluation of Protein Adequacy From Plant-Based Dietary Scenarios in Simulation Studies: A Narrative Review

Although a diet high in plant foods can provide beneficial nutritional outcomes, unbalanced and restrictive plant-based diets may cause nutrient deficiencies. Protein intake from these diets is widely discussed, but the comparison of animal and plant proteins often disregards amino acid composition and digestibility as measurements of protein quality. Poor provision of high-quality protein may result in adverse outcomes, especially for individuals with increased nutrient requirements. Several dietary modeling studies have examined protein adequacy when animal-sourced proteins are replaced with traditional and novel plant proteins, but no review consolidating these findings are available. This narrative review aimed to summarize the approaches of modeling studies for protein intake and protein quality when animal-sourced proteins are replaced with plant foods in diet simulations and examine how these factors vary across age groups. A total of 23 studies using dietary models to predict protein contribution from plant proteins were consolidated and categorized into the following themes-protein intake, protein quality, novel plant-based alternatives, and plant-based diets in special populations. Protein intake from plant-based diet simulations was lower than from diets with animal-sourced foods but met country-specific nutrient requirements. However, protein adequacy from some plant-sourced foods were not met for simulated diets of children and older adults. Reduced amino acid adequacy was observed with increasing intake of plant foods in some scenarios. Protein adequacy was generally dependent on the choice of substitution with legumes, nuts, and seeds providing greater protein intake and quality than cereals. Complete replacement of animal to plant-sourced foods reduced protein adequacy when compared with baseline diets and partial replacements.

Bone mass accrual in children

PURPOSE OF REVIEW

Bone accrual during childhood and adolescence is critical for the attainment of peak bone mass and is a major contributing factor towards osteoporosis in later life. Bone mass accrual is influenced by nonmodifiable factors, such as genetics, sex, race, ethnicity, and puberty, as well as modifiable factors, such as physical activity and diet. Recent progress in bone imaging has allowed clinicians and researchers to better measure the morphology, density, and strength of the growing skeleton, thereby encompassing key characteristics of peak bone strength. In this review, the patterning of bone accrual and contributors to these changes will be described, as well as new techniques assessing bone mass and strength in pediatric research and clinical settings.

RECENT FINDINGS

This review discusses factors influencing peak bone mass attainment and techniques used to assess the human skeleton.

SUMMARY

The rate of bone accrual and the magnitude of peak bone mass attainment occurs in specific patterns varying by sex, race, ethnicity, longitudinal growth, and body composition. Physical activity, diet, and nutritional status impact these processes. There is a need for longitudinal studies utilizing novel imaging modalities to unveil factors involved in the attainment and maintenance of peak bone strength.

Diet Quality Mediates the Relationship Between Chronic Stress and Inflammation in Patients With Metabolic Syndrome

BACKGROUND

Chronic stress is associated with promotion of inflammation and development of metabolic syndrome, as well as deterioration of diet quality. Inflammation can be modified by changes in dietary intake.

OBJECTIVE

The aim of this study was to test the hypothesis that diet quality mediates the relationship of chronic stress with inflammation in patients with metabolic syndrome.

METHODS

Participants with metabolic syndrome (n = 73, 62 ± 12 years old, 71% female) completed questionnaires on chronic stress (Perceived Stress Scale-10) and diet quality (Healthy Eating Index-2020). The Perceived Stress Scale-10 was dichotomized. The Healthy Eating Index-2020 score was used as a continuous variable, and higher scores indicate better diet quality. Inflammation was assessed using plasma high-sensitivity C-reactive protein (log-transformed). We used PROCESS in SPSS to test the hypothesis.

RESULTS

Patients in the higher stress group had lower Healthy Eating Index-2020 scores (worse diet quality) than those in the lower stress group (57 ± 13 vs 64 ± 10, P = .01). Diet quality mediated the relationship between chronic stress and inflammation (indirect effect, 0.211; 95% bootstrap confidence interval, 0.006-0.496). Higher stress was associated with lower diet quality (effect, -7.152; 95% confidence interval, -13.168 to -1.137) that was associated with increased inflammation (effect, -0.030; 95% confidence interval, -0.052 to -0.007).

CONCLUSIONS

Our findings show the important role of diet quality in the relationship of chronic stress with inflammation in patients with metabolic syndrome. Healthcare providers should encourage patients with higher stress to improve diet quality, which can decrease inflammation.

Effect of low sodium and high potassium diet on lowering blood pressure and cardiovascular events

Incorporating aggressive lifestyle modifications along with antihypertensive medication therapy is a crucial treatment strategy to enhance the control rate of hypertension. Dietary modification is one of the important lifestyle interventions for hypertension, and it has been proven to have a clear effect. Among food ingredients, sodium and potassium have been found to have the strongest association with blood pressure. The blood pressure-lowering effect of a low sodium diet and a high potassium diet has been well established, especially in hypertensive population. A high intake of potassium, a key component of the Dietary Approaches to Stop Hypertension (DASH) diet, has also shown a favorable impact on the risk of cardiovascular events. Additionally, research conducted with robust measurement methods has shown cardiovascular benefits of low-sodium intake. In this review, we aim to discuss the evidence regarding the relationship between the low sodium and high potassium diet and blood pressure and cardiovascular events.

The imprecision of micronutrient requirement values: the example of vitamin D

Food, not nutrients, is the fundamental unit in nutrition. Nutrient requirement values and recommended daily intakes have long been determined and organized in tables by several regulators. These figures, however, overlook the complexity of mixing different foods in a diet and the mediation by human gut microbiota on digestion, metabolism, and health. The microbiome molecular mechanisms and its potential influence on nutrient requirements are far from clear. Guidelines should depend on the sort of intake, along with the dietary habits, rather than focusing on single nutrients. Despite many decades of attempts to investigate the proximate nutrient composition of foods consumed by different world populations, there are still neither standardization of food composition databases nor harmonized dietary intake methods of assessment of nutrients. No all-inclusive attempt was yet made to emphasize the requirements of the various micronutrients, phytonutrients, and non-nutrients on gut microbiota and vice versa, and thereafter reflected into dietary guidelines. New multifaceted methods have been advanced to reevaluate the way nutrients and nutrient requirements are assessed within the intricate biological systems. Our main goal here was to enhance the fact that existing food guidelines hold inherent strengths and limitations but fail, in many aspects, namely, in not taking into account essential geographical, ethnic and cultural differences, and the different stages of life, infant nutrition, and the microbiota impact on several micronutrient requirements. Vitamin D is given as an illustration on present inaccuracy of its requirements. Defining dietary reference intakes is therefore an ongoing process specific for each population.

Effects of a Nutrition Education Programme in Stage IV Cardiac Rehabilitation Patients: A 3-Arm Randomised Controlled Trial

This trial examined the influence of two nutrition intervention programmes on health-related and nutritional intake indices pertinent to cardiovascular disease compared to usual care in stage IV cardiac rehabilitation patients. Sixty-six patients were recruited from the Heartbeat North-West cardiac rehabilitation centre in Preston (United Kingdom). Patients were randomly assigned to Usual care, Biggest loser or Nutrition education arms. Usual care undertook their usual two exercise classes per week without nutritional support, Biggest loser underwent weekly education sessions focussing on weight loss using the themes within the British Heart Foundation 'So You Want to Lose Weight for Good' guidelines, and Nutrition education followed the same themes as Biggest loser but in a more focussed manner informed by patient focus groups. In total, this was a 12-week trial in which patients spent 6 weeks engaged in their allocated intervention arm, after which all participants switched to Usual care. The primary outcome was systolic blood pressure, and secondary measures of anthropometric, blood biomarker, nutritional knowledge (via the Mediterranean Diet Assessment Tool) and nutritional intake indices were measured at baseline, 6 weeks, and 12 weeks (follow-up). Intention-to-treat analyses revealed no significant alterations in the primary outcome (Usual care: baseline = 130.45 mmHg, 6 weeks = 127.83 mmHg, and follow-up = 126.35 mmHg, Biggest loser: baseline = 133.50 mmHg, 6 weeks = 123.06 mmHg, and follow-up = 135.22 mmHg, or Nutrition education: baseline = 135.23 mmHg, 6 weeks = 129.20 mmHg, and follow-up = 126.26 mmHg) between arms. However, at 6 weeks, improvements in triglycerides were significantly greater in Usual care (baseline = 1.61 mmol/L and 6 weeks = 1.43 mmol/L) group compared to Nutrition education (baseline = 1.70 mmol/L and 6 weeks = 2.21 mmol/L). Improvements in nutrition knowledge were significantly greater in Nutrition education (baseline = 8.48, 6 weeks = 9.77, and follow-up = 10.07) compared to Usual care (baseline = 7.71, 6 weeks = 8.00, and follow-up = 8.00) and Biggest loser (baseline = 7.71, 6 weeks = 8.73, and follow-up = 8.36). At 6 weeks, the Biggest loser group (baseline = 4.75 g and 6 weeks = 3.83 g) exhibited significantly greater improvements in salt intake compared to Usual care (baseline = 4.87 g and 6 weeks = 4.28 g) and Nutrition education (baseline = 19.25 g and 6 weeks = 16.78 g) in saturated fatty acids compared to Usual care (baseline = 20.26 g and 6 weeks = 21.34 g). This trial shows the effectiveness of nutritional interventions for improving nutritional knowledge and dietary practices in stage IV cardiac rehabilitation, but the mechanisms and longer-term effects of increased triglyceride levels in the Nutrition education group requires further exploration.

Influence of dietary pattern on anti-tuberculosis treatment outcomes in persons with dysglycemia: a Peruvian prospective cohort study

Introduction

Dietary patterns (DPs) are associated with overall nutritional status and may alter the clinical prognosis of tuberculosis. This interaction can be further intricated by dysglycemia (i.e., diabetes or prediabetes). Here, we identified DPs that are more common with tuberculosis-dysglycemia and depicted their association with tuberculosis treatment outcomes.

Methods

A prospective cohort study of persons with tuberculosis and their contacts was conducted in Peru. A food frequency questionnaire and a multidimensional systems biology-based analytical approach were employed to identify DPs associated with these clinical groups. Potential independent associations between clinical features and DPs were analyzed.

Results

Three major DPs were identified. TB-dysglycemia cases more often had a high intake of carbohydrates (DP1). Furthermore, DP1 was found to be associated with an increased risk of unfavorable TB outcomes independent of other factors, including dysglycemia.

Conclusion

Our findings suggest that the evaluation of nutritional status through DPs in comorbidities such as dysglycemia is a fundamental action to predict TB treatment outcomes. The mechanisms underlying the association between high intake of carbohydrates, dysglycemia, and unfavorable tuberculosis treatment outcomes warrant further investigation.

Reducing dietary intake of added sugars could affect the nutritional adequacy of vitamin A in adolescents: the Costa Rica case

BACKGROUND

In countries where sugar fortification with vitamin A is mandatory, strategies to reduce the prevalence of overweight/obesity in adolescents that involve lowering added sugar intake could lead to vitamin A inadequate intakes, since vitamin A-fortified sugar for home consumption contributes to a high proportion of this vitamin intake in the adolescent diet.

METHODS

The study employed a hierarchical linear model to perform a mediation analysis on a cross-sectional sample of adolescents (13-18 years old) in the province of San José, Costa Rica.

RESULTS

Lowering the total energy intake derived from added sugars to less than 10% significantly increases the prevalence of vitamin A inadequate intake in adolescents by 12.1% (from 29.6% to 41.7%). This is explained by the mediation model in which, the reduced adequacy of vitamin A intake is mediated by a reduction in total energy intake derived from added sugars fortified with vitamin A.

CONCLUSIONS

The vitamin A fortification of sugar for household consumption should be reassessed according to the current epidemiological profile in Costa Rica to promote strategies that reduce the prevalence of overweight/obesity in adolescents by lowering the consumption of added sugars without affecting vitamin A intake.

Nutritional Strategies for the Management of Type 2 Diabetes Mellitus: A Narrative Review

BACKGROUND

Thinking about greater adherence to dietary planning, it is extremely important to be aware of all nutritional strategies and dietary prescriptions available in the literature, and of which of them is the most efficient for the management of T2DM.

METHODS

A search was carried out in 2023 for randomized clinical trials, systematic reviews, meta-analyses, and guidelines in the following databases: Pubmed, Scielo, Web of Science, CrossRef and Google Scholar. In total, 202 articles were collected and analyzed. The period of publications was 1983-2023.

RESULTS

There is still no consensus on what the best nutritional strategy or ideal dietary prescription is, and individuality is necessary. In any case, these references suggest that Mediterranean Diet may of greater interest for the management of T2DM, with the following recommended dietary prescription: 40-50% carbohydrates; 15-25% proteins; 25-35% fats (<7% saturated, 10% polyunsaturated, and 10% monounsaturated); at least 14 g of fiber for every 1000 kcal consumed; and <2300 mg sodium.

CONCLUSIONS

Individuality is the gold standard for dietary prescriptions, however, the Mediterranean diet with low levels of carbohydrates and fats seems to be the most promising strategy for the management of T2DM.

Carbohydrate quality, fecal microbiota and cardiometabolic health in older adults: a cohort study

The impact of carbohydrate quality, measured by the carbohydrate quality index (CQI), on gut microbiota and health has been scarcely investigated. The aim of this study was to cross-sectionally and longitudinally explore the relationships between CQI, fecal microbiota, and cardiometabolic risk factors in an elderly Mediterranean population at high cardiovascular risk. At baseline and 1-year, CQI was assessed from food frequency questionnaires data, cardiometabolic risk factors were measured, and fecal microbiota profiled from 16S sequencing. Multivariable-adjusted linear regression models were fitted to assess the associations between tertiles of baseline CQI, fecal microbiota, and cardiometabolic risk factors at baseline, and between tertiles of 1-year change in CQI, 1-year change in fecal microbiota and cardiometabolic risk factors. Cross-sectionally, higher CQI was positively associated with Shannon alpha diversity index, and abundance of genera Faecalibacterium and Christensenellaceae R7 group, and negatively associated with the abundance of Odoribacter, and uncultured Rhodospirillales genera. Some of these genera were associated with higher glycated hemoglobin and lower body mass index. In addition, we observed a positive association between CQI, and some pathways related with the metabolism of butyrate precursors and plants-origin molecules. Longitudinally, 1-year improvement in CQI was associated with a concurrent increase in the abundance of genera Butyrivibrio. Increased abundance of this genera was associated with 1-year improvement in insulin status. These observations suggest that a better quality of carbohydrate intake is associated with improved metabolic health, and this improvement could be modulated by greater alpha diversity and abundance of specific genera linked to beneficial metabolic outcomes.

Digital Twin-Enabled Personalized Nutrition Improves Metabolic Dysfunction-Associated Fatty Liver Disease in Type 2 Diabetes: Results of a 1-Year Randomized Controlled Study

OBJECTIVE

Postprandial hyperglycemia drives insulin resistance and inflammation, leading to metabolic dysfunction-associated fatty liver disease (MAFLD). Prediction of postprandial glycemic responses by digital twin (DT) technology can fashion a personalized nutrition, activity, and sleep to treat type 2 diabetes (T2D) and MAFLD. This study examines the effects of DT-enabled personalized nutrition, activity, and sleep on glycemic status, surrogate markers of MAFLD, and magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) in patients with T2D.

METHODS

In an open-label randomized trial (2:1), 319 people with T2D were eligible to intervention (DT) or standard care (SC). DT patients followed personalized meal plans with foods suggested by artificial intelligence with least predicted postprandial glycemic response. The primary end point was to compare change in hemoglobin A1c (HbA1c) and medicine reduction between the DT and SC groups. Key secondary end points included remission to compare liver function test scores and visceral adiposity using MRI.

RESULTS

HbA1C was significantly better for DT than for SC (-2.9 [1.8] vs -0.3 [1.2]; P < .001) at 1 year with 72.7% remission of T2D. In patients with abnormal baseline values, significant improvements were seen in DT vs SC patients from baseline to 1 year in nonalcoholic fatty liver disease liver fat score (mean [SD]; -2.5 [2.0] vs -0.1 [1.5]; P < .001) and nonalcoholic fatty liver disease fibrosis score (-1.20 [0.9] vs -0.1 [1.0]; P < .001), respectively. Improvements are seen with DT compared with SC in other liver fat, fibrosis score, and %liver fat by MRI-PDFF.

CONCLUSION

At 1 year, DT-enabled personalized treatment significantly improved hyperglycemia and surrogate markers of MAFLD and MRI-PDFF.

Rest-activity rhythms across the lifespan: cross-sectional findings from the US representative National Health and Nutrition Examination Survey

STUDY OBJECTIVES

Rest-activity rhythms (RAR) may mark development, aging, and physical and mental health. Understanding how they differ between people may inform intervention and health promotion efforts. However, RAR characteristics across the lifespan have not been well-studied. Therefore, we investigated the association between RAR measures with demographic and lifestyle factors in a US nationally representative study.

METHODS

RAR metrics of interdaily stability (IS), intradaily variability (IV), relative amplitude (RA), and mean amplitude and timing of high (M10) and low (L5) activity were derived from 2011 to 2012 and 2013 to 2014 National Health and Nutrition Examination Survey (NHANES) actigraphy data. Population-weighted linear and logistic regression models were fit to examine the associations of age, gender, smoking, alcohol, season, body mass index (BMI), income-to-poverty ratio, and race/ethnicity with RAR. Significance was based on a false-discovery rate-corrected P-value of <0.05.

RESULTS

Among n = 12 526 NHANES participants (3-≥80 years), IS (higher = greater day-to-day regularity) and RA (higher = greater rhythm strength) generally decreased with age and were lower among males, whereas IV (higher = greater rhythm fragmentation) increased with age (p < 0.05). Dynamic changes in RAR trajectories were observed during childhood and adolescence. Income, BMI, smoking, and alcohol use were associated with RAR metrics, as well as season among children and teenagers (p < 0.05). RAR also differed by race/ethnicity (p < 0.05), with trajectories initially diverging in childhood and continuing into adulthood.

CONCLUSIONS

RAR differed by demographic and health-related factors, representing possible windows for public health intervention and sleep health promotion. RAR differences by race/ethnicity begin in childhood, are evident in early adolescence, and persist throughout adulthood.

Healthy helpers: using culinary lessons to improve children's culinary literacy and self-efficacy to cook

Background

Children do not eat the recommended amounts of vegetables, and school-based nutrition education has not been found to impact this behavior. Cooking education is associated with improved children's culinary literacy (CL) and eating behaviors. This study investigated the impact of a culinary literacy (CL) curriculum on children's acceptance of vegetable-added (mushrooms) recipes, CL, self-efficacy to cook (SE), and willingness to try vegetables (WV).

Methods

A convenience sample of 39 fourth and fifth graders were exposed to a six-lesson virtual CL curriculum that taught basic cooking skills and how to prepare six recipes, including three traditional recipes and the same recipes with added vegetables.

Results

Children who participated in the CL curriculum accepted vegetables added to pizza pockets, but vegetables added to macaroni and cheese and fajitas negatively affected the acceptance of recipes. Children improved their CL and SE but did not show a significant change in their WV.

Conclusion

Findings suggest that CL programs focusing on vegetables may drive factors associated with dietary behavior change, SE, and acceptance of vegetables. Future studies should consider CL as a potential method to improve vegetable intake in children in tandem with nutrition education or as a sole intervention. The study was limited by its small sample size, the virtual setting, and the use of mushrooms as the primary vegetable source. Future studies should be conducted with a larger sample size, in a traditional classroom setting, use a variety of vegetables, and collect qualitative data on the sensory characteristics affecting children's WV.

Associations of the MIND Diet with Cardiometabolic Diseases and Their Risk Factors: A Systematic Review

Purpose

Recent studies have expanded the scope of research on the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet beyond its impact on cognitive performance. These investigations have specifically explored its potential to provide protection against cardiometabolic diseases and associated risk factors, including obesity and dyslipidemia.

Methods

We systematically summarized and evaluated all existing observational and trial evidence for the MIND diet in relation to cardiometabolic diseases and their risk factors in adults. PubMed, Embase, CINAHL and Cochrane Library databases were systematically searched to extract original studies on humans published until September 2023, without date restrictions. A total of 491 studies were initially retrieved, out of which 23 met the eligibility criteria and were included in the final review. Duplicated and irrelevant studies were screened out by five independent reviewers using the Rayyan platform. Quality assessment was ascertained using the Newcastle-Ottawa scale for observational studies and the Cochrane risk-of-bias tool (RoB 2) for randomized trials.

Results

Across the different study designs, the MIND diet was generally associated with an improvement in anthropometric measures and other cardiometabolic outcomes, such as blood pressure, glycemic control, lipid profile, inflammation and stroke. The effects of the MIND eating pattern on some cardiovascular diseases are less conclusive.

Conclusion

The findings of this systematic review support the recommendation of the MIND diet as a strategy to reduce cardiometabolic risk in adults. Further well-designed and long-term studies are warranted.

Applying the Adjusted Chinese Dietary Balance Index-16 to Assess the Dietary Quality of Chinese Postpartum Lactating Mothers

A balanced diet is considered necessary in maternal recovery and neonatal development; however, the dietary quality of lactating mothers in China has not been systematically evaluated in different regions and stages of lactation. In addition, the release of the Chinese Dietary Guidelines in 2022 implies that the dietary index method needs to be adjusted accordingly. In this study, the adjusted Chinese Dietary Balance Index-16 (DBI-16) was used to assess the dietary quality of lactating women, referred to as the Dietary Balance Index for lactating women (DBI-L). This study is part of the MUAI study, in which dietary intake and demographic characteristics of lactating mothers from six cities in China and at different stages of lactation were obtained through a self-administered questionnaire and a food frequency questionnaire; 2532 puerperal women were included. According to the DBI-L, 66.2% of participants had inadequate dietary intake (79.1% vegetables, 79.1% fruits, 86.7% dairy products, 39.7% soybeans, and 69.4% fish products, respectively), 57.8% had excessive intake (76.0% cereals, 64.4% meat, and 29.1% eggs, respectively) and 92.2% had unbalanced dietary consumption. Dietary quality was optimal for mothers in the first month after delivery, and the dietary quality of mothers in economically developed places such as Shanghai and Guangzhou was significantly better than that in less developed places such as Lanzhou and Changchun. The dietary quality of lactating women in China is imbalanced, with excessive and inadequate dietary intake. The country should strengthen nutritional interventions for lactating mothers, especially in economically underdeveloped regions.

Knowledge, safety, and impact of alcohol consumption in young adults with type 1 diabetes mellitus: a qualitative study

PURPOSE

To explore the lived experiences of alcohol consumption among young adults with type 1 diabetes.

METHODS

Fourteen semi-structured interviews were conducted amongst young adults aged between 18 and 25 years, inclusive, with type 1 diabetes and experience consuming alcohol. Interviews were transcribed verbatim and analysed to identify common themes regarding their experiences.

RESULTS

The interviews confirmed that young adults with type 1 diabetes engage in social, and occasionally excessive, drinking behaviour. Furthermore, the interviews revealed four key themes: (i) Several sources contribute to a widely inconsistent understanding of the impact and management of alcohol consumption; (ii) Perceived inconvenience of maintaining healthy glycaemic control whilst drinking socially; (iii) Engagement in proactive strategies for harm reduction occurred when convenient; and (iv) Impact of modern diabetes technology in overcoming previous burdens and promoting glycaemic safety.

CONCLUSION

Young adults with type 1 diabetes continue to need anticipatory education surrounding safe alcohol consumption and behaviours, as well as ongoing support and encouragement to ensure engagement with traditional self-management tasks. Significant alcohol-diabetes related safety issues, particularly hypoglycaemia do occur, and were captured within this small sample and study. Diabetes technology has an important complementary role along with education and tailored support strategies to support health and safe glucose control during alcohol consumption.

Medical and Psychological Aspects of Pregnancy in Women with Obesity and after Bariatric Surgery

Chronic diseases are potential risk factors for pregnancy duration and neonatal outcomes. This narrative review aimed to summarize the research results on the specifics of pregnancy in women with obesity and after bariatric surgery. PubMed and Google Scholar databases were searched. Systematic reviews, meta-analyses, clinical trials, and references to identified articles from the last ten years (2013-2023) were included. Ultimately, 107 literature items were qualified. It has been shown that women with obesity planning pregnancy should reduce their body weight because obesity is a risk factor for adverse obstetric and neonatal outcomes. Bariatric surgery effectively reduces excessive body weight and the health risks in women with obesity during pregnancy and their offspring. However, at least a year interval between surgery and conception is recommended. An interdisciplinary medical team should provide patient care during pregnancy with knowledge and skills related to people after bariatric surgery. Due to the increased risk of mental disorders, especially depression, it is necessary to constantly monitor the mental state of women and provide psychological support and education on a healthy lifestyle during pregnancy and the postpartum period.

Association between daily alcohol consumption and serum alpha klotho levels among U.S. adults over 40 years old: a cross-sectional study

BACKGROUND

Klotho is a hormone considered to be an anti-aging biomarker. The relationships between daily alcohol consumption and serum klotho are mainly unknown. The purpose of this study is to assess the relationship between alcohol consumption and serum alpha klotho (α-klotho) levels in the U.S.

METHODS

The data came from 11,558 participants aged ≥ 40 in the 2007-2016 National Health and Nutrition Examination Survey. Adults with reliable α-klotho plasma results were the target population. The self-report method was used to assess alcohol consumption. The relationship between daily alcohol intake and serum α-klotho levels was estimated using multivariable linear regression models. We also performed a stratified analysis of clinically important variables.

RESULTS

The mean serum α-klotho level among the 11,558 participants was 843.82 pg/mL. After full adjustment, participants with current moderate and heavy alcohol intake had lower serum α-klotho levels than those who never alcohol intake (β =  - 62.64; 95% CI: - 88.86, - 36.43; P < 0.001; β =  - 81.54; 95% CI: - 111.54, - 51.54; P < 0.001, respectively). Furthermore, the stratified analysis indicated that the association was insignificant in individuals with cardiovascular disease, chronic kidney disease, or cancer.

CONCLUSION

Daily alcohol consumption was inversely associated with serum α-klotho levels among U.S. adults over 40 years old. However, individuals with cardiovascular disease, chronic kidney disease, or cancer found no such relationship.

Physical Activity and Type 2 Diabetes: In Search of a Personalized Approach to Improving β-Cell Function

Type 2 diabetes mellitus (T2DM) is one of the most widespread diseases worldwide. Lifestyle interventions, including diet and physical activity (PA), are fundamental non-pharmacological components of T2DM therapy. Exercise interventions are strongly recommended for people with or at risk of developing or already with overt diabetes, but adherence to PA guidelines in this population is still challenging. Furthermore, the heterogeneity of T2DM patients, driven by differing residual β-cell functionality, as well as the possibility of practicing different types and intensities of PA, has led to the need to develop tailored exercise and training plans. Investigations on blood glucose variation in response to exercise could help to clarify why individuals do not respond in the same way to PA, and to guide the prescription of personalized treatments. The aim of this review is to offer an updated overview of the current evidence on the effects of different regimens and modalities of PA regarding glucose sensing and β-cell secretory dynamics in individuals with prediabetes or T2DM, with a special focus on β-cell function.