Dietary Patterns are Associated with Leukocyte LINE-1 Methylation in Women: A Cross-Sectional Study in Southern Italy

AI nutritionist: Intelligent software as the next generation pioneer of precision nutrition

With the rapid development of information technology and artificial intelligence (AI), people have acquired the abilities and are encouraged to develop intelligent tools and software, which begins to shed light on intelligent and precise food nutrition. Despite the rapid development of such software, disparities still exist in terms of methodology, contents, and implementation strategies. Hence, a set of panoramic profiles is urgently needed to elucidate their values and guide their future development. Here a comprehensive review was conducted aiming to summarize and compare the objects, contents, intelligent algorithms, and functions realized by the already released software in current research. Consequently, 177 AI nutritionists in recent years were collected and analyzed. The advantages, limitations, and trends concerning their application scenarios were analyzed. It was found that AI nutritionists have been gradually advancing the production modes and efficiency of food recognition, dietary recording/monitoring, nutritional assessment, and nutrient/recipe recommendation. Most AI nutritionists have a relatively low level of intelligence. However, new trends combining advanced AI algorithms, intelligent sensors and big data are coming with new applications in real-time and precision nutrition. AI models concerning molecular-level behaviors are becoming the new focus to drive AI nutritionists. Multi-center and multi-level studies have also gradually been realized to be necessary.

An industrialized diet as a determinant of methylation in the 1F region of the NR3C1 gene promoter

Background

Dietary composition can modify gene expression, favoring the development of chronic diseases via epigenetic mechanisms.

Objective

Our study aimed to investigate the relationship between dietary patterns and NR3C1 gene methylation in users of the Brazilian Public Unified Health System (SUS).

Methods

We recruited 250 adult volunteers and evaluated their socioeconomic status, psychosocial characteristics, lifestyle, and anthropometrics. Peripheral blood was collected and evaluated for cortisol levels, glycemia, lipid profile, and insulin resistance; methylation of CpGs 40-47 of the 1F region of the NR3C1 gene was also measured. Factors associated with degree of methylation were evaluated using generalized linear models (p < 0.05). Lifestyle variables and health variables were included as confounding factors.

Results

The findings of our cross-sectional study indicated an association between NR3C1 DNA methylation and intake of processed foods. We also observed relevant associations of average NR3C1 DNA across the segment analyzed, methylation in component 1 (40-43), and methylation in component 2 (44-47) with a pattern of consumption of industrialized products in relation to BMI, serum cortisol levels, and lipid profile. These results may indicate a relationship between methylation and metabolic changes related to the stress response.

Conclusion

These findings suggest an association of methylation and metabolic alterations with stress response. In addition, the present study highlights the significant role of diet quality as a stress-inducing factor that influences NR3C1 methylation. This relationship is further linked to changes in psychosocial factors, lifestyle choices, and cardiometabolic variables, including glucose levels, insulin resistance, and hyperlipidemia.

Addressing nutritional issues and eating behaviours among university students: a narrative review

University life is a critical period for establishing healthy eating habits and attitudes. However, university students are at risk of developing poor eating habits due to various factors, including economic conditions, academic stress and lack of information about nutritional concepts. Poor diet quality leads to malnutrition or overnutrition, increasing the risk of preventable diseases. Food environments on university campuses also play a significant role in shaping the dietary habits of students, with the availability of and accessibility to healthy food options being important factors influencing food choices and overall diet quality. Disordered eating habits and body dissatisfaction are prevalent among university students and can lead to eating disorders. Income and living arrangements also influence dietary habits, with low household income and living alone being associated with unhealthy eating habits. This study is a narrative review that aimed to address nutritional issues and eating behaviours, specifically among university students. We investigated the eating behaviours of university students, including their dietary patterns, food choices and food environments. The objective of this review was to provide insights into the nutritional issues and eating behaviours of university students, with the aim of identifying target areas for intervention to improve the overall health and wellbeing among college students. University food environments need to be restructured to promote healthy eating, including the availability, accessibility, affordability and labelling of healthy foods, and policies to limit the availability of unhealthy foods and drinks on campus.

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

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

Does Pizza Consumption Favor an Improved Disease Activity in Rheumatoid Arthritis?

To our knowledge, no studies so far have investigated the role of pizza and its ingredients in modulating disease activity in rheumatoid arthritis (RA). We assessed this question via a recent cross-sectional study including 365 participants from Italy, the birthplace of pizza. Multiple robust linear and logistic regression models were fitted with the tertile consumption categories of each available pizza-related food item/group (i.e., pizza, refined grains, mozzarella cheese, and olive oil) as independent variables, and each available RA activity measure (i.e., the Disease Activity Score on 28 joints with C-reactive protein (DAS28-CRP), and the Simplified Disease Activity Index (SDAI)) as the dependent variable. Stratified analyses were carried out according to the disease severity or duration. Participants eating half a pizza >1 time/week (vs. ≤2 times/month) reported beneficial effects on disease activity, with the significant reductions of ~70% (overall analysis), and 80% (the more severe stratum), and the significant beta coefficients of -0.70 for the DAS28-CRP, and -3.6 for the SDAI (overall analysis) and of -1.10 and -5.30 (in long-standing and more severe RA, respectively). Among the pizza-related food items/groups, mozzarella cheese and olive oil showed beneficial effects, especially in the more severe stratum. Future cohort studies are needed to confirm this beneficial effect of pizza and related food items/groups on RA disease activity.

The Effect of Maternal Dietary Patterns on Birth Weight for Gestational Age: Findings from the MAMI-MED Cohort

Limited evidence exists on the effects of maternal dietary patterns on birth weight, and most studies conducted so far did not adjust their findings for gestational age and sex, leading to potentially biased conclusions. In the present study, we applied a novel method, namely the clustering on principal components, to derive dietary patterns among 667 pregnant women from Catania (Italy) and to evaluate the associations with birth weight for gestational age. We identified two clusters reflecting distinct dietary patterns: the first one was mainly characterized by plant-based foods (e.g., potatoes, cooked and raw vegetables, legumes, soup, fruits, nuts, rice, wholemeal bread), fish and white meat, eggs, butter and margarine, coffee and tea; the second one consisted mainly of junk foods (sweets, dips, salty snacks, and fries), pasta, white bread, milk, vegetable and olive oils. Regarding small gestational age births, the main predictors were employment status and primiparity, but not the adherence to dietary patterns. By contrast, women belonging to cluster 2 had higher odds of large for gestational age (LGA) births than those belonging to cluster 1 (OR = 2.213; 95%CI = 1.047-4.679; p = 0.038). Moreover, the odds of LGA increased by nearly 11% for each one-unit increase in pregestational BMI (OR = 1.107; 95%CI = 1.053-1.163; p < 0.001). To our knowledge, the present study is the first to highlight a relationship between adherence to an unhealthy dietary pattern and the likelihood of giving birth to a LGA newborn. This evidence adds to the current knowledge about the effects of diet on birth weight, which, however, remains limited and controversial.

ROS induced the Rab26 promoter hypermethylation to promote cigarette smoking-induced airway epithelial inflammation of COPD through activation of MAPK signaling

Cigarette smoking (CS) exposure-induced airway inflammatory responses drive the occurrence and development of emphysema and chronic obstructive pulmonary disease (COPD). However, its precise mechanisms have not been fully elucidated. In this study, we explore the role of Rab26 in CS exposure modulating the inflammatory response of airway epithelium and the novel mechanism of CS exposure regulation Rab26. These data showed that CS exposure and H₂O₂ (a type of ROS) suppressed the expression of Rab26 and increased the expression of DNMT3b in vivo and in vitro. GEO data analysis found the level of Rab26 was decreased in the lung tissue of COPD patients. CSE-induced ROS promoted DNA methylation of the Rab26 promoter and inhibited its promoter activity by elevating the DNMT3b level. Antioxidants N-Acetyl-l-cysteine (NAC), 5-Aza-2'-deoxycytidine (5-AZA) (DNA methylation inhibitor) and DNMT3B siRNA alleviated CSE's inhibitory effect on Rab26 expression in vitro. Importantly, NAC alleviated the improved expression of Rab26 and reduced DNMT3B expression, in the airway of smoking exposure as well as attenuated the inflammatory response in vivo. Overexpression of Rab26 attenuated CSE-induced production of inflammatory mediators through part inactivation of p38 and JNK MAPK. On the contrary, silencing Rab26 enhanced p38 and JNK activation and aggravated inflammatory response. These findings suggest that ROS-mediated Rab26 promoter hypermethylation is a critical step in cigarette smoking-induced airway epithelial inflammatory response. Restoring Rab26 in the airway epithelium might be a potential strategy for treating airway inflammation and COPD.

The Application of Clustering on Principal Components for Nutritional Epidemiology: A Workflow to Derive Dietary Patterns

In the last decades, different multivariate techniques have been applied to multidimensional dietary datasets to identify meaningful patterns reflecting the dietary habits of populations. Among them, principal component analysis (PCA) and cluster analysis represent the two most used techniques, either applied separately or in parallel. Here, we propose a workflow to combine PCA, hierarchical clustering, and a K-means algorithm in a novel approach for dietary pattern derivation. Since the workflow presents certain subjective decisions that might affect the final clustering solution, we also provide some alternatives in relation to different dietary data used. For example, we used the dietary data of 855 women from Catania, Italy. Our approach-defined as clustering on principal components-could be useful to leverage the strengths of each method and to obtain a better cluster solution. In fact, it seemed to disentangle dietary data better than simple clustering algorithms. However, before choosing between the alternatives proposed, it is suggested to consider the nature of dietary data and the main questions raised by the research.

Nutrient intakes and telomere length of cell-free circulating DNA from amniotic fluid: findings from the Mamma & Bambino cohort

Pregnancy represents a crucial period in which several exposures—and especially maternal diet—might shape children’s health. Thus, identifying how maternal dietary intakes early affect biological aging in children represents a public health mission. We aimed to assess the relationship between maternal intake of nutrients in early pregnancy and telomere length of cell-free circulating DNA (cfDNA) from amniotic fluid. We used data and samples from the ongoing prospective “Mamma & Bambino” study, which recruits mother–child pairs from Catania at the first prenatal visit. Maternal nutrient intakes were assessed using a Food Frequency Questionnaire, while relative telomere length of cfDNA was assessed by real-time polymerase chain reaction. Our analysis included 174 mother–child pairs. The intakes of iron, vitamin B1, and magnesium were positively correlated with relative telomere length (p-values < 0.05). However, only the intake of magnesium was positively associated with relative telomere length, after applying a linear regression model (β = 0.002; SE = 0.001; p = 0.024). Magnesium deficiency was negatively associated with relative telomere length after adjusting for the same covariates (β = −0.467; SE = 0.176; p = 0.009). To our knowledge, this is the first evidence of a positive relationship between maternal nutrient intake and telomere length of cfDNA. Further efforts are needed for deeply investigating the effect of maternal dietary intakes on telomere length, in order to develop effective public health strategies.

Antioxidant and inflammatory potential of diet among women at risk of cervical cancer: findings from a cross-sectional study in Italy

OBJECTIVE

To evaluate the association of Composite Dietary Antioxidant Index (CDAI) and Dietary Inflammatory Index (DII) with the prevalence of high-grade cervical intraepithelial neoplasia (CIN).

DESIGN

A cross-sectional study was conducted on women with abnormal Papanicolaou test, who underwent high-risk human papillomavirus (HPV) screening and histological test through colposcopy. Dietary data were collected using a FFQ and used to assess both CDAI and DII.

SETTING

Women were recruited from 2012 to 2015 at the Cervical Cancer Screening Unit of the 'Azienda Sanitaria Provinciale' of Catania (Italy).

PARTICIPANTS

The study included 539 women with a mean age of 40·2 years, who were classified as cases (n 127 with CIN2 or more severe lesions) and controls (n 412 with normal cervical epithelium or CIN1).

RESULTS

Although we observed a lower proportion of HPV-positive women among those with higher CDAI (P < 0·001), the index was not associated with the diagnosis of CIN2 or more severe lesions. By contrast, women with medium or high DII showed higher odds to be diagnosed with CIN2 or more severe lesions than those with low DII (OR = 2·15; 95 % CI 1·11, 4·17; P = 0·024 and OR = 3·14; 95 % CI 1·50, 6·56; P = 0·002, respectively), after adjusting for age, HPV status, educational level, BMI, smoking status, parity, use of oral contraceptives and supplements.

CONCLUSIONS

Our findings suggested that a pro-inflammatory diet might be associated with an increased risk of CIN2 and more severe lesions. However, further prospective studies should be encouraged to support this evidence.

Evaluating Dietary Patterns in Women from Southern Italy and Western Mexico

Traditional diets are known to be beneficial; however, both Italian and Mexican populations are gradually moving away from the Mediterranean and traditional Mexican diets. Since women play a key role in safeguarding dietary traditions and may reflect population dietary changes, we aimed to identify Italian and Mexican women’s current dietary patterns (DPs) and characterize their nutrient content. Cross-sectional analyses were separately conducted on two convenience samples of 811 women from Southern Italy and 215 women from Western Mexico. Food frequency questionnaires, 24 h recalls, and a principal component analysis (PCA) approach were used to derive a posteriori DPs. In Italian women, the first DP was characterized by the consumption of legumes, vegetables, and fish (8.8% of the total variance), while the second DP was characterized by snack foods, processed meats, and non-olive oils. In Mexican women, the first DP was characterized by the consumption of meats and processed foods (12.6% of the total variance), while the second DP by fruits, vegetables, and whole grains. In both populations, adhering to the DPs rich in healthy foods (i.e., fruits, vegetables, legumes, and fish) was associated with a higher quality of diet in terms on nutrient content. However, adherence to the Western-type DPs was more common among women of younger age (p < 0.035). Thus, more extraordinary efforts are needed in promoting each country’s traditional healthy diet, especially among the new generations.

MicroRNA expression is deregulated by aberrant methylation in B-cell acute lymphoblastic leukemia mouse model

BACKGROUND

The expression of microRNAs (miRNAs) in the serum of B-cell acute lymphoblastic leukemia (B-ALL) patients is abnormal. Nevertheless, the underlying mechanism remains unclear. Recent studies indicate that the methylation state of circulating cell-free DNA (cfDNA) is different between cancer patients and healthy individuals. Therefore, we speculate that abnormal expression of miRNA may be associated with cfDNA methylation.

METHODS

A green fluorescent protein (GFP) labeled B-ALL transplantation animal model was established to explore the relationship between the miRNA expression and cfDNA methylation of the related gene. Quantitative real-time PCR (qRT-PCR) was used to detect the expression levels of miRNAs. Further, cfDNA methylation levels of the related genes were evaluated through bisulfite sequencing polymerase chain reaction (BSP).

RESULTS

The expression levels of miR-196b, miR-203, miR-34a-5p, miR-335-3p, miR-34b-5p, miR-615, miR-375-3p and miR-193b-5p in the serum of the model mice were significantly lower than those of the control group (P < 0.05). The methylation level of miR-196b promoter in cfDNA of the model group was significantly lower than that of the control group (P < 0.05), whereas no significant difference was noted in miR-203 promoter. The methylation levels of miR-196b and miR-203 coding region in cfDNA of the model group were significantly higher than those of the control group (P < 0.05).

CONCLUSIONS

These results showed that CpG island hypermethylation in the miRNA coding region of cfDNA is related to the low expression of miR-196b and miR-203.

The Relationship between Body Mass Index, Obesity, and LINE-1 Methylation: A Cross-Sectional Study on Women from Southern Italy

Uncovering the relationship between body mass index (BMI) and DNA methylation could be useful to understand molecular mechanisms underpinning the effects of obesity. Here, we presented a cross-sectional study, aiming to evaluate the association of BMI and obesity with long interspersed nuclear elements (LINE-1) methylation, among 488 women from Catania, Italy. LINE-1 methylation was assessed in leukocyte DNA by pyrosequencing. We found a negative association between BMI and LINE-1 methylation level in both the unadjusted and adjusted linear regression models. Accordingly, obese women exhibited lower LINE-1 methylation level than their normal weight counterpart. This association was confirmed after adjusting for the effect of age, educational level, employment status, marital status, parity, menopause, and smoking status. Our findings were in line with previous evidence and encouraged further research to investigate the potential role of DNA methylation markers in the management of obesity.

Personalized nutrition for dementia prevention

The role of nutrition has been investigated for decades under the assumption of one-size-fits-all. Yet there is heterogeneity in metabolic and neurobiological responses to diet. Thus a more personalized approach may better fit biological reality and have increased efficacy to prevent dementia. Personalized nutrition builds on the food exposome, defined as the history of diet-related exposures over the lifetime, and on its interactions with the genome and other biological characteristics (eg, metabolism, the microbiome) to shape health. We review current advances of personalized nutrition in dementia research. We discuss key questions, success milestones, and future roadmap from observational epidemiology to clinical studies through basic science. A personalized nutrition approach based on the best prescription for the most appropriate target population in the most relevant time-window has the potential to strengthen dementia-prevention efforts.

Fine-grained investigation of the relationship between human nutrition and global DNA methylation patterns

PURPOSE

Nutrition is an important, modifiable, environmental factor affecting human health by modulating epigenetic processes, including DNA methylation (5mC). Numerous studies investigated the association of nutrition with global and gene-specific DNA methylation and evidences on animal models highlighted a role in DNA hydroxymethylation (5hmC) regulation. However, a more comprehensive analysis of different layers of nutrition in association with global levels of 5mC and 5hmC is lacking. We investigated the association between global levels of 5mC and 5hmC and human nutrition, through the stratification and analysis of dietary patterns into different nutritional layers: adherence to Mediterranean diet (MD), main food groups, macronutrients and micronutrients intake.

METHODS

ELISA technique was used to measure global 5mC and 5hmC levels in 1080 subjects from the Moli-sani cohort. Food intake during the 12 months before enrolment was assessed using the semi-quantitative EPIC food frequency questionnaire. Complementary approaches involving both classical statistics and supervised machine learning analyses were used to investigate the associations between global 5mC and 5hmC levels and adherence to Mediterranean diet, main food groups, macronutrients and micronutrients intake.

RESULTS

We found that global DNA methylation, but not hydroxymethylation, was associated with daily intake of zinc and vitamin B3. Random Forests algorithms predicting 5mC and 5hmC through intakes of food groups, macronutrients and micronutrients revealed a significant contribution of zinc, while vitamin B3 was reported among the most influential features.

CONCLUSION

We found that nutrition may affect global DNA methylation, suggesting a contribution of micronutrients previously implicated as cofactors in methylation pathways.

Lifestyle correlates of dietary patterns among young adults: evidence from an Australian birth cohort

OBJECTIVE

Previous studies of sociodemographic and lifestyle correlates of dietary patterns among young adults have primarily focused on physical activity and smoking, with inconclusive results. This study aims to examine the associations between a broader range of lifestyles of young adults and their patterns of food consumption.

DESIGN

Cross-sectional.

SETTING

Brisbane, Australia.

PARTICIPANTS

The data set are from a long running birth cohort study which commenced in 1981. Details of dietary intake and sociodemographic and lifestyle factors were from the 21-year follow-up of the Mater-University of Queensland Study of Pregnancy (MUSP) birth cohort. The effective cohort (n 2665, 57 % women) is of young adult offspring. Usual dietary intake was assessed using a Food Frequency Questionnaire (FFQ). Data on sociodemographic and lifestyle variables were obtained from self-reports.

RESULTS

Western and prudent dietary patterns were identified for the combined cohort of women and men using principal components analysis. Multivariable linear regression models were used to examine the associations between lifestyle variables and dietary patterns adjusting for potential confounders. Results from multivariable adjusted models showed that physical activity, watching TV and smoking were strongly associated with each dietary pattern; alcohol consumption and BMI showed weaker associations (P < 0·05 for all).

CONCLUSIONS

Our study describes a clustering of unhealthy lifestyles in young adults. Young adults with unhealthy lifestyles less often adhere to a healthy prudent dietary pattern and more often an unhealthy Western pattern. Dietary preferences are enmeshed in a lifestyle matrix which includes physical activity, sedentary activity, smoking and alcohol consumption of young adults.

Epigenetic Regulation of Peroxisome Proliferator-Activated Receptor Gamma Mediates High-Fat Diet-Induced Non-Alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in Western countries and has become a serious public health concern. Although Western-style dietary patterns, characterized by a high intake of saturated fat, is considered a risk factor for NAFLD, the molecular mechanisms leading to hepatic fat accumulation are still unclear. In this study, we assessed epigenetic regulation of peroxisome proliferator-activated receptor γ (PPARγ), modifications of gene expression, and lipid uptake in the liver of mice fed a high-fat diet (HFD), and in hepatocyte culture challenged with palmitic acid. Bisulfate pyrosequencing revealed that HFD reduced the level of cytosine methylation in the pparγ DNA promoter. This was associated with increased expression of the hepatic PPARγ, very low-density lipoprotein receptor (VLDLR) and cluster differentiating 36 (CD36), and enhanced uptake of fatty acids and very low-density lipoprotein, leading to excess hepatic lipid accumulation. Furthermore, palmitic acid overload engendered comparable modifications in hepatocytes, suggesting that dietary fatty acids contribute to the pathogenesis of NAFLD through epigenetic upregulation of PPARγ and its target genes. The significance of epigenetic regulation was further demonstrated in hepatocytes treated with DNA methylation inhibitor, showing marked upregulation of PPARγ and its target genes, leading to enhanced fatty acid uptake and storage. This study demonstrated that HFD-induction of pparγ DNA promoter demethylation increased the expression of PPARγ and its target genes, vldlr and cd36, leading to excess lipid accumulation, an important initiating mechanism by which HFD increased PPARγ and lipid accumulation. These findings provide strong evidence that modification of the pparγ promoter methylation is a crucial mechanism of regulation in NAFLD pathogenesis.

The Effect of Alcohol on Telomere Length: A Systematic Review of Epidemiological Evidence and a Pilot Study during Pregnancy

Several studies—albeit with still inconclusive and limited findings—began to focus on the effect of drinking alcohol on telomere length (TL). Here, we present results from a systematic review of these epidemiological studies to investigate the potential association between alcohol consumption, alcohol-related disorders, and TL. The analysis of fourteen studies—selected from PubMed, Medline, and Web of Science databases—showed that people with alcohol-related disorders exhibited shorter TL, but also that alcohol consumption per se did not appear to affect TL in the absence of alcohol abuse or dependence. Our work also revealed a lack of studies in the periconceptional period, raising the need for evaluating this potential relationship during pregnancy. To fill this gap, we conducted a pilot study using data and samples form the Mamma & Bambino cohort. We compared five non-smoking but drinking women with ten non-smoking and non-drinking women, matched for maternal age, gestational age at recruitment, pregestational body mass index, and fetal sex. Interestingly, we detected a significant difference when analyzing relative TL of leukocyte DNA of cord blood samples from newborns. In particular, newborns from drinking women exhibited shorter relative TL than those born from non-drinking women (p = 0.024). Although these findings appeared promising, further research should be encouraged to test any dose–response relationship, to adjust for the effect of other exposures, and to understand the molecular mechanisms involved.

The role of DNA methylation in syndromic and non-syndromic congenital heart disease

Congenital heart disease (CHD) is a common structural birth defect worldwide, and defects typically occur in the walls and valves of the heart or enlarged blood vessels. Chromosomal abnormalities and genetic mutations only account for a small portion of the pathogenic mechanisms of CHD, and the etiology of most cases remains unknown. The role of epigenetics in various diseases, including CHD, has attracted increased attention. The contributions of DNA methylation, one of the most important epigenetic modifications, to CHD have not been illuminated. Increasing evidence suggests that aberrant DNA methylation is related to CHD. Here, we briefly introduce DNA methylation and CHD and then review the DNA methylation profiles during cardiac development and in CHD, abnormalities in maternal genome-wide DNA methylation patterns are also described. Whole genome methylation profile and important differentially methylated genes identified in recent years are summarized and clustered according to the sample type and methodologies. Finally, we discuss the novel technology for and prospects of CHD-related DNA methylation.

Applying a hierarchical clustering on principal components approach to identify different patterns of the SARS-CoV-2 epidemic across Italian regions

Italy has experienced the epidemic of Severe Acute Respiratory Syndrome Coronavirus 2, which spread at different times and with different intensities throughout its territory. We aimed to identify clusters with similar epidemic patterns across Italian regions. To do that, we defined a set of regional indicators reflecting different domains and employed a hierarchical clustering on principal component approach to obtain an optimal cluster solution. As of 24 April 2020, Lombardy was the worst hit Italian region and entirely separated from all the others. Sensitivity analysis—by excluding data from Lombardy—partitioned the remaining regions into four clusters. Although cluster 1 (i.e. Veneto) and 2 (i.e. Piedmont and Emilia-Romagna) included the most hit regions beyond Lombardy, this partition reflected differences in the efficacy of restrictions and testing strategies. Cluster 3 was heterogeneous and comprised regions where the epidemic started later and/or where it spread with the lowest intensity. Regions within cluster 4 were those where the epidemic started slightly after Veneto, Emilia-Romagna and Piedmont, favoring timely adoption of control measures. Our findings provide policymakers with a snapshot of the epidemic in Italy, which might help guiding the adoption of countermeasures in accordance with the situation at regional level.

The Impact of Socio-Demographic Factors on Breastfeeding: Findings from the "Mamma & Bambino" Cohort

Background and objectives: The World Health Organization (WHO) recommends women (1) to initiate breastfeeding within one hour of birth; (2) to exclusively breastfeed for the first six months; and (3) to continue breastfeeding until two years of age. However, women do not always adhere to these recommendations, threatening the health of their children. The present study aims to evaluate breastfeeding status and the main maternal factors associated with exclusive breastfeeding for six months among women from the "Mamma & Bambino" study, a prospective cohort settled in Catania, Italy. Materials and Methods: We used data from 220 women (median age = 37 years) enrolled in the "Mamma & Bambino" cohort during prenatal obstetric counselling. Self-reported breastfeeding status was collected during the follow-up interviews at 1 and 2 years, referring to breastfeeding status (i.e., yes or no) and type of breastfeeding (i.e., exclusive or predominant). We also collected data about duration of breastfeeding to classify women into those who adhered to the WHO recommendation and those who did not. Results: In the general population, we noted that the proportion of women who have breastfed increased with increasing educational level. Accordingly, logistic regression analysis demonstrated that medium (OR = 3.171; 95% CI = 1.285-7.822; p = 0.012) and high educational levels (OR = 4.549; 95% CI = 1.525-13.570; p = 0.007) were positively associated with breastfeeding if compared to low educational level. Among women who have breastfed, instead, the proportion of adherents to the WHO recommendation was higher among those with medium-high educational level and those who were employed. In line with this, we demonstrated that full-time employment (OR = 2.158; 95% CI = 1.033-4.508; p = 0.041) and medium educational level (OR = 4.632; 95% CI = 1.227-17.484; p = 0.024) were positively associated with exclusive breastfeeding for the first six months. Conclusions: Socio-demographic factors should be taken into account through public health strategies for improving maternal knowledge about health benefits of exclusive breastfeeding.

Epidemiology and (Patho)Physiology of Folic Acid Supplement Use in Obese Women before and during Pregnancy

Preconception folic acid supplement use is a well-known method of primary prevention of neural tube defects (NTDs). Obese women are at a higher risk for having a child with a NTD. As different international recommendations on folic acid supplement use for obese women before and during pregnancy exist, this narrative review provides an overview of epidemiology of folate deficiency in obese (pre)pregnant women, elaborates on potential mechanisms underlying folate deficiency, and discusses considerations for the usage of higher doses of folic acid supplements. Women with obesity more often suffer from an absolute folate deficiency, as they are less compliant to periconceptional folic acid supplement use recommendations. In addition, their dietary folate intake is limited due to an unbalanced diet (relative malnutrition). The association of obesity and NTDs also seems to be independent of folate intake, with studies suggesting an increased need of folate (relative deficiency) due to derangements involved in other pathways. The relative folate deficiency, as a result of an increased metabolic need for folate in obese women, can be due to: (1) low-grade chronic inflammation (2) insulin resistance, (3) inositol, and (4) dysbiotic gut microbiome, which plays a role in folate production and uptake. In all these pathways, the folate-dependent one-carbon metabolism is involved. In conclusion, scientific evidence of the involvement of several folate-related pathways implies to increase the recommended folic acid supplementation in obese women. However, the physiological uptake of synthetic folic acid is limited and side-effects of unmetabolized folic acid in mothers and offspring, in particular variations in epigenetic (re)programming with long-term health effects, cannot be excluded. Therefore, we emphasize on the urgent need for further research and preconception personalized counseling on folate status, lifestyle, and medical conditions.

Cell lineage-specific methylome and genome alterations in gout

In this study, we examined data from 69 gout patients and 1,455 non-gout controls using a MethylationEPIC BeadChip assay and Illumina HiSeq platform to identify lineage-specific epigenetic alterations and associated genetic factors that contributed to gouty inflammation. Cell lineage-specific differentially methylated sites were identified using CellDMC after adjusting for sex, age, alcohol drinking, smoking status, and smoking history (total pack-years). Different cell lineages displayed distinct differential methylation. Ingenuity Pathway Analysis and NetworkAnalyst indicated that many differential methylated sites were associated with interleukin-1β expression in monocytes. On the UCSC Genome Browser and WashU Epigenome Browser, metabolic trait, cis-methylation quantitative trait loci, genetic, and functional annotation analyses identified nine methylation loci located in interleukin-1β-regulating genes (PRKCZ, CIDEC, VDAC1, CPT1A, BIRC2, BRCA1, STK11, and NLRP12) that were associated specifically with gouty inflammation. All nine sites mapped to active regulatory elements in monocytes. MoLoTool and ReMap analyses indicated that the nine methylation loci overlapped with binding sites of several transcription factors that regulated interleukin-1β production and gouty inflammation. Decreases in PRKCZ and STK11 methylation were also associated with higher numbers of first-degree relatives who also had gout. The gouty-inflammation specific methylome and genome alterations could potentially aid in the identification of novel therapeutic targets.

Epigenetic Aging and Colorectal Cancer: State of the Art and Perspectives for Future Research

Although translational research has identified a large number of potential biomarkers involved in colorectal cancer (CRC) carcinogenesis, a better understanding of the molecular pathways associated with biological aging in colorectal cells and tissues is needed. Here, we aim to summarize the state of the art about the role of age acceleration, defined as the difference between epigenetic age and chronological age, in the development and progression of CRC. Some studies have shown that accelerated biological aging is positively associated with the risk of cancer and death in general. In line with these findings, other studies have shown how the assessment of epigenetic age in people at risk for CRC could be helpful for monitoring the molecular response to preventive interventions. Moreover, it would be interesting to investigate whether aberrant epigenetic aging could help identify CRC patients with a high risk of recurrence and a worst prognosis, as well as those who respond poorly to treatment. Yet, the application of this novel concept is still in its infancy, and further research should be encouraged in anticipation of future applications in clinical practice.

The Effects of Dietary Interventions on DNA Methylation: Implications for Obesity Management

Previous evidence from in vivo and observational research suggested how dietary factors might affect DNA methylation signatures involved in obesity risk. However, findings from experimental studies are still scarce and, if present, not so clear. The current review summarizes studies investigating the effect of dietary interventions on DNA methylation in the general population and especially in people at risk for or with obesity. Overall, these studies suggest how dietary interventions may induce DNA methylation changes, which in turn are likely related to the risk of obesity and to different response to weight loss programs. These findings might explain the high interindividual variation in weight loss after a dietary intervention, with some people losing a lot of weight while others much less so. However, the interactions between genetic, epigenetic, environmental and lifestyle factors make the whole framework even more complex and further studies are needed to support the hypothesis of personalized interventions against obesity.

Adherence to the Mediterranean diet partially mediates socioeconomic differences in leukocyte LINE-1 methylation: evidence from a cross-sectional study in Italian women

Although previous research demonstrated that socioeconomic status (SES) might affect DNA methylation, social inequalities alone do not completely explain this relationship. We conducted a cross-sectional study on 349 women (Catania, Italy) to investigate whether behaviors might mediate the association between SES and long interspersed nuclear elements (LINE-1) methylation, a surrogate marker of global DNA methylation. Educational level, used as an indicator of SES, and data on behaviors (i.e. diet, smoking habits, physical activity, and weight status) were collected using structured questionnaires. Adherence to Mediterranean diet (MD) was assessed by the Mediterranean Diet Score (MDS). Leukocyte LINE-1 methylation was assessed by pyrosequencing. Mediation analysis was conducted using the procedure described by Preacher and Hayes. Women with high educational level exhibited higher MDS (β = 0.669; 95%CI 0.173-1.165; p < 0.01) and LINE-1 methylation level (β = 0.033; 95%CI 0.022-0.043; p < 0.001) than their less educated counterpart. In line with this, mediation analysis demonstrated a significant indirect effect of high educational level on LINE-1 methylation through the adherence to MD (β = 0.003; 95%CI 0.001-0.006). Specifically, the mediator could account for 9.5% of the total effect. To our knowledge, this is the first study demonstrating the mediating effect of diet in the relationship between SES and DNA methylation. Although these findings should be confirmed by prospective research, they add value to the promotion of healthy dietary habits in social disadvantaged people.

How Dietary Factors Affect DNA Methylation: Lesson from Epidemiological Studies

Over the past decades, DNA methylation has been proposed as a molecular mechanism underlying the positive or negative effects of diet on human health. Despite the number of studies on this topic is rapidly increasing, the relationship between dietary factors, changes in DNA methylation and health outcomes remains unclear. In this review, we summarize the literature from observational studies (cross-sectional, retrospective, or prospective) which examined the association of dietary factors (nutrients, foods, and dietary patterns) with DNA methylation markers among diseased or healthy people during the lifetime. Next, we discuss the methodological pitfalls by examining strengths and limitations of published studies. Finally, we close with a discussion on future challenges of this field of research, raising the need for large-size prospective studies evaluating the association between diet and DNA methylation in health and diseases for appropriate public health strategies.

Systemic Investigation of Promoter-wide Methylome and Genome Variations in Gout

Current knowledge of gout centers on hyperuricemia. Relatively little is known regarding the pathogenesis of gouty inflammation. To investigate the epigenetic background of gouty inflammation independent of hyperuricemia and its relationship to genetics, 69 gout patients and 1455 non-gout controls were included. Promoter-wide methylation was profiled with EPIC array. Whole-genome sequencing data were included for genetic and methylation quantitative trait loci (meQTL) analyses and causal inference tests. Identified loci were subjected to co-methylation analysis and functional localization with DNase hypersensitivity and histone marks analysis. An expression database was queried to clarify biologic functions of identified loci. A transcription factor dataset was integrated to identify transcription factors coordinating respective expression. In total, seven CpG loci involved in interleukin-1β production survived genetic/meQTL analyses, or causal inference tests. None had a significant relationship with various metabolic traits. Additional analysis suggested gouty inflammation, instead of hyperuricemia, provides the link between these CpG sites and gout. Six (PGGT1B, INSIG1, ANGPTL2, JNK1, UBAP1, and RAPTOR) were novel genes in the field of gout. One (CNTN5) was previously associated with gouty inflammation. Transcription factor mapping identified several potential transcription factors implicated in the link between differential methylation, interleukin-1β production, and gouty inflammation. In conclusion, this study revealed several novel genes specific to gouty inflammation and provided enhanced insight into the biological basis of gouty inflammation.

Science and Healthy Meals in the World: Nutritional Epigenomics and Nutrigenetics of the Mediterranean Diet

The Mediterranean Diet (MD), UNESCO Intangible Cultural Heritage of Humanity, has become a scientific topic of high interest due to its health benefits. The aim of this review is to pick up selected studies that report nutrigenomic or nutrigenetic data and recapitulate some of the biochemical/genomic/genetic aspects involved in the positive health effects of the MD. These include (i) the antioxidative potential of its constituents with protective effects against several diseases; (ii) the epigenetic and epigenomic effects exerted by food components, such as Indacaxanthin, Sulforaphane, and 3-Hydroxytyrosol among others, and their involvement in the modulation of miRNA expression; (iii) the existence of predisposing or protective human genotypes due to allelic diversities and the impact of the MD on disease risk. A part of the review is dedicated to the nutrigenomic effects of the main cooking methods used in the MD and also to a comparative analysis of the nutrigenomic properties of the MD and other diet regimens and non-MD-related aliments. Taking all the data into account, the traditional MD emerges as a diet with a high antioxidant and nutrigenomic modulation power, which is an example of the “Environment-Livings-Environment” relationship and an excellent patchwork of interconnected biological actions working toward human health.

Dietary Antioxidant Intake and Human Papillomavirus Infection: Evidence from a Cross-Sectional Study in Italy

Several lines of evidence suggested that antioxidants might play a protective role against high-risk human papillomavirus (hrHPV) infection and cervical cancer. However, the effect of combined intake of antioxidants has not been investigated thus far. The current cross-sectional study aimed to understand the relationship between dietary antioxidant intake and the risk of high-risk HPV (hrHPV) infection among 251 Italian women with normal cervical cytology. Women were tested for hrHPV using the Digene HC2 HPV DNA Test. Dietary antioxidant intakes were assessed using a semi-quantitative food frequency questionnaire, and a Composite Dietary Antioxidant Index (CDAI) was constructed on the basis of zinc, selenium, manganese, vitamin A, vitamin C, vitamin E, carotenoid, and flavonoid intake. Logistic regression analysis was used to assess odds ratio (OR) and 95% confidence interval (95% CI) for the associations of antioxidant intakes or CDAI with hrHPV status, adjusting for age, smoking status, body mass index, parity, educational level, marital status, and use of multivitamins and oral contraceptives. We first observed that hrHPV-positive women (n = 84) reported lower intake of zinc, manganese, and vitamins A and C than non-infected women. Specifically, we found a negative association between dietary intake of zinc and hrHPV-positive status when all antioxidants were considered simultaneously (OR = 0.46; 95% CI = 0.27–0.80; p = 0.006). With respect to cumulative dietary antioxidant intake, we demonstrated that women with high CDAI (third tertile) had lower odds of being hrHPV-positive than those with low CDAI (first tertile) (OR = 0.39; 95% CI = 0.18–0.85; p = 0.018). To our knowledge, this is the first study demonstrating that a diet based on the combined intake of nutrients with antioxidant properties might reduce the risk of hrHPV infection. However, further research is needed to understand whether dietary antioxidant intake is associated with hrHPV infection or its persistence.

Dietary Habits of Saharawi Type II Diabetic Women Living in Algerian Refugee Camps: Relationship with Nutritional Status and Glycemic Profile

Diabetes is one of the main health problems among Saharawi refugees living in Algerian camps, especially for women. As is known, diet plays an important role in the management of diabetes. However, the dietary habits of Saharawi diabetic women are unknown. Therefore, we investigated the dietary habits and established their relationship with the nutritional status and glycemic profile of such women. We recruited 65 Saharawi type II diabetic women taking orally glucose-lowering drugs only. Dietary habits were investigated using qualitative 24 h recall carried out over three non-consecutive days. Anthropometric measurements were taken and blood parameters were measured. About 80% of the women were overweight and about three out of four women had uncompensated diabetes and were insulin resistant. The Saharawi diet was found to mainly include cereals, oils, sugars, vegetables (especially onions, tomatoes, and carrots), tea, and meat. Principal component analysis identified two major dietary patterns, the first one “healthy” and the second one “unhealthy”. Women in the higher tertile of adherence to the unhealthy dietary pattern had a higher homeostatic model assessment for insulin resistance (HOMA) index (b = 2.49; 95% CI: 0.41–4.57; p = 0.02) and circulating insulin (b = 4.52; 95% CI: 0.44–8.60; p = 0.03) than the women in the lowest tertile. Food policies should be oriented to improve the quality of diet of Saharawi diabetic women.

Dietary Folate Intake and Folic Acid Supplements among Pregnant Women from Southern Italy: Evidence from the "Mamma & Bambino" Cohort

Folate requirement among women who plan to become pregnant should be raised to 600 μg/day during the periconceptional period. To meet this need, several countries began to promote the use of folic acid supplements before and during pregnancy. Here, we investigated prevalence and determinants of dietary folate intake and folic acid supplement use among 397 pregnant women (aged 15–50 years old, median = 37 years old). We also investigated their effects on neonatal outcomes in a subgroup of women who completed pregnancy. For doing that, we used data from the “Mamma & Bambino” project, an ongoing mother-child cohort settled in Catania (Italy). Inadequate folate intake was evaluated using a Food Frequency Questionnaire and defined as an intake < 600 μg/day. Women were also classified as non-users (i.e., women who did not use folic acid supplements), insufficient users (i.e., women who did not take folic acid supplements as recommended), and recommended users of folic acid supplements. Neonatal outcomes of interest were preterm birth (PTB) and small for gestational age (SGA). Nearly 65% of women (n = 257) reported inadequate folate intake, while 74.8% and 22.4% were respectively classified as insufficient or recommended users of supplements. We demonstrated higher odds of inadequate folate intake among smoking women (OR = 1.457; 95%CI = 1.046–2.030; p = 0.026), those who followed dietary restrictions (OR = 2.180; 95%CI = 1.085–4.378; p = 0.029), and those with low adherence to the Mediterranean Diet (OR = 3.194; 95%CI = 1.958–5.210; p < 0.001). In a subsample of 282 women who completed pregnancy, we also noted a higher percentage of SGA among those with inadequate folate intake (p < 0.001). Among 257 women with inadequate folate intake, those with low educational level were more likely to not take folic acid supplements than their more educated counterpart (OR = 5.574; 95%CI = 1.487–21.435; p = 0.012). In a subsample of 184 women with inadequate folate intake and complete pregnancy, we observed a higher proportion of SGA newborns among women who did not take supplement before pregnancy and those who did not take at all (p = 0.009). We also noted that the proportion of PTB was higher among non-users and insufficient users of folic acid supplements, but difference was not statistically significant. Our study underlined the need for improving the adherence of pregnant women with recommendations for dietary folate intake and supplement use. Although we proposed a protective effect of folic acid supplement use on risk of SGA, further research is encouraged to corroborate our findings and to investigate other factors involved.

How dietary patterns affect left ventricular structure, function and remodelling: evidence from the Kardiovize Brno 2030 study

Little is still known about the effect of dietary patterns on left ventricular hypertrophy (LVH). Here, we derived dietary patterns by principal component analysis (PCA) and evaluated their association with LV structure, function, and remodelling. Our cross-sectional study included 438 members (aged 25–65 years; 59.1% women) of the Kardiovize Brno 2030 with no history of cardiovascular disease. Two dietary patterns were derived using PCA, namely prudent and western. Primary outcomes were echocardiographic parameters and LV geometric patterns, such as concentric LV remodelling (cLVR), concentric LVH (cLVH), and eccentric LVH (eLVH). Interestingly, participants with high adherence to the prudent dietary pattern had decreased odds of cLVH after adjustment for socio-demographic, clinical and behavioral covariates (OR = 0.24, 95% CI = 0.08–0.88; p = 0.031). By contrast, several echocardiographic parameters increased with increasing adherence to the western dietary pattern, which resulted in higher odds of cLVH among participants with high adherence (OR = 5.38, 95% CI = 1.17–23.58; p = 0.035). Although our findings may have an immediate relevance for public-health strategies, further large-size prospective studies should be encouraged to better understand the observed association and their causality.

A Systematic Review of Ecological Momentary Assessment of Diet: Implications and Perspectives for Nutritional Epidemiology

The ecological momentary assessment (EMA) of eating behaviors represents an innovative, detailed and valid approach to capture the complexity of food intake and to overcome limitations of traditional dietary assessment methods. Moreover, EMA studies might generate a large variety of data (e.g., dietary, behavioral, physical, sociopsychological, and contextual information), thereby enabling to examine concurrent exposures and events. Due to the increasing number of studies in this field of research, here we systematically reviewed EMA methods for the assessment of dietary intake in epidemiological studies, and discussed implications and perspectives for future research. Our study summarized several protocols and platforms that may be applied to assess diet in terms of eating frequency, choices, and habits. Nearly 38% of studies used an event-contingent strategy by asking participants to report foods and beverages consumed in real-time at each eating occasion. Instead, approximately 55% of studies used a signal-contingent prompting approach that notified the participants to record their dietary consumption. The remaining studies used a combination of event- and signal-contingent protocols to compare their accuracy or to improve the assessment of dietary data. Although both approaches might improve the accuracy and ecological validity of dietary assessment—also reducing the burden for participants—some limitations should nevertheless be considered. Despite these limitations, our systematic review pointed out that EMA can be applied in various fields of nutritional epidemiology, from the identification of determinants of dietary habits in healthy people to the management of patients with eating or metabolic disorders. However, more efforts should be encouraged to improve the validity and the reliability of EMA and to provide further technological innovations for public health research and interventions.