Diets Rich in Fruits and Vegetables Are Associated with Lower Cardiovascular Disease Risk in Adolescents

Adherence to Mediterranean Diet and Health Outcomes in Adolescents: An Umbrella Review

CONTEXT

Proper nutrition represents 1 of the domains of adolescents' well-being. In this context, the Mediterranean diet (MD), as a healthy, traditional, and sustainable dietary pattern, plays a crucial role in promoting adequate growth and preventing chronic noncommunicable diseases.

OBJECTIVE

The currently available evidence on the effects of adherence to the MD (AMD) in association with several physical health outcomes in adolescence is summarized in this review.

DATA SOURCES

Five electronic databases were searched.

STUDY SELECTION

Systematic reviews with or without meta-analysis of observational studies and randomized clinical trials, published in English during 2013-2022, and that assessed the health impact of AMD among adolescents were eligible.

DATA EXTRACTION

Details on study design, methods, population, assessment of dietary patterns, health outcomes, and main results were extracted.

RESULTS

The search yielded 59 references after removal of duplicates. Applying PICOS criteria, 4 systematic reviews and 3 meta-analyses ultimately were included in this review. The AMD was evaluated in association with overweight/obesity and adiposity in 2 studies, musculoskeletal health in another 2, inflammation in 1 study, and cardiometabolic health in 1 study. The seventh review examined all mentioned health outcomes (overweight and obesity, musculoskeletal health, inflammation, and cardiometabolic health) in relation to AMD.

CONCLUSIONS

Overall, this umbrella review showed limited evidence and a lack of consistency about the relation between AMD and health outcomes of interest in adolescence, indicating the need for more studies to better understand it.

SYSTEMIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023428712.

Phenolic Compounds from Cherries and Berries for Chronic Disease Management and Cardiovascular Risk Reduction

Cardiovascular diseases (CVDs) are a leading cause of mortality worldwide. Therefore, there is increasing interest in dietary interventions to reduce risk factors associated with these conditions. Cherries and berries are rich sources of bioactive compounds and have attracted attention for their potential cardiovascular benefits. This review summarises the current research on the effects of cherry and berry consumption on cardiovascular health, including in vivo studies and clinical trials. These red fruits are rich in phenolic compounds, such as anthocyanins and flavonoids, which have multiple bioactive properties. These properties include antioxidant, anti-inflammatory, and vasodilatory effects. Studies suggest that regular consumption of these fruits may reduce inflammation and oxidative stress, leading to lower blood pressure, improved lipid profiles, and enhanced endothelial function. However, interpreting findings and establishing optimal dosages is a challenge due to the variability in fruit composition, processing methods, and study design. Despite these limitations, the evidence highlights the potential of cherries and berries as components of preventive strategies against CVD. Further research is needed to maximise their health benefits and improve clinical practice.

Dietary assessment of type 2 diabetic patients using healthful plant-based diet score in the Eastern Province of Saudi Arabia

BACKGROUND

Diabetes mellitus is a chronic disease characterized by a wide range of metabolic problems. The current study sought to assess nutritional habits of Saudi patients with type 2 diabetes (T2D) and to propose recommendations to improve these patients' dietary habits and delay possible disease complications.

METHODS

Over a period of three years, (2017-2019) 577 patients with T2D attending the outpatient's diabetic clinics at King Fahd Hospital of the University, Al Khobar, Saudi Arabia were invited to participate in this study. Data of dietary intake were collected by trained nurses using a pretested structured validated semi quantitative food frequency questionnaire. The dietary data were collected using 7-day dietary recall questionnaire. A modified score system that associates dietary habits with glycemic control and lipid profile was used.

RESULTS

Overall, a high healthful plant-based diet score was associated with a significant (P = 0.018) reduction in triglycerides (TG) level (mean difference - 3.78%; 95% CI, -0.65% to -6.81%) and a statistically non-significant (P = 0.06) increase in high density lipoprotein (HDL) levels (mean difference 1.87%; 95% CI -0.06-3.84%) in T2D patients from the Eastern Province of Saudi Arabia. Additionally, in our patient group, the prevalence of coronary artery disease, stroke, peripheral artery disease, and chronic kidney disease in T2D patients was 11.3%, 6.2%, 3.3%, and 8.4%, respectively and were higher when compared to the prevalence in the general population.

CONCLUSION

The present study showed that adherence to a healthful plant-based diet, when compared to high glycemic index diet, is associated with a favorable outcome in glycemic control and lipid profile in T2D patients. Prior assessment of total diet quality may be beneficial when giving nutritional advice to T2D patients with the possibility of improving glycemic control and lipid profile.

Association between alternative healthy eating index (AHEI) with metabolic health status in adolescents with overweight and obesity

BACKGROUND

There has been lack of evidence on the association between healthy dietary patterns and metabolic health status of adolescents. The present study aimed to evaluate the association between alternative healthy eating index (AHEI) and metabolic health status among a relatively representative sample of Iranian adolescents with overweight/obesity.

METHODS

Adolescents with extra body weight (n = 203, aged 12-18 y), were selected for this cross-sectional study by a multistage cluster random-sampling method. Habitual dietary intakes and diet quality of individuals were assessed using validated food frequency questionnaire and AHEI-2010, respectively. Data on other covariates were also gathered by pre-tested questionnaires. To determine fasting glucose, insulin and lipid profiles, fasting blood samples were collected. Participants were categorized as having metabolically healthy overweight/obesity (MHO) or metabolically unhealthy overweight/obesity (MUO) phenotypes, based on two approaches (International Diabetes Federation (IDF) and combination of IDF with Homeostasis Model Assessment Insulin Resistance (HOMA-IR)).

RESULTS

The overall prevalence of MUO was 38.9% (based on IDF criteria) and 33.0% (based on IDF/HOMA-IR criteria). After considering all potential confounders, participants in highest tertiles of AHEI-2010 had lower odds of MUO profile according to both IDF (OR = 0.05; 95% CI: 0.01-0.15) and IDF/HOMA-IR (OR = 0.05; 95% CI: 0.02-0.19) definitions. This association was stronger in adolescents with overweight compared with obese ones and also among girls than boys. Moreover, each unit increase in AHEI-2010 score was associated with lower risk of MUO based on both criteria.

CONCLUSIONS

Higher adherence to AHEI-2010 was inversely associated with odds of MUO in Iranian adolescents with overweight/obesity.

Place of Residence Is Associated with Dietary Intake and BMI-SDS in Children and Adolescents: Findings from the DONALD Cohort Study

We aimed to determine whether place of residence in the German urban food environment is associated with habitual dietary intake (energy, macronutrients, and food groups) and body mass index (standard deviation score of BMI and BMI-SDS). Our hypothesis was that place of residence may explain some variation in dietary intake and nutritional outcomes. For the cross-sectional analyses of DONALD study data, we grouped participants according to their geocoded residence in the north or south of Dortmund. We applied robust multi-level mixed effects regression models using residence as a predictor and (1) BMI-SDS or (2) dietary data (daily intake of energy (kcal), macronutrients (energy percentage), or food groups (g/1000 kcal)) as the outcome. Models were adjusted for age, sex, and household socio-economic status. An analysis was carried out on 1267 anthropometric measurements collected annually from 360 participants aged 6-18 years (935 3-day weighed dietary records from 292 participants) between 2014 and 2019. In the fully adjusted models, residence in the south was associated with a lower BMI-SDS (β = -0.42, p = 0.02), lower intake of sugar-sweetened beverages (β = -47.00, p = 0.04), and higher intake of vegetables (β = 11.13, p = 0.04). Findings suggest that the place of residence, beyond individuals' socio-economic statuses, may be a contributing factor to dietary quality.

Dietary fruits and vegetables and risk of cardiovascular diseases in elderly Chinese

BACKGROUND

Evidence regarding the potential effect of fruit and vegetable consumption on cardiovascular diseases (CVD) was limited and inconsistent among Asian people.

METHODS

We prospectively examined associations of fruit and vegetable consumption with the risk of CVD among 9740 participants aged 65 years and older (mean baseline age: 88 years) in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008-2018). Dietary data were collected using a validated food frequency questionnaire.

RESULTS

During 37 366 person-years of follow-up, a total of 3738 CVD cases were recorded. After adjusting for demographics, dietary, lifestyle and economical social factors, higher intakes of total fruits and vegetables were associated with lower risk of CVD [comparing with extreme quintiles, hazard ratio and 95% confidence interval: 0.84 (0.74, 0.95)]. The inverse association was mainly driven by vegetable consumption [0.86 (0.77, 0.95)]. Furthermore, the inverse association was stronger for the risk of hypertension [0.84 (0.72, 0.98)]. These associations were consistent across age, sex, body mass index, residence, exercise status, smoking, drinking, meat intake, modified hPDI and health status.

CONCLUSIONS

This study suggests higher intakes of total fruits and vegetables are associated with a lower risk of CVD among elderly Chinese people, supporting the current recommendations of increasing fruit and vegetable consumption as part of a healthy diet for the prevention of CVD.

Association between nutrient intake from vegetables and BMI category of in-school adolescents in urban and rural areas in Davao City, Philippines

Consumption of vegetables may contribute to alleviating the double burden of malnutrition, which is widespread among adolescents. However, the link between specific nutrient intakes from vegetables and the body mass index (BMI) of in-school adolescents is not widely studied. This study determined the association between the nutrient intakes from the vegetables consumed and the BMI category of in-school adolescents in urban and rural areas in Davao City, Philippines. Self-reported vegetable consumption was collected from the respondents, and the corresponding nutrient intakes were calculated using the USDA food composition tables. The BMI of the participating adolescents was also measured. The results show that being underweight or overweight is generally associated with lower macronutrient and micronutrient intakes from the vegetables consumed, namely, bell pepper, bitter gourd, cabbage, carrot, chayote, Chinese cabbage, cucumber, eggplant, Malabar spinach, moringa, mung bean, okra, potato, sponge gourd, squash, string beans, sweet potato, sweet potato tops, taro, tomato, water spinach (P < 0.05). The nutrient intakes from vegetables consumed by adolescents from urban households were generally higher. The findings highlight the contribution of vegetables to the nutrient intakes in the adolescent population. This study reinforces the need for targeted dietary guidelines and further promotion of vegetables, especially indigenous ones, to improve the nutritional status of adolescents in the Philippines.

Barriers to consumption of fruits and vegetables and strategies to overcome them in low- and middle-income countries: a narrative review

This review provides an overview of the barriers to the consumption of fruits and vegetables (FVs) as well as strategies to improve the intake of FVs in low- and middle-income countries (LMICs). The importance of the consumption of FVs and its role in disease prevention are discussed briefly. Trends in the consumption of FVs in LMICs are also summarised. The WHO recommends that every individual should consume at least five servings or 400 grams of FVs per day. Epidemiological and clinical investigations have demonstrated that FVs contain numerous bioactive compounds with health-protecting activities. Despite their health benefits, the intake of FVs in LMICs remains low. Major barriers identified were socio-demographic factors, environmental conditions, individual and cultural factors, and macrosystem influences. These barriers may be lowered at the household, school, community, and national level through multi-component interventions including behaviour change communication (BCC) initiatives, nutrition education (NE), gardening initiatives, farm to institution programs (FIPs), food baskets, cash transfers, nutrition-agriculture policy and program linkages, and food-market environment-based strategies. This review has research implications due to the positive outcomes of strategies that lower such barriers and boost consumption of FVs in LMICs.

Effect of nano-encapsulated food flavorings on streptozotocin-induced diabetic rats

Flavors and aromas are widely used in food and pharmaceutical industries to enhance food palatability. However, it is worth noting that they may also have bioactivity. This study aims to examine the potential impact of key flavors and their nanocapsules on health and diseases, such as type 2 diabetes mellitus (T2DM). The 36 nanocapsules of key flavorings were prepared by high shear homogenization (HSH). Seventy-two male Sprague-Dawley rats received a single dosage of streptozotocin (35 mg kg-1 body weight) intraperitoneally. All of the nutritional and biochemical parameters were statistically analyzed. A virtual docking study was conducted. Linalool nanoemulsion results showed the highest encapsulation efficiency (86.76%), while isoamyl acetate nanoparticles showed the lowest (69.99%). According to GC-MS analysis, encapsulation did not affect the flavoring structure with particle size distributions ranging from 277.3 to 628.8 nm. Using TEM, nanoemulsion particles appeared spherical with a desired nanometric diameter size. In the oral glucose tolerance test, flavorings in oil and nanoforms had no discernible hypoglycemia effects in normal rats. The nutritional and biochemical parameters confirmed that both normal and nanoencapsulation forms demonstrated a potential anti-hyperglycemic effect, and enhanced the rat health compared to the raw flavorings. The studied flavorings and their nanocapsules seem to have the potential double effect of a flavor compound as a food palatability enhancer with a potential beneficial effect on type 2 diabetes mellitus without any health drawbacks.

The possible relationship between the healthy eating index-2015 and the 10-year risk of cardiovascular diseases

BACKGROUND

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide. This underlies the need to evaluate different targets, such as diet quality. In this regard, we conducted the present study to find whether the healthy eating index-2015 (HEI-2015) score is associated with a 10-year risk of CVDs based on Framingham Risk Score (FRS) and QRISK3 in different body mass index (BMI) groups.

METHODS

This cross-sectional study was performed based on Shiraz University of Medical Sciences Employees Health Cohort Study (SUMS EHCS) data in April 2020. A total of 764 participants met the inclusion criteria. An expert performed demographic, anthropometric, and dietary evaluations. A semi-quantitative food frequency questionnaire (FFQ) was applied to assess the diet quality, and FRS and QRISK3 were used to evaluate the 10-year risk of CVDs.

RESULTS

Based on the results, many components of HEI-2015 indicated an increasing trend through quartiles (p < 0.001). However, the consumption of refined grains in higher quartiles showed a decreasing trend (p < 0.001). The consumption of added sugar and saturated fatty acids (SFAs) in higher quartiles revealed an increasing trend (p < 0.001). In addition, lower HEI-2015 scores and lower whole grain consumption were significantly associated with higher BMI (p < 0.05). Also, lower consumption of fruits showed a significant relationship with higher risk scores of Framingham and QRISK3 (p < 0.05). Higher added sugar and SFAs intake was significantly related to lower FRS (p < 0.05). A significant reverse association between HEI-2015 and QRISK3 and Framingham risk scores was seen (p < 0.05).

CONCLUSION

Our findings support dietary recommendations to increase fruit and whole grains intake to prevent CVD and obesity. Moreover, a significant inverse association between HEI-2015 and QRISK3 and Framingham risk scores was observed. Since the results for added sugars and SFA intakes were controversial, further studies are needed.

Adherence to '5-2-1-0' guidelines and multiple risky behaviours among adolescents in nine sub-Saharan African countries: evidence from Global School-based Student Health Survey 2012-2017

OBJECTIVE

Overweight and obesity constitute a new challenge in low-income and middle-countries. The obesity prevention programme, called '5-2-1-0', promotes healthy eating habits, physical activity and limited screen time among young people.This study aimed to assess adherence to the '5-2-1-0' recommendations and to study multiple risky behaviours among adolescents in nine countries in sub-Saharan Africa.

METHODS

Meta-analyses with a random effect were used to calculate overall prevalence. Non-random patterns of the co-occurrence of the four risky behaviours were explored using observed/expected prevalence ratios. Data came from the Global School-based Health Survey and 18 314 adolescents were considered.

RESULTS

Among the participants, 12.7% (95% CI 7.5% to 19.0%) had overweight and 3.2% (95% CI 1.1% to 6.1%) had obesity. In almost all countries studied, girls were more affected by overweight and obesity than boys.While only 0.2% (95% CI 0.1% to 0.4%) of the adolescents fully complied with the recommendations, 4.8% (95% CI 3.1% to 6.9%), 28.4% (95% CI 22.4% to 34.8%), 43.8% (95% CI 41.9% to 45.8%) and 17.0% (95% CI 11.8% to 23.0%), respectively, combined 1, 2, 3 and 4 risky behaviours among the four '5-2-1-0' criteria. The most observed combination was found for co-occurrence of three risky behaviours: insufficient fruit/vegetables consumption, physical activity and non-zero consumption of sugar-sweetened beverages.

CONCLUSION

In conclusion, the insufficient adherence to '5-2-1-0' recommendations and the high prevalence of the co-occurrence of risky behaviours underscore the need to strengthen health interventions and programmes to prevent obesity among adolescents in sub-Saharan Africa.

Offering vegetables to children at breakfast time in nursery and kindergarten settings: the Veggie Brek feasibility and acceptability cluster randomised controlled trial

BACKGROUND

In many Westernised countries, children do not consume a sufficient amount of vegetables for optimal health and development. Child-feeding guidelines have been produced to address this, but often only promote offering vegetables at midday/evening meals and snack times. With guidance having limited success in increasing children's vegetable intake at a population level, novel approaches to address this must be developed. Offering vegetables to children at breakfast time in nursery/kindergarten settings has the potential to increase children's overall daily vegetable consumption as children typically attend nursery/kindergarten and many routinely eat breakfast there. However, the feasibility and acceptability of this intervention (Veggie Brek) to children and nursery staff has not been investigated.

METHODS

A feasibility and acceptability cluster randomised controlled trial (RCT) was undertaken in eight UK nurseries. All nurseries engaged in one-week baseline and follow-up phases before and after an intervention/control period. Staff in intervention nurseries offered three raw carrot batons and three cucumber sticks alongside children's main breakfast food each day for three weeks. Control nurseries offered children their usual breakfast. Feasibility was assessed by recruitment data and nursery staff's ability to follow the trial protocol. Acceptability was assessed by children's willingness to eat the vegetables at breakfast time. All primary outcomes were assessed against traffic-light progression criteria. Staff preference for collecting data via photographs versus using paper was also assessed. Further views about the intervention were obtained through semi-structured interviews with nursery staff.

RESULTS

The recruitment of parents/caregivers willing to provide consent for eligible children was acceptable at 67.8% (within the amber stop-go criterion) with 351 children taking part across eight nurseries. Both the feasibility and acceptability of the intervention to nursery staff and the willingness of children to consume the vegetables met the green stop-go criteria, with children eating some part of the vegetables in 62.4% (745/1194) of instances where vegetables were offered. Additionally, staff preferred reporting data using paper compared to taking photographs.

CONCLUSIONS

Offering vegetables to children at breakfast time in nursery/kindergarten settings is feasible and acceptable to children and nursery staff. A full intervention evaluation should be explored via a definitive RCT.

TRIAL REGISTRATION

NCT05217550.

Antihyperglycemic Potential of Spondias mangifera Fruits via Inhibition of 11β-HSD Type 1 Enzyme: In Silico and In Vivo Approach

The 11 β- hydroxysteroid dehydrogenase 1 (11 β-HSD1) is hypothesized to play a role in the pathogenesis of type 2 diabetes and its related complications. Because high glucocorticoid levels are a risk factor for metabolic disorders, 11β-HSD1 might be a viable therapeutic target. In this investigation, docking experiments were performed on the main constituents of Spondias mangifera (SM) oleanolic acid, β-amyrin, and β-sitosterol to ascertain their affinity and binding interaction in the human 11β-hydroxysteroid dehydrogenase-1 enzyme’s active region. The results of in vitro 11β HSD1 inhibitory assay demonstrated that the extract of S. mangifera had a significant (p < 0.05) decrease in the 11-HSD1% inhibition (63.97%) in comparison to STZ (31.79%). Additionally, a non-insulin-dependent diabetic mice model was used to examine the sub-acute anti-hyperlipidemic and anti-diabetic effects of SM fruits. Results revealed that, in comparison to the diabetic control group, SM fruit extract (SMFE) extract at doses of 200 and 400 mg/kg body weight considerably (p < 0.05 and p < 0.01) lowered blood glucose levels at 21 and 28 days, as well as significantly decreased total cholesterol (TC) and triglycerides (TG) and enhanced the levels of high-density lipoprotein (HDL). After 120 and 180 s of receiving 200 and 400 mg/kg SMFE, respectively, disease control mice showed significantly poorer blood glucose tolerance (p < 0.05 and p < 0.01). SMFE extract 200 (p < 0.05), SMFE extract 400 (p < 0.01), and Glibenclamide at a dosage of 5 mg/kg body weight all resulted in statistically significant weight increase (p < 0.01) when compared to the diabetic control group after 28 days of treatment. According to in silico, in vitro, and in vivo validation, SMFE is a prospective medication with anti-diabetic and hypoglycemic effects.

Clinical interventions to increase vegetable intake in children

PURPOSE OF REVIEW

Eating behaviors and dietary patterns begin in early childhood and persist into adolescence and adulthood, affecting lifelong acute and chronic disease risk. Vegetables provide a high density of necessary vitamins, minerals, and fiber. Dietary intake data show that children of all ages consume below the recommended range for vegetables. Pediatric providers are optimally positioned to promote vegetable intake in childhood. This review seeks to summarize lessons learned from behavioral interventions useful in the pediatric primary care setting to improve vegetable intake.

RECENT FINDINGS

Ten published studies tested behavioral interventions in primary care to increase child vegetable intake. Strategies tested include teaching healthy eating behaviors and role modeling to parents of infants, and motivational interviewing paired with frequent office visits and reminders for families of older children and adolescents. Some strategies suggested positive change, despite study quality being limited by underpowered samples, heterogeneity of outcome measures, and statistical analytic approach.

SUMMARY

Increased vegetable intake was achieved in infants through parental role-modeling when providers emphasized healthy dietary choices in parents. Older children increased their vegetable intake with motivational interviewing and frequent reminders from providers. Despite the high prevalence of inadequate vegetable intake among children, at present, there is only a modest body of literature to help guide pediatric providers in implementing practice-based interventions to improve vegetable intake in childhood, highlighting a need for high-quality research in this area.

Associations between dietary intake, physical activity, and obesity among public school teachers in Jeddah, Saudi Arabia

Objective

We aimed to assess the dietary intake of certain food groups in a representative sample of public-school teachers living in Jeddah city. We also, examined the association of dietary intake with physical activity and obesity among schoolteachers.

Methods

The study was a cross-sectional online survey, conducted among 640 (177 male, 463 female) schoolteachers aged between 20 and 62 years old and working in public primary, intermediate, and high schools in Jeddah. Measurements included gender, weight, height, body mass index (BMI), health problems, and lifestyle behaviours, including physical activity levels, smoking status, and dietary intake.

Results

Based on gender, number of non-smoking women (94%) was higher than number of non-smoking men (57.1%) (P < 0.001). However, men were more active than women (P = 0.03). Regarding BMI, there were more overweight men than women, while obese women numbered more than men (P = 0.003). There was no significant difference in dietary intake between men and women except that men consumed more soft drinks than women (P = 0.002). Lower physically active schoolteachers were less likely to consume salad (OR = 0.6, 95% CI 0.4-0.9; P = 0.02), vegetables (OR = 0.6, 95% CI 0.3-0.9; P = 0.01), beans and legumes (OR = 0.4, 95% CI 0.2-0.7; P = 0.005), wholegrain bread (OR = 0.6, 95% CI 0.4-0.9; P = 0.03), dairy products (OR = 0.6, 95% CI 0.4-0.9; P = 0.01), snacks (OR = 0.5, 95% CI 0.2-0.8; P = 0.01), and fish (OR = 0.4, 95% CI 0.2-0.9; P = 0.04) compared to those with high levels of physical activity. Only fruit intake was considered statistically significant (OR = 0.4, 95% CI 0.3-0.7; P = 0.003). The study found a relationship between the BMI of schoolteachers and food intake. Obese schoolteachers had lower consumption of fruits (OR = 0.3, 95% CI 0.2-0.7; P = 0.007) and white meat (OR = 0.5, 95%CI 0.3-0.9; P = 0.03) than schoolteachers in the normal weight group.

Conclusion

The high prevalence of physical activity, dietary intake and body weight among Saudi teachers is a major public health concern. The present study identified several lifestyle factors associated with body weight that may represent valid targets for the prevention and management of obesity among Saudi school teachers. Promoting active lifestyles and healthy diets would be primary targets for obesity prevention.

The association of problematic gaming characteristics with dietary habits among Finnish vocational school students

Digital gaming is a popular pastime among young people, but its links to dietary habits have been little studied. The purpose of the study was to describe dietary habits and to examine their associations to problematic gaming behavior with regard to the degree of daily digital gaming time and the overall levels of disordered-like gaming behavior among students in vocational education in the Oulu region of Finland. This cross-sectional study consisted of a total of 773 first-year vocational school students who had played digital games regularly. Data was collected by using an online survey measuring sociodemographic information, dietary habits, amount of digital gaming time, and symptoms of problematic gaming behavior. Most prevalent weekly consumed food types were chicken (90.1%), chips (87.7%), and sausages/cold cuts (85.4%). Around one-fourth of students skipped breakfast on weekdays and at weekends. A higher amount of digital gaming time was associated with skipping breakfast on weekdays. More elevated levels of disordered gaming behavior were particularly associated with the use of a group of food types encompassing carbohydrate-dense and fast food. Current research provides indications that digital gaming may have an impact on youths' dietary habits, while at the same time, however, emphasizing that the issue can be affected by several interrelated and complex factors.

Maternal Depressive Symptoms and Adolescents' Unhealthy Behavior: A 15-year Longitudinal Study

OBJECTIVES

First, to leverage 15 years of longitudinal data, from child ages 2 to 17, to examine whether maternal depressive symptoms in early and middle childhood and in adolescence predict their child's unhealthy behaviors during adolescence. Second, to examine whether the timing of maternal depressive symptoms or specific unhealthy behaviors matter and whether child depressive symptoms and body mass index explain these associations.

METHODS

Data came from a prospective-longitudinal community sample with multi-informant data (N = 213) from child ages 2 to17. A cumulative adolescent unhealthy behavior index was calculated, summing the presence of poor sleep, poor diet, physical inactivity, sedentary behavior, and smoking. Regression analyses examined associations of maternal depressive symptoms in early childhood (ages 2 to 5), middle childhood (ages 7 to 10), and adolescence (age 15) with adolescents' unhealthy behaviors (ages 16 to17). Indirect effects of child depressive symptoms and body mass index were tested using a path model.

RESULTS

Adolescents' unhealthy behaviors were common (eg, 2 out of 3 engaged in at least 1 unhealthy behavior). Higher levels of maternal depressive symptoms in middle childhood and adolescence were associated with adolescent engagement in more unhealthy behaviors at ages 16 to 17. Maternal depressive symptoms in early childhood were associated with adolescent unhealthy behaviors through indirect effects involving children's depressive symptoms and continuity of maternal depressive symptoms.

CONCLUSIONS

Maternal depressive symptoms are associated with the number of adolescent unhealthy behaviors, both directly and indirectly. Promoting mothers' mental health can be crucial for promoting children's health behaviors and health.

Would offering vegetables to children for breakfast increase their total daily vegetable intake?

The consumption of vegetables is vitally important for children's health and development. However, in many Westernised countries, most children do not eat sufficient quantities of vegetables and consume many energy-dense and high-sugar foods; a health behaviour associated with the onset of non-communicable diseases. To address this important public health concern, it is necessary to think 'outside the box' and consider innovative and pragmatic ways to increase children's daily vegetable intake. In many countries, caregivers implementing best-practice child feeding methods typically offer children vegetables at lunch, dinner and for snacks. It is unusual for children to be routinely offered vegetables for breakfast, yet there is no nutritional, physiological or medical reason why vegetables should not be eaten at breakfast. Indeed, in some countries, children frequently consume vegetables for breakfast. Increasing children's exposure to vegetables at breakfast from an early age would allow for the development of a positive association between eating vegetables and breakfast, thus providing another opportunity in the day where vegetables might be regularly consumed by children. In this paper, we propose a rationale for why vegetables should be routinely offered to young children at breakfast time in countries where this may not be the norm. Future research assessing the feasibility and acceptability of such a public health intervention would provide health policy agencies with evidence about a potentially effective and easily implementable approach for increasing children's vegetable intake, thus improving their overall nutritional status, as well as their heath and development.

Smartphone Usage Patterns and Dietary Risk Factors in Adolescents

BACKGROUND

Whereas earlier studies have shown that traditional screen time such as TV watching influences dietary behaviors in adolescents, little is known about the effects of modern screen time such as smartphone use.

OBJECTIVES

We examined the associations of smartphone usage duration and content type with dietary risk factors among adolescents.

METHODS

We conducted a cross-sectional analysis using a nationally representative sample of 54,601 middle- and high-school students (aged 12-18 y; 26,928 boys and 27,673 girls) in the Korea Youth Risk Behavior Web-Based Survey 2017. Smartphone use (average duration and most frequently used content type) and dietary intakes [frequent breakfast skipping; less frequent intakes of fruits and vegetables; more frequent intakes of instant noodles, fast food, chips/crackers, and sugar-sweetened beverages (SSBs)] were self-reported via an online-based questionnaire. Multivariable logistic regression was performed to estimate ORs and 95% CIs for the associations of smartphone usage duration and content type with prevalence of dietary risk factors, adjusting for potential confounders. All analyses accounted for complex survey sampling.

RESULTS

Prolonged smartphone use (≥300 compared with 1-59 min/d) was associated with (OR; 95% CI) higher prevalence of frequent breakfast skipping (1.60; 1.45, 1.76); frequent intakes of instant noodles (1.65; 1.47, 1.84), fast food (1.36; 1.20, 1.53), and SSBs (1.92; 1.75, 2.11); and less frequent intakes of fruits (1.44; 1.30, 1.59) and vegetables (1.32; 1.18, 1.47). Adjusting for usage duration, using smartphones mainly for messenger/e-mail, social networking service (SNS)/forum, and games were associated with less frequent intakes of fruits (OR: 1.21; 95% CI: 1.12, 1.31; OR: 1.28; 95% CI: 1.17, 1.40; and OR: 1.20; 95% CI: 1.10, 1.32, respectively) and vegetables (OR: 1.24; 95% CI: 1.12, 1.37; OR: 1.26; 95% CI: 1.13, 1.40; and OR: 1.25; 95% CI: 1.12, 1.40, respectively) than was using smartphones for education/information search. Using smartphones mainly for messenger/e-mail (OR: 1.24; 95% CI: 1.14, 1.35) and SNS/forum (OR: 1.18; 95% CI: 1.08, 1.29) were also associated with more frequent intake of SSBs.

CONCLUSIONS

Our data suggest that both duration and content type of smartphone use are independently associated with dietary risk factors among adolescents.

Antihypertensive Effect of Dietary β-Conglycinin in the Spontaneously Hypertensive Rat (SHR)

Dietary β-conglycinin has been shown to increase plasma adiponectin concentration and decrease visceral adipose tissue weight in rats. Since adiponectin is one of the factors regulating blood pressure, as well as modulating lipid metabolism, we examined whether dietary β-conglycinin affects blood pressure in spontaneously hypertensive rats. The experimental diets were prepared according to the AIN-93G formula containing 20% protein, either casein (Control) or casein replaced with soy protein isolate (SOY) or β-conglycinin (β-CON) at the proportion of 50%. Male rats (SHR/Izm, 6 wk-old) were fed the diets for 7 weeks. The SOY compared with the Control significantly suppressed the blood pressure both at week 4 (p = 0.011, Control vs. SOY) and thereafter, and β-CON had even higher suppression (p = 0.0002, Control vs. β-CON). SOY and β-CON increased plasma adiponectin concentration followed by an increase in plasma nitric oxide and possibly a decreasing trend of gene expressions of angiotensinogen in the liver and renin in the kidney. The results indicated suppression by β-conglycinin of increasing blood pressure through an enhancement of plasma adiponectin, probably in combination with a regulation of the renin–angiotensin system in spontaneously hypertensive rats.

Nutrient pattern analysis of mineral based, simple sugar based, and fat based diets and risk of metabolic syndrome: a comparative nutrient panel

BACKGROUND

Although there is growing evidence on the association between nutrient patterns and metabolic risk factors, very little is known about the relationship between nutrient patterns and metabolic syndrome (MetS). The aim of this study was to examine the associations of nutrient patterns with MetS among apparently healthy obese adults living in Tabriz, Iran.

METHODS

Three hundred and forty-seven apparently healthy obese (BMI ≥ 30 kg/m²) adults aged 20-50 years were included in this cross-sectional study. Dietary intake of 38 nutrients was assessed by a validated semi-quantitative food frequency questionnaire (FFQ) of 132 food items. Nutrient patterns were determined using factor analysis. The MetS was defined based on the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (ATP III).

RESULTS

Three major nutrient patterns were extracted: "Mineral based pattern", "Simple sugar based pattern" and "Fat based pattern". There was no significant association between nutrient patterns and MetS, in the crude model even after adjusting for confounders. There was a significant difference between quartiles in the mineral based pattern for free mass (FFM), diastolic blood pressure (DBP), large Waist circumference (WC) and Waist-to-hip ratio (WHR). In the simple sugar based pattern, we observed a significant association for SBP, DBP, and triglyceride (TG) levels. In addition, the fat based pattern was positively associated with BMI, and weight.

CONCLUSIONS

We did not observe any significant association of nutrient patterns with the risk of MetS amongst the apparently healthy obese adult's population. Whereas we confirmed the deleterious effect of the simple sugar and fat based patterns on several metabolic risk factors, our findings also showed that the mineral based pattern is related to healthier metabolic factors in an Iranian population. These results should be approved by future studies to recognize any causal relationship between adherence to specific nutrient patterns and MetS.

Dietary patterns in association with the risk of elevated blood pressure, lipid profile and fasting plasma glucose among adults in Jiangsu Province of China

BACKGROUND AND AIMS

This study aimed to identify unique dietary patterns, and to examine the correlation of dietary patterns with elevated blood pressure, lipid profile and fasting plasma glucose (FPG) among adults in Jiangsu Province of China.

METHODS AND RESULTS

4951 individuals were selected in this cross-sectional study from nutrition and health survey in Jiangsu Province in 2014. Factor analysis was used to identify the dietary patterns. Higher quartile of the cereals-seafood-dairy dietary pattern was inversely associated with high low-density lipoprotein cholesterol (LDL) (composed to Q1, OR = 0.834, 95% CI: 0.700∼0.993, P < 0.05) and FPG (composed to Q1, OR = 0.725, 95% CI: 0.609-0.862, P < 0.05), while higher quartile of the traditional Jiangsu dietary pattern was positively associated with low high-density lipoprotein cholesterol (HDL) (composed to Q1, OR = 1.395, 95% CI: 1.067∼1.825, P < 0.05) and high systolic blood pressure (SBP) (composed to Q1, OR = 1.238, 95% CI: 1.020∼1.503, P < 0.05). Higher scores of the refined food-oriented dietary pattern was inversely related to high triglycerides (TG) (composed to Q1, OR = 0.665, 95% CI: 0.551∼0.802, P < 0.05), but was positively related to high TC (composed to Q1, OR = 2.179, 95% CI: 1.817∼2.614), high LDL (composed to Q1, OR = 2.431, 95% CI: 2.037∼2.902, P < 0.05) and elevated FPG (composed to Q1, OR = 1.734, 95% CI: 1.458∼2.061, P < 0.05).

CONCLUSION

Different structure of dietary patterns do affect the blood pressure, lipid profile and fasting plasma glucose among adults in Jiangsu Province, China.

Association between Physical Activity, Sedentary Behaviors, Sleep, Diet, and Adiposity among Children and Adolescents in China

INTRODUCTION

Physical activity (PA), sedentary behaviors (SB), sleep, and diet are related to adiposity among children and adolescents. However, there may be interactions between PA, SB, sleep, and diet, and these lifestyle behaviors may work together to affect body weight. The purpose of this study was to explore the impact of multiple lifestyle behaviors of PA, SB, sleep, and diet on childhood adiposity (body mass index z-score and overweight/obesity), and to investigate the effect of meeting multiple guidelines on adiposity among children and adolescents in China.

METHODS

Cross-sectional results were based on 28,048 children aged 6-17 years from the China National Nutrition and Health Surveillance in 2010-2012. Information about PA, SB, and sleep was measured through interview-administered questionnaire. Dietary intake was assessed with food frequency questionnaire. The associations between multiple lifestyle behaviors and BMI z-score and overweight/obese were examined.

RESULTS

The prevalence of overweight/obesity in the participants was 19.2%. The average time of moderate-to-vigorous PA (MVPA), leisure SB, and sleep was 76.7 ± 45.5 min, 2.9 ± 1.4 h, and 8.5 ± 1.1 h per day, respectively. The China Dietary Guidelines Index for Youth (CDGI-Y) score was 62.6 ± 11.0. Sleep duration and diet score were negative associated with BMI z-score (both p < 0.001). MVPA and SB time were positive associated with BMI z-score (p = 0.041, 0.004). Meeting the SB, sleep, and diet guidelines had a lower BMI z-score (all p < 0.01) and lower odds of overweight/obesity (all p < 0.05). There were significant interactions between PA and diet. Compared with meeting no guidelines, those who met multiple guidelines had a lower risk of overweight/obesity (all p < 0.01). The more guidelines the participants met, the lower odds of overweight/obesity (p for trend <0.001).

CONCLUSIONS

PA, SB, sleep, and diet are important behaviors associated with adiposity among children and adolescents. Attaining adequate amounts of appropriate multiple behaviors provided an additional benefit. It is important for children to meet recommended behavioral guidelines or recommendations. Interventions that aim to improve awareness of and compliance with these guidelines are needed in future.

Qualidade da dieta de adolescentes da rede pública de ensino de um município do sul do Brasil: estudo transversal, 2019

Resumo Objetivo Identificar os fatores associados à qualidade da dieta de estudantes do 9º ano da rede municipal de ensino de Pelotas, Rio Grande do Sul, Brasil. Métodos Estudo transversal, realizado em 2019. As informações alimentares foram coletadas por formulário de frequência alimentar, e a qualidade da dieta foi avaliada mediante índice desenvolvido pelos autores. A dieta foi classificada como de baixa, intermediária ou alta qualidade. A associação foi avaliada por regressão logística multinomial. Resultados Os 808 adolescentes avaliados obtiveram média de 16,0 pontos (desvio-padrão=4,1) no índice desenvolvido. A alta qualidade da dieta mostrou-se associada a experimentação de tabaco [razão de chances, ou odds ratio (OR) 2,92; intervalo de confiança de 95% (IC95%) 1,74;4,92] e prática de atividade física no lazer (OR=1,65; IC95% 1,15;2,38). Conclusão Destaca-se a importância do incentivo à prática de atividade física, monitoramento de comportamentos de riscos nos adolescentes e promoção do consumo de alimentos considerados saudáveis.

Implementing the 2020-2025 Dietary Guidelines for Americans: Recommendations for a path forward

The Dietary Guidelines for Americans (DGA) provide science-based recommendations for healthy dietary patterns to promote health and reduce risk of chronic diseases. Yet, since their inception in 1980 and updates every 5 years, Americans fall short of meeting dietary recommendations and diet-related chronic diseases continue to be a public health concern. In May of 2021, the Institute of Food Technologists and the Department of Food Science at the University of Massachusetts, Amherst, convened a diverse group of thought leaders in health, nutrition, and food science to identify opportunities and approaches to improve consumer adoption of the DGA recommendations. The invited leaders collaborated in roundtable discussions to develop recommendations and strategies to promote adoption of the DGA recommendations after hearing sessions on the latest consumer trends, advances in food science and technology, and effective communications approaches. Participants agreed that changes in consumer behaviors and heightened interest in health due to the novel coronavirus pandemic have created an opportune time to engage consumers about healthy eating. Communications must be simple, tailored to the consumer, and delivered by influencer(s)/spokesperson(s) who are credible sources and share personal values. Innovations in food science and technology have enabled improvements in the safety, health, acceptability, affordability, and availability of foods but opportunities to provide more options to enhance consumption of desired food groups, such as fruits, vegetables, and whole grains, remain. Moving Americans toward healthier dietary patterns aligned with DGA recommendations will require collaborations within the food sector and beyond to achieve broad scale amplification and investment.

Implementing the 2020-2025 Dietary Guidelines for Americans: Recommendations for a Path Forward

The Dietary Guidelines for Americans (DGA) provide science-based recommendations for healthy dietary patterns to promote health and reduce risk of chronic diseases. Yet, since their inception in 1980 and updates every 5 y, Americans fall short of meeting dietary recommendations and diet-related chronic diseases continue to be a public health concern. In May of 2021, the Institute of Food Technologists and the Department of Food Science at the University of Massachusetts, Amherst, convened a diverse group of thought leaders in health, nutrition, and food science to identify opportunities and approaches to improve consumer adoption of the DGA recommendations. The invited leaders collaborated in roundtable discussions to develop recommendations and strategies to promote adoption of the DGA recommendations after hearing sessions on the latest consumer trends, advances in food science and technology, and effective communications approaches. Participants agreed that changes in consumer behaviors and heightened interest in health due to the novel coronavirus pandemic have created an opportune time to engage consumers about healthy eating. Communications must be simple, tailored to the consumer, and delivered by influencer(s)/spokesperson(s) who are credible sources and share personal values. Innovations in food science and technology have enabled improvements in the safety, health, acceptability, affordability, and availability of foods, but opportunities to provide more options to enhance consumption of desired food groups, such as fruits, vegetables, and whole grains, remain. Moving Americans toward healthier dietary patterns aligned with DGA recommendations will require collaborations within the food sector and beyond to achieve broad-scale amplification and investment.

Healthy and Sustainable Dietary Patterns in Children and Adolescents: A Systematic Review

The need for adherence to a healthy and sustainable dietary pattern in the pediatric stage is discussed worldwide, being linked to a progressive incidence of noncommunicable diseases in adulthood. The aims of this systematic review were to summarize the healthy and/or sustainable dietary patterns, defined a priori, described in the literature for use during the pediatric stage; to evaluate the adherence to these dietary patterns; and identify the health-related benefits associated with adherence to these patterns. A literature search was carried out on Medline, Scopus, and Web of Science from 2010 up to 2021, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 128 articles were included according to the following criteria: participants 2-17 y old, healthy and/or sustainable dietary patterns defined by an a priori methodology; articles written in English or Portuguese; and published since 2010. Fifty instruments with 14 adaptations that measure adherence to healthy and/or sustainable dietary patterns in children and adolescents were found. The Mediterranean Diet was the most studied dietary pattern. Adherence to healthy and/or sustainable dietary patterns has wide variations worldwide. Most of the instruments described have been little studied at pediatric ages, reducing the ability to extrapolate results. Higher adherence to these dietary patterns was associated with lower body fat, waist circumference, blood pressure, and metabolic risk. There is no consensus regarding the association with BMI. No studies have proofs of the sustainability characteristics of these instruments, it being necessary to produce a new sustainable instrument or test the association of the previous ones with, for example, the ecological footprint. Further validations of these instruments in each country and more prospective studies are needed to establish temporal relations with health-related outcomes. This systematic review was registered at www.crd.york.ac.uk/prospero/ as CRD42020221788.

Leisure-time and study-time Internet use and dietary risk factors in Korean adolescents

BACKGROUND

Prolonged screen time is associated with an increased risk of obesity in adolescents. However, little is known about whether Internet use is also associated with dietary risk factors including consumption of obesogenic foods.

OBJECTIVES

In this study, we examined the associations of leisure-time and study-time Internet use with dietary risk factors in Korean adolescents using nationally representative survey data.

METHODS

We conducted a cross-sectional analysis among 54,416 middle and high school students in the Korea Youth Risk Behavior Web-based Survey 2015. Participants were asked to report the average duration of leisure-time and study-time Internet use, days of skipping breakfast, and frequency of fruit, vegetable, instant noodle, fast-food, chip/cracker, and sugar-sweetened beverage (SSB) intakes. We performed multivariable logistic regression to estimate ORs and 95% CIs for the relations between duration of Internet use and dietary risk factors, accounting for complex survey sampling and adjusting for potential confounders.

RESULTS

Prolonged leisure-time Internet use (≥241 compared with 1-60 min/d) was associated with higher prevalence of frequent skipping breakfast (OR: 1.39; 95% CI: 1.29, 1.49), low intakes of fruits (OR: 1.27; 95% CI: 1.18, 1.36) and vegetables (OR: 1.43; 95% CI: 1.33, 1.55), and high intakes of instant noodles (OR: 1.87; 95% CI: 1.74, 2.02), fast-food (OR: 1.63; 95% CI: 1.49, 1.78), chips/crackers (OR: 1.37; 95% CI: 1.24, 1.52), and SSBs (OR: 1.63; 95% CI: 1.52, 1.75). Prolonged study-time Internet use (≥121 compared with 1-60 min/d) was inversely associated with prevalence of low fruit (OR: 0.94; 95% CI: 0.88, 1.00) and vegetable (OR: 0.91; 95% CI: 0.85, 0.98) intakes but was positively associated with high intakes of instant noodles (OR: 1.10; 95% CI: 1.03, 1.19) and chips/crackers (OR: 1.13; 95% CI: 1.04, 1.23). The overall associations remained consistent in analyses stratified by sex, grade, region, parental co-residence, perceived household income, perceived stress level, physical activity, and obesity status.

CONCLUSIONS

Our data suggest that prolonged Internet use, particularly during leisure time, is associated with less healthful dietary behaviors in Korean adolescents.

Analysis of Food Habits during Pandemic in a Polish Population-Based Sample of Primary School Adolescents: Diet and Activity of Youth during COVID-19 (DAY-19) Study

The improper dietary behaviors of children and adolescents during the COVID-19 pandemic, which are associated with lockdowns and reduced physical activity, are a complex problem, potentially resulting in increased risk of diet-related diseases, including overweight and obesity and their consequences. The aim of the study was to assess the food habits during the COVID-19 pandemic and to define their association with physical activity and body mass changes in a Polish population of primary school adolescents within the Diet and Activity of Youth During COVID-19 (DAY-19) Study. The DAY-19 Study was conducted in June 2020 in a national cohort of 1334 primary school students aged 10–16 years, recruited based on a stratified random sampling of schools (sampling counties from voivodeships and schools from counties). The Adolescent Food Habits Checklist (AFHC) was used to assess food habits, associated with food purchase, preparation, and consumption, which in the studied group were analyzed separately for the period before (retrospective data) and during the COVID-19 pandemic (prospective data). The recognizable physical activity changes and recognizable body mass changes were also assessed (retrospective data) and respondents were classified as those declaring that their physical activity and body mass decreased, remained stable, or increased during the COVID-19 pandemic. It was observed that during the COVID-19 pandemic the majority of food habits changed in a statistically significant way (p < 0.05). Within food purchase habits, the number of respondents who declared choosing a low-fat lunch away from home decreased, often buying pastries or cakes decreased, and buying a low-fat crisps brand increased (p < 0.05). Within food preparation habits, the number of respondents who declared trying to keep overall fat intake down increased, trying to keep overall sugar intake down increased, eating at least one serving of vegetables or salad with evening meal increased, and usually including some chocolate and/or biscuits in a packed lunch decreased (p < 0.05). Within food consumption habits, the number of respondents who declared making sure that they eat at least one serving of fruit a day increased, eating at least three servings of fruit most days increased, making sure that they eat at least one serving of vegetables or salad a day increased, trying to ensure that they eat plenty of fruit and vegetables increased, often choosing a fruit when they have a snack between meals increased, eating at least three servings of fruit most days increased, and generally trying to have a healthy diet increased (p < 0.05). It was concluded that in the period of the COVID-19 pandemic and resultant remote education, adolescents in Poland presented different food habits than before, while the majority of changes were positive. The positive food purchase, preparation, and consumption habits were observed mainly in sub-groups of adolescents declaring decreased body mass or increased physical activity during the COVID-19 pandemic. It may be suggested that physical activity may support positive changes of dietary behaviors and while combined positive changes of diet and increased physical activity, they may effectively promote body mass reduction in adolescents.

Impact of a "vegetables first" approach to complementary feeding on later intake and liking of vegetables in infants: a study protocol for a randomised controlled trial

BACKGROUND

Vegetables as first complementary foods for infants may programme taste preferences that lead to improved vegetable intake in children. Yet few studies have investigated the impact of a "vegetables first" approach to complementary feeding, especially in New Zealand. The purpose of this randomised control trial is to investigate the effect of starting complementary feeding with vegetables only on infants' later intake and liking of vegetables, compared to those starting with fruit and vegetables.

METHODS/DESIGN

One-hundred and twenty mother-infant pairs living in Auckland, New Zealand, will be randomised to receive either vegetables only (intervention) or fruit and vegetables (control) for 28 days, starting from the first day of complementary feeding at around 4-6 months of age. Infants will be presented with a brassica (broccoli), followed by a green leafy vegetable (spinach) and sweet fruit (pear) at 9 months of age. The primary outcome measures of intake of each food will be assessed using a weighed food diary. Secondary outcome measures of overall intake, liking and wanting of vegetables will be assessed using a food frequency questionnaire, liking tool and video coding tool, respectively, at 9, 12, and 24 months of age. Infant growth and iron status will be assessed as part of health screening and monitoring at baseline, post intervention and 9 months of age. Other biological samples to be collected include infant stool samples, vitamin D (mother and infant), iron status (mother), and mothers' diet.

DISCUSSION

This randomised, controlled trial will be the first to our knowledge to investigate a "vegetables first" approach to complementary feeding on infants' liking and intake of vegetables in New Zealand. Comparison against standard practice (fruit and vegetables as first foods) should complement other trials underway, such as the Baby's First Bites and Nordic OTIS trial. Results may contribute to the evidence supporting complementary feeding guidelines in New Zealand and worldwide.

TRIAL REGISTRATION

Australian New Zealand Clinical Trial Registry ACTRN12619000737134 . Registered on 16 May 2019.

Increasing Vegetable Diversity Consumption Impacts the Sympathetic Nervous System Activity in School-Aged Children

Evidence about the impact of vegetable and fruit diversity consumption on the autonomic nervous system (ANS) functioning is scarce. In this cross-sectional study (513 participants, 49.9% girls aged 7 to 12 years), we evaluated the association between vegetable and fruit diversity consumption and the ANS in school-aged children. Dietary intake was collected using a single 24-h recall questionnaire. Fruit and vegetable diversity consumption was estimated by summing up all the different individual vegetables and fruits consumed in one day. Pupillometry was used to assess pupillary light response, which evaluated the ANS activity. Adjusted linear regressions estimated the association between vegetable and fruit diversity consumption with pupillary light response measures. There was a positive and significant association between vegetable diversity consumption and the average dilation velocity, a measure related to the sympathetic nervous system activity (β-coefficient = 0.03, 95%CI: 0.002; 0.07). Our findings show that vegetable diversity consumption is associated with the ANS response, a possible early link between diet and health in school-aged children.

Metabolic syndrome in Thai adolescents and associated factors: the Thai National Health Examination Survey V (NHES V)

Background

Presence of metabolic syndrome (MetS) in early life may influence cardiovascular outcome later in adulthood. There is limited data regarding MetS among Thai adolescents. This study aimed to estimate the prevalence of MetS and related factors in Thai adolescents.

Methods

Data on MetS components of 1934 Thai adolescents aged 10–16 years were obtained from the 5th National Health Examination Survey. Age at first screen time exposure, duration of screen time, frequency of food intake and physical activities were collected from interviews. MetS was defined according to 3 definitions: International Diabetes Federation (IDF), Cook’s, and de Ferranti’s.

Results

The prevalence of MetS was 4.1% by IDF, 8.0% by Cook’s, and 16.8% by de Ferranti’s definition. The overall prevalence was higher in male (19.0%) than female adolescents (15.3%). The most common MetS components composition among Thai adolescents was high waist circumference with high serum triglyceride and low HDL-cholesterol (40.0% for IDF, 22.6% for Cook’s and 43.5% for de Ferranti’s definition). Exposure to screen media during the first 2 years of life had a 1.3- fold increased odds of MetS by 1 out of 3 definitions (OR 1.30, 95% CI. 1.01–1.68). Duration of physical activity associated with decreased odds of MetS by Cook’s definition (OR 0.96, 95% CI. 0.92–0.99).

Conclusions

The prevalence of MetS among Thai adolescents was higher than previously reported by other studies. Screen media exposure during the first 2 years of life should be discouraged and measures to promote physical activity among children and adolescents should be strengthen.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10728-6.

Cross-Species Comparison of Metabolomics to Decipher the Metabolic Diversity in Ten Fruits

Fruits provide humans with multiple kinds of nutrients and protect humans against worldwide nutritional deficiency. Therefore, it is essential to understand the nutrient composition of various fruits in depth. In this study, we performed LC-MS-based non-targeted metabolomic analyses with ten kinds of fruit, including passion fruit, mango, starfruit, mangosteen, guava, mandarin orange, grape, apple, blueberry, and strawberry. In total, we detected over 2500 compounds and identified more than 300 nutrients. Although the ten fruits shared 909 common-detected compounds, each species accumulated a variety of species-specific metabolites. Additionally, metabolic profiling analyses revealed a constant variation in each metabolite’s content across the ten fruits. Moreover, we constructed a neighbor-joining tree using metabolomic data, which resembles the single-copy protein-based phylogenetic tree. This indicates that metabolome data could reflect the genetic relationship between different species. In conclusion, our work enriches knowledge on the metabolomics of fruits, and provides metabolic evidence for the genetic relationships among these fruits.

Association between diet quality index and cardiometabolic risk factors in adolescents: Study of Cardiovascular Risks in Adolescents (ERICA)

OBJECTIVE

This study evaluated the association between diet quality, assessed by the Diet Quality Index for Adolescents adapted for Brazilians (DQIA-BR), and cardiometabolic markers in adolescents.

METHODS

The DQIA-BR and cardiometabolic markers were assessed in 36 956 Brazilian adolescents (12-17 y old) enrolled in the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based cross-sectional multicenter study in Brazil. For analyses, the sample was stratified by sex and nutritional status. Multiple linear regressions were used to investigate the association between DQIA-BR and cardiometabolic markers (total cholesterol, HDL-c, LDL-c, triglycerides, fasting glucose and HOMA-IR). Adjusted models were constructed with two input levels of covariates. The first model was adjusted for sex, age, and socioeconomic status; in the second model, total energy intake, physical activity, and sedentary behavior were included.

RESULTS

A higher DQIA-BR score was associated with a better cardiometabolic profile in girls with normal weight; however, no association was observed in those with overweight/obesity. In boys with overweight/obesity, a better quality of diet was associated with lower concentrations of total cholesterol (β = -0.338, 95% confidence interval [CI]: -0.611 to -0.066) and LDL-c (β = -0.227, 95% CI: -0.448 to -0.005), but only LDL-c remained significant in those with normal weight (β = -0.115, 95% CI: -0.224 to 0.005).

CONCLUSION

The effects of diet quality on cardiometabolic risk factors differ according to sex and the presence of overweight/obesity. Overall, DQIA-BR is a suitable tool to evaluate the association between diet quality and cardiometabolic markers in normal-weight adolescents, but not for adolescents, especially girls, with overweight/obesity.

School-Based Intervention to Improve Healthy Eating Practices Among Malaysian Adolescents: A Feasibility Study Protocol

Introduction: School environments can influence students' dietary habits. Hence, implementing a healthy canteen intervention programme in schools is a recommended strategy to improve students' dietary intake. This study will evaluate the feasibility of providing healthier food and beverage options in selected secondary schools in Malaysia by working with canteen vendors. It also will assess the changes in food choices before and after the intervention.

Methods: A feasibility cluster randomised controlled study will be conducted in six secondary schools (intervention, n = 4; control, n = 2) comprising of rural and urban schools located in Selangor and Perak states in Malaysia. Four weeks of intervention will be conducted among Malaysian adolescents aged 15 years old. Two interventions are proposed that will focus on providing healthier food options in the canteen and convenience shops in the selected schools. Interventions 1 and 2 will entail training the canteen and school convenience shop operators. Intervention 2 will be applied to subsidise the cost of low energy-dense kuih (traditional cake), vegetables, and fruits. The control group will continue to sell the usual food. Trained dietitians will audit the canteen menu and food items sold by the school canteen and convenience shops in all schools. Anthropometric measurements, blood pressure and dietary assessment will be collected at baseline and at the end of 4-week intervention. Focus group discussions with students and in-depth interviews with headmasters, teachers, and school canteen operators will be conducted post-intervention to explore intervention acceptability. Under this Healthy School Canteen programme, school canteens will be prohibited from selling “red flag” foods. This refers to foods which are energy-dense and not nutritious, such as confectionery and deep-fried foods. They will also be prohibited from selling soft drinks, which are sugar-rich. Instead, the canteens will be encouraged to sell “green flag” food and drinks, such as fruits and vegetables.

Conclusion: It is anticipated that this feasibility study can provide a framework for the conception and implementation of nutritional interventions in a future definitive trial at the school canteens in Malaysia.

Exploring Rural Adolescents' Dietary Diversity and Its Socioeconomic Correlates: A Cross-Sectional Study from Matlab, Bangladesh

The majority of 36 million Bangladeshi adolescents live in rural areas. Improved understanding of their dietary patterns is of great public health importance. This study aimed to explore dietary diversity (DD) with its socioeconomic and gender stratification in a rural adolescent cohort and to isolate factors associated with inadequate DD. Household survey provided data for constructing dietary diversity scores (DDS) and assessing relevant socio-demographic variables. Final analysis included 2463 adolescents. Means and proportions were compared, and a binary logistic regression model was fitted. Inadequate DD was observed among 42.3% (40.3–44.2). Consumption of nutrient-rich foods varied significantly across gender and SES categories. Belonging to the poorest households (adjusted odds ratio (aOR) 1.59; 95% CI: 1.27, 2.00) and food insecure households (aOR 1.34; 95% CI: 1.13, 1.59), adolescents’ attainment of secondary education (aOR 1.38; 95% CI: 1.11, 1.71), and having mothers with secondary education or above (aOR 0.76; 95% CI: 0.60, 0.96) were associated with inadequate DD. Compared with girls from food secure households, girls from food insecure ones had higher odds of inadequate DD (aOR_girl 1.42; 95% CI: 1.12, 1.81). Improving rural adolescents’ DD would require targeted interventions as well as broader poverty alleviation.

Association Between Meeting Physical Activity, Sleep, and Dietary Guidelines and Cardiometabolic Risk Factors and Adiposity in Adolescents

PURPOSE

The aim of the study was to assess the associations of meeting physical activity (PA), sleep, and dietary guidelines with cardiometabolic risk factors and adiposity in adolescents.

METHODS

The sample included adolescents aged 10-16 years. Accelerometry was used to measure PA and sleep over 7 days, 24 h/d. The PA guideline was defined as ≥60 min/d of moderate-to-vigorous PA. The sleep guideline was 9-11 hours (10-13 years) or 8-10 hours (14-16 years) per night. The dietary guideline was based on the Healthy Eating Index calculated from dietary recalls. Cardiometabolic risk factors and adiposity were assessed in an in-patient setting. Linear regression was used to examine the association between meeting each guideline and cardiometabolic risk factors/adiposity, adjusted for confounders and meeting other guidelines.

RESULTS

Of the 342 participants, 251 (73%) provided complete measurements. Adolescents were 12.5 ± 1.9 years (African American [37%] and white [57%], girls [54%], and overweight or obesity [48%]). Half met the sleep guideline (52%), few met the PA guideline (11%), and the top quintile was preselected as meeting the diet guideline (20%). Most met one (47%) or no guidelines (35%), and few met multiple guidelines (18%). Meeting the PA guideline was associated with lower cardiometabolic risk factors and adiposity (p < .05 for all). Compared with meeting no guidelines, those who met multiple guidelines had lower cardiometabolic risk factors and adiposity (p < .05 for all).

CONCLUSIONS

Few met the PA or multiple guidelines, and those not meeting guidelines were associated with adverse cardiometabolic factors and adiposity. Multidisciplinary strategies for improving multiple behaviors are needed to improve adolescent health.

A longitudinal study of fruit juice consumption during preschool years and subsequent diet quality and BMI

Background

The role of fruit juice in pediatric dietary guidelines continues to be controversial, particularly with respect to concerns about unhealthy dietary habits and the potential promotion of excessive weight gain. The objective of the current study was to determine the association between preschool fruit juice consumption and the following outcomes during childhood and adolescence: whole and total fruit intake, diet quality, likelihood of meeting current dietary recommendations, and BMI change.

Methods

The data were previously collected from 100 children enrolled in the Framingham Children’s Study at 3–6 years of age and subsequently followed for 10 years. Dietary data were collected annually using multiple sets of 3-day diet records. Compliance with dietary recommendations was estimated based on 2015–2020 Dietary Guidelines for Americans and diet quality was measured using the associated Healthy Eating Index (HEI). Mixed linear and logistic regression models were used for statistical analyses.

Results

Preschool children (3–6 years) who drank ≥1.0 (vs. < 0.5) cup of 100% fruit juice/day consumed 0.9 cups/day more total fruit (p < 0.0001) and 0.5 cups/day more whole fruit (p < 0.0001) during adolescence (14–18 years). Total HEI scores during adolescence for those with the highest preschool juice intakes were almost 6 points higher than those with the lowest fruit juice intakes (p = 0.0044). Preschoolers consuming < 0.5 cups/day of fruit juice had sharply declining whole fruit intake throughout childhood compared with those preschoolers consuming ≥1.0 cups/day who had stable intakes of whole fruit throughout childhood. Those children who consumed ≥0.75 cups/day of fruit juice during preschool (vs. less) were 3.8 times as likely to meet Dietary Guidelines for whole fruit intake during adolescence (p < 0.05). Finally, in multivariable models, there was no association between fruit juice consumption and BMI change throughout childhood.

Conclusion

These data suggest that preschool consumption of 100% fruit juice is associated with beneficial effects on whole fruit intake and diet quality without having any adverse effect on BMI during childhood and into middle adolescence.

Dietary inflammatory potential, cardiometabolic risk and inflammation in children and adolescents: a systematic review

The Dietary Inflammatory Index (DII^®) is a tool developed for quantifying the dietary inflammatory potential of individuals' diets, with the goal of assessing the effect of diet-associated inflammation on health outcomes. With most studies focusing on adults, little is known about the consequences for health of a more proinflammatory diet early in life. Hence, this study analyzed the available evidence on the association between the DII or the children's C-DII (C-DII^TM) and cardiometabolic risk and inflammatory biomarkers in children and adolescents. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed at the LILACS, ScienceDirect, Cochrane and PubMed databases, without any restriction regarding the dates of the publications. A total of six observational studies qualified; including three cross-sectional and three longitudinal studies focused on children and adolescents between 3 and 18 years of age representing both sexes. All papers found a positive association between the DII or C-DII with cardiometabolic markers. These included adiposity (i.e., BMI, waist and hip circumference, waist-to-height ratio and fat mass index), and/or to inflammatory biomarkers (interleukins 1, 2 and 6, tumor necrosis factor-alpha, interferon gamma, and soluble vascular cell adhesion molecule-1). In conclusion, findings currently available in the literature indicate that a proinflammatory diet is associated with a higher risk of early development of cardiometabolic and inflammatory changes during childhood. Also, the findings show the applicability of the DII and C-DII in epidemiological studies and underscore the need for strategies to encourage healthy, anti-inflammatory diets to prevent chronical illnesses. Systematic Review Registration Number (PROSPERO: CRD42019123939).

In silico analysis of antidiabetic potential of phenolic compounds from blue corn (Zea mays L.) and black bean (Phaseolus vulgaris L.)

The growing interest in bioactive compounds, especially in polyphenols, is due to their abundance in the human diet and potentially positive effects on health. The consumption of polyphenols has been shown to possess anti-diabetic properties by preventing insulin resistance or insulin secretion through different signaling pathways, this effect is associated with their capacity to exert genomic modulations. Several studies have suggested that polyphenols could also bind to cellular proteins and modulate their activity, however, the mechanisms of action underlying their beneficial effects are complex and are not fully understood. The aim of this work was to characterize phenolic compounds present in blue corn and black bean extracts as well as identify their potential interactions with target proteins involved in diabetes pathogenesis using in silico approach. Total polyphenols content of both blue corn and black beans was identified using UPLC-ESI/qTOF/MS and quantified by colorimetric assays. In this work we identified twenty-eight phenolic compounds in the extracts, mainly anthocyanins, flavonols, hydroxycinamic acids, dihydroxybenzoic acids, flavones, isoflavones, and flavanols. Interactome of these compounds with thirteen target proteins involved in type 2 diabetes mellitus was performed in-silico. In total, 312 bioactive compounds/protein interaction analyses were acquired. Molecular docking results highlighted that nine of the top ten interactions correspond to anthocyanins, cyanidin 3-glucoside with 11β-HS, GFAT, PPARG; delphinidin 3-glucoside with 11β-HS, GFAT, PTP and RTKs; and petunidin 3-glucoside with 11β-HS and PTP. These proteins are involved in mechanisms regulating functions such as inflammation, insulin resistance, oxidative stress, glucose and lipid metabolism. In conclusion, this work provides a prediction of the potential molecular mechanism of black bean and blue corn polyphenols, specifically anthocyanins and could constitute new pathways by which compounds exert their antidiabetic benefits.

When should cardiovascular prevention begin? The importance of antenatal, perinatal and primordial prevention

Cardiovascular diseases represent a major health problem, being one of the leading causes of morbidity and mortality worldwide. Therefore, in this scenario, cardiovascular prevention plays an essential role although it is difficult to establish when promoting and implementing preventive strategies. However, there is growing evidence that prevention should start even before birth, during pregnancy, aiming to avoid the onset of cardiovascular risk factors, since events that occur early in life have a great impact on the cardiovascular risk profile of an adult. The two pillars of this early preventive strategy are nutrition and physical exercise, together with prevention of cardio-metabolic diseases during pregnancy. This review attempts to gather the growing evidence of the benefits of antenatal, perinatal and primordial prevention, discussing also the possibility to reverse or to mitigate the cardiovascular profile developed in the initial stages of life. This could pave the way for future research, investigating the optimal time and duration of these preventing measures, their duration and maintenance in adulthood, and the most effective interventions according to the different age and guiding in the next years, the best clinical practice and the political strategies to cope with cardiovascular disease.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.

Longitudinal Associations between Emotion Regulation and Adiposity in Late Adolescence: Indirect Effects through Eating Behaviors

The prevalence of obesity among U.S. youth continues to increase, with many adolescents engaging in unhealthy eating behaviors. Increasingly, research points to the role of self-regulation in obesity development, yet existing work has largely focused on young children and/or clinical adult populations. This multi-method longitudinal study (N = 153) utilized a path analysis to delineate links between emotion regulation (age 15), emotional eating and dietary restraint (age 16), and adiposity (% body fat) using a BodPod for body composition assessment (age 19). Emotion regulation was negatively associated with emotional eating (β = −0.30, p < 0.001) and positively associated with dietary restraint (β = 0.15, p < 0.05) at age 16, but was not associated with age 19 adiposity (β = −0.01, p = ns). Emotional eating was positively associated with adiposity (β = 0.24, p < 0.01). Indirect effects suggested that emotional eating, but not dietary restraint, at age 16 serves as a mechanism that helps explain the associations between emotion regulation and adiposity four years later. Results from this study suggest that both emotion regulation and emotional eating represent promising targets for that should be included in future interventions aimed at preventing adolescent obesity.

Clustering of Multiple Energy Balance-Related Behaviors in School Children and its Association with Overweight and Obesity-WHO European Childhood Obesity Surveillance Initiative (COSI 2015⁻2017)

It is unclear how dietary, physical activity and sedentary behaviors co-occur in school-aged children. We investigated the clustering of energy balance-related behaviors and whether the identified clusters were associated with weight status. Participants were 6- to 9-year-old children (n = 63,215, 49.9% girls) from 19 countries participating in the fourth round (2015/2017) of the World Health Organization (WHO) European Childhood Obesity Surveillance Initiative. Energy balance-related behaviors were parentally reported. Weight and height were objectively measured. We performed cluster analysis separately per group of countries (North Europe, East Europe, South Europe/Mediterranean countries and West-Central Asia). Seven clusters were identified in each group. Healthier clusters were common across groups. The pattern of distribution of healthy and unhealthy behaviors within each cluster was group specific. Associations between the clustering of energy balance-related behaviors and weight status varied per group. In South Europe/Mediterranean countries and East Europe, all or most of the cluster solutions were associated with higher risk of overweight/obesity when compared with the cluster 'Physically active and healthy diet'. Few or no associations were observed in North Europe and West-Central Asia, respectively. These findings support the hypothesis that unfavorable weight status is associated with a particular combination of energy balance-related behavior patterns, but only in some groups of countries.