Nutritional research is moving to a whole-diet approach, time for food policy

What dietary interventions have been tested in heart failure with preserved ejection fraction? A systematic scoping review

AIMS

To determine what dietary interventions have been tested in heart failure with preserved ejection fraction (HFpEF), the modulation method, and outcomes employed and to summarize any evidence for benefit.

METHODS AND RESULTS

We performed key word searches in five bibliographic databases from 2001 to 2021, to identify randomized or experimental dietary interventions tested in HFpEF or mixed heart failure (HF) samples. Study characteristics were summarized according to population, intervention, comparator, outcome categories and intervention complexity was assessed. Twenty-five clinical investigations were retrieved; only 10 (40%) were conducted exclusively in HFpEF; the remainder enrolled mixed HF samples. Most studies employed either highly tailored prescribed diets (n = 12, 48%) or dietary supplementation (n = 10, 40%) modalities. Dietary pattern interventions (n = 3, 12%) are less well represented in the literature.

CONCLUSION

Heterogeneity made pooling studies challenging. Better reporting of baseline characteristics and the use of standardized HF lexicon would ensure greater confidence in interpretation of studies involving mixed HF populations. The field would benefit greatly from explicit reporting of the biological mechanism of action (e.g. the causal pathway) that an intervention is designed to modulate so that studies can be synthesized via their underlying mechanism of action by which diet may affect HF. An extension of the current set of core outcomes proposed by the European Society of Cardiology Heart Failure Association would ensure dietary clinical endpoints are more consistently defined and measured.

REGISTRATION

PROSPERO: CRD42019145388.

Towards healthier and more sustainable diets in the Australian context: comparison of current diets with the Australian Dietary Guidelines and the EAT-Lancet Planetary Health Diet

BACKGROUND

There is increasing focus on moving populations towards healthier and more environmentally sustainable dietary patterns. The Australian Dietary Guidelines provide dietary patterns that promote health and wellbeing. It is unclear how these guidelines align with the more recently published global recommendations of the EAT-Lancet Planetary Health Reference Diet, and how Australian diets compare to both sets of recommendations.

METHODS

Data from one 24-h recall collected for the 2011-13 National Nutrition and Physical Activity Survey were analysed for 5,920 adults aged 19-50 years. Subgroups of this population were identified by diet quality and lower or higher consumption of foods often considered to be environmentally intensive (higher animal meat and dairy foods) or associated with healthiness (higher vegetables and lower discretionary choices). Food group and nutrient composition of Australian diets were compared to diets modelled on the Australian Dietary Guidelines and Planetary Health Reference Diet. The environmental impacts of diets were estimated using an index of combined metrics.

RESULTS

Compared with the Planetary Health Reference Diet, the Australian Dietary Guidelines contained more servings of the vegetable, dairy and alternatives, fruit, and discretionary choices. The amount of meat and alternatives was higher in the Planetary Health Reference Diet than Australian Dietary Guidelines due to the inclusion of more plant-based meat alternatives. The average Australian diet contained two to almost four times the Australian Dietary Guidelines and Planetary Health Reference Diet maximum recommended intake of discretionary choices, and provided inadequate amounts of the vegetables, cereals, unsaturated fats and meats and alternatives food groups, primarily due to lower intakes of plant-based alternatives. The average Australian diet also contained less dairy and alternatives than the Australian Dietary Guidelines. In the average Australian diet, red meat and poultry contributed 73% to the total servings of meat and alternatives compared to 33% and 10% for the Australian Dietary Guidelines and Planetary Health Reference Diet respectively. The modelled Australian Dietary Guidelines diet met the relevant nutrient reference value for all 22 nutrients examined, whereas the Planetary Health Reference Diet contained an inadequate amount of calcium. The environmental impact scores of the Planetary Health Reference Diet and Australian Dietary Guidelines were 31% and 46% lower than the average Australian diet.

CONCLUSIONS

Significant changes are required for Australians' dietary intake to align more closely with national and global dietary recommendations for health and environmental sustainability.

Effects of Catfish (Ictalurus punctatus) Bone Powder on Consumers’ Liking, Emotions, and Purchase Intent of Fried Catfish Strips

Catfish are the predominant U.S. aquacultural product. However, byproducts from filleting, including bones that are high in calcium, typically go to waste or are sold as a low-valued feed. This research evaluated the potential use of catfish bone powder (CBP; 21.07% calcium) as a food ingredient. Catfish fillet strips were dredged with a breading mix (CBPM) containing 0% (0CBPM), 10% (10CBPM), and 20% (20CBPM) CBP before frying. Consumers (N = 211) evaluated sensory liking (nine-point hedonic scale) and attribute intensity (JAR scale), emotions (check-all-that-apply), and purchase intent (PI, yes/no) of samples. Color and texture were measured instrumentally. CBP did not show any negative effects on liking scores, although crispiness was scored higher for 20CBPM (mean = 6.88) than 10CBPM (mean = 6.43). Positive emotions were most relevant to CBP-containing samples, with significantly higher rates of adventurous and understanding. Information about calcium fortification using CBP increased PI to 81.04% for the 10CBPM and 83.89% for the 20CBPM samples and showed a greater effect on Latin Americans/Hispanics than U.S. Americans. Consumers were not averse to the consumption of CBP which can contribute to sustainable nutrition through waste reduction. Successful calcium fortification of fried catfish dredged with 20% CBP did not compromise sensory liking and may be feasible in other products.