Dietary Folate Intake Is Negatively Associated with Excess Body Weight in Brazilian Graduates and Postgraduates (CUME Project)

Association between dietary patterns and obesity: a longitudinal prospective cohort study

OBJECTIVES

The obesity prevalence in South Korea in 2021 stood at 38.4%. South Korea faces unique challenges in providing essential and emergency guidelines for weight management because of stepping into an aging society. We aimed to determine the daily diet patterns among the general Korean population and to investigate the association between such patterns and different obesity.

STUDY DESIGN

Longitudinal prospective cohort study.

METHODS

A total of 6539 adult participants (mean age 50.8 years, 52.9% male) with normal-weight adults were included from the Ansan-Ansung cohort of 10,030 Korean adults aged 40 or older and followed for an average of 11 years. Obesity was defined according to the criteria from the Korean Society for The Study of Obesity. Baseline dietary intake was assessed using a validated 103-item food frequency questionnaire. Dietary patterns were derived from k-means cluster analysis.

RESULTS

In the multivariate analysis, referring to white rice + baechu kimchi, participants from multigrain rice + baechu kimchi showed lower HR for obesity development (waist circumference defined-obesity; HR: 0.87, 95% CI: 0.79, 0.95; body fat percentage defined-obesity; HR: 0.89, 95% CI: 0.80, 0.98). Further analysis documented that except for body fat percentage defined-obesity, consuming milk or dairy products was linked to a reduced incidence of the other three obesity (body mass index defined-obesity; HR: 0.84, 95% CI: 0.72, 0.99; waist circumference defined-obesity; HR: 0.82, 95% CI: 0.71, 0.94; waist-to-hip ratio defined-obesity; HR: 0.75, 95% CI: 0.61, 0.91).

CONCLUSIONS

Following a diet that includes multigrain rice, fermented baechu kimchi, and dairy products is linked to a decreased risk of obesity in Korean adults. Public health programs and policies could incorporate these dietary recommendations, targeting specific population groups such as schoolchildren, adults, and the elderly. Additionally, further research is needed to explore the synergistic effects of various foods and their interactions within dietary patterns on obesity outcomes.

Associations of oxidative balance score with total abdominal fat mass and visceral adipose tissue mass percentages among young and middle-aged adults: findings from NHANES 2011-2018

Objective

This study aimed to explore the association of the oxidative balance score (OBS) with total abdominal fat mass (TAFM) and visceral adipose tissue mass (VATM) percentages among young and middle-aged U.S. adults.

Methods

Young and middle-aged adults in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 were included. Analysis of variance and Rao-Scott adjusted chi-square tests were used to compare the characteristics across quartiles of OBS. Univariate and multivariate weighted logistic regression models were employed to explore the relationship between OBS and the risks of high TAFM or high VATM percentage in the general population and subgroups, while the interaction effects were tested with a likelihood test. Weighted restricted cubic spline analyses were utilized to assess the non-linear association of OBS with TAFM and VATM percentages.

Results

The final sample included 8,734 young and middle-aged non-institutionalized U.S. adults representing 134.7 million adults. Compared with adults in the first quartile of OBS, those with higher OBS were less likely to have a high TAFM percentage; the ORs and 95% CI for adults in the second, third, and highest quartiles of OBS were 0.70 (0.53-0.94), 0.49 (0.36-0.60), and 0.25 (0.18-0.36), respectively. Similar trends were observed in the association between OBS and VATM percentages. Moreover, similar effects were confirmed in the sensitivity analyses and subgroup analyses according to demographic characteristics. Regarding the OBS subclass, higher dietary OBS and lifestyle OBS were also correlated with decreased ORs of high TAFM and VATM percentages.

Conclusion

This study strongly suggests that higher OBS, as well as higher dietary OBS and lifestyle OBS, are significantly correlated with lower risks of abdominal obesity and visceral fat accumulation. The findings highlight the importance of an antioxidant-rich diet and maintaining a healthy lifestyle in reducing the risks.

Association between total dietary antioxidant capacity and food groups and incidence of depression in a cohort of Brazilian graduates (CUME Project)

This study aims to evaluate the association between Dietary Total Antioxidant Capacity (dTAC) and Total Antioxidant Capacity of food groups (fgTAC) with the incidence of depression in Brazilian graduates participating in the Cohort of Universities of Minas Gerais (CUME Study). The sample consisted of 2572 participants without a medical diagnosis of depression at baseline who responded to at least one follow-up questionnaire from the CUME Project. The Ferric Reducing Antioxidant Power assay was used to determine dTAC. Incidence of depression was estimated by self-reported medical diagnosis of depression during the years of cohort follow-up. Cox regression models were used to relate dTAC and fgTAC to the incidence of depression. The mean follow-up time was 2·96 (1·00) years, and 246 cases of depression were observed (32·3/1000 person-years). The mean dTAC was 11·03 (4·84) mmol/d. We found no associations between higher dTAC and lower risk of developing depression after adjusting for possible confounders. The incidence of depression was inversely associated with fgTAC of the beans and lentils group (hazard ratio (HR): 0·61; 95 % CI 0·41, 0·90). The fgTAC of the junk food group was positively associated with higher incidence of depression after all adjustments (HR: 1·57; 95 % CI 1·08, 2·26). Our findings do not support an association between dTAC and the incidence of depression in a highly educated Brazilian population. However, associations of fgTAC show the importance of analysing the food matrix in which these antioxidants are inserted. We highlight the need for more prospective studies with different nationalities to confirm these results.

The effect of folic acid supplementation on body weight and body mass index: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND AND OBJECTIVE

Several trials have evaluated the effects of folate supplementation on obesity indices. However, their results were inconsistent. Therefore, the current meta-analysis was conducted to summarize data from available randomized clinical trials (RCTs) about the impact of folate supplementation on weight and body mass index (BMI).

METHOD

Medline/PubMed, Scopus, Embase, and ISI web of science were searched to identify relevant articles up to December 2020. The effect sizes were expressed as weighted mean difference (WMD) and 95% confidence intervals (CI) using the random-effects model.

RESULTS

Pooled data from nine studies showed that folic acid supplementation did not change body weight (WMD: -0.16 kg, 95%CI: -0.47 to 0.16, P = 0.32) and BMI (WMD: -0.23 kg/m², 95%CI: -0.49 to 0.03, P = 0.31), but there was significant heterogeneity between the included studies for BMI (I² = 90.1%, P < 0.001). Moreover, subgroup analyses in level of homocysteine and health status indicated significant effect of folic acid supplementation on BMI in those with homocysteine level ≥15 μmol/L (WMD: -0.17 kg/cm2, -0.33 to -0.01, p = 0.03) and in women with polycystic ovary syndrome (PCOS) (WMD: - 0.30kg/cm2, -0.54 to -0.06, p = 0.01).

CONCLUSION

Our outcomes demonstrated that folic acid improves BMI in those with homocysteine levels ≥15 μmol/L and women with PCOS.

Serum Folate Related to Five Measurements of Obesity and High-Sensitivity C-Reactive Protein in Korean Adults

This study investigated the effects of folic acid on obesity and high-sensitivity C-reactive protein (CRP) levels. Using data from the Korea National Health and Nutrition Examination Survey (KNHANES VII 2016–2018), 6394 adults (aged 19–80 years) who met the study criteria were identified and divided into young, middle-aged, and older adult groups. The analysis assessed associations using logistic regression for complex samples. Obesity was measured using body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), a body shape index (ABSI), and body roundness index (BRI). The odds ratio (OR) of obesity based on BMI were statistically significant for young adults and older participants with low levels of folic acid compared to those with high levels (OR: 1.33 and 1.58, respectively). The OR of obesity based on BMI, WC, WHtR, ABSI, and BRI was significant with low levels of folic acid in middle-aged individuals (OR: 1.36, 1.32, 1.41, 1.29, and 1.47, respectively). Low folate levels were related to higher high-sensitivity CRP levels in middle-aged patients. In conclusion, folate level showed a significant inverse association with obesity and inflammatory biomarkers, especially in the middle-aged group. Further longitudinal or randomized controlled trials are needed to confirm and expand our results.

Fat Intake and High Triglyceride-Glucose Index in Individuals at Cardiometabolic Risk: An Isocaloric Substitution Analyses

Insulin resistance (IR) is an important risk factor for cardiovascular diseases, and the triglyceride-glucose index (TyG index) is a potential IR biomarker. Evidence also suggests that fat intake may modulate IR status, but this relationship remains unclear. Thus, the present study aimed to analyze the relationship between the TyG index and isocaloric replacement of macronutrients, including the profile of dietary fatty acids in individuals at cardiometabolic risk.

This cross-sectional study enrolled 264 individuals at cardiometabolic risk (age 43.1 ± 16.3 years) who participated in a nutritional intervention study (ReBEC, id: RBR-5n4y2g). The baseline demographic, anthropometric, clinical, dietary, and lifestyle data were used. The TyG index was calculated using the formula ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. Multivariate nutrient density models were used to analyze isocaloric replacement of fatty acids (as 5% of energy). The chance of having a high TyG index (TyG index >8.83, median value) was decreased by 60% after replacing 5% of the energy intake of polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), and trans fatty acid (TFA) with monounsaturated fatty acid (MUFA) or PUFA and SFA with protein.

Isocaloric replacement of PUFA, SFA, and TFA with MUFA and protein was associated with lower chances of having a high TyG index. These results indicate the importance of macronutrient and dietary fat profiles in the dietary planning of individuals at cardiometabolic risk.

Optimal Dietary Intake Composition of Choline and Betaine Is Associated with Minimized Visceral Obesity-Related Hepatic Steatosis in a Case-Control Study

Few studies on humans have comprehensively evaluated the intake composition of methyl-donor nutrients (MDNs: choline, betaine, and folate) in relation to visceral obesity (VOB)-related hepatic steatosis (HS), the hallmark of non-alcoholic fatty liver diseases. In this case-control study, we recruited 105 patients with HS and 104 without HS (controls). HS was diagnosed through ultrasound examination. VOB was measured using a whole-body analyzer. MDN intake was assessed using a validated quantitative food frequency questionnaire. After adjustment for multiple HS risk factors, total choline intake was the most significant dietary determinant of HS in patients with VOB (Beta: -0.41, p = 0.01). Low intake of choline (<6.9 mg/kg body weight), betaine (<3.1 mg/kg body weight), and folate (<8.8 μg/kg body weight) predicted increased odds ratios (ORs) of VOB-related HS (choline: OR: 22, 95% confidence interval [CI]: 6.5-80; betaine: OR: 14, 95% CI: 4.4-50; and folate: OR: 19, 95% CI: 5.2-74). Combined high intake of choline and betaine, but not folate, was associated with an 81% reduction in VOB-related HS (OR: 0.19, 95% CI: 0.05-0.69). Our data suggest that the optimal intake of choline and betaine can minimize the risk of VOB-related HS in a threshold-dependent manner.

Serum folate concentration and health-related quality of life among the elderly in South Korea

Background

The purpose of this study was to investigate the association between serum folate concentration and health-related quality of life (HRQOL) among the elderly in South Korea.

Materials and methods

The data used in this study were drawn from 1,021 participants over 65 years old in the Korea National Health and Nutrition Examination Survey from 2016–2018. HRQOL was measured by the EQ-5D questionnaire. Participants were divided into tertiles of folate concentration (ranges 1.7–5.6, 5.7–9.4, and 9.5–31.9 ng/mL). We performed multivariable linear regression to examine the relationship between folate and HRQOL, and multivariable logistic regression to examine the relationship between folate and the dimensional problem of HRQOL.

Results

Higher folate concentrations were significantly associated with higher HRQOL in the elderly. The average HRQOL score of the elderly in the highest tertile of the folate level was 0.0289 higher than that of the lowest tertile (coefficient: 0.0289; 95% CI 0.0016, 0.0563). The HRQOL score increased by 0.0174 points when the folate concentration increased by 100%. When analyzing specific dimensions, a significant association with folate concentration was found only for the self-care dimension of HRQOL (odds ratio for self-care problems: 0.63; 95% CI 0.41, 0.99).

Conclusions

The elderly with higher serum folate concentration tended to have higher HRQOL. Among HRQOL dimensions, self-care was only significantly associated with folate concentration.

Associations between dietary intake of B vitamins and cardiovascular risk factors in elderly men: A cross-sectional study

OBJECTIVE

Low intake of B vitamins can lead to hyperhomocysteinaemia, which is reported as a risk factor for cardiovascular disease (CVD). However, little is known about this relationship. Therefore, we decided to examine the association between dietary intake of B vitamins and cardiovascular risk factors in elderly men.

METHODS

The present cross-sectional study consisted of 357 elderly men. Dietary intake was assessed using a validated and reliable food frequency questionnaire. All biochemical factors [fasting blood sugar (FBS), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6) and tumour necrosis factor-α (TNF-α)], waist circumference (WC) and blood pressure (BP) were assessed using standard methods.

RESULTS

A significant inverse association was observed between high dietary intake of total B vitamins (OR_{Total B vitamins} : 0.30; 95% CI: 0.10, 0.86; P = .01) and vitamin B9 (OR_{vitamin B9} : 0.20; 95% CI: 0.02, 0.52; P = .002) with high WC. Furthermore, an inverse association was observed between high dietary intake of vitamin B6 (OR_{vitamin B6} : 0.28; 95% CI: 0.08, 1.00; P = .05) and vitamin B9 (OR_{vitamin B9} : 0.20; 95% CI: 0.06, 0.70; P = .01) with hs-CRP level.

CONCLUSIONS

In elderly men, a high dietary intake of total B vitamins and vitamin B9 was associated with lower odds of having a high WC. Similarly, high dietary intake of vitamin B6 and B9 was associated with lower odds of having a high hs-CRP level.

Maternal weight as an additional first trimester spina bifida screening marker

OBJECTIVE

To evaluate first trimester maternal weight as a spina bifida screening marker.

METHODS

Case-control study of spina bifida and unaffected pregnancies; cases were from national records and controls from women referred to prenatal screening centers in the Ukraine. The median and inter-quartile range of weight, body mass index (BMI) and the obesity rate (BMI ≥ 30 kg/m²) were compared. Discriminatory power was assessed by logistic regression. Gaussian modeling was used to predict the additional spina bifida detection when weight was included as a screening marker risk in addition to first trimester biparietal diameter (BPD) and serum α-fetoprotein (AFP).

RESULTS

There were 97 cases and 274 controls. The distribution of maternal weight was increased in cases by 3 kg, on average, about 5% (p < .05); BMI was increased about 8% (p < .005). Some 15% of cases were obese compared with 6.9% of controls (p < .02). In logistic regression including BMI and maternal age, 29% cases and 9.8% controls had high risk of spina bifida. Modeling predicted that incorporating weight would increase the detection rate compared with BPD and AFP alone by 3% and BMI would increase it by 4%.

CONCLUSION

Incorporating maternal weight into first trimester spina bifida screening protocols will increase detection.

Dietary intake, clinical-nutritional status, and homocysteine in hemodialysis subjects: the mediating role of inflammation (NUGE-HD study)

The aim of the present study was to test the hypothesis that inflammation mediates the associations among food intake, clinical-nutritional status, and plasma homocysteine (Hcys) in hemodialysis (HD) subjects. This was a cross-sectional analysis of data on 129 subjects undergoing HD (58.9% male, 61.8 ± 15.5 years of age) from the cohort Nutrition and Genetics on HD outcomes (NUGE-HD study). Sociodemographic, anthropometric, and metabolic data were collected, and food intake was assessed using a quantitative food frequency questionnaire. Plasma C-reactive protein (CRP) was used as an inflammatory marker. Data were analyzed by structural equation modeling. Regarding the direct effects, complex B vitamin intake was negatively associated with body mass index, and diabetes mellitus was positively associated with CRP. Plasma CRP also showed a negative association with Hcys, and the ratio of saturated and polyunsaturated fatty acids intake showed a positive association with Hcys. Regarding indirect effects, the results showed that the relationship between the presence of diabetes mellitus and Hcys is mediated by plasma CRP. In conclusion, the ratio of saturated and polyunsaturated fatty acids had a direct effect on plasma Hcys, whereas inflammation had a direct and mediating effect on the relationship between Hcys and diabetes mellitus in HD subjects. Novelty In end-stage renal disease, CRP influences plasma Hcys directly and also indirectly through its mediating effect. The quantity and quality of dietary fatty acids influence plasma Hcys concentrations in HD subjects.

Low folate intake and serum levels are associated with higher body mass index and abdominal fat accumulation: a case control study

BACKGROUND

The link between folate metabolism and obesity has recently been underlined, suggesting that folate deficiency may lead to body weight gain and adiposity. We thus wished to determine whether the inefficiency in folate metabolism caused by genetic variation in the MTHFR and DHFR genes in folate metabolism, or inadequate folate intake, is associated with obesity.

METHODS

A case-control study including 421 healthy participants (aged 20-40) was performed in Poznań, Poland. The cases were 213 subjects with BMI > 25 kg/m2, while the controls were 208 subjects with BMI < 25 kg/m2. Genotyping of rs70991108 (DHFR) and rs1801133 (MTHFR) was performed using TaqMan probes. Serum folate concentrations were measured using an enzyme-linked immunosorbent assay and homocysteine was assessed with high performance liquid chromatography.

RESULTS

Subjects with overweight and obesity had 12% lower folate intake (p < 0.05) and 8.5% lower folate serum concentrations (p < 0.01) than the controls. Serum folate concentrations and folate intake were inversely associated with body fat percentage (p < 0.05) and waist circumference (p < 0.05 and p < 0.001, respectively). Serum folate concentration, though not folate intake, was negatively associated with WHR and BMI (p < 0.05, for both associations).

CONCLUSIONS

Lower folate intake and serum levels are weakly, but independently, associated with greater body weight and central adiposity in people aged 20-40. MTHFR and DHFR polymorphism seems not to have significant impact on body weight.

Overweight & obese Australian adults and micronutrient deficiency

Background

Micronutrients have been implicated as an important factor in regulating various metabolic processes and thus playing a role in the aetiology of obesity. Many studies have been conducted worldwide that clearly show a direct link between obesity and micronutrient deficiencies. The aim of this study was to assess the nutritional status of overweight and obese Australian adults to see if there were any associations between BMI and serum micronutrient levels.

Methods

Baseline serum micronutrient data of overweight and obese individuals with a body mass index (BMI) between 25 and 40 kg/m² and aged between 18 and 65 years was compared to the clinical micronutrient reference ranges for associations between BMI and micronutrient status.

Results

There were significant negative associations between BMI and serum vitamin D (p = 0.044), folate (p = 0.025), magnesium (p = 0.010) and potassium (p = 0.023).

Conclusions

Overweight and obesity appears to impact on the bioavailability and utilisation of micronutrients with absorption, excretion, storage/distribution (fat sequestering, tissue dispersion), metabolism (catabolic losses, possibly oxidative), increased physiologic requirements, and lower absolute total dietary intake being the current theory for observed differences. While vitamins D, folate, magnesium and potassium showed a negative relationship to BMI, other micronutrients did not. This may be explained by the fortification of certain processed foods, or the possibility of overweight and obese people eating more to satisfy their nutritional requirements.

Diet and nutrient status of legume consumers in Sweden: a descriptive cross-sectional study

Background

Legumes are nutrient-dense foods and can be an environmentally sustainable alternative to meat consumption. Data on legume intake are scarce and data on legume consumption in Sweden are lacking. This study investigated dietary intake and dietary patterns, together with iron, vitamin D, and folate status, in relation to legume consumption in Sweden.

Methods

Cross-sectional dietary and biomarker data (n 1760) from the 2011 Riksmaten national survey were analyzed. All legume foods (including soy) were identified from 4-day dietary records and ferritin, folate, and vitamin D status in a subgroup (n 280). Participants were classified into non-consumers and quartiles of legume intake. Principal Component Analysis (PCA) was performed to uncover dietary patterns associated with legume intake. Partial Least Square (PLS) regression was used to identify variables associated with variations in legume consumption.

Results

Legumes were consumed by 44% of the population, with mean (SD) intake of 138 (84) g/d in the highest and 11 (5) g/d in the lowest quartiles. Among consumers, 6% reported being vegetarian, compared with 0.9% among non-consumers. Legume consumers drank less alcohol, but had higher intakes of energy, dietary fiber, folate, thiamin, and several minerals, and more often met recommended intake levels for folate and fiber, critical nutrients in Sweden. Biomarker status did not differ with legume intake. PCA revealed multiple loadings on legumes that generally reflected healthier eating habits for legume-consuming women. PLS revealed that vegetarianism was most influential for high legume intake. Other influential variables were high fruit, tea, nut, and seed intakes. High intake of meat, sodas, fast foods, and sweet foods, together with omnivorism, were influential for low legume intake. The associations were similar for men and women.

Conclusions

This study supports dietary recommendations on inclusion of legumes in a healthy diet. Greater focus on assessment of legume intake is necessary to explore the population-wide health effects of legumes as sustainable meat alternatives, and to reinforce national nutritional guidelines.

Dietary inflammatory index and prevalence of overweight and obesity in Brazilian graduates from the Cohort of Universities of Minas Gerais (CUME project)

OBJECTIVES

The aim of this study was to evaluate the independent association of the dietary inflammatory index (DII®) score with overweight and obesity in Brazilian participants of the Cohort of Universities of Minas Gerais (CUME project).

METHODS

This was a cross-sectional study consisting of 3,151 graduates and postgraduates (2197 women) with a mean (SD) age of 36.3 y (±9.4 y). Sociodemographic characteristics, lifestyle, and anthropometric data were assessed via online self-reported questionnaire. Additionally, a validated food frequency questionnaire with 144 food items was used to generate energy-adjusted DII (E-DII^TM) scores, which evaluated the inflammatory potential of the diet.

RESULTS

The prevalence of overweight and obesity were 28.2% and 11%, respectively. Participants in the highest E-DII quartile (most proinflammatory diet) were more likely to be smokers/former smokers; sedentary; and consumers of red and ultra-processed meats, fats and oils (excluding olive oil), bottled fruit juices and soft drinks, sugars, sweets, and higher overall caloric intake, compared with the first quartile of E-DII. Both men and women in the fourth E-DII quartile had the highest prevalence of overweight and obesity (prevalence ratio [PR], 1.35; 95% confidence interval [CI], 1.14-1.59 and PR, 1.97; 95% CI, 1.20-3.22, respectively, in men; PR, 1.38; 95% CI, 1.17 to 1.65 and PR, 1.95; 95% CI, 1.31-2.90, respectively, in women).

CONCLUSION

The most proinflammatory dietary pattern was associated with a higher prevalence of overweight and obesity and other unhealthy lifestyles including being sedentary, smoking, and consuming a obesogenic diet.

Central But Not General Obesity Is Positively Associated with the Risk of Hyperhomocysteinemia in Middle-Aged Women

Objective: Obesity and homocysteine (Hcy) are two important risk factors for cardiovascular disease (CVD). However, evidence on the association between obesity and Hcy concentration was conflicting. The aim of our study is to explore the associations of general and central obesity with hyperhomocysteinemia (HHcy) in middle-aged women. Methods: The current analysis was based on data from 11,007 women aged 40–60 years. Height, weight, and waist circumference (WC) were measured and serum homocysteine was determined. Multiple logistic regression models were used to assess the associations of the risk of hyperhomocysteinemia (HHcy, Hcy > 15 μmol/L) with BMI and WC. Results: 13.71% women had HHcy. The prevalences of BMI-based general obesity and WC-based central obesity were 11.17% and 22.88%, respectively. Compared with non-obese women, the mean serum Hcy concentration was significantly higher in WC-based central obese women (p = 0.002), but not in BMI-based general obese women (p > 0.05). In the multiple logistic regression models, central obesity was positively related to the risk of HHcy (OR = 1.30, 95% CI = 1.10 to 1.52), while general obesity was inversely related to the risk of HHcy (OR = 0.82, 95% CI = 0.72 to 0.93 and OR = 0.71, 95% CI = 0.57 to 0.89). Conclusions: Central obesity was positively related to the risk of HHcy, while general obesity was negatively related. Menopause showed no effect modification on these associations.