A Systematic Review of the Methods Used to Assess and Report Dietary Patterns

Low-carbon diets across diverse dietary patterns: Addressing population heterogeneity under constrained optimization

Mathematical optimization is a useful tool for modeling diets that fulfill requirements for health and environmental sustainability, however, population-based optimization approaches fail to account for underlying dietary diversity in populations. This study proposes a methodological approach to consider diverse dietary intake patterns in mathematical optimization of nutritionally adequate low-carbon diets and investigates the differences between different population groups, along with trade-offs between greenhouse gas emission (GHGE) reduction and the inconvenience of dietary changes required to achieve optimized diets. A k-means clustering analysis was applied to individual dietary intake data from Denmark, which resulted in four clusters with different dietary patterns. This was followed by quadratic programming, wherein the total dietary changes required from the observed diet within each cluster were used as a proxy for consumer inconvenience (i.e., "inconvenience index") and were minimized while fulfilling nutrient constraints and incrementally tightened GHGE constraints. Across clusters, a steep increase of the inconvenience index was observed at GHGE levels below approximately 3 kg CO2e/10 MJ, corresponding to GHGE reductions of 24-36 % in different clusters. In all clusters, the optimized diets with nutritional and GHGE constraints showed common traits of increased content of cereals and starches, eggs, and fish and decreased amounts of beef and lamb, cheese, animal-based fats, and alcoholic beverages, but differences across clusters were also observed, maintaining characteristics of the clusters' baselines. When additional health-based targets for food amounts were applied as constraints, the optimized diets converged towards the same type of diet. The total inconvenience of dietary changes required to fulfill constraints differed between clusters, indicating that specific sub-populations may be more effective targets for dietary transition. The method has potential for future integration of more sustainability aspects and different consumer preferences.

Developing a Dietary Questionnaire for Rural Mexican Americans

Latinos form the largest ethnic population in the United States (18.5%), and the majority are Mexican Americans (61.4%). Many Mexican Americans have unique dietary behaviors, yet few food frequency questionnaires explicitly define Mexican American diets. The objective of this work was to engage with a population of rural Mexican Americans to develop a Mexican American food frequency questionnaire. Because acculturation is linked to dietary intake, we also examined acculturation by diet. We used mixed methods with three phases: (1) a qualitative phase in which a sample of rural Mexican-Americans (N = 15) identified and provided rich data about foods they ate; (2) a developmental phase in which 4 day food records were completed sequentially by two new and different samples of Mexican Americans (N = 19); and 3) a preliminary assessment phase where a new sample of Mexican Americans (N = 49) completed the final food frequency questionnaire. The final questionnaire included many traditional Mexican foods and beverages identified by study participants as part of their typical diet. Traditional Mexican foods and beverages were consumed regularly; little variation in diet was seen by level of acculturation. Respondents perceived diets containing commercial sugar-sweetened beverages as unhealthful, but not those with traditional Mexican drinks, which may represent an unappreciated source of added sugar in the diet. Future work includes studies examining dietary patterns in other urban and rural communities with traditional Mexican diets.

Association of Dietary Patterns, Suspected Sarcopenia, and Frailty Syndrome among Older Adults in Poland-A Cross-Sectional Study

BACKGROUND

The association of sarcopenia and frailty syndrome with dietary patterns is not yet well recognized.

THE AIM

The aim of the study was to evaluate the association among dietary patterns, suspected sarcopenia, and frailty syndrome among older people in Poland.

METHODS

The study was conducted in 2022 and 2023 among people aged 55 and older. The sample was chosen arbitrarily. The following questionnaires were used in the study: the KomPAN (assessment of frequency of food intake and sociodemographic characteristics), the SARC-F (assessment of risk of sarcopenia), and the EFS (diagnosis of frailty syndrome). To confirm the suspicion of sarcopenia, muscle strength was assessed using the HGS and FTSST, and physical fitness was assessed using the GST. Based on the frequency of food consumption, 11 DPs (factors) were selected using PCA analysis. SARC-F, HGS, FTSST, and GST results were used to identify homogeneous groups (clusters) using cluster analysis, a k-means method.

RESULTS

Two clusters were identified: cluster 1 (the non-sarcopenic cluster, or nSC) and cluster 2 (the sarcopenic cluster, or SC). Associations between variables were assessed using logistic regression. Suspected sarcopenia was found in 32.0% of respondents, more in men than women, and more among those either over 75 or 65 and under. EFS results showed that the risk (22.1%) or presence of frailty syndrome (23.8%) was more common in men than women and more common in those aged 75 and older than in other age groups. Male gender; older age; and unfavorable dietary patterns, i.e., consumption of white bread and bakery products, white rice and pasta, butter, and potatoes (factor 1) and cheese, cured meat, smoked sausages, and hot dogs (factor 9), increased the likelihood of sarcopenia and frailty syndrome, while the pattern associated with fruit and water consumption (factor 7) had the opposite effect.

CONCLUSIONS

Confirmation of the importance of dietary patterns in the etiology and pathogenesis of sarcopenia and frailty syndrome should be documented in prospective cohort studies.

Unveiling the Roles of Immune Function and Inflammation in the Associations Between Dietary Patterns and Incident Type 2 Diabetes

OBJECTIVE

To investigate the associations between data-driven dietary patterns, immune function, and incident type 2 diabetes (T2D) and the mediating effects of immune function.

METHODS

This study included 375,665 participants without diabetes at baseline in the UK Biobank study. Dietary patterns were derived through principal component analysis of food frequency questionnaire data. Immune function was assessed using 14 individual inflammatory markers and an integrated low-grade inflammation score (INFLA-score). Cox proportional hazard models were used to estimate the associations of dietary patterns or immune function with incident T2D. Linear regressions were used to estimate the associations of dietary patterns with immune function. Mediating effects of immune function were quantified.

RESULTS

During a median 14.6-year follow-up, 13,932 participants developed T2D. Four dietary patterns were identified: prudent diet (high in whole grains, vegetables, fruits, fish), wheat/dairy/eggs restrictive diet (limiting these foods), meat-based diet (high in red/processed meat, salt), and full-cream dairy diet (preference for full cream milk or dairy products). The prudent diet was negatively (HRQ4 vs Q1, 0.69 [95% CI, 0.65-0.72]), while the wheat/dairy/eggs restrictive diet (HRQ4 vs Q1, 1.08 [95% CI, 1.03-1.13]), meat-based diet (HRQ4 vs Q1, 1.12 [95% CI, 1.06-1.17]), and full-cream dairy diet (HRQ4 vs Q1, 1.08 [95% CI, 1.03-1.12]) were positively associated with incident T2D (all p for trend ≤0.04). The prudent diet was negatively and the full-cream dairy diet was positively associated with most inflammatory markers. Most inflammatory markers, especially INFLA-score (HR, 1.18 [95% CI, 1.16-1.20]), were positively associated with incident T2D. INFLA-score mediated 13% of the association with incident T2D for the prudent diet and 34% for the full-cream dairy diet.

CONCLUSIONS

This study identified four distinct dietary patterns and a range of inflammatory markers associated with incident T2D. A notable proportion of the associations between dietary patterns and T2D was mediated by immune function.

Analytic Methods for Understanding the Temporal Patterning of Dietary and 24-H Movement Behaviors: A Scoping Review

Dietary and movement behaviors [physical activity (PA), sedentary behavior (SED), and sleep] occur throughout a 24-h day and involve multiple contexts. Understanding the temporal patterning of these 24-h behaviors and their contextual determinants is key to determining their combined effect on health. A scoping review was conducted to identify novel analytic methods for determining temporal behavior patterns and their contextual correlates. We searched Embase, ProQuest, and EBSCOhost databases in July 2022 to identify studies published between 1997 and 2022 on temporal patterns and their contextual correlates (e.g., locational, social, environmental, personal). We included 14 studies after title and abstract (n = 33,292) and full-text (n = 135) screening, of which 11 were published after 2018. Most studies (n = 4 in adults; n = 5 in children and adolescents), examined waking behavior patterns (i.e., both PA and SED) of which 3 also included sleep and 6 included contextual correlates. PA and diet were examined together in only 1 study of adults. Contextual correlates of dietary, PA, and sleep temporal behavior patterns were also examined. Machine learning with various clustering algorithms and model-based clustering techniques were most used to determine 24-h temporal behavior patterns. Although the included studies used a diverse range of methods, behavioral variables, and assessment periods, results showed that temporal patterns characterized by high SED and low PA were linked to poorer health outcomes, than those with low SED and high PA. This review identified temporal behavior patterns, and their contextual correlates, which were associated with adiposity and cardiometabolic disease risk, suggesting these methods hold promise for the discovery of holistic lifestyle exposures important to health. Standardized reporting of methods and patterns and multidisciplinary collaboration among nutrition, PA, and sleep researchers; statisticians; and computer scientists were identified as key pathways to advance future research on temporal behavior patterns in relation to health.

Maternal diet quality trajectories from pregnancy to 3.5 years postpartum and associated maternal factors

PURPOSE

This study examined maternal diet quality trajectories from pregnancy to 3.5 years postpartum and associated maternal factors.

METHODS

Data of 473 Australian women from the Healthy Beginnings Trial were used. A food frequency questionnaire collected dietary intake in pregnancy and 1, 2 and 3.5 years postpartum. Diet quality scores were calculated using the 2013 Dietary Guideline Index (DGI-2013) and RESIDential Environments Guideline Index (RDGI). Group-based trajectory modelling identified diet quality trajectories from pregnancy to 3.5 years postpartum. Multivariable logistic regression investigated factors associated with maternal diet quality trajectories.

RESULTS

Two stable trajectories of low or high diet quality were identified for the DGI-2013 and RDGI. Women who smoked had higher odds of following the low versus the high DGI-2013 (OR 1.77; 95%CI 1.15, 2.75) and RDGI (OR 1.80; 95%CI 1.17, 2.78) trajectories, respectively. Women who attended university had lower odds of following the low versus the high DGI-2013 (OR 0.41; 95%CI 0.22, 0.76) and RDGI (OR 0.38; 95%CI 0.21, 0.70) trajectories, respectively. Women who were married had lower odds of following the low versus the high DGI-2013 trajectory (OR 0.39; 95%CI 0.17, 0.89), and women who were unemployed had higher odds of following the low versus the high RDGI trajectory (OR 1.78; 95%CI 1.13, 2.78). Maternal age, country of birth, household composition and pre-pregnancy body mass index were not associated with diet quality trajectories.

CONCLUSION

Maternal diet quality trajectories remained stable from pregnancy to 3.5 years postpartum. Women who smoked, completed high school or less, were not married or were unemployed tended to follow low, stable diet quality trajectories.

Difference in Gastrointestinal Cancer Risk and Mortality by Dietary Pattern Analysis: A Systematic Review and Meta-Analysis

CONTEXT

Several studies have demonstrated that dietary patterns identified by a posteriori and hybrid methods are associated with gastrointestinal (GI) cancer risk and mortality. These studies applied different methods for analyzing dietary data and reported inconsistent findings.

OBJECTIVE

This systematic review and meta-analysis were aimed to determine the association between dietary patterns, derived using principal component analysis (PCA) and reduced rank regression (RRR), and GI cancer risk and GI cancer-caused mortality.

DATA SOURCE

Articles published up to June 2023 in English were eligible for inclusion. The Medline, SCOPUS, Cochrane Library, CINHAL, PsycINFO, ProQuest, and Web of Sciences databases were used to identify prospective studies. The Preferred Reporting Item for Systematic Review and Meta-analysis Protocol 2020 was used to report results.

DATA EXTRACTION

A total of 28 studies were eligible for inclusion. Varied approaches to deriving dietary patterns were used, including PCA (n = 22), RRR (n = 2), combined PCA and RRR (n = 1), cluster analysis (CA; n = 2) and combined PCA and CA (n = 1).

DATA ANALYSIS

Two dietary patterns, "healthy" and "unhealthy," were derived using PCA and RRR. The healthy dietary pattern was characterized by a higher intake of fruits, whole grains, legumes, vegetables, milk, and other dairy products, whereas the unhealthy dietary pattern was characterized by a higher intake of red and processed meat, alcohol, and both refined and sugar-sweetened beverages. The findings indicated that the PCA-derived healthy dietary pattern was associated with an 8% reduced risk (relative risk [RR], 0.92; 95% CI, 0.87-0.98), and the unhealthy dietary pattern was associated with a 14% increased risk (RR, 1.14; 95% CI, 1.07-1.22) of GI cancers. Similarly, the RRR-derived healthy dietary pattern (RR, 0.83; 95% CI, 0.61-1.12) may be associated with reduced risk of GI cancers. In contrast, the RRR-derived unhealthy dietary pattern (RR, 0.93; 95% CI, 0.57-1.52) had no association with a reduced risk of GI cancers. Similarly, evidence suggested that PCA-derived healthy dietary patterns may reduce the risk of death from GI cancers, whereas PCA-derived unhealthy dietary patterns may increase the risk.

CONCLUSION

Findings from prospective studies on the association of PCA-derived dietary patterns and the risk of GI cancers support the evidence of healthy and unhealthy dietary patterns as either protective or risk-increasing factors for GI cancers and for survivorship, respectively. The findings also suggest that the RRR-derived healthy dietary pattern reduces the risk of GI cancers (albeit with low precision), but no association was found for the RRR-derived unhealthy dietary pattern. Prospective studies are required to further clarify disparities in the association between PCA- and RRR-derived dietary patterns and the risk of GI cancers. Systematic review registration: PROSPERO registration no. CRD42022321644.

Relation of preconception eating behaviours to dietary pattern trajectories and gestational weight gain from preconception to late pregnancy

Studies examining preconception eating behaviours with longitudinal dietary patterns from preconception to late pregnancy as well as gestational weight gain (GWG) are limited. We derived dietary pattern trajectories from preconception to late-pregnancy, and related preconception eating behaviours to these trajectories and GWG. Preconception eating behaviours were assessed using the Three-Factor Eating Questionnaire measuring cognitive restraint (CR) - conscious restriction of food intake, emotional eating (EE) - overeating in response to negative emotions, and uncontrolled eating (UE) - overeating with a feeling of lack of control. Dietary intakes were measured at preconception, 20-21 and 34-36 weeks' gestation with food frequency questionnaires. Dietary patterns were determined using factor analysis, and trajectories derived using group-based trajectory modelling. Inadequate and excessive GWG were defined according to Institute of Medicine guidelines based on weights at preconception and the last antenatal visit (median: 38 weeks' gestation). Two dietary patterns were derived: 'Fast Food, Fried Snacks and Desserts (FFD)' and 'Soup, Fish and Vegetables (SFV)'. Adherence trajectories from preconception to late-pregnancy were characterised as consistently high ("stable-high") and low ("stable-low"). Women with higher UE scores had higher odds of being in the "stable-high" trajectory (n = 34) of the FFD pattern [Odds Ratio (OR): 1.25, 95% Confidence Interval (CI): 1.03, 1.51], compared to "stable-low" (n = 260). Percentages of women with inadequate, adequate or excessive GWG were 21.7% (n = 70), 25.8% (n = 83), and 52.5% (n = 169), respectively; women with higher EE scores had a higher likelihood of excessive GWG [Relative Risk Ratio (RRR): 1.35, 95% CI: 1.02, 1.80], but this association was attenuated after adjusting for preconception body mass index. Eating behaviour interventions to improve dietary patterns among pregnant women may need to start as early as preconception, incorporating strategies to manage UE.

Still too little evidence: the role of diet in colorectal cancer survivorship - a systematic review

Colorectal cancer incidence (CRC) is influenced by dietary factors, yet the impact of diet on CRC-specific mortality and recurrence-free survival (RFS) remains unclear. This review provides a narrative summary of existing research on dietary factors affecting CRC-specific mortality, RFS, and disease-free survival (DFS). This study searched electronic databases to identify cross-sectional/prospective research investigating dietary intake on CRC-specific mortality, RFS, or DFS. Twenty-eight studies were included in the corpus. Because of high study heterogeneity, we performed a narrative synthesis of studies. Limited, but suggestive evidence indicates beneficial effects of adhering to the American Cancer Society (ACS) guidelines and a plant rich low-carbohydrate diet on risk of CRC-specific mortality, potentially driven by fiber from cereals, vegetables, and wholegrains, but not fruit. For RFS and DFS, a Western dietary pattern, high intake of refined grains, and sugar sweetened beverages correlated with increased risk of CRC recurrence and development of disease/death. Conversely, greater adherence to the ACS dietary and alcohol guidelines, higher ω-3 polyunsaturated fatty acids, and dark fish consumption reduced risk. Our findings underscore the need for (i) standardized investigations into diet's role in CRC survivorship, including endpoints, and (ii) comprehensive analyses to isolate specific effects within correlated lifestyle components.

Towards consistency in dietary pattern scoring: standardising scoring workflows for healthy dietary patterns using 24-h recall and two variations of a food frequency questionnair

Healthy dietary patterns such as the Mediterranean diet (MeDi), Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) have been evaluated for their potential association with health outcomes. However, the lack of standardisation in scoring methodologies can hinder reproducibility and meaningful cross-study comparisons. Here we provide a reproducible workflow for generating the MeDi, DASH and MIND dietary pattern scores from frequently used dietary assessment tools including the 24-h recall tool and two variations of FFQ. Subjective aspects of the scoring process are highlighted and have led to a recommended reporting checklist. This checklist enables standardised reporting with sufficient detail to enhance the reproducibility and comparability of their outcomes. In addition to these aims, valuable insights in the strengths and limitations of each assessment tool for scoring the MeDi, DASH and MIND diet can be utilised by researchers and clinicians to determine which dietary assessment tool best meets their needs.

Breastmilk mineral composition among well-educated mothers from Central Poland - Associations with maternal dietary intake, dietary patterns and infant psychomotor development

BACKGROUND

Maternal dietary habits could affect breastmilk mineral composition, which may influence infant development. Mineral dietary intake or supplementation slightly affects its breastmilk concentration. However, the intake of selected food groups or dietary patterns that reflect diet complexity could have a greater impact. Hence, the aim of the study was to assess breastmilk mineral composition at one, three, and six months of lactation among mothers living in urban area of Central Poland, as well as the evaluate maternal dietary determinants and associations with infant anthropometric and psychomotor development.

METHODS

The study was conducted among 43 healthy and exclusively breastfeeding mothers. In the first, third, and sixth months of lactation, we collected breastmilk samples and assessed the concentration of Ca, P, Zn, Fe, Se, Ni, As, Pb, and Cd using the ICP-MS method. Maternal dietary habits were evaluated by a food frequency questionnaire in the first month of lactation, whereas in the third and sixth by the three-day food record. Based on the collected data adherence to the Polish-adapted Mediterranean (Pl-aMED; 1 month) and the DASH diet (Mellen's Index; 3 and 6 months) was assessed. In the third and sixth months of lactation infant anthropometric parameters and the sixth month of lactation psychomotor development were evaluated.

RESULTS

Breastmilk Se, Ni, As, Pb, and Cd levels were under the LOQ in all the breastmilk samples at all study visits. Median breastmilk mineral concentrations of Ca, P, Zn, and Fe in the first, third, and sixth months of lactation varied from 381.9 to 332.7 mg/L, 161.6 to 139.1 mg/L, 2.2 to 0.8 mg/L, and 0.26 to 0.17 mg/L, respectively. Maternal dietary intake and supplementation did not affect breastmilk Ca, P, Zn, and Fe. Pl-aMED scores were associated with breastmilk Ca (β = 0.489, 95% CI 0.180 - 0.799, p = 0.003) and Zn (β = 0.499, 95% CI 0.199 - 0.798, p = 0.002) in the first month of lactation, whereas no association with the DASH diet were observed in the third and sixth month of lactation. Breastmilk Fe in the third month was associated with infant motor development (β = 0.420, 95% CI 0.113 - 0.727, p = 0.009) in the sixth month of life, but no other associations with anthropometric or psychomotor development were observed. Moreover, we estimated that few infants meet their adequate intake (AI) requirements for P, Zn, and Fe.

CONCLUSION

Our study showed that maternal adherence to Pl-aMED is a significant predictor of breastmilk Ca and Zn in the first month of lactation, which may be especially important considering that more than 75% of infants had inadequate Zn intake. Moreover, we found that breastmilk Fe positively influenced infant motor development, despite the majority of infants having inadequate intake. On the other hand, no infant had deficiency symptoms, which emphasizes the necessity to evaluate of AI norms for infants.

Western, Healthful, and Low-Preparation Diet Patterns in Preschoolers of the STRONG Kids2 Program

OBJECTIVE

Identify and describe diet patterns of children during early childhood using confirmatory factor analysis (CFA).

DESIGN

Longitudinal data were drawn from the STRONG Kids 2 program.

PARTICIPANTS

Mothers were surveyed about their child's diet at 24 (n = 337), 36 (n = 317), and 48 (n = 289) months old.

VARIABLES MEASURED

The Block Food Frequency Questionnaire for children aged 2-7 years was used to derive diet patterns; 23 food groups were created for analyses.

ANALYSIS

Principal component analysis was used to obtain preliminary factor loadings, and loadings were used to form a priori hypotheses for CFA-derived diet patterns. Independent samples t tests were used to compare food groups, nutrient intakes, and child and family characteristics by CFA pattern scores above vs at/below the median.

RESULTS

Three diet patterns consistently emerged: (1) processed meats, sweets, and fried foods; (2) vegetables, legumes, and starchy vegetables; and (3) grains, nuts/seeds, and condiments (only 24 and 36 months). Patterns were related to differences in added sugars, dietary fiber and potassium intakes, maternal education, and household income.

CONCLUSIONS AND IMPLICATIONS

Opposing healthful vs Western patterns, extant in child and adult literature, were observed across all ages. The third pattern differed between 24/36 and 48 months, representing a potential shift in food choices or offerings as children age.

Conceptualization and Assessment of 24-H Timing of Eating and Energy Intake: A Methodological Systematic Review of the Chronic Disease Literature

Timing of eating (TOE) and energy intake (TOEI) has important implications for chronic disease risk beyond diet quality. The 2020 Dietary Guidelines Advisory Committee recommended developing consistent terminology to address the lack of TOE/TOEI standardization. The primary objective of this methodological systematic review was to characterize the conceptualization and assessment of TOE/TOEI within the chronic disease literature (International Prospective Register of Systematic Reviews registration number: CRD42021236621). Literature searches in Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Embase, PubMed, and Scopus were limited to English language publications from 2000 to August 2022. Eligible studies reported the association between TOE/TOEI and obesity, cardiovascular disease, type 2 diabetes mellitus, cancer, or a related clinical risk factor among adults (≥19 y) in observational and intervention studies. A qualitative synthesis described and compared TOE/TOEI conceptualization, definitions, and assessment methods across studies. Of the 7579 unique publications identified, 259 studies (observational [51.4 %], intervention [47.5 %], or both [1.2 %]) were eligible for inclusion. Key findings indicated that most studies (49.6 %) were conducted in the context of obesity and body weight. TOE/TOEI variables or assigned conditions conceptualized interrelated aspects of time and eating or energy intake in varying ways. Common TOE/TOEI conceptualizations included the following: 1) timepoint (specific time to represent when intake occurs, such as time of breakfast [74.8 %]); 2) duration (length of time or interval when intake does/does not occur, such as "eating window" [56.5 %]); 3) distribution (proportion of daily intake at a given time interval, such as "percentage of energy before noon" [29.8 %]); and 4) cluster (grouping individuals based on temporal ingestive characteristics [5.0 %]). Assessment, definition, and operationalization of 24-h TOE/TOEI variables varied widely across studies. Observational studies most often used surveys or questionnaires (28.9 %), whereas interventions used virtual or in-person meetings (23.8 %) to assess TOE/TOEI adherence. Overall, the diversity of terminology and methods solidifies the need for standardization to guide future research in chrononutrition and to facilitate inter-study comparisons.

Are Major a Posteriori Dietary Patterns Reproducible in the Italian Population? A Systematic Review and Quantitative Assessment

Although a posteriori dietary patterns (DPs) naturally reflect actual dietary behavior in a population, their specificity limits generalizability. Among other issues, the absence of a standardized approach to analysis have further hindered discovery of genuinely reproducible DPs across studies from the same/similar populations. A systematic review on a posteriori DPs from principal component analysis or exploratory factor analysis (EFA) across study populations from Italy provides the basis to explore assessment and drivers of DP reproducibility in a case study of epidemiological interest. First to our knowledge, we carried out a qualitative (i.e., similarity plots built on text descriptions) and quantitative (i.e., congruence coefficients, CCs) assessment of DP reproducibility. The 52 selected articles were published in 2001-2022 and represented dietary habits in 1965-2022 from 70% of the Italian regions; children/adolescents, pregnancy/breastfeeding women, and elderly were considered in 15 articles. The included studies mainly derived EFA-based DPs on food groups from food frequency questionnaires and were of "good quality" according to standard scales. Based on text descriptions, the 186 identified DPs were collapsed into 113 (69 food-based and 44 nutrient-based) apparently different DPs (39.3% reduction), later summarized along with the 3 "Mixed-Salad/Vegetable-based Patterns," "Pasta-and-Meat-oriented/Starchy Patterns," and "Dairy Products" and "Sweets/Animal-based Patterns" groups, by matching similar food-based and nutrient-based groups of collapsed DPs. Based on CCs (215 CCs, 68 DPs, 18 articles using the same input lists), all pairs of DPs showing the same/similar names were at least "fairly similar" and ∼81% were "equivalent." The 30 "equivalent" DPs ended up into 6 genuinely different DPs (80% reduction) that targeted fruits and (raw) vegetables, pasta and meat combined, and cheese and deli meats. Such reduction reflects the same study design, list of input variables, and DP identification method followed across articles from the same groups. This review was registered at PROSPERO as CRD42022341037.

Dietary Patterns and Health: Insights From NESR Systematic Reviews to Inform the Dietary Guidelines for Americans

This perspective article shares unique insights from the extensive experience of the US Department of Agriculture Nutrition Evidence Systematic Review branch in conducting systematic reviews on dietary patterns and health outcomes to inform the Dietary Guidelines for Americans. Methodological approaches for reviewing dietary patterns research are described, including approaches to operationalizing definitions and analyzing labeled dietary patterns. The review also describes techniques for synthesizing dietary patterns research across life stages in systematic reviews that inform food-based, federal dietary guidance. Current research activities and recommendations for how to improve or address gaps in dietary patterns research in the future are also discussed.

Dietary patterns among adults in three low-income urban communities in Accra, Ghana

OBJECTIVE

Dietary patterns describe the dietary behaviour and habits of individuals. Unhealthy dietary patterns provide individuals with limited nutrients while increasing the risk of nutrition-related diseases. Unhealthy dietary patterns are high in urban areas, especially among low-income urban residents. This study examined dietary patterns in three low-income urban communities in Accra, Ghana, between 2011 and 2013.

METHODS

This study used Wave 2 and 3 data from the Urban Health and Poverty Survey (EDULINK 2011 and 2013). The sample size was 960 in 2011 and 782 in 2013. Dietary pattern was examined using factor analysis and the NOVA food classification system. Summary statistics were computed for sociodemographic characteristics and diet frequency and pattern. Differences in dietary behaviours between 2011 and 2013 were also estimated. Three logistic regression models were computed to determine the predictors of dietary patterns.

RESULTS

The frequency of consumption of animal-source foods (ASF) and fruits was higher in 2013 compared with 2011. The intake of processed culinary ingredients (NOVA Group 2), processed foods (NOVA Group 3) and ultra-processed foods (NOVA Group 4) was higher in 2013 versus 2011. In 2013, 29% consumed ultra-processed foods compared to 21% in 2011. Three dietary patterns (rice-based, snack-based, and staple and stew/soup) were identified. About two out of every five participants consumed the food items in the rice (43%) and staple and sauce patterns (40%). The proportion of participants who consumed the food items in the snack pattern was 35% in 2011 but 41% in 2013. Respondents aged 25-34 and those with higher education often consumed the snack-based and rice-based dietary patterns. In 2013, participants in Ussher Town had a higher probability of consuming food items in the snack pattern than those living in Agbogbloshie.

CONCLUSIONS

This study found that between 2011 and 2013, more participants consumed ASFs, fruits, and processed foods. A complex interplay of personal and socio-cultural factors influenced dietary intake. The findings of this study mirror global changes in diet and food systems, with important implications for the primary and secondary prevention of NCDs. Health promotion programs at the community level are needed to address the increasing levels of processed food consumption.

Dietary Patterns and Their Association with Cardiometabolic Biomarkers and Outcomes among Hispanic Adults: A Cross-Sectional Study from the National Health and Nutrition Examination Survey (2013-2018)

Cardiovascular disease and metabolic disorders are disproportionately prevalent among Hispanic and Latino adults in the United States. We extracted a posteriori dietary patterns (DPs) among a nationally representative sample of 2049 Hispanic adults using the 2013-2018 National Health and Nutrition Examination Survey. Three primary DPs and their tertiles were identified, and their associations with cardiometabolic outcomes were examined. Those with higher levels of the Solids Fats, Cheeses, Refined Carbohydrates DP were more likely younger, male, and Mexican American. Those with higher levels of the Vegetables DP were more likely female, higher income, and long-term immigrant residents. Those with higher levels of The Plant-Based DP tended to have higher education levels. Higher levels of the Solid Fats, Cheeses, Refined Carbohydrates DP level were positively associated with body mass index (Tertile 2, β: 1.07 [95%CI: 0.14, 1.99]) and negatively associated with lower high-density lipoprotein cholesterol (HDL-C) levels (Tertile 3, β: -4.53 [95%CI: -7.03, -2.03]). Higher levels of adherence to the Vegetables DP were negatively associated with body fat (Tertile 3, β: -1.57 [95%CI: -2.74, -0.39]) but also HDL-C (Tertile 2, β: -2.62 [95%CI: -4.79, -0.47]). The Plant-Based DP showed no associations with cardiometabolic outcomes. Future research and interventions should consider these associations as well as the sociodemographic differences within each DP.

Validation of the illustrated questionnaire on food consumption for Brazilian schoolchildren (QUACEB) for 6- to 10-year-old children

Introduction

Evaluating the food consumption of school-aged children is crucial to monitor their dietary habits, promote targeted interventions, and contribute public policies that aimed healthy eating. In this context, our objective was to develop and validate the Illustrated Questionnaire on Food Consumption for Brazilian Schoolchildren (QUACEB) of 6 to 10 years old, which is a self-reported illustrated recall.

Methods

Validity was obtained in four stages as follows: selection of foods, validation of items, validation of illustrations, and pretest. Foods were selected by considering the data from the main surveys that have been conducted with the Brazilian population and schoolchildren in recent years, the degree of food processing, and the main foods from each of the country's five macroregions. The content of the items was validated by comparing the children's and their parent's responses. For this, the questionnaire was published in an online format, and 6- to 10-year-old elementary schoolchildren were recruited using the snowball technique. The first part of the questionnaire was answered by the parent after the child's lunch, and the second was completed by the child the following day. Thirty-two parent and child dyads participated. Sensitivity, specificity, area under the curve (AUC), and kappa (k) tests were performed.

Results

Of the 30 foods presented on the questionnaire, 15 were reported as consumed. High sensitivity (mean of 88.5%), high specificity (average of 92.0%), substantial agreement (k = 0.78), low disagreement (6.2%), and AUC of 0.90 were found. The illustrations were validated in a focus group with fourth-grade children from a school chosen for convenience. The food illustrations were designed for children, who were asked to name the food. Eighteen children participated and verified that the images were representative of the foods. In the pretest, three schools were chosen for convenience that announced the link to the online questionnaire in WhatsApp groups of parents with students from first to fifth grade. Fifteen children answered the questionnaire and 86.7% (n = 13) judged it excellent or good.

Conclusion

Thus, the food consumption questionnaire is valid for elementary schoolchildren of 6 to 10 years old and can be applied in research to assess the dietary patterns of children in Brazil.

Novel Lines of Research on the Environmental and Human Health Impacts of Nut Consumption

Nuts have formed part of human diets throughout the ages. In recent decades, research has shown they are key foods in dietary patterns associated with lower chronic disease risk. The current state of climate change, however, has introduced an imperative to review the impact of dietary patterns on the environment with a shift to plant-based diets. Nuts emerge as a significant source of protein in plant-based diets and are a minimally processed and sustainable food. Research in this area is evolving to drive better production methods in varying climate conditions. Nevertheless, nut consumption remains an important contributor to human health. The mechanisms of action can be explained in terms of the nutrients they deliver. Studies of nut consumption have linked components such as monounsaturated fatty acids, plant omega-3 fatty acids, antioxidants, and plant sterols to improved lipoprotein profiles, lower blood pressure, and reduced cardiovascular disease risk. Preliminary research also indicates possible beneficial effects of nut consumption on reproductive health. In any case, the ultimate effects of foods on health are the results of multiple interactive factors, so where nuts fit within dietary patterns is a significant consideration for research translation. This has implications for research methodologies, including categorization within food groups and inclusion in Healthy Dietary Indices. The aim of this narrative review is to outline new focal points for investigation that examine the environmental and some novel human health impacts of nut consumption and discuss future directions for research.

Associations between dietary fatty acid patterns and non-alcoholic fatty liver disease in typical dietary population: A UK biobank study

Background and Aims

Dietary fatty acid composition is associated with non-alcoholic fatty liver disease (NAFLD). Few evidence had identified a clear role of dietary fatty acid composition of typical diet in NAFLD. We aimed to investigate the relationship between dietary patterns and NAFLD in populations with typical diets and to explore the effect of fatty acid composition in dietary patterns on NAFLD.

Methods

Principal component analysis was used to identify 4 dietary patterns in UK Biobank participants. Logistic regression was used to estimate the association between dietary patterns and NAFLD. Mediation analysis was performed to evaluate the extent to which the relationship between dietary patterns and NAFLD was explained by dietary fatty acid combinations, as surrogated by serum fatty acids measured by nuclear magnetic resonance.

Results

A dietary fatty acid pattern (DFP1) characterized by "PUFA enriched vegetarian" was negatively associated with NAFLD risk. Serum fatty acids were significantly associated with DFP1 and NAFLD. Mediation analysis showed SFA (27.8%, p < 0.001), PUFA (25.1%, p < 0.001), ω-6 PUFA (14.3%, p < 0.001), LA (15.6%, p < 0.001) and DHA (10%, p < 0.001) had a significant indirect effect on the association between DFP1 and NAFLD. A dietary pattern characterized by "PUFA enriched carnivore" (DFP2) was not associated with NAFLD risk.

Conclusion

A "PUFA enriched vegetarian" dietary pattern with increased LA and DHA, may be beneficial for the treatment or prevention of NAFLD, while a "PUFA enriched carnivore" dietary pattern may not be harmful to NAFLD.

Maternal preconception circulating blood biomarker mixtures, child behavioural symptom scores and the potential mediating role of neonatal brain microstructure: the S-PRESTO cohort

Human brain development starts in the embryonic period. Maternal preconception nutrition and nutrient availability to the embryo may influence brain development at this critical period following conception and early cellular differentiation, thereby affecting offspring neurodevelopmental and behavioural disorder risk. However, studying this is challenging due to difficulties in characterizing preconception nutritional status and few studies have objective neurodevelopmental imaging measures in children. We investigated the associations of maternal preconception circulating blood nutrient-related biomarker mixtures (~15 weeks before conception) with child behavioural symptoms (Child Behaviour Checklist (CBCL), aged 3 years) within the Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO) study. The CBCL preschool form evaluates child behaviours based on syndrome scales and Diagnostic and Statistical Manual of Mental Disorders (DSM) oriented scales. These scales consist of internalizing problems, externalizing problems, anxiety problems, pervasive developmental problems, oppositional defiant, etc. We applied data-driven clustering and a method for modelling mixtures (Bayesian kernel machine regression, BKMR) to account for complex, non-linear dependencies between 67 biomarkers. We used effect decomposition analyses to explore the potential mediating role of neonatal (week 1) brain microstructure, specifically orientation dispersion indices (ODI) of 49 cortical and subcortical grey matter regions. We found that higher levels of a nutrient cluster including thiamine, thiamine monophosphate (TMP), pyridoxal phosphate, pyridoxic acid, and pyridoxal were associated with a higher CBCL score for internalizing problems (posterior inclusion probability (PIP) = 0.768). Specifically, thiamine independently influenced CBCL (Conditional PIP = 0.775). Higher maternal preconception thiamine level was also associated with a lower right subthalamic nucleus ODI (P-value = 0.01) while a lower right subthalamic nucleus ODI was associated with higher CBCL scores for multiple domains (P-value < 0.05). One potential mechanism is the suboptimal metabolism of free thiamine to active vitamin B1, but additional follow-up and replication studies in other cohorts are needed.

A Review on Dietary Patterns and Double Burden of Malnutrition: Knowledge Gaps for Future Research

Nutrition transition is characterized by shifts in dietary patterns (DPs) and is one of the factors associated with the double burden of malnutrition (DBM). Evidence indicates correlations between DPs and obesity, diabetes, and cardiovascular diseases. However, little is known on how DP influences DBM. This mini-review examined DP-DBM relationship among adults along with different DP approaches and DBM definitions. A structured search of peer-reviewed articles was performed from Web of Science. Keywords related to "dietary patterns," "double burden of malnutrition," and "adults" were used. A total of 133 studies were included. Results showed that factor analysis was the predominant DP analysis method. DBM was frequently assessed at the national level and defined as the coexistence of overweight/obesity and underweight. From the 133 studies, only four articles investigated DP-DBM association and suggested that healthier DPs positively improved DBM. Significant knowledge gaps remain, including (1) application of a combination of DP approaches, (2) evaluation of individual-level and household-level DBM, and (3) inconsistency of micronutrient deficiencies and non-communicable disease indicators in DBM definition. This review revealed paucity of studies on the nexus of DPs and DBM. Future research is imperative to establish evidence on the link between food patterns and multiple burdens of malnutrition.

Measuring Adherence to Sustainable Healthy Diets: A Scoping Review of Dietary Metrics

Comprehensive metrics that provide a measure of dietary patterns at global and national levels are needed to inform and assess the effectiveness of policy actions that promote sustainable healthy diets. In 2019, the Food and Agriculture Organization of the United Nations and the World Health Organization reported 16 guiding principles of sustainable healthy diets, but it is still unknown how these principles are considered in dietary metrics. This scoping review aimed to explore how principles of sustainable healthy diets are considered in dietary metrics used worldwide. Forty-eight food-based, investigator-defined dietary pattern metrics assessing diet quality in free-living, healthy populations at the individual or household level were assessed against the 16 guiding principles of sustainable healthy diets, which was used as a theoretical framework. A strong adherence of the metrics to health-related guiding principles was found. Metrics had a weak adherence to principles related to environmental and sociocultural aspects of diets, except for the principle related to diets being culturally appropriate. No existing dietary metric captures all principles of sustainable healthy diets. Notably, the significance food processing, environmental, and sociocultural aspects of diets are generally understated. This likely reflects the lack of focus on these aspects in current dietary guidelines, which highlights the importance of including these emerging topics in future dietary recommendations. The absence of quantitative metrics that comprehensively measure sustainable healthy diets limits the body of evidence that would otherwise inform national and international guideline developments. Our findings can help grow the quantity and quality of the body of evidence available to inform policy activities to realize 2030 Sustainable Development Goals of multiple United Nations. Adv Nutr 2022;x:xx.

Using the Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) Approach to Assess the Strength of Evidence on Associations between Dietary Patterns and All-Cause Mortality

Dietary guidelines should be underpinned by high-quality evidence. Quality assessment methods that reflect traditional evidence hierarchies prioritise evidence from randomised controlled trials (RCTs). The Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) approach is an alternative quality assessment method for research questions that for practical and/or ethical reasons, cannot be answered using RCTs. The aim of this study was to investigate how the HEALM approach could be used to assess the strength of evidence on associations between dietary patterns and all-cause mortality (a research question that is difficult to answer using RCTs). Two data sources were used: an existing systematic review of dietary patterns and all-cause mortality that synthesised evidence from observational studies; and an overview of reviews that was conducted to summarise relevant evidence from mechanistic and intervention studies. A set of four criteria were developed and used in the application of HEALM. Using different datasets in combination, the strength of evidence was rated as 'Grade B: moderate/suggestive' or 'Grade C: insufficient/inconclusive'. HEALM is a novel approach for integrating and assessing the strength of evidence from mechanistic, intervention, and observational studies. Further research is needed to address the practical challenges that were identified in the application of HEALM.