Food sources of energy and nutrients among adults in the US: NHANES 2003–2006

Temporal changes in micronutrient intake among United States Adults, NHANES 2003 through 2018: A cross-sectional study

BACKGROUND

Changes in the United States food supply and food choices make examination of temporal changes in micronutrient intake and their effect on meeting nutrient recommendations necessary.

OBJECTIVES

This study aimed to examine 15-year trends of the contribution of foods and beverages (FB) and dietary supplements (DSs) to meeting nutrient recommendations among United States adults aged 19 y or older and compare usual mean intake distributions of FB alone with those of FB+DSs with dietary reference intakes [percentage below the estimated average requirement (%AI)].

METHODS

This cross-sectional study used food, beverage, and DSs intake data from NHANES 2003-2018 (N = 39,925) to determine usual mean intakes for 21 micronutrients. Changes in intakes from FB and from FB+DSs, by sex, were compared in a time-trend analysis of 2-y cycles. Changes in mean intake as %AI were determined.

RESULTS

Over the time studied, United States adults underconsumed vitamins A, C, D, E, and K; calcium; potassium; magnesium; and choline, even when DSs intake was included. Sodium was overconsumed. In males, there were significant increases in %

CONCLUSIONS

Although some progress has been made, nutrient intake and percentage of the population meeting nutritional recommendations among United States adults has changed little over the 15 y studied.

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Key Words

• adequate intake
• dietary recommendations
• dietary supplements
• estimated average requirement
• nutrient intake
• underconsumed nutrients

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MESH Headings

• Humans
• Micronutrients/administration & dosage
• Cross-Sectional Studies
• Adult
• Male
• Female
• United States
• Nutrition Surveys
• Middle Aged
• Young Adult
• Diet
• Dietary Supplements
• Aged

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Affiliation(s)

Marjorie R Freedman Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States; Oak Ridge Institute for Science and Education, Belcamp, MD, United States.
Victor L Fulgoni Nutrition Impact, 9725 D Drive North, Battle Creek, MI, United States
Harris R Lieberman Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States

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ONE QUALITY concept: a narrative perspective to unravel nutritional challenges, controversies, and the imperative need of transforming our food systems

Ensuring a healthy and sustainable diet for all should be a global priority, and to achieve this goal the food system requires substantial changes. Adopting a one-size-fits-all approach is not feasible, and we need to consider the cultural particularities of each geography and not try to export models that work in one place but may be unsustainable in others. Our discussion will center on two key aspects within this overarching process: (a) the combination of a rigorous evidence-based approach with existing or proposed Nutritional Guidelines and policies required to realize the "ONE HEALTH" and "ONE QUALITY" concepts. Examining the Mediterranean diet and the latest findings on saturated fats will aid us in comprehending the necessary paradigm shift required to formulate new guidelines with substantial impact in preventing the rising prevalence of Non-Communicable Diseases worldwide; (b) the adequacy and scope of the data bank necessary to develop a global, science-based approach.

Associations Between Dietary Potassium Intake From Different Food Sources and Hyperkalemia in Patients With Chronic Kidney Disease

OBJECTIVE

Previous studies reported mixed results on associations between dietary potassium intake and hyperkalemia in patients with chronic kidney disease (CKD). This study investigated the association between potassium intake from different food sources and hyperkalemia in patients with non-dialysis-dependent CKD.

METHODS

A total of 285 patients were recruited at a university hospital and 2 city hospitals in Tokyo. Dietary potassium intake was estimated by a validated diet history questionnaire. Associations of potassium intake from all foods and individual food groups with serum potassium were examined by multivariable linear regression among potassium binder nonusers. An association between tertile groups of potassium intake and hyperkalemia, defined as serum potassium ≥5.0 mEq/L, was evaluated by multivariable logistic regression.

RESULTS

Among 245 potassium binder nonusers, total potassium intake was weakly associated with serum potassium (regression coefficient = 0.147, 95% confidence interval (CI): 0.018-0.277), while an association with hyperkalemia was not observed (first vs third tertile: adjusted odds ratio = 0.98, 95% CI: 0.29-3.26). As for food groups, potassium intakes from potatoes, pulses, and green/yellow vegetables were positively associated with serum potassium. Patients in the highest tertile of potassium intake from potatoes had higher odds of hyperkalemia as compared to those in the lowest tertile (adjusted odds ratio = 4.12, 95% CI: 1.19-14.34).

CONCLUSION

Total potassium intake was weakly associated with serum potassium, but not with hyperkalemia. Potassium intake from potatoes was associated with hyperkalemia. These findings highlight the importance of considering food sources of potassium in the management of hyperkalemia in CKD.

Associations between Cholesterol Intake, Food Sources and Cardiovascular Disease in Chinese Residents

Cholesterol is a nutrient commonly found in the human diet. The relationship between dietary cholesterol, its sources, and cardiovascular disease (CVD) is still a topic of debate. This study aimed to investigate the association between dietary cholesterol, its sources, and cardiovascular events in a Chinese population. The present study analyzed data from the China Health and Nutrition Survey (CHNS) cohort between 1991 and 2015. This study analyzed data from 3903 participants who were 40 years of age or older at baseline and had no history of cardiovascular disease, diabetes, or hypertension. During a median follow-up of 14 years, 503 cardiovascular disease events were identified through follow-up questionnaires administered every 2-3 years. The events included fatal and nonfatal coronary heart disease, stroke, heart failure, and other cardiovascular disease deaths. Cox regression was used to estimate risk ratios (HR) for CVD events after adjusting for demographic, socioeconomic, and behavioral factors. It was discovered that sources of dietary cholesterol varied among different subgroups of the population. The top three sources of cholesterol among all participants were eggs, red meat, and seafood, accounting for 57.4%, 28.2%, and 9.0% of total daily cholesterol intake, respectively. The present study found that there was a significant association between total dietary cholesterol intake, and the risk of developing cardiovascular disease (adjusted HR [95% CI]: total cholesterol (highest and lowest quartiles compared) 1.57 [1.17-2.11]). Cholesterol from poultry, seafood, and eggs was also significantly associated with a reduced risk of CVD (adjusted HR [95% CI]: poultry 0.18 [0.04-0.82], seafood 0.11 [0.02-0.54], and eggs 0.16 [0.03-0.73]). After adjusting for daily caloric intake, daily fat intake, and daily saturated fat intake, the previously observed association between red meat cholesterol and cardiovascular events (unadjusted HR [95% CI]: 0.44 [0.35-0.55]) was no longer statistically significant (adjusted HR [95% CI]: 0.21 [0.04-1.01]).

Adherence to the Planetary Health Diet Index and correlation with nutrients of public health concern: an analysis of NHANES 2003-2018

BACKGROUND

The Planetary Health Diet Index (PHDI) is a novel measure adapted to quantify alignment with the dietary evidence presented by the EAT-Lancet Commission on Food, Planet, Health.

OBJECTIVES

To examine how population-level health and sustainability of diet as measured by the PHDI changed from 2003 to 2018, and to assess how PHDI correlated with inadequacy for nutrients of public health concern (iron, calcium, potassium, and fiber) in the United States.

METHODS

We estimated survey-weighted trends in PHDI scores and median intake of PHDI components in a nationally representative sample of 33,859 adults aged 20+ y from 8 cycles (2003-2018) of the National Health and Nutrition Examination Survey with 2 d of dietary recall data. We used the National Cancer Institute method to examine how PHDI correlated with inadequate intake of iron, calcium, potassium, and fiber.

RESULTS

Out of a theoretical range of 0-140, the median PHDI value increased by 4.2 points over the study period, from 62.7 (95% confidence interval [CI]: 62.0, 63.4) points in 2003-2004 to 66.9 (66.2, 67.7) points in 2017-2018 (P-trend < 0.001), although most of this change occurred before 2011-2012 and plateaued thereafter. For adequacy components that are encouraged for consumption, nonstarchy vegetable intake significantly decreased over time, whereas whole grains, nuts and seeds, and unsaturated oils increased. For moderation components with recommended limits for consumption, poultry and egg intake increased, but red and processed meat, added sugars, saturated fats, and starchy vegetables decreased over time. Higher PHDI values were associated with a lower probability of iron, fiber, and potassium inadequacy.

CONCLUSIONS

Although there have been positive changes over the past 20 y, there is substantial room for improving the health and sustainability of the United States diet. Shifting diets toward EAT-Lancet recommendations would improve nutrient adequacy for iron, fiber, and potassium. Policy action is needed to support healthier, more sustainable diets in the United States and globally.

Usual Nutrient Intake Distribution and Prevalence of Nutrient Intake Inadequacy among Japanese Children and Adults: A Nationwide Study Based on 8-Day Dietary Records

In this cross-sectional study, we evaluated nutrient intake adequacy in 4450 Japanese people aged 1-79 years. Dietary data was collected through non-consecutive 8-day weighed dietary records. Usual nutrient intakes from foods and beverages were estimated using the Multiple Source Method. Participant proportions with intakes below and above the Japanese Dietary Reference Intakes (2020) were calculated. Usual intakes of most nutrients were below the Estimated Average Requirement; calcium showed a high percentage of inadequacy across all sex and age groups (29-88%), and iron showed a high inadequacy among females aged 12-64 years (79-95%). The percentages of energy from protein and carbohydrates, dietary fibre, and potassium were typically below the lower limit of the Tentative Dietary Goal for Preventing Lifestyle-related Diseases (DG). Furthermore, over 20% of the participants exceeded the upper limit of the DG for the percentages of energy from total and saturated fats, and over 88% exceeded the upper limit of the DG for sodium. Japanese children and adults could improve their nutrient intake by increasing calcium, iron, dietary fibre, and potassium and reducing total and saturated fats and sodium. These findings can inform policies and interventions to improve nutrient intake in Japan.

Dietary Zn deficiency, the current situation and potential solutions

Zinc (Zn) deficiency is a worldwide problem, and this review presents an overview of the magnitude of Zn deficiency with a particular emphasis on present global challenges, current recommendations for Zn intake, and factors that affect dietary requirements. The challenges of monitoring Zn status are clarified together with the discussion of relevant Zn bioaccessibility and bioavailability issues. Modern lifestyle factors that may exacerbate Zn deficiency and new strategies of reducing its effects are presented. Biofortification, as a potentially useful strategy for improving Zn status in sensitive populations, is discussed. The review proposes potential actions that could deliver promising results both in terms of monitoring dietary and physiological Zn status as well as in alleviating dietary Zn deficiency in affected populations.

Dietary nutrient intake and cognitive function in the Age-Related Eye Disease Studies 1 and 2

INTRODUCTION

The objective was to analyze associations between dietary intake of multiple nutrients and altered cognitive function and/or decline.

METHODS

Observational analyses of participants (n = 6334) in two randomized trials of nutritional supplements for age-related macular degeneration: Age-Related Eye Disease Study (AREDS) and AREDS2.

RESULTS

In AREDS, for 4 of 38 nutrients examined, higher intake quintiles were significantly associated with decreased risk of cognitive impairment on the Modified Mini-Mental State test (<80): β-carotene, copper, docosahexaenoic acid, and insoluble fiber. In AREDS2, for 13 of 44 nutrients, higher intake quintiles were associated with decreased risk on the Telephone Interview Cognitive Status-Modified (<30). Rate of cognitive decline over up to 10 years was not significantly different with higher intake of any nutrient.

DISCUSSION

Higher dietary intake of multiple nutrients, including specific vitamins, minerals, carotenoids, fatty acids, and fiber, was associated with lower risk of cognitive impairment but not slower decline in cognitive function.

Dairy intake and risk of hip fracture in prospective cohort studies: non-linear algorithmic dose-response analysis in 486 950 adults

Previous studies on the relationship between dairy consumption and hip fracture risk have reported inconsistent findings. Therefore, we aimed to conduct an algorithmically driven non-linear dose-response meta-analysis of studies assessing dairy intake and risk of developing incident hip fracture. Meta-analysis from PubMed and Google Scholar searches for articles of prospective studies of dairy intake and risk of hip fracture, supplemented by additional detailed data provided by authors. Meta-regression derived dose-response relative risks, with comprehensive algorithm-driven dose assessment across the entire dairy consumption spectrum for non-linear associations. Review of studies published in English from 1946 through December 2021. A search yielded 13 studies, with 486 950 adults and 15 320 fractures. Non-linear dose models were found to be empirically superior to a linear explanation for the effects of milk. Milk consumption was associated with incrementally higher risk of hip fractures up to an intake of 400 g/d, with a 7 % higher risk of hip fracture per 200 g/d of milk (RR 1⋅07, 95 % CI 1⋅05, 1⋅10; P < 0⋅0001), peaking with 15 % higher risk (RR 1⋅15, 95 % CI 1⋅09, 1⋅21, P < 0⋅0001) at 400 g/d versus 0 g/d. Although there is a dose-risk attenuation above 400 g/d, milk consumption nevertheless continued to exhibit elevated risk of hip fracture, compared to zero intake, up to 750 g/d. Meanwhile, the analysis of five cohort studies of yoghurt intake per 250 g/d found a linear inverse association with fracture risk (RR 0⋅85, 95 % CI 0⋅82, 0⋅89), as did the five studies of cheese intake per 43 g/d (~1 serving/day) (RR 0⋅81, 95 % CI 0⋅72, 0⋅92); these studies did not control for socioeconomic status. However, no apparent association between total dairy intake and hip fracture (RR per 250 g/d of total dairy = 0⋅97, 95 % CI 0⋅93, 1⋅004; P = 0⋅079). There were both non-linear effects and overall elevated risk of hip fracture associated with greater milk intake, while lower risks of hip fracture were reported for higher yoghurt and cheese intakes.

Dairy food consumption is beneficially linked with iodine status in US children and adults: National Health and Nutrition Examination Surveys 2001-2018

OBJECTIVES

The objective of this study was to determine the association between the consumption of dairy foods with urinary iodine concentration (UIC) and iodine deficiency risk in a nationally representative sample of the US population.

DESIGN, SETTING AND PARTICIPANTS

24-hour dietary recall data and laboratory data for UIC (μg/l) from subjects 2+ years old US population participating in National Health and Nutrition Examination Surveys 2001-2018 were used (n 26 838) for analyses after adjusting for demographic covariates. Significant associations were assessed at P < 0·05.

RESULTS

Mean intakes of total dairy were 2·21, 2·17 and 1·70 cup equivalents (cup eq) among those 2-8, 9-18 and 19+ years, respectively. Of the dairy components, intake of milk was highest followed by cheese and yogurt for all age groups. Total dairy intakes were positively associated with UIC among those 2-8 years (β = 29·9 ± 9·9 μg/l urine/cup eq dairy) and 9-18 years (β = 26·0 ± 4·8 μg/l urine/cup eq dairy) but not associated among those 19+ years. Total dairy intakes were associated with lowered risks (30 %, 21 % and 20 % for among 2-8, 9-18 and 19+ years, respectively) of being classified as iodine insufficient (UIC < 100 μg/l) or lowered risk (47 %, 30 % and 26 % among 2-8, 9-18 and 19+ years, respectively) of being classified as iodine severely deficient (UIC < 20 μg/l).

CONCLUSIONS

The results indicate that dairy foods are beneficially associated with UIC and lowered iodine deficiency risk.

Food Composition Databases (FCDBs): A Bibliometric Analysis

Food composition databases (FCDBs) are important tools that provide information on the nutritional content of foods. Previously, it was largely unclear what nutritional contents and which FCDBs were involved in highly cited papers. The bibliometric study aimed to identify the most productive authors, institutions, and journals. The chemicals/chemical compounds with high averaged citations and FCDBs used by highly cited papers were identified. In July 2023, the online database Web of Science Core Collection (WoSCC) was queried to identify papers related to FCDBs. A total of 803 papers were identified and analyzed. The first paper indexed in WoSCC was published in 1992 by Pennington, which described the usefulness of FCDB for researchers to identify core foods for their own studies. In that paper, the FCDB described was the USDA 1987-88 NFCS (the United States Department of Agriculture 1987-88 Nationwide Food Consumption Survey). The most productive author was Dr. Paul M. Finglas, the Head of the Food Databanks National Capability at the Quadram Institute (Norwich, UK) and the Managing Director of EuroFIR. His most cited paper among this dataset was about the development of an online Irish food composition database together with EuroFIR. The most productive institutions were the USDA and the World Health Organization (WHO) instead of universities. Flavonoid was the most recurring chemical class among the highly cited ones. The anti-oxidative properties and protective effects against heart disease and cancer of flavonoids might be some of the reasons for their popularity in research. Among the highly cited papers, the most heavily used FCDBs were the USDA database for the flavonoid content of selected foods, Fineli, the USDA National Nutrient Database for Standard Reference (USNDB), EuroFIR eBASIS-Bioactive Substances in Food Information Systems, and Phenol-Explorer. High-quality national and international FCDBs should be promoted and made more accessible to the research and public communities to promote better nutrition and public health on a global scale.

Ultraprocessed Foods and Obesity Risk: A Critical Review of Reported Mechanisms

Epidemiologic evidence supports a positive association between ultraprocessed food (UPF) consumption and body mass index. This has led to recommendations to avoid UPFs despite very limited evidence establishing causality. Many mechanisms have been proposed, and this review critically aimed to evaluate selected possibilities for specificity, clarity, and consistency related to food choice (i.e., low cost, shelf-life, food packaging, hyperpalatability, and stimulation of hunger/suppression of fullness); food composition (i.e., macronutrients, food texture, added sugar, fat and salt, energy density, low-calorie sweeteners, and additives); and digestive processes (i.e., oral processing/eating rate, gastric emptying time, gastrointestinal transit time, and microbiome). For some purported mechanisms (e.g., fiber content, texture, gastric emptying, and intestinal transit time), data directly contrasting the effects of UPF and non-UPF intake on the indices of appetite, food intake, and adiposity are available and do not support a unique contribution of UPFs. In other instances, data are not available (e.g., microbiome and food additives) or are insufficient (e.g., packaging, food cost, shelf-life, macronutrient intake, and appetite stimulation) to judge the benefits versus the risks of UPF avoidance. There are yet other evoked mechanisms in which the preponderance of evidence indicates ingredients in UPFs actually moderate body weight (e.g., low-calorie sweetener use for weight management; beverage consumption as it dilutes energy density; and higher fat content because it reduces glycemic responses). Because avoidance of UPFs holds potential adverse effects (e.g., reduced diet quality, increased risk of food poisoning, and food wastage), it is imprudent to make recommendations regarding their role in diets before causality and plausible mechanisms have been verified.

The Impacts of Animal-Based Diets in Cardiovascular Disease Development: A Cellular and Physiological Overview

Cardiovascular disease (CVD) is the leading cause of death in the United States, and diet plays an instrumental role in CVD development. Plant-based diets have been strongly tied to a reduction in CVD incidence. In contrast, animal food consumption may increase CVD risk. While increased serum low-density lipoprotein (LDL) cholesterol concentrations are an established risk factor which may partially explain the positive association with animal foods and CVD, numerous other biochemical factors are also at play. Thus, the aim of this review is to summarize the major cellular and molecular effects of animal food consumption in relation to CVD development. Animal-food-centered diets may (1) increase cardiovascular toll-like receptor (TLR) signaling, due to increased serum endotoxins and oxidized LDL cholesterol, (2) increase cardiovascular lipotoxicity, (3) increase renin-angiotensin system components and subsequent angiotensin II type-1 receptor (AT1R) signaling and (4) increase serum trimethylamine-N-oxide concentrations. These nutritionally mediated factors independently increase cardiovascular oxidative stress and inflammation and are all independently tied to CVD development. Public policy efforts should continue to advocate for the consumption of a mostly plant-based diet, with the minimization of animal-based foods.

Are (poly)phenols contained in 100% fruit juices mediating their effects on cardiometabolic risk factors? A meta-regression analysis

Background

The consumption of 100% fruit juices has not been associated with substantial detrimental outcomes in population studies and may even contribute to improving the cardiometabolic profile if included in a healthy balanced diet. The main contributors to such potential beneficial effects include vitamins, minerals, and likely the (poly)phenol content. This study aimed to investigate whether the (poly)phenols contained in 100% fruit juices may mediate their effects on cardiometabolic risk factors based on published randomized controlled trials (RCT).

Methods

A systematic search in PubMed/MEDLINE and Embase, updated till the end of October 2022, was carried out to identify RCT providing quantitative data on (poly)phenol content in 100% fruit juices and used as an intervention to improve cardiometabolic parameters such as blood lipids, glucose, and blood pressure. Meta-regression analysis was performed to calculate the effect of the intervention [expressed as standardized mean difference and 95% confidence intervals (CI)] using the (poly)phenol content as moderator.

Results

A total of 39 articles on RCT investigating the effects of 100% fruit juices on cardiometabolic risk factors reporting data on total (poly)phenol and anthocyanin content were included in the analysis. Total (poly)phenol content was substantially unrelated to any outcome investigated. In contrast, each 100 mg per day increase in anthocyanins was related to 1.53 mg/dL decrease in total cholesterol (95% CI, -2.83, -0.22, p = 0.022) and 1.94 mg/dL decrease in LDL cholesterol (95% CI, -3.46, -0.42, p = 0.012). No other potential mediating effects of anthocyanins on blood triglycerides, glucose, systolic and diastolic pressure were found, while a lowering effect on HDL cholesterol after excluding one outlier study was observed.

Discussion

In conclusion, the present study showed that anthocyanins may mediate the potential beneficial effects of some 100% fruit juices on some blood lipids. Increasing the content of anthocyanins through specific fruit varieties or plant breeding could enhance the health benefits of 100% fruit juices.

Food sources of energy and nutrients among US college students: The Health Starts Here cohort study

Objective: Identifying the food sources contributing most to total energy percentage, macronutrients, vitamin and mineral consumption among college freshmen, and whether sex played a role. Participants: First-year undergraduate students (N = 269). Methods: Diet was assessed using a DHQ-III and estimated with food source composition tables. Nutrient intakes were expressed as a percentage of total dietary intakes for each food category. Mann-Whitney U tests were used to determine the differences between the two sexes for each food category. Results: A significant proportion of energy and nutrients is contributed by certain food categories, such as grain products, meat, poultry, fish; however, other less desirable sources of energy and nutrient are also identified, including sugary and sports drinks. Among female students, a greater portion of nutritional intakes came from healthier choices. Conclusions: A majority of total energy intake comes from food categories that are energy-dense but also provide essential nutrients.

A Qualitative Process Evaluation of Participant Experiences in a Feasibility Randomised Controlled Trial to Reduce Indulgent Foods and Beverages

There is a growing interest in the effects of ultra-processed/energy-dense nutrient-poor foods on health outcomes, and few interventions to reduce their consumption have been tested. We tested a simple intervention to help people reduce the indulgences they consume (energy-dense nutrient-poor (EDNP) foods). Herein, we report the qualitative findings to understand how participants reduced their consumption by exploring intervention fidelity and the factors affecting consumption. We conducted a qualitative descriptive study of 23 adults who had taken part in a feasibility randomised controlled trial that asked participants to say no to seven indulgences/week and record what they said no to. Data were collected using face-to-face semi-structured interviews and analysed thematically. A total of 23 adults with an average BMI of 30.8 kg/m2 took part. Participants liked the term indulgence, as they could apply it to their normal dietary intake and make small changes. They found self-monitoring what they said no to helpful and reported that emotional eating and habits affected consumption. They had difficulty overcoming these. As most people are consuming too many foods that are EDNP, this simple intervention of “Say No” seven times/week has the potential to be developed as a public health campaign.

Impact of a Low-Insulin-Stimulating Bread on Weight Development-A Real Life Randomised Controlled Trial

The impact on body weight development is usually analysed by comparing different diet types. Our approach was to change only one component, namely bread, common to most diets. In a single-centre triple-blind randomised controlled trial the effects of two different breads on body weight were analyzed without further lifestyle modification. Overweight adult volunteers (n = 80) were randomised 1:1 to exchange previously consumed breads for either a rye bread from milled whole grain (control) or a medium-carbohydrate, low-insulin-stimulating bread (intervention). Pre-tests demonstrated that the two bread types strongly differed in the glucose and insulin response elicited, but had similar energy content, texture and taste. The primary endpoint was the estimated treatment difference (ETD) in change of body weight after 3 months of treatment. Whereas body weight remained unchanged in the control group (-0.1 ± 2.0 kg), significant weight reduction was observed in the intervention group (-1.8 ± 2.9 kg), with an ETD of -1.7 ± 0.2 kg (p = 0.007), that was more pronounced in participants ≥ 55 years (-2.6 ± 3.3 kg), paralleled by significant reductions in body mass index and hip circumference. Moreover, in the intervention group, the percentage of participants with significant weight loss (≥1 kg) was twice as high as in the control group (p < 0.001). No other statistically significant changes in clinical or lifestyle parameters were noted. Simply exchanging a common insulinogenic bread for a low-insulin-stimulating bread demonstrates potential to induce weight loss in overweight persons, especially those at older age.

Carbohydrate Intakes below Recommendations with a High Intake of Fat Are associated with Higher Prevalence of Metabolic Syndrome

BACKGROUND

More than one-third of adults in the United States have metabolic syndrome, and dietary carbohydrate intake may modify the likelihood of developing this condition. Currently, there is a lack of consistent evidence demonstrating the relationship between carbohydrate intake that falls below recommendations and metabolic syndrome. Not accounting for the differences in fatty acid classes of these dietary patterns may be a reason for inconsistent findings.

OBJECTIVE

This study evaluated the association between a carbohydrate intake below recommendations and metabolic syndrome stratified by fat quantity and fatty acid classes in a nationally representative sample of US adults.

DESIGN

This cross-sectional study acquired data on food and nutrient intake and markers of metabolic syndrome from respondents in the National Health and Nutrition Examination Survey 1999-2018.

PARTICIPANTS/SETTING

This study included 19,078 respondents who were aged 20 years or older, had reliable and complete data on food and nutrient intake and markers of metabolic syndrome, and were not pregnant or breastfeeding.

MAIN OUTCOME MEASURES

The main outcome was prevalence of metabolic syndrome.

STATISTICAL ANALYSES PERFORMED

Usual dietary intake was estimated using the National Cancer Institute's usual intake methodology. Multivariable logistic regression models assessed the relative odds of prevalent metabolic syndrome between those who had a carbohydrate intake below recommendations and those who met carbohydrate recommendations.

RESULTS

Those who had a carbohydrate intake below recommendations had 1.067 (95% CI 1.063 to 1.071) times greater odds of having metabolic syndrome compared with those who met carbohydrate recommendations (P < 0.001). High intake of fat of any class was associated with higher odds of metabolic syndrome (total fat: 1.271, 95% CI 1.256 to 1.286; saturated fatty acid: 1.072, 95% CI 1.060 to 1.085; monounsaturated fatty acid: 1.317, 95% CI 1.300 to 1.333; polyunsaturated fatty acid: 1.056, 95% CI 1.047 to 1.066; P < 0.001 for all comparisons) in those who had a carbohydrate intake below recommendations.

CONCLUSIONS

The odds of prevalent metabolic syndrome were higher among individuals who had a carbohydrate intake below recommendations compared with individuals who met carbohydrate recommendations.

E, K, B5, B6, and B9 vitamins and their specific immunological effects evaluated by flow cytometry

It has been proven that vitamins play an essential role in preventing certain diseases since ancient times. It is thus fruitless to approach the roles of vitamins without making reference to the techniques used in evaluating the effects of these micronutrients. Therefore, the aim of this paper was to summarize the immunological effects of E, K, B5, B6, and B9 vitamins evaluated by flow cytometry. Some of these significant effects were presented and discussed: (a) The role of vitamins E in the prevention and treatment of different types of cancer. (b) The properties of K vitamins in the development and maintenance of pheochromocytoma Cell Line 12 (PC12) cells in Parkinson's disease; (c) The improvement effect of vitamin B5 on the loss of bone mass in low estrogen conditions; (d) The anticancer role of vitamins B6. (e) The role of Vitamin B9 in the regulation of Treg cells. As such, the flow cytometry technique used to assess these properties is essential to evaluate the immunomodulatory effects of certain vitamins. The technique undergoes constant improvement which makes it possible to determine several parameters with a role in the modulation of the immune function and at the same time increase the accuracy of the methods that highlight them.

Soaking to Reduce Potassium and Phosphorus Content of Foods

OBJECTIVES

To achieve and maintain normal serum potassium and phosphorus levels reducing potassium and phosphorus intake is frequently recommended for adults living with chronic kidney disease. Exploring food preparation methods to reduce potassium and phosphorus content appears warranted. The study aim is to determine the impact of soaking foods in hot water on potassium and phosphorus content in a variety of plant- and animal-based foods.

METHODS

Twenty foods were selected that are common staples in Brazilian diet patterns. Food was soaked for 5-10 minutes in deionized water that had been brought to a boil and then removed from heat using a 5-part water to 1-part sample ratio. The potassium content was determined by flame photometry. The phosphorus content was determined by visible ultraviolet spectrophotometry.

RESULTS

Soaking foods resulted in a reduction in potassium and phosphorus. Potassium reduction in beef, green leafy vegetables, and grains was 40-49%; in chicken, fish, and nonleafy vegetables 30-39%; and tubers 10-20%. Phosphorus reduction in grains and beans was 30-39%; in nonleafy vegetables 20-29%; and beef, chicken, and fish 10-20%.

CONCLUSIONS

Soaking foods in hot water for 5-10 minutes reduces potassium and phosphorus content. Using this technique to prepare foods may be a more acceptable alternative to longer demineralization periods making it easier for adults living with chronic kidney disease to follow diet recommendations.

Effect of increasing plant protein intake on protein quality and nutrient intake of US adults

Three cycles of NHANES (2013-2018) were used to assess protein intake, protein quality (protein digestibility-corrected amino acid score; PDCAAS), protein cost, and nutrient intakes across quartiles of plant protein intake (Q1: <28.2%; Q2: 28.2% to <32.1%; Q3: 32.1 to <36.2%; Q4: ≥36.2%) over a 24 h period (≥19 years, n = 14 888). Grains represented the primary source of plant protein across quartiles and increased from 5.01% (Q1) to 13.5% (Q4). Across all the USDA's Food and Nutrient Database for Dietary Studies (FNDDS) food groups, grains were the most economical source of protein (24.3-26 g protein/$1). Legumes were the most economical plant-based protein (28-37.7 g protein/$1) within the "Protein Foods" FNDDS group. Absolute protein intake (96.6 g/day) and PDCAAS (0.91) of diets were progressively lower from Q1 to 72.0 g/day and 0.8 in Q4, respectively. Modelling the replacement of 50% of amino acids from grains in the diet with amino acids from legumes increased the PDCAAS by 10% in Q4. Intake levels of fibre, folate, iron, and zinc, were higher in Q2-Q4 compared to Q1 but had lower intakes of vitamins B12 and D. Amino acid complementation is required to effectively integrate higher levels plant protein into US diets.

J-shaped association between dietary zinc intake and new-onset hypertension: a nationwide cohort study in China

We aimed to investigate the relationship of dietary zinc intake with new-onset hypertension among Chinese adults. A total of 12,177 participants who were free of hypertension at baseline from the China Health and Nutrition Survey were included. Dietary intake was assessed by three consecutive 24-h dietary recalls combined with a household food inventory. Participants with systolic blood pressure ≽ 140 mmHg or diastolic blood pressure ≽ 90 mmHg or diagnosed by a physician or under antihypertensive treatment during the follow-up were defined as having new-onset hypertension. During a median follow-up duration of 6.1 years, 4269 participants developed new-onset hypertension. Overall, the association between dietary zinc intake and new-onset hypertension followed a J-shape (P for non-linearity < 0.001). The risk of new-onset hypertension significantly decreased with the increment of dietary zinc intake (per mg/day: hazard ratio (HR) 0.93; 95% confidence interval (CI) 0.88-0.98) in participants with zinc intake < 10.9 mg/day, and increased with the increment of zinc intake (per mg/day: HR 1.14; 95% CI 1.11-1.16) in participants with zinc intake ≽ 10.9 mg/day. In conclusion, there was a J-shaped association between dietary zinc intake and new-onset hypertension in general Chinese adults, with an inflection point at about 10.9 mg/day.

Riboflavin intake and status and relationship to anemia

Riboflavin in its coenzyme forms, flavin mononucleotide and flavin adenine dinucleotide, is essential for multiple redox reactions necessary for energy production, antioxidant protection, and metabolism of other B vitamins, such as niacin, pyridoxine, and folate. Erythrocyte glutathione reductase activity coefficient (EGRac) is a biomarker of riboflavin status; ratios ≥1.40 are commonly interpreted as indicating biochemical deficiency. Most research on riboflavin status comes from low-income countries and rural settings, which reported high rates of riboflavin deficiency and inadequate intake. However, some studies suggest that riboflavin deficiency, based on the functional indicator EGRac, is also of concern in middle- and high-income countries. Biochemical riboflavin deficiency that does not cause clinical symptoms may contribute to anemia, particularly among women and children. Riboflavin enhances iron absorption, and riboflavin deficiency decreases iron mobilization from stores. The current knowledge on riboflavin's role in metabolic processes and its biochemical status is summarized in this review, and the available evidence on the role of riboflavin in anemia among different populations is discussed.

Dietary Intakes of Patients with Alcohol Use Disorder During a 4-Week Protocol on an Inpatient Treatment Unit Found to Meet Dietary Reference Intakes for Macronutrients, but Have Variability in Energy Balance and Adequacy of Micronutrient Intake

BACKGROUND

Despite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for alcohol use disorder (AUD).

OBJECTIVE

The aim was to quantify dietary intake and energy balance of patients with AUD during inpatient treatment.

DESIGN

This was a secondary analysis of data from a 4-week observational protocol. Participants self-selected food from a room service menu. Dietary intake was recorded by patients and reviewed by nutrition staff. To quantify nutrient and food group intake, data were coded into Nutrition Data Systems for Research software, versions 2016 and 2017. Daily average intake was calculated for all dietary variables.

PARTICIPANTS/SETTING

Participants (n = 22) were adults seeking treatment for AUD at the National Institutes of Health Clinical Center (Bethesda, MD) between September 2016 and September 2017 and who were enrolled in a study examining the microbiome during AUD rehabilitation. Four participants discontinued protocol participation before study week 4 and were not included in analyses examining change over time.

MAIN OUTCOME MEASURES

Weight change, daily energy, and macronutrient and select micronutrient intakes were the main outcome measures included.

STATISTICAL ANALYSES PERFORMED

Mean differences in intake and weight were assessed using nonparametric tests.

RESULTS

Sixty-four percent of participants were male; mean ± SD age was 46.3 ± 13.0 years, mean ± SD body mass index (calculated as kg/m2) was 23.9 ± 2.5, and mean intake was 2,665 kcal/d (consisting of 45.9% carbohydrate, 34.9% fat, and 19.1% protein). Eighty percent or more of this sample met the Estimated Average Requirement for 10 of 16 micronutrients assessed. Male participants consumed more energy than estimated needs (P = .003) and gained a mean ± SD of 2.67 ± 1.84 kg (P = .006) when an outlier with weight loss and acute pancreatitis was removed from analysis. Female participants did not gain weight or consume more than estimated energy needs.

CONCLUSIONS

Overall macronutrient intake was within recommended ranges, but intake of other dietary components and weight gain were variable, supporting the need for individualized nutrition care during AUD treatment.

Evaluation of the predictive value of different dietary antioxidant capacity assessment methods on healthy and unhealthy phenotype in overweight and obese women

Purpose

Predictive value of different dietary antioxidant capacity assessment methods on healthy and unhealthy phenotypes in overweight and obese women is still unclear. This study aimed to evaluate the predictive value of different dietary antioxidant capacity assessment methods on healthy and unhealthy phenotypes in overweight and obese women.

Methods

A total of 290 overweight and obese women were included in this cross-sectional study. Food intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). Dietary antioxidant capacity was calculated using valid databases of antioxidant value. The receiver operating characteristic (ROC) curve method was used to evaluate the predictive value of antioxidant capacity indices, including dietary antioxidant quality score (DAQS), ferric reducing ability of plasma (FRAP), total reactive antioxidant potential (TRAP), and trolox equivalent antioxidant capacity (TEAC).

Results

The results showed that the highest area under the ROC curve for predicting metabolically healthy obesity (MHO) belongs to the TRAP method (area under the curve (AUC) = 0.53). In addition, this method had the highest AUC for predicting inflammatory marker of C-reactive protein (hs-CRP) (AUC = 0.54) and the index of the homeostatic model assessment for insulin resistance (HOMA-IR) (AUC = 0.59). The highest AUC for triglyceride prediction was related to the DAQS method (AUC = 0.56). Moreover, a significant correlation of FRAP (r = -0.15, P = 0.02), TRAP (r = -0.19, P < 0.001), TEAC (r = -0.18, P< 0.001) with HOMA-IR was reached.

Conclusion

The findings of this study show that the best way to predict the status of MHO is TRAP method. This method is also the best predictor of hs-CRP and HOMA-IR. DAQS method is the best predictor for TG.

Certain dietary patterns including potatoes are associated with higher and lower diet quality and physiological measures in children and adults, NHANES 2001-2018

A large percentage of daily vegetable intake is attributed to white potatoes, but limited information is available on how potatoes are incorporated into dietary patterns in the US. Therefore, the objective of this study was to determine food patterns that include potatoes and to compare the associated diet quality and association with biomarkers to a food pattern without potatoes. Data from American subjects 2-18 and 19 years and older who participated in the What We Eat in America portion of the National Health and Nutrition Examination Survey cycles 2001-2018 were utilized in the current study. Diet quality was assessed using the Healthy Eating Index-2015. Anthropometric variables included body mass index (BMI), waist circumference, and weight. Biomarkers analyzed included glucose, insulin, triglycerides, HDL-, LDL-, and total cholesterol. Multiple food clusters containing potatoes were identified with several having higher and lower diet quality as compared to a food pattern without potatoes. Children and adolescents in one potato cluster had lower BMI, waist circumference, and body weight compared to those in a no potato dietary pattern, whereas adults in 3 potato clusters had higher anthropometric variables than those in a no potato pattern. In adults, some dietary patterns including potatoes were also associated with lower and higher HDL and total cholesterol and higher insulin levels. The percentage of calories from potatoes across patterns was small, ∼9-12%, suggesting the differences observed in diet quality and biomarkers were due to other food categories consumed in the pattern. This study suggests there are ways to incorporate potatoes as part of a healthy eating pattern but depends more on the other foods included in the diet.

Can Mediterranean Diet Have a Positive Impact on Kidney Health? A Pending Answer to a Long-Time Question

Dietary studies conducted in chronic kidney disease (CKD) patients were focused on the quantities of single nutrients, however it is possible that the excessive attention put on the restriction of proteins, sodium, potassium and phosphorus may compromise the overall quality of the diet in terms of micronutrients and palatability. Instead, concentrating on the nutritional quality healthy dietary patterns, may provide a better approach to improve nutritional prescriptions in CKD patients. All these dietary regimens share common features as reduced content of red meat, salt and saturated fatty acids, and higher fiber content, but may differ in terms of single nutrients consumption. In particular, Mediterranean Diet (Med Diet) has been associated with reduced incidence of diabetes, cardiovascular diseases and obesity, all conditions that are also strictly related to CKD. Given its low content of animal proteins and high contents of fiber it is possible that Med Diet may exert also positive effects on CKD as well as on its metabolic complications. In this review we summarize the role of Med Diet in primary prevention of CKD and on its progression.

Dietary Carbohydrate as Glycemic Load, Not Fat, Coupled with Genetic Permissiveness Favoring Rapid Growth and Extra Calories, Dictate Metabolic Syndrome and Diabetes Induction in Nile Rats (Arvicanthis niloticus)

Objective: Whether dietary carbohydrate (CHO) or fat is more involved in type 2 diabetes (T2DM) induction uncomplicated by dietary fiber was addressed in a spontaneous diabetic model, the diurnal Nile rat that mimics the human condition. Methods: A total of 138 male Nile rats were fed plant-based and animal-based saturated fat where 10% energy as CHO and fat were exchanged across 5 diets keeping protein constant, from 70:10:20 to 20:60:20 as CHO:fat:protein %energy. Diabetes induction was analyzed by: 1. diet composition, i.e., CHO:fat ratio, to study the impact of diet; 2. quintiles of average caloric intake per day to study the impact of calories; 3. quintiles of diabetes severity to study the epigenetic impact on diabetes resistance. Results: High glycemic load (GLoad) was most problematic if coupled with high caloric consumption. Diabetes severity highlighted rapid growth and caloric intake as likely epigenetic factors distorting glucose metabolism. The largest weanling rats ate more, grew faster, and developed more diabetes when the dietary GLoad exceeded their gene-based metabolic capacity for glucose disposal. Diabetes risk increased for susceptible rats when energy intake exceeded 26 kcal/day and the GLoad was >175/2000 kcal of diet and when the diet provided >57% energy as CHO. Most resistant rats ate <25 kcal/day independent of the CHO:fat diet ratio or the GLoad adjusted to body size. Conclusion: Beyond the CHO:fat ratio and GLoad, neither the type of fat nor the dietary polyunsaturated/saturated fatty acid (P/S) ratio had a significant impact, suggesting genetic permissiveness affecting caloric and glucose intake and glucose disposition were key to modulating Nile rat diabetes. Fat became protective by limiting GLoad when it contributed >40% energy and displaced CHO to <50% energy, thereby decreasing the number of diabetic rats and diabetes severity.

Red meat consumption, incident CVD and the influence of dietary quality in the Jackson Heart Study

OBJECTIVES

We investigated the prospective associations between meat consumption and CVD and whether these relationships differ by dietary quality among African American (AA) adults.

DESIGN

Baseline diet was assessed with a regionally specific FFQ. Unprocessed red meat included beef and pork (120 g/serving); processed meat included sausage, luncheon meats and cured meat products (50 g/serving). Incident total CVD, CHD, stroke and heart failure were assessed annually over 9·8 years of follow-up. We characterised dietary quality using a modified Healthy Eating Index-2010 score (m-HEI), excluding meat contributions.

SETTING

Jackson, MS, USA.

PARTICIPANTS

AA adults (n 3242, aged 55 y, 66 % female).

RESULTS

Mean total, unprocessed red and processed meat intakes were 5·7 ± 3·5, 2·3 ± 1·8 and 3·3 ± 2·7 servings/week, respectively. Mostly, null associations were observed between meat categories and CVD or subtypes. However, greater intake of unprocessed red meat (three servings/week) was associated with significantly elevated risk of stroke (hazard ratio = 1·43 (CI: 1·07,1·90)). With the exception of a more positive association between unprocessed meat consumption and stroke among individuals in m-HEI Tertile 2, the strength of associations between meat consumption categories and CVD outcomes did not differ by m-HEI tertile. In formal tests, m-HEI did not significantly modify meat-CVD associations.

CONCLUSIONS

In this cohort of AA adults, total and processed meat were not associated with CVD outcomes, with the exception that unprocessed red meat was related to greater stroke risk. Dietary quality did not modfiy these associations. Research is needed in similar cohorts with longer follow-up and greater meat consumption to replicate these findings.

Dietary Intake of Toxic Heavy Metals with Major Groups of Food Products—Results of Analytical Determinations

Food contains a complex matrix of various substances, including essential nutrients, non-nutritive substances, and toxins, including metals. The main purpose of the study was to evaluate the contribution of major groups of food products to an overall intake of toxic heavy metals (Cd, Pb, Hg, and Ni) using a combination of the 24-dietary recall technique, the ICP-OES (Inductively Coupled Plasma Optical Emission Spectrometry) method, and chemometric tools. The obtained results reveal that there is a high potential risk of developing nephrotoxicity through the dietary intake of Pb in the case of both genders. The dietary intake determined for other elements (Cd, Hg, and Ni) was far below the limits established by European Food Safety Authority (EFSA). Principal Component Analysis (PCA) supported analytical determinations and revealed that cereals and vegetables were major contributors to a total intake of Cd (39.6 and 17.4% of the total exposure, respectively), Ni (40.4 and 19.3%), and Hg (16.8 and 19.6%), while water and beverages were major dietary sources of Pb (31% of the total daily intake). In contrast, eggs, fats and oils, and milk and dairy products provided the smallest amounts of Cd, Pb, and Ni. Despite containing high amounts of Hg, considering very low consumption, fish were not found to be an important source of this element.

Most Frequently Consumed Red/Processed Meat Dishes and Plant-Based Foods and Their Contribution to the Intake of Energy, Protein, and Nutrients-to-Limit among Canadians

Using cross-sectional data from the 2015 Canadian Community Health Survey–Nutrition, we aimed to identify and characterize the top 10 most frequently consumed plant-based foods and red/processed meat dishes in the Canadian population. Plant-based foods and red/processed meat dishes categories included 659 and 265 unique food codes, respectively, from the Canadian Nutrient File. A total of 20,176 Canadian individuals aged ≥1 year were included in our analysis. The most frequently consumed plant-based food was “Cooked regular long-grain white rice”, which made a significant contribution to energy (12.1 ± 0.3%) and protein (6.1 ± 0.2%) intake among consumers. The most frequently consumed red/processed meat dish in Canada was “Cooked regular, lean or extra lean ground beef or patty”. Among red/processed meat dishes, “ham and cheese sandwich with lettuce and spread” made the most significant contribution to the intake of energy (21.8 ± 0.7%), saturated fat (31.0 ± 1.0%), sodium (41.8 ± 1.3%), and sugars (8.2 ± 0.5%) among the consumers. Ground beef is the most frequently consumed red/processed meat dish and white rice is the most frequently consumed plant-based food among Canadians. Red/processed meat dishes are major drivers of the excessive intake of nutrients-to-limit.

Nutritional Health in Premenopausal Women: A Cross-Sectional Study from Turkey

Background

The aim of this study was to evaluate the nutritional habits of premenopausal women using the Food Consumption Frequency Questionnaire (FCFQ) and to evaluate the relationship between anthropometric measurements, lipid parameters, and the presence of anemia with the findings obtained.

Methods

This study was carried out in the internal medicine outpatient clinics of the Health Sciences University Bursa Yüksek İhtisas Training Research Hospital (located in Yıldırım districts) and Gürsu State Hospital (located in Gürsu districts) of Bursa province between 1 June-31 August 2019. We used clustered sampling in patient selection. One hundred seventy-one premenopausal participants aged between 18 and 55 who were known to be healthy and who came for routine control to the internal medicine outpatient clinics were included in the study. The FCFQ was used to determine how often the participants consumed different food groups in the last 1 month.

Results

Overweight participants were 29.20% and 17% were obese. 43.90% of the women had anemia and 65.50% of the women had iron deficiency. The milk-dairy products nutrition score of the group with triglycerides (TG) <150 mg/dL was higher than the group with TG ≥150 mg/dL (P = 0.029). The meat-egg-legumes nutrition score (2.11 ± 0.57) of the group with high density lipoprotein (HDL) ≥50 mg/dL was higher than the group with HDL <50 mg/dL (1.91 ± 0.58) (P = 0.04).

Conclusions

Anemia and obesity are high in premenopausal women. Community-based screening programs are needed to evaluate premenopausal women for anemia and obesity. Scales to assess the nutritional habits of the population are also needed in screening programs.

The Effect of Downsizing Packages of Energy-Dense, Nutrient-Poor Snacks and Drinks on Consumption, Intentions, and Perceptions-A Scoping Review

The single-serve packaging of discretionary foods is becoming increasingly popular, but evidence is limited on whether smaller package sizes can reduce food intake. The aim of this scoping review is to assess the effect of reducing the package size of energy-dense, nutrient-poor (EDNP) snacks and drinks on consumption, intentions, and perception, and to examine the effects of potential moderators or mediators. The search was conducted in six selected databases and grey literature sources, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for the scoping review process (PRISMA-ScR) guidelines. After screening 5562 articles, 30 articles comprising 47 intervention studies were included. Twelve of 15 studies found a significant effect in lowering the actual or intended consumption when a single smaller package was offered compared with a single larger package. When the total serving size was held constant between varying package conditions, such as a multipack, single package, or unpackaged, the results on the actual and intended consumption were inconsistent and varied according to the presence of moderators. Overall, these findings suggest that an overall reduction in the size of a single package is a more promising strategy than providing multipacks to reduce consumption. Changes to the current food environment to promote single smaller packages of EDNP snacks and drinks are necessary to support the better selection of appropriate portion sizes and reduce consumption.

Looking beyond traditional nutrients: the role of bioactives and the food matrix on health

The unique physical-chemical properties of foods directly impact their digestion and absorption. Dairy foods are key components of healthy eating patterns because they provide protein and essential vitamins and minerals to the diet. Additionally, scientific evidence has shown that the benefits of milk and dairy foods on health are due to the overall composition of the whole food rather than its individual nutrients. Indeed, the unique bioactive components of milk and dairy products are integral to the health benefits attributed to dairy foods. A better understanding of the dairy matrix and the protein- and fat-derived bioactive components of milk and dairy products will help inform evidence-based dietary guidance.

Vegan Alternatives to Processed Cheese and Yogurt Launched in the European Market during 2020: A Nutritional Challenge?

Vegan alternatives to cheese (VAC) and yogurt (VAY) are fast-growing markets in Europe due to the increasing interest in plant-based alternatives to dairy products. This study aimed to take a closer look at the year 2020 and accordingly retrieved the nutritional information of dairy cheese and yogurt and their vegan counterparts for comparison. It was found that VAY (n = 182) provide more energy, total fats, and carbohydrates than dairy yogurt (n = 86), while saturated fatty acids (SFAs), sugars, and salt were not different between the two categories. Compared to dairy products (25.6%), 72.9% of the alternative products were declared low/no/reduced allergen, hence providing a larger spectrum of products to respond to consumers’ requirements. VAC (n = 114) showed high versatility of form compared to dairy (n = 115). Nutritionally, VAC have higher total fats, SFAs, and carbohydrates, but lower protein, salt, and sugar than dairy cheese. Food developers will continue to look for clean label solutions to improve the nutritional values of vegan products through the incorporation of natural ingredients, besides enhancing their taste and texture to appeal to flexitarians.

The Role of Fortified and Enriched Refined Grains in the US Dietary Pattern: A NHANES 2009-2016 Modeling Analysis to Examine Nutrient Adequacy

Background: While dietary recommendations call for greater whole-grain intake and reduced refined grain consumption, there are limited peer-reviewed studies examining the influence of fortified/enriched refined grains on nutrient adequacy. Methods: A modeling analysis using data from National Health and Nutrition Examination Survey (NHANES) 2009-2016 estimated usual daily intake of shortfall nutrients for Dietary Guidelines for Americans (DGA) in the current dietary pattern and when specific percentages of fortified/enriched refined grain foods (bread, ready-to-eat cereals, and all-grained foods) were removed from the diet (19-50-year-old adults, N = 11,169; 51-99-year-old adults, N = 9,641). Results: While American adults are currently falling short of nutrient recommendations, eliminating 25, 50, and 100% of all grains consumed in the US dietary pattern resulted in a greater percentage of adults not meeting recommendations for several shortfall nutrients, including dietary fiber, folate DFE, iron, and magnesium. Removal of all grains led to a reduced energy intake by ~10% in both age groups examined. Currently, ~3.8% of 19-50-year-old adults meet the adequate intake (AI) for dietary fiber. Removal of 25, 50, and 100% of grains from the diet resulted in 2.6 ± 0.3, 1.8 ± 0.2, and 0.7 ± 0.1% of adults exceeded the AI for dietary fiber, respectively. Similarly, 11.0 and 13.8% of younger and older adults, respectively, fall short of folate, DFE recommendations with the current diet. Following the removal of 100% of grains from the diet, 43.4 ± 1.1 and 56.2 ± 1.0%, respectively, were below the estimated average requirement (EAR) for folate DFE. For iron, current dietary pattern consumption shows 8.4% and 0.8% of younger and older adults, respectively, are not meeting iron recommendations, however, removal of 100% of grains from the diet results in nearly 10 and 22% falling short of the EAR. Currently, about 51 and 54% of younger and older adults are below the EAR for magnesium; however, with the removal of 100% of grains, 68 and 73%, respectively, fall below the EAR. Conclusion: Removal of specific refined grains led to an increased percentage of Americans not meeting recommendations for several shortfall nutrients, including dietary fiber, folate, iron, and magnesium.

Packaged Foods Labeled as Organic Have a More Healthful Profile Than Their Conventional Counterparts, According to Analysis of Products Sold in the U.S. in 2019-2020

The organic food market's recent rapid global growth reflects the public's interest in buying certified organic foods, including packaged products. Our analysis shows that packaged foods containing fewer ingredients associated with negative public health outcomes are more likely to be labeled organic. Previous studies comparing organic and conventional foods focused primarily on nutrient composition. We expanded this research by additionally examining ingredient characteristics, including processing and functional use. Our dataset included nutrition and ingredient data for 8240 organic and 72,205 conventional food products sold in the U.S. from 2019 to 2020. Compared to conventional foods, organic foods in this dataset had lower total sugar, added sugar, saturated fat and sodium content. Using a mixed effects logistic regression, we found that likelihood of classification as organic increased as sodium content, added sugar content and the number of ultra-processed ingredients and cosmetic additives on the product label decreased. Products containing no trans-fat ingredients were more likely to be labeled organic. A product was more likely to be classified "organic" the more potassium it contained. These features of organic foods sold in the U.S. are significant because lower dietary ingestion of ultra-processed foods, added sugar, sodium and trans-fats is associated with improved public health outcomes.

Low-carbohydrate diet and maternal glucose metabolism in Chinese pregnant women

Few studies have suggested that long-term adherence to low-carbohydrate diets (LCD) may affect maternal glucose metabolism in Western countries. We aimed to investigate the association between LCD during pregnancy and glucose metabolism in a Chinese population. A total of 1018 women in mid-pregnancy were recruited in 2017-2018. Participants underwent a 75 g oral glucose tolerance test (OGTT). Daily dietary intakes over the past month were accessed using a validated FFQ. The overall, animal and vegetable LCD scores which represent adherence to different low-carbohydrate dietary patterns were calculated. Mixed linear regression and generalised linear mixed regression were conducted to evaluate the associations between LCD scores and maternal glucose metabolism. Of the 1018 subjects, 194 (19·1 %) were diagnosed with gestational diabetes mellitus (GDM). The overall LCD score (β: 0·024, se 0·008, PFDR = 0·02) and animal LCD score (β: 0·023, se 0·008, PFDR = 0·02) were positively associated with OGTT 1-h glucose. No significant associations were found between the three different LCD scores with fasting plasma glucose, OGTT 2-h glucose, or insulin resistance, respectively. Compared with the lowest quartile, the crude OR of GDM for the highest quartile were 1·84 (95 % CI 1·14, 2·95) for overall LCD score (Pfor trend = 0·02) and 1·56 (95 % CI 1·00, 2·45) for animal LCD score (Pfor trend = 0·02). However, these associations became non-significant after adjustment for covariates. In conclusion, a low-carbohydrate dietary pattern with high animal protein and fat is associated with higher postprandial 1-h glucose levels in Chinese pregnant women.

A Review Study of a Green Diet and Healthy Ageing

Nowadays people are living longer, and there has been a substantial growth in the global elderly population in the past decades. While life expectancy is increasing, there are growing concerns towards the heavy financial and social burdens related to chronic diseases among the elderly. These have been critical health care issues, and healthy ageing is considered a top priority in public health. Diet and eating habits are crucial factors contributing to healthy ageing. These important aspects have attracted much attention in health research, particularly in consideration of the causes and management of chronic conditions which affect most elder adults in the world. Recently, a growing number of investigations have reported significant findings on the association of reduction in the risks of chronic non-communicable diseases with plant-based diets. Meanwhile, there have been worldwide initiatives and programmes implemented for reduction of salt intake. A green diet, which emphasises the consumption of a diet rich in plant foods with minimal portions of red or processed meat and reduced salt intake, is advocated with due consideration to the importance of sustainable environment and healthy ageing. This paper highlights a brief review of the recent advance of knowledge in diet and health, its effects on the elderly and the significance of a green diet on healthy ageing. Implications for a green diet and recommendations for future research are also discussed.

Sources of Added Sugars Intake Among the U.S. Population: Analysis by Selected Sociodemographic Factors Using the National Health and Nutrition Examination Survey 2011-18

Recent estimates of added sugars intake among the U.S. population show intakes are above recommended levels. Knowledge about the sources of added sugars contributing to intakes is required to inform dietary guidance, and understanding how those sources vary across sociodemographic subgroups could also help to target guidance. The purpose of this study was to provide a comprehensive update on sources of added sugars among the U.S. population, and to examine variations in sources according to sociodemographic factors. Regression analyses on intake data from NHANES 2011-18 were used to examine sources of added sugars intake among the full sample (N = 30,678) and among subsamples stratified by age, gender, ethnicity, and income. Results showed the majority of added sugars in the diet (61-66%) came from a few sources, and the top two sources were sweetened beverages and sweet bakery products, regardless of age, ethnicity, or income. Sweetened beverages, including soft drinks and fruit drinks, as well as tea, were the largest contributors to added sugars intake. There were some age-, ethnic-, and income-related differences in the relative contributions of added sugars sources, highlighting the need to consider sociodemographic contexts when developing dietary guidance or other supports for healthy eating.

Nutritional Significance of Fruit and Fruit Products in the Average Polish Diet

The aim of the present study was to analyze the supply of energy, 19 nutrients, free sugars, and dietary fiber in the average Polish diet from fruit and fruit products. Our analysis is based on 2016 data from the national representative household budget survey conducted on a sample of 36,886 households, yielding a population of 99,230 individuals. Fruit and fruit products provided 3.12% of energy to the average diet in Poland with the highest share of bananas and apples. The highest significance of this food group was found for vitamin C (23.65%), including citrus fruits providing 8.03% of vitamin C, berries (5.97%), other fruits (3.45%), and apples (3.13%). The share of fruit and their products in the supply of free sugars is equally high and amounts to 23.52%. This means that apples provide 6.34% of free sugars, while other fruits also have a high supply of free sugars, including berries 3.68%, stone fruits 3.06%, bananas 2.56%, and citrus fruits 2.54%. The proportion of supply exceeding the percentage of energy (which was 3.12%) was obtained for carbohydrate (5.79%), and fiber (13.66%). The food group studied was particularly important (more than 5% share) in providing four minerals: potassium (8.59%), iron (5.07%), magnesium (5.51%), copper (8.81%), and three vitamins: vitamin C (23.65%), vitamin B6 (5.74%), and vitamin E (5.53%). The influence of sociodemographic and economic characteristics of households on the structure of energy and nutrient supply from fruit and fruit products was assessed using cluster analysis. There were four clusters characterized by different energy, nutrient, and fiber supply. The factors with the highest statistical significance on the supply of energy, nutrients, and fiber from fruit and fruit products were month of study, income, degree of urbanization, education, size of town, and land use. The obtained results concerning energy and nutrient supply from fruits and fruit products are important for the Polish society from the public health point of view, as indicated in the discussion of results and conclusions.

Formulation and Characterization of Calcium-Fortified Jelly and Its Proximate Composition and Sensory Analysis

Calcium is a dynamic mineral. Recent discoveries designate that low intake of calcium generates deficiencies and path to other diseases. Food fortification could play a key role to overcome this problem. To cope with this deficiency problem, jellies were formulated with food-grade calcium salts and chicken eggshell powder. In the present study, three different concentrations of calcium salts, as well as eggshell powder were used to formulate jellies. The results of the sensory evaluation indicated that the two jelly products (A&D) in the current study were suitable for consumers. Results of Atomic Absorption Spectrophotometer revealed Jelly A and jelly D had 151±0.05 ppm and 133±0.06 ppm calcium concentration, respectively. Proximate analysis of Jelly A showed that it has 6.0±0.01% ash, 9.2±0.1% moisture, 0.4±0.01 g crude protein, 82.79±0.001 g crude fiber, and 0.61±0.001 g crude fat, while the jelly D that was made with chicken eggshell powder exhibited 6.0±0.01% ash, 10.1±0.1% moisture, 0.5±0.01 g protein, 84.54±0.01 g crude fiber and 1.61±0.01 g crude fat. Therefore, these two jelly A & D were greatly appreciated among other attributes. In spite of naturally available calcium-rich sources, calcium-fortified jellies can be consumed by individuals who are incapable to take sufficient calcium from their diet.

Multidimensional Approach to Assess Nutrition and Lifestyle in Breastfeeding Women during the First Month of Lactation

The first month of lactation is a vulnerable nutritional period for the mother. Our aims were (1) to evaluate the nutritional status of breastfeeding women in the first month of lactation, and (2) to explore different aspects of nutrition and lifestyle through a multidimensional approach. A total of 30 healthy breastfeeding women were enrolled in this study. Dietary pattern was assessed through a 72-hour dietary recall questionnaire (days 7 and 28 postpartum) and data were compared with Dietary Recommendation Values (DRV), and through the Adherence to Healthy Food Pyramid (HFP) questionnaire (day 28). Anthropometric parameters were evaluated by bioimpedance. Using factor analysis, nutritional dimensions were extracted, and linear regression models were used to analyze the association between anthropometric parameters and dimensions. Compared to the DRV, women showed insufficient energy, water, vitamin D, and potassium intake and excessive proteins, vitamins B1, B2, B3, B6, B12, and iron intake. We observed a moderate adherence to the HFP, with women being high in the fruits, vegetables, and oil categories, and low adherence to the physical activity, dairy products, and hydration categories. The nutritional dimension, including the HFP categories of physical activity, hydration, and animal protein intake together, was negatively associated with body weight (β = -3.7 ± 1.7; p-value = 0.047). In conclusion, during the first month postpartum, breastfeeding women exhibited several nutritional imbalances and poor physical activity negatively influencing anthropometric parameters. We propose a multidimensional approach to assess the nutritional status of breastfeeding women as a tool to detect specific deficiencies, allowing for personalized counseling.

Low-carbohydrate high-fat weight reduction diet induces changes in human gut microbiota

Obesity has become a major public health problem in recent decades. More effective interventions may result from a better understanding of microbiota alterations caused by weight loss and diet. Our objectives were (a) to calculate the fiber composition of a specially designed low‐calorie weight loss diet (WLD), and (b) to evaluate changes in the composition of gut microbiota and improvements in health characteristics during WLD. A total of 19 overweight/obese participants were assigned to 20%–40% reduced calories low‐carbohydrate high‐fat diet for four weeks. Protein and fat content in the composed diet was 1.5 times higher compared to that in the average diet of the normal weight reference group, while carbohydrate content was 2 times lower. Food consumption data were obtained from the assigned meals. Microbial composition was analyzed before and after WLD intervention from two sequential samples by 16S rRNA gene sequencing. During WLD, body mass index (BMI) was reduced on average 2.5 ± 0.6 kg/m² and stool frequency was normalized. The assigned diet induced significant changes in fecal microbiota. The abundance of bile‐resistant bacteria (Alistipes, Odoribacter splanchnicus), Ruminococcus bicirculans, Butyricimonas, and Enterobacteriaceae increased. Importantly, abundance of bacteria often associated with inflammation such as Collinsella and Dorea decreased in parallel with a decrease in BMI. Also, we observed a reduction in bifidobacteria, which can be attributed to the relatively low consumption of grains. In conclusion, weight loss results in significant alteration of the microbial community structure.

Low Mediterranean Diet scores are associated with reduced kidney function and health related quality of life but not other markers of cardiovascular risk in adults with diabetes and chronic kidney disease

BACKGROUND AND AIMS

How Mediterranean-style diets impact cardiovascular and health outcomes in patients with diabetes and chronic kidney disease (CKD) is not well known. Our aim was to investigate the association between diet quality, using Mediterranean Diet Scores (MDS) and health outcomes.

METHODS AND RESULTS

This is a post-hoc analysis of an RCT and longitudinal study investigating patients with diabetes and CKD. MDS was calculated annually. Scores were analyzed for correlation with lipids, HbA_1c, serum potassium, health-related quality of life (HRQOL) and depression. 178 diet records from 50 patients who attended two or more visits were included. Mean MDS was moderate (4.1 ± 1.6) and stable over time. Stage 1-2 vs 3-5 CKD had lower raw MDS (3.8 ± 1.5 vs 4.6 ± 1.5, p < 0.001). Having hyperkalemia was associated with a lower raw MDS scores (3.6 ± 1.6 vs 4.2 ± 1.5, p = 0.03) but not energy adjusted MDS. MDS was not associated with HbA_1c or lipids. High vs low MDS was associated with improved HRQOL (mental health 84.4 ± 14.3 vs 80.3 ± 17.1, p < 0.05; general health 62.6 ± 21.0 vs 56.3 ± 19.8, p < 0.001) and fewer depressive symptoms (9.1 ± 7.4 vs 11.7 ± 10.6, p = 0.01).

CONCLUSIONS

Low MDS was associated with reduced kidney function and health related quality of life, but not other markers of cardiovascular risk. Further studies are needed to understand the nature and direction of the association between diet quality and disease outcomes in this population.

Lack of calcium rich foods in the diet, low knowledge on calcium level recommendations and severe food insecurity predicts low calcium intake among Vietnamese women

OBJECTIVE

To assess nutrition knowledge related to osteoporosis and calcium, osteoporosis health beliefs, dietary calcium intake and household food insecurity among adult women in Vietnam.

METHODS

Two hundred fifty-one women aged 30-65 years living in a rural district in Hanoi -Vietnam were recruited. A questionnaire was used to collect information on nutrition knowledge related to osteoporosis and calcium intake, health beliefs, household food security, and dietary calcium intake. Data analysis included descriptive statistics and regressions.

RESULTS

Majority of the participants did not know calcium recommendations (95%) and recommended daily servings of calcium-rich foods (60%). In addition, majority of the participants (83.7%) were not aware of osteoporosis risk factors. Slightly less than half of the participants (46.2%) reported that they would have difficulties changing their current diets to consume more calcium rich foods. Half of the participants (50.4%) reported being food insecure, with 22% of them reporting having severe food insecurity. Mean dietary calcium intake was 534.5 mg/day, of which milk and dairy products contributed only 4%. Nutrition knowledge, perceived benefits, and self-efficacy were positively associated with calcium intake (p < 0.05); whereas perceived barriers and severe food insecurity were significantly associated with low dietary calcium intake (p < 0.05).

CONCLUSIONS

The results of this study showed calcium intake among the participating Vietnamese women was lower than the national recommendation, indicating the need for nutrition programs and promotions to increase calcium intake. These programs should aim at increasing awareness on national calcium recommendations and skills to obtain and consume calcium-rich foods while considering development of safety nets for food insecure households, as pertaining to adequate dietary calcium intake.

Vegetables, Potatoes and Their Products as Sources of Energy and Nutrients to the Average Diet in Poland

The aim of our study was to analyse vegetables, potatoes and their products as sources of energy and nutrients in the average diet in Poland. Representative data of the 2016 Household Budget Survey from 36,886 households were used. This is the largest study sample in Poland, so we generalized the conclusions to the whole population using the statement ‘average diet’. We analysed three main product groups: vegetables, vegetable products, and potatoes and potatoes products, dividing them into 14 subgroups (e.g., tomatoes, cabbage, carrots, other vegetables, and mushrooms). The percentages of energy, protein, carbohydrates, total fat, nine vitamins (thiamine, riboflavin, niacin, vitamin B6, folate, vitamin C, vitamin A, vitamin D, and vitamin E), seven minerals (calcium, phosphorus, sodium, potassium, iron, magnesium and zinc), and fibre from the analysed food subgroups are presented. Additionally, the influence of household characteristics on the supply of energy and nutrients from each subgroup of vegetables, potatoes, and their products was evaluated using cluster analysis. In the analysis, R programme and Kohonen neural networks were applied. Our study showed that vegetables, potatoes, and their products provide 7.3% of daily dietary energy supply. Vegetables contribute more than 20% of the supply of six nutrients: vitamin C (51.8%), potassium (32.5%), folate (31.0%), vitamin A (30.6%), vitamin B6 (27.8%), and magnesium (20.2%), as well as fibre (31.8%). Cluster analysis distinguished three clusters that differed in nutritional supply from vegetables, potatoes, and their products. Educational level, income measured by quintile groups, village size, socio-economic characteristics, urbanization degree, and land use were the most important factors determining differences between clusters.

Association of dietary calcium, magnesium, and vitamin D with type 2 diabetes among US adults: National health and nutrition examination survey 2007-2014-A cross-sectional study

Higher dietary intake of calcium (Ca), magnesium (Mg), and vitamin D has been associated with reduced risk of type 2 diabetes (T2DM), and a higher intracellular ratio of Ca to Mg leads to insulin resistance. Previous epidemiological studies did not examine the combined effects of dietary Ca, Mg, and vitamin D as well as ratio of Ca to Mg with T2DM. Therefore, we assessed the relationship between dietary intakes of Mg, Ca, and vitamin D (using 24-hr recalls) individually and in composite and T2DM in the National Health and Nutrition Examination Survey 2007-2014, which involved 20,480 adults (9,977 men and 10,503 women) with comprehensive information on related nutrients, and anthropometric, demographic, and biomarker variables using multivariable logistic regression. The results indicated that dietary calcium at Q3 (812 mg/day) was significantly linked with T2DM in women (OR: 1.30; 95% CI: 1.02, 1.65). Dietary vitamin D at Q3 (5.25 μg/day) significantly reduced the odds of T2DM by 21% in men (OR: 0.79; 95% CI: 0.64, 0.98). This is an interesting study that has important implications for dietary recommendations. It is concluded that US adults having dietary Ca below the RDA were associated with increased risk of T2DM in all population and women, while higher ratio of Ca to Mg was associated with increased risk of T2DM in all population and increased vitamin D intake is related to decreased risk of T2DM in men. Moreover, further research is needed to make more definitive nutritional recommendations.