Foods, Nutrients, and Dietary Patterns: Interconnections and Implications for Dietary Guidelines

Healthful plant-based diet and incidence of hypertension in Brazilian adults: A six-year follow-up of the CUME study

BACKGROUND

Studies demonstrate that consuming plant-based diets has beneficial effects on several health outcomes. However, the evaluation of the healthiness of plant-based diets and the incidence of hypertension has still been little explored in the literature.

OBJECTIVES

Thus, this study aimed to evaluate the association between plant-based diet indices and the incidence of hypertension in Brazilian adults and test whether the interaction between hPDI, sociodemographic, and lifestyle variables modifies this association.

METHODS

This longitudinal study included 3192 (F = 2125, average age 34 years) participants from the Cohort of Universities of Minas Gerais (CUME Study, Brazil, 2016-2022). Dietary intakes were assessed using a validated food frequency questionnaire. We measured three plant-based diet indices: overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI). Participants were classified as new cases of hypertension if they were free of this disease at baseline, had a systolic blood pressure ≥ 140 mmHg, a diastolic blood pressure ≥90 mmHg, were using antihypertensive medications, or had a diagnosis of hypertension by a physician in at least one of the follow-ups. Crude and adjusted Cox regression models were used to evaluate the relationship between plant-based diet indices and hypertension incidence and a multiplicative interaction was tested.

RESULTS

The incidence of hypertension was 19,8/1000 person-years total. The mean follow-up time was 3.36 years. There was an inverse association between the highest quintiles of hPDI (HR = 0.56, 95% CI = 0.37-0.86; HR = 0.55, 95% CI = 0.35-0.88) and hypertension. In subgroup analysis, inverse associations between hPDI and hypertension risk were stronger in participants who were insufficiently active and overweight (p-interaction < 0.05).

CONCLUSION

Greater consumption of healthful plant foods, reduced consumption of animal-source foods, and less consumption of unhealthful plant foods are important for hypertension prevention in the Brazilian population.

Eating for Optimization: Unraveling the Dietary Patterns and Nutritional Strategies in Endometriosis Management

Endometriosis is a chronic gynecological disorder affecting millions of women worldwide, causing chronic pelvic pain, dyspareunia, dysmenorrhea, and infertility, and severely impacting their quality of life. Treatment primarily involves hormonal therapies and surgical excision, but high recurrence rates and the economic burden are substantial. With these challenges, significant discussion surrounds the potential role of dietary patterns in managing endometriosis, making it necessary to bridge this critical gap. This review investigates the current scientific evidence on the dietary patterns (eg, Mediterranean, vegetarian, anti-inflammatory, low-fermentable oligosaccharides, disaccharides, monosaccharides, and polyols [low-FODMAP], and Western-style diets) associated with endometriosis and provides a concise, yet thorough, overview on the subject. In addition, antioxidants, microbiota, and artificial intelligence (AI) and their potential roles were also evaluated as future directions. An electronic-based search was performed in MEDLINE, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, Scopus, and Web of Science. The current data on the topic indicate that a diet based on the Mediterranean and anti-inflammatory diet pattern, rich in dietary fiber, omega-3 fatty acids, plant-based protein, and vitamins and minerals, has a positive influence on endometriosis, yielding a promising improvement in patient symptoms. Preclinical investigations and clinical trials indicate that dietary antioxidants and gut microbiota modulation present potential new approaches in managing endometriosis. Also, AI may offer a promising avenue to explore how dietary components interact with endometriosis. Ultimately, considering genetic and lifestyle factors, a healthy, balanced, personalized approach to diet may offer valuable insights on the role of diet as a means of symptom improvement, facilitating the utilization of nutrition for the management of endometriosis.

Dietary patterns derived using reduced rank regression in postmenopausal women and risk of mortality: A population-based study

OBJECTIVES

The menopause transition increases the risk of chronic conditions in women. Given the crucial role of diet in health, we identified dietary patterns that explain variations in factors related to major health concerns in postmenopausal women. Also, we explored their association with all-cause and cardiovascular mortality.

STUDY DESIGN

This study was conducted on 1814 postmenopausal women from the population-based Rotterdam Study.

MAIN OUTCOME MEASURES

Dietary patterns were identified using reduced rank regression. Response variables included bone mineral density, body composition parameters, lipid profile markers, insulin resistance, systolic blood pressure, cognitive function, depression, and sleep quality. The associations with risk of mortality were assessed using Cox proportional hazard models.

RESULTS

The first dietary pattern, characterized by higher intake of vegetables, whole grains, legumes, nuts, coffee, tea, alcoholic beverages, and cheese, explained 2.95 % of the variation in responses, accounted for 12.11 % of the variation in general cognitive function captured by G-factor, 5.62 % in systolic blood pressure, and 4.13 % in bone mineral density, and was correlated with less adiposity, lower blood pressure, lipid markers, and insulin resistance. The second dietary pattern, characterized by higher intakes of processed meat, unprocessed red meat, poultry, eggs, and coffee, and lower intakes of sweets and tea, explained 1.54 % of the variation in responses, accounted for 5.45 % of variation in fat mass percentage, 3.47 % in lean mass index, and 3.29 % in bone mineral density, and was correlated with higher adiposity, insulin resistance, and lipid markers. No associations with mortality risk were identified after adjusting for confounders such as demographics, socioeconomic status, lifestyle, disease history, and medication use.

CONCLUSIONS

We identified dietary patterns explaining a range of variation in health factors related to postmenopausal health. While these dietary patterns explained a large variation in some of the individual factors, their combined explained variation across multiple risk factors simultaneously was limited and no significant association with mortality risk was observed. This study provides a foundation for future research aimed at identifying optimal dietary patterns, integrating diverse health aspects, to improve health in postmenopausal populations.

Associations of maternal diet with nutritional and chemical exposure markers in human milk from the LACTACOL cohort of preterm infants

PURPOSE

Maternal diet may impact human milk composition. Our objective was to characterize the association between maternal diet and the presence of nutritional and chemical exposure markers of human milk in the context of prematurity.

METHODS

One hundred and three mothers of preterm infants, recruited in the west of France near the Atlantic coast, completed a food frequency questionnaire to assess daily food intake. Milk was sampled up to discharge for analysis of Fatty Acids (FAs), Human Milk Oligosaccharides (HMOs) and Persistent Organic Pollutants (POPs).

RESULTS

Four dietary patterns were identified by principal component analysis coupled with hierarchical clustering. The pattern "Snack Eater" with the highest n-6:n-3 ratio in terms of polyunsaturated FA intake showed the lowest levels of n-3 FAs (e.g., DocosaHexaenoic Acid (DHA), p = 0.037) and POPs in milk. The highest level of dibenzodioxin was observed among the "Omnivores" pattern (p = 0.027). Butter intake was associated with FAs in milk, mainly saturated (e.g., 15:0, β = 59.2, 95%CI [30.0-88.5]) and some POPs (e.g., PCB138, β = 53.3, 95%CI [10.9-95.6]), but not with HMO. Fish intake was associated with POPs in milk.

CONCLUSION

Maternal diet may be associated with the FAs and POPs composition of milk in mothers of preterm infants, as it is for full-term infants. To improve the nutritional composition of human milk, it would be advisable to avoid the "Snack-eater" pattern and to favour the consumption of nutrient-rich foods. Butter consumption has been identified as a major contributor of pollutants and saturated fatty acids, and should therefore be given particular attention.

FTO rs9939609 polymorphism is associated with dietary quality in Korean females

PURPOSE

Variation in fat mass and obesity-associated gene (FTO) is a critical risk factor in the etiology of obesity. FTO is associated with preference and sensory perception of nutrients and dietary intake. However, the effect of genetic variation on overall dietary quality has not yet been fully elucidated. This study examined whether FTO rs9939609 (T > A) was associated with dietary quality in Koreans.

METHODS

Data of 46,928 individuals from the Korean Genome and Epidemiology Study were analyzed according to FTO rs9939609 genotype, general characteristics, and diet quality based on the Korean Healthy Eating Index (KHEI), employing sex- and age-stratified approaches.

RESULTS

The FTO genotype did not significantly influence overall diet quality; however, female carriers of the obesity risk allele A (TA + AA) showed significantly higher KHEI scores for balance of energy nutrient consumption, especially for carbohydrate ratio (2.00 ± 1.99 versus 1.90 ± 1.98, Padjusted <0.001) and fat ratio (2.87 ± 2.15 versus 2.76 ± 2.17, Padjusted <0.001) than A-allele non-carriers (TT). Furthermore, when the females were grouped based on their median age (51 years), such an association between the FTO genotype and energy nutrient ratio was only evident in the younger group. However, such an effect of the genetic variant on diet quality and energy nutrient consumption was not evident in males, and the interactive effect of FTO and sex and age was not statistically significant.

CONCLUSION

The FTO rs9939609 (T > A) polymorphism is associated with dietary quality, particularly influencing the balance of energy nutrient intake in Korean females.

Adherence to dietary guidelines and liver cancer risk: Results from two prospective cohort studies

BACKGROUND AND AIMS

Although dietary factors have been extensively investigated as potential risk factors for liver cancer, the evidence is inconclusive. Our study systematically assessed the associations between ten dietary guidelines compliance scores and liver cancer risk among adult people, and found out the dietary patterns for liver cancer prevention.

METHODS

Participants of 59,844 men and 72,680 women, aged 40-74 years and living in urban Shanghai, were included in two prospective cohort studies conducted between 2002-2006 and 1996-2000, respectively. Dietary intakes were assessed during baseline in-person interviews using validated food-frequency questionnaires, and dietary guideline compliance scores were calculated by adjusting for total energy intake and adapting existing dietary recommendations. Hazards ratios (HRs) with 95 % confidence intervals (CIs) were evaluated by both tertile categories and per standard deviation (SD) increment using Cox proportional hazard regression models to assess the associations between ten dietary guideline compliance scores and liver cancer risk.

RESULTS

In the two cohorts, 431 male and 256 female incident liver cancer cases were identified during a mean follow-up of 11.90 and 17.44 years, respectively. There were no statistically significant associations between these ten dietary guidelines and male liver cancer risk (P > 0.05). In contrast, only the modified reversed Empirical Dietary Inflammation Pattern (rEDIP) tended to be associated with the low risk of female liver cancer (HR T3 vs. T1 = 0.67, 95 % CI: 0.48-0.92, Ptrend = 0.016, HR per SD = 0.94, 95 % CI: 0.85-1.03). The inverse associations appeared stronger between rEDIP and liver cancer risk at younger ages (<55 years) in women (HR per SD = 0.91, 95 % CI: 0.84-0.99) compared to the older women (≥55 years). There were suggestive but non-significant inverse associations between the modified Diabetes Risk Reduction Diet (mDRRD) (men: HR per SD = 0.92, 95 % CI: 0.84-1.02; women: HR per SD = 0.97, 95 % CI: 0.84-1.02) and the modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) (men: HR per SD = 0.93, 95 % CI: 0.84-1.02; women: HR per SD = 0.91, 95 % CI: 0.80-1.03) and liver cancer incidence. The associations of mDRRD (HR per SD = 0.82, 95 % CI: 0.75-0.98) and mWCRF/AICR (HR per SD = 0.83, 95 % CI: 0.74-0.99) on liver cancer risk were significant in men who ever smoked.

CONCLUSIONS

Our findings confirm that greater adherence to some healthy dietary patterns (i.e. rEDIP, mDRRD and mWCRF/AICR) is inversely associated with liver cancer risk, especially in certain populations. Future studies are required to confirm these findings and elucidate potential mechanisms.

Micronutrient Inadequacy Differs by Intake of Fat Amount and Class Among Adults That Consume a Restricted Carbohydrate Diet: National Health and Nutrition Examination Survey, 2007-2018

BACKGROUND

Restricted carbohydrate diets remain among the most popular for weight loss and general health improvement. Recent evidence demonstrates that carbohydrate restricted diets are low in overall diet quality, yet their association with micronutrient inadequacy has not been well characterized at a population-level in adults in the United States.

OBJECTIVE

To evaluate the prevalence of not meeting daily micronutrient recommendations in US adults that met the Acceptable Macronutrient Distribution Ranges and those who restricted carbohydrate intake to <45% energy, and to examine the effect of total fat and fat class on these results for the restricted carbohydrate group.

DESIGN

This study utilized 24-hour recall data on food and nutrient intake from respondents in the National Health and Nutrition Examination Survey 2007-2018.

PARTICIPANTS/SETTING

This study included 15 029 respondents who were aged 20 years and older, had complete and reliable nutrient intake data, and were not pregnant or breastfeeding.

MAIN OUTCOME MEASURES

The main outcome was the prevalence of not meeting daily micronutrient recommendations based on Dietary Reference Intakes.

STATISTICAL ANALYSES PERFORMED

The National Cancer Institute's usual intake methodology was used to estimate usual dietary intake and the prevalence of the US adult population not meeting the Dietary Reference Intakes.

RESULTS

Compared with participants that met the Acceptable Macronutrient Distribution Ranges, those that consumed restricted carbohydrate diets had greater prevalence of inadequacy (%

CONCLUSION

This study shows that there are different types of restricted carbohydrate diets that can be characterized by fat amount and class, each with their own association with micronutrient intake. This information can be used by clinicians to provide more targeted dietary counseling to their patients who restrict carbohydrates, depending on the amount and type of fat they consume.

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Key Words

• Carbohydrate restriction
• Fat composition
• Micronutrient inadequacy
• NHANES
• Popular diet

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MESH Headings

• Humans
• Female
• Male
• Adult
• Micronutrients/administration & dosage
• United States
• Nutrition Surveys
• Middle Aged
• Dietary Fats/administration & dosage
• Diet, Carbohydrate-Restricted/statistics & numerical data
• Diet, Carbohydrate-Restricted/methods
• Young Adult
• Recommended Dietary Allowances
• Aged
• Energy Intake

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Grants Collapse

Affiliation(s)

Alaa Ilayan Department of Human Sciences, The Ohio State University, Columbus, Ohio. Current Affiliation: Post-Master's Fellow, Oak Ridge Institute for Science and Engineering, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
Dakota Dustin The Ohio State University Nutrition PhD Program, Graduate School, The Ohio State University, Columbus, Ohio
Corina Kowalski College of Arts & Sciences, William & Mary, Williamsburg, Virginia
Martha A Belury Department of Food Science and Technology, The Ohio State University, Columbus, Ohio
LuAnn K Johnson Independent Contractor, Warren, Minnesota
Zach Conrad Department of Kinesiology, William & Mary, Williamsburg, Virginia; Global Research Institute, William & Mary, Williamsburg, Virginia.

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What Do Australians Eat? A Systematic Review of Dietary Patterns and Adverse Health Outcomes

CONTEXT

A suboptimal diet is a leading factor in the current burden of chronic diseases. In Australia, dietary factors contribute to one-fifth of the chronic disease burden. Understanding the dietary patterns of Australian adults and summarizing their effects on chronic conditions are imperative for improving interventions targeting dietary behaviors.

OBJECTIVE

This systematic review aims to summarize the dietary patterns of Australian adults derived using a posteriori and hybrid analysis methods and their associations with adverse health outcomes.

DATA SOURCES

Six databases were first searched in December 2020 and updated in August 2023.

DATA EXTRACTION

Cardiometabolic health, cardiovascular mortality, cancer, pregnancy-related metabolic conditions (gestational diabetes mellitus [GDM] or hypertensive disorders during pregnancy [HDP]), mental health, and cognitive function were the main health outcomes.

DATA ANALYSIS

Dietary patterns from each study were classified as either healthy or unhealthy. A narrative synthesis was used to describe the association of dietary patterns with adverse health outcomes in longitudinal studies. Fifty-nine observational studies (31 cross-sectional, 3 case-control, 22 longitudinal, and 3 combining both cross-sectional and longitudinal designs) were included, involving a total of 362 263 participants aged 18 years and older.

CONCLUSION

Higher adherence to a healthy dietary pattern (characterized by higher consumption of dark-yellow, green leafy, cruciferous vegetables and fruits, nuts, whole grains, tomatoes, fish, and low-fat dairy) is associated with improved cardiometabolic risk factors, reduced risk of GDM and HDP, better mental health, and improved pregnancy outcomes. On the other hand, an unhealthy dietary pattern (characterized by a higher intake of processed and red meat, takeaway foods, white bread, high-fat dairy, potatoes, discretionary fat, sweet snacks, soft drinks, fat spreads, jam, and Vegemite) is linked to increased cardiometabolic risks. Overall, while healthy dietary patterns are associated with a reduced risk of several physical and mental health outcomes, unhealthy dietary patterns are linked to an increased risk in Australian adults.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023452960.

Dietary Phaffia rhodozyma-Synthesized 3S, 3'S-Astaxanthin Promotes Body Coloration and Muscle Quality in Pacific White Shrimp Litopenaeus vannamei

The focus of people on the yield of aquatic products has gradually shifted to superior quality. Astaxanthin is well-known for its superior antioxidant capacity, while research on its regulatory effect on muscle quality is limited. This study aims to investigate whether dietary Phaffia rhodozyma-synthesized 3S, 3'S-astaxanthin (L-AST) could promote the body coloration and muscle quality of Litopenaeus vannamei. Experimental diets with L-AST levels of 0, 30, 60, and 90 mg/kg were fed to L. vannamei (IBW: 2.72 ± 0.03 g) for 8 weeks. The results revealed that the shrimp fed L-AST diets presented better body coloration with decreased L ∗ values whereas increased a∗ values and possessed higher levels of muscle astaxanthin. Dietary supplementation with 60 mg/kg L-AST significantly enhanced muscle texture (hardness, chewiness, resilience, and gumminess), which could be attributed to an increase in alkaline-insoluble collagen content and a decrease in myofiber diameter. Interestingly, dietary supplementation with 60 or 90 mg/kg L-AST markedly increased the content of glycine (a sweet amino acid) and total flavor amino acid (glutamic acid, aspartate, alanine, glycine). Further study showed that dietary supplementation with 60 or 90 mg/kg L-AST significantly improved free fatty acid profile by increasing contents of some monounsaturated fatty acids (C17:1n7, C18:1n9t and C24:1n9) and polyunsaturated fatty acids (C20:02 and C22:6n3). Taken together, dietary P. rhodozyma-synthesized L-AST considerably promoted muscle quality in L. vannamei by promoting histological and texture properties, elevating alkaline-insoluble collagen content while improving the profile of free amino acids and fatty acids.

The development of a food-group, tree classification method and its use in exploring dietary associations with metabolic dysfunction-associated Steatotic liver disease (MASLD) and other health-related outcomes in a UK population

Background

Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) affects up to one in five people in the UK, with persistent overeating and a sedentary lifestyle being significant risk factors. Exploring dietary patterns at a food level is a novel approach to understand associations between diet and disease.

Methods

This cross-sectional case-control study included 168 MASLD patients and 34 healthy controls from Nottingham (UK). Dietary data were collected using the EPIC-food frequency questionnaire. A food-group, tree classification method was developed which categorized 923 ingredients into three levels (main food group, sub-types, and cooking methods) and intakes were associated with clinical outcomes using logistic regression and degree of liver fibrosis using linear regression.

Results

Significant associations were found for red meat intake with MASLD (OR [CI]: 1.013 [1.001-1.025]) and fibrosis (Beta [SE]: +0.048 [0.013]); intakes of nuts (OR [CI]: 0.951 [0.905-0.999]); and fish (OR [CI]: 0.985 [0.971-0.999]) with MASLD; "Cereals and cereals products", "salt and gravy" and baked foods with fibrosis (Beta [SE]: +0.018 to +0.057 [0.005-0.23]); white and organ meat (Beta [SE]: -0.04 to -0.61 [0.015-0.249]); diet soda (OR [CI]: +0.01 [1-1.003]) and red meat intakes (OR [CI]:+0.002 [1.002-1.016]) with T2DM; wholegrain wheat, red meat, and semi-skimmed dairy intakes with hypercholesterolemia (ORs [CI]: -0.003 to -0.023 [1-1.043]); "herbs and spices" and wholegrain rice with hypercholesterolaemia (ORs [CI]: -0.08 to -0.98 [0.159-0.989); fresh herbs and boiled foods intakes with hypertension (ORs [CI]: -0.001 to -2.21 [0.013-1]).

Conclusion

The study introduces a new food-group, tree classification method to characterise UK diet data and identify risk factors for MASLD, potentially informing the development of culturally applicable dietary guidelines designed to improve public health.

Bitter and Sweet Diets Alter Taste Response and Alcohol Consumption Behavior in Mice

BACKGROUND/OBJECTIVES

Taste guides the consumption of food and alcohol for both humans and rodents. Given that chronic dietary exposure to bitter and sweet foods are purported to alter the perception of bitter and sweet tastes respectively, we hypothesized that dietary habits may shape how the taste properties of ethanol are perceived and thus how it is consumed.

METHODS

Using C57BL/6 mice as a model, we contrasted taste behavior, morphology, and expression after a 4-week diet featuring consistent bitter, sweet, or neutral (water) stimuli.

RESULTS

Our results demonstrated that a 4-week bitter diet containing a quinine solution increased preference for ethanol, while a 4-week sweet diet consisting of a sucralose solution did not alter ethanol preference nor intake. The quinine diet also reduced the number of sweet- or umami-sensing T1R3-positive cells in the circumvallate papillae taste buds of the mice.

CONCLUSIONS

Based on the behavioral changes observed with the bitter diet, it is possible that either bitter or sweet taste, or both together, drive the increase in ethanol preference. The implications of these findings for alcohol consumption are that dietary habits that do not necessarily concern alcohol may be capable of altering alcohol preference via taste habituation. Habitual intake of bitter and/or sweet foods can shift the perception of taste over time. Changes to how the taste components of alcohol are perceived may also alter how acceptable the taste of alcohol is when experienced as a whole, thereby having the unintended consequence of shifting alcohol consumption levels. Our study demonstrates another side to bitter habituation, which, thus far, has been studied in the more positive context of developing a set of dietary tactics for promoting bitter vegetable intake.

Dietary patterns and colorectal cancer risk: Global Cancer Update Programme (CUP Global) systematic literature review

BACKGROUND

The 2018 World Cancer Research Fund/American Institute for Cancer Research Third Expert Report, including studies up to 2015, determined limited-no conclusion evidence on dietary patterns and colorectal cancer (CRC) risk due to insufficient data and varying pattern definitions.

OBJECTIVES

This updated review synthesized literature on dietary patterns and CRC risk/mortality.

METHODS

PubMed and Embase were searched through 31 March, 2023, for randomized controlled trials (RCTs) and prospective cohort studies on adulthood dietary patterns. Patterns were categorized by derivation method: a priori, a posteriori, or hybrid, and were then descriptively reviewed in relation to the primary outcomes: CRC risk or mortality. The Global Cancer Update Programme Expert Committee and Expert Panel independently graded the evidence on the likelihood of causality using predefined criteria.

RESULTS

Thirty-two dietary scores from 53 observational studies and 3 RCTs were reviewed. Limited-suggestive evidence was concluded for higher alignment with a priori-derived patterns: Mediterranean, healthful plant-based index, Healthy Eating Index (HEI)/alternate HEI, and Dietary Approaches to Stop Hypertension (DASH), in relation to lower CRC risk. Common features across these diets included high plant-based food intake and limited red/processed meat. Hybrid-derived patterns: the empirical dietary index for hyperinsulinemia (EDIH) and the empirical dietary inflammatory pattern (EDIP), showed strong-probable evidence for increased CRC risk. Evidence for a priori-derived low-fat dietary interventions and a posteriori-derived patterns was graded as limited-no conclusion. By cancer subsite, higher alignment with Mediterranean diet showed limited-suggestive evidence for lower rectal cancer risk, and that with HEI/alternate HEI and DASH showed limited-suggestive evidence for lower colon and rectal cancer risks. EDIH and EDIP showed strong-probable evidence for increased colon cancer risks. All exposure-mortality pairs and other pattern-outcome associations were graded as limited-no conclusion.

CONCLUSIONS

This review highlights the role of dietary patterns in CRC risk/mortality, providing insights for future research and public health strategies. This review was registered at PROSPERO as CRD42022324327 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022324327).

Relationship of Body Composition and Somatotype with Physical Activity Level and Nutrition Knowledge in Elite and Non-Elite Orienteering Athletes

Objectives: The primary aim of this single cross-sectional study was to identify the physical characteristics (anthropometric, somatotype, body composition) of orienteering athletes (OAs) and to compare them with nutrition knowledge (NK) and physical activity level (PAL). Methods: Data were collected from 58 subjects of seven countries, including Angola (n = 1), Brazil (n = 5), Poland (n = 1), Portugal (n = 26), South Africa (n = 1), Spain (n = 22) and Sweden (n = 2). The subjects included 10 elite (E) female (F) OAs [age: 25.5 ± 6.4 years, body mass: 59.5 ± 7.7 kg, stature: 168.1 ± 6.5 cm, body mass index (BMI): 21.0 ± 1.9 kg/m2], 13 E male (M) OAs (age: 24.3 ± 5.0 years, body mass: 65.0 ± 5.5 kg, stature: 175.1 ± 6.0 cm, BMI: 21.3 ± 2.2 kg/m2), 18 non-elite (NE) FOAs (age: 41.7 ± 10.3 years, body mass: 60.6 ± 8.5 kg, stature: 161.3 ± 11.7 cm, BMI: 23.4 ± 3.7 kg/m2), and 17 NEMOAs (age: 37.2 ± 14.6 years, body mass: 71.5 ± 14.2 kg, stature: 174.0 ± 8.8 cm, BMI: 23.6 ± 4.1 kg/m2). The participants were selected to ensure a diverse and representative sample of international-level orienteering athletes. Measurements were taken at two IOF world ranking events, the "Portugal "O" Meeting (POM)" and the "35° Trofeo Internacional Murcia Costa Cálida", where only top-ranked orienteers compete. The selected participants from these seven countries were among the registered athletes in these international competitions. The OAs were measured according to the guidelines of the International Society for the Advancement of Kinanthropometry (ISAK). NK was evaluated using the updated Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ). PAL was assessed using the short version of the self-reported International Physical Activity Questionnaire-Short Form (IPAQ-SF). Results: The percentage of body fat (p < 0.01) in MOAs was significantly lower than in FOAs. Endomorphy (p = 0.037) and mesomorphy (p = 0.025) in EOAs were significantly lower than in NEOAs, but ectomorphy (p = 0.038) was significantly higher. EMOAs are ectomorphic mesomorphs, while NEMOAs are balanced mesomorphs, EFOAs are central, and NEFOAs are endomorphic mesomorphs. Significant differences (p < 0.01) were also observed in sports nutrition knowledge (SNK) among EOAs and NEOAs, with the former group achieving a higher percentage of correct responses. In the case of total nutritional knowledge (TNK), EOAs of both sexes scored significantly higher (p = 0.043) than their NEOA counterparts. A significant negative correlation was also observed between percentage of body fat (%BF) and metabolic equivalent (MET) in minutes per week (min/week) (r = -0.39, p = 0.038), bone mass (BM) and MET-min/week (r = -0.40, p = 0.033), and endomorphy and SNK (r = -0.38, p = 0.045) in FOAs. Among MOAs, the most significant findings included a negative correlation between age and METmin/week (r = -0.49, p = 0.010), kilocalorie (kcal) per week (r = -0.46, p = 0.016), and SNK (r = -0.40, p = 0.029). Conclusions: The key findings indicate that EOAs have lower BF percentages and higher NK scores compared to NEOAs. These results on the physical characteristics of OAs and the score of PAL and classification of NK can be useful to coaches and sports scientists to improve orienteer's performance.

Comparison of Nutrient Intake Across Different Dietary Patterns in Brazilian Community-Dwelling Older Adults

BACKGROUND/OBJECTIVES

Dietary patterns are able to capture the complexity of the diet. The present study aimed to compare the nutrient intake across different dietary patterns in Brazilian community-dwelling older adults.

METHODS

Dietary patterns from 295 (predominantly women, 85%) of Brazilian community-dwelling older adults were identified using principal component analysis, based on a 24 h dietary recall (24HR). The following patterns were identified: the "traditional" pattern (consisting of in natura or minimally processed food); the "modified" pattern (consisting of processed foods, confectionery), and the "snack" pattern (composed of coffee, whole milk, bread, toast, butter, or margarine). Participants were divided into three tertiles according to their scores in each pattern. A comparison of energy and nutrient intake across the tertiles of the three patterns was analyzed using the Kruskal-Wallis rank sum test. Then, the intake of energy and macro and micronutrients were analyzed.

RESULTS

Older adults with higher scores for the "traditional" pattern had significantly higher intakes of total energy, all macronutrients, beta-carotene, vitamin C, E and K, thiamine, pyridoxine, and total folate (p < 0.05). Participants with higher scores for the "modified" pattern had significantly higher intakes of total energy, added sugar, total and animal protein, leucine, arginine, monounsaturated fat, cholesterol, niacin, and pyridoxine; the second tertile had lower vitamin A than the first tertile (p < 0.05). Finally, older adults with higher scores for the "snack" pattern had significantly lower intakes of total and insoluble fiber, animal and vegetable proteins, vitamins (A, E, and K), niacin, and pyridoxine (p < 0.05). The "Traditional" pattern exhibited the most appropriate dietary pattern regarding the availability of essential nutrients, resulting in a better quality of habitual intake and outcomes that are related to health promotion and reduction in the risk of non-chronic issues.

CONCLUSIONS

The results reinforce the importance of public policies that encourage the maintenance of the traditional Brazilian dietary pattern, which is in alignment with Brazilian Dietary Guidelines, especially in the older population.

High prediagnostic dietary intake of vitamin B2 and vitamin B6 is associated with favorable prognosis of colorectal cancer among Chinese colorectal cancer patients

The potential impact of one-carbon metabolism (OCM)-related B vitamins (vitamin B2, B6, B12, and folate) on colorectal cancer survival warrants investigation but research is sparse. This cohort study examined the association between the prediagnostic dietary intakes of OCM-related B vitamins and colorectal cancer survival. A total of 2799 colorectal cancer patients from the Guangdong Colorectal Cancer Cohort, enrolled at baseline in 2010, were followed for mortality outcomes through 2023. Dietary data were collected from patients using a food frequency questionnaire for the year prior to their diagnosis. Multivariable Cox proportional hazards regression models were applied to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) to examine the association between OCM-related B vitamins and colorectal cancer survival. Restricted cubic spline analyses and stratified analysis were performed. During the follow-up period of approximately 60.33 months, 639 deaths were documented, of which 574 were colorectal cancer-specific deaths. Dietary vitamin B2 and B6 intake was significantly associated with survivals. The adjusted HRs in the highest versus the lowest quartile of vitamin B2 intake were 0.77 (0.62-0.97) for overall survival and 0.71 (0.55-0.90) for colorectal cancer-specific survival, and vitamin B6 intake were 0.79 (0.64-0.99) for overall survival and 0.75 (0.59-0.94) for colorectal cancer-specific survival. Nonlinear associations were observed between vitamin B6 intake and both overall survival and colorectal cancer-specific survival. However, no significant association was found between vitamin B12 or folate intake and survivals. These results suggest that high prediagnostic intake of vitamin B2 and B6 may be associated with improved survivals in colorectal cancer patients.

Increased adherence to the DASH dietary pattern in community dwelling older adults: Findings from two National Health and Nutrition Surveys

OBJECTIVES

To assess adherence to the Dietary Approaches to Stop Hypertension (DASH) diet over a decade among community-dwelling older adults, with and without hypertension and to examine associated factors.

STUDY DESIGN

Cross-sectional study.

METHODS

Data from two cross-sectional Israel National Health and Nutrition Surveys (NHNS) for older adults, from 2005 to 2006 (NHNS1) and 2014-2015 (NHNS2) were analysed. Trained personnel conducted face-to-face interviews and collected demographic, health, and lifestyle data, along with anthropometric measurements. Adherence to the DASH diet was determined from a single 24-h dietary recall using Mellen's DASH score. Logistic regression analyses were applied to estimate odds ratios (ORs) and 95 % confidence intervals (CIs) for high DASH adherence (scores ≥4.5) versus low adherence (scores <4.5). Individual nutrient targets of the DASH diet were also assessed.

RESULTS

The dataset was comprised of 1722 participants from NHNS1 and 916 from NHNS2. Following adjustment for potential confounders, the OR for DASH adherence among participants in NHNS2 was 1.65 (95 % CI 1.34-2.04) compared to NHNS1. NHNS2 participants reported better adherence to DASH nutrient recommendations for saturated fatty acids, total fat, protein, dietary fibre, and calcium among individuals with and without hypertension. No statistically significant differences were found for cholesterol, potassium, and sodium target intakes between surveys.

CONCLUSIONS

A positive trend towards healthier dietary patterns was identified among both the hypertensive and non-hypertensive older adults over a 10-year period. This underscores the importance of ongoing monitoring to appropriately address changing population needs and promote healthy dietary practices.

Effects of a Digital Intervention to Improve DASH and Blood Pressure Among US Adults

BACKGROUND

Dietary Approaches to Stop Hypertension (DASH) is a recommended first-line treatment for adults with hypertension, yet adherence to DASH is low. To evaluate the efficacy of a digital health intervention (DHI), compared with attention control, on changes in DASH adherence and blood pressure among adults with hypertension.

METHODS

Nourish was a 12-month, parallel, 2-arm, randomized controlled trial of a virtually delivered DHI. Participants had a previous diagnosis of hypertension. The primary outcome was a 6-month change in DASH adherence. The secondary outcome was a change in blood pressure. We used linear mixed models to compare 6 and 12-month changes in DASH adherence, systolic blood pressure, and diastolic blood pressure.

RESULTS

Nourish randomized 301 adults who averaged 54.4 (SD, 13.4) years and predominately identified as female (65%), White (53%), or Black (31%). Adjusted mean baseline DASH score was 2.30 (95% CI, 2.03-2.58). The adjusted mean baseline systolic blood pressure and diastolic blood pressure were 123.2 (95% CI, 119.5-126.9) and 77.1 (95% CI, 74.6-79.6) mm Hg. DASH score change was not significantly different between arms at 6 months (Mdiff, 0.02 [95% CI, -0.37 to 0.40]). Yet, DHI participants had significantly greater 12-month changes in DASH score, relative to control (Mdiff, 0.62 [95% CI, 0.16-1.08]). Between-group differences in 6-month changes were insignificant for systolic blood pressure and marginally significant for diastolic blood pressure, despite the DHI group showing significant blood pressure reductions from baseline.

CONCLUSIONS

A DHI led to modest improvements in DASH and blood pressure among adults with hypertension but did not outperform the attention control. Further research is needed to understand the utility of DHIs to promote DASH and identify intervention components that support long-term behavior change.

Association between hyperuricemia and dietary retinol intake in Southwest China: a cross-sectional study based on CHNS database

Background

Hyperuricemia is increasingly common in Southwestern China and poses significant health risks, including gout and cardiovascular disease. Retinol intake has been hypothesized to affect uric acid levels, but this relationship remains unclear.

Methods

Data from 4,658 participants in the China Health and Nutrition Survey (CHNS) from 1991 to 2018 were analyzed. Dietary retinol intake was categorized using quantile-based methods, and hyperuricemia was identified as the primary outcome. Logistic regression models were used to estimate odds ratios and 95% confidence intervals, with analyses stratified by gender. Restricted cubic splines were utilized to evaluate the dose-response relationship.

Results

The average age of participants was 40 ± 17.83 years, and 20.29% met the criteria for hyperuricemia. Logistic regression analysis identified a positive association between dietary retinol intake and hyperuricemia, with a more pronounced effect observed in men. The restricted cubic spline analysis revealed that the odds of hyperuricemia increased significantly when dietary retinol intake exceeded 3,538 IU/day for men and 4,504 IU/day for women.

Conclusion

High dietary retinol intake is associated with an increased risk of hyperuricemia, with a stronger association observed in males. These findings suggest that dietary retinol intake under recommendation levels might be necessary to prevent hyperuricemia-related adverse health outcomes.

The role of nutrition-related clinical trials in informing dietary recommendations for health and treatment of diseases

BACKGROUND

Dietary guidance is based on a robust evidence base including high-quality clinical trials, of which some have been designed to establish causal relationships between dietary interventions and atherosclerotic cardiovascular disease (ASCVD) risk reduction. However, the complexity associated with conducting these studies has resulted in criticism of nutrition and dietary recommendations because the strength and quality of evidence falls short of that for some pharmaceutical interventions.

SOURCES OF MATERIAL

In this paper, we aim to promote greater awareness of the nutrition-related clinical trials that have been conducted showing ASCVD benefits and how this evidence has contributed to dietary recommendations.

ABSTRACT OF FINDINGS

Compared to clinical trials of pharmaceutical agents, nutrition-related clinical trials have several unique considerations, including complexities of intervention design, challenges related to the blinding of participants to treatment, modest effect magnitudes, variability in baseline dietary exposures, absence of objective dietary adherence biomarkers, achieving sustained participant adherence, and the significant timeline for endpoint responses. Evidence-based dietary recommendations are made based on multiple lines of evidence including that from randomized controlled trials, epidemiological studies, as well as animal and in vitro studies.

CONCLUSION

This research has provided foundational evidence for the role of diet in prevention, management, and treatment of ASCVD. Based on the clinical trials that have been conducted, a strong consensus has evolved regarding the key elements of healthy dietary patterns that decrease ASCVD risk. Going forward, implementation research is needed to identify effective translation approaches to increase adherence to evidence-based dietary recommendations.

Associations of oxidative balance score and cognition in US older adults: A cross-sectional study of National Health and Nutrition Examination Survey (NHANES) 2011 to 2014

Background

Oxidative stress is linked to cognitive decline in the elderly. Diet, as a key energy source, affects brain function and serves as a modifiable risk factor for cognitive decline.

Objective

This study investigates the relationship between the Oxidative Balance Score (OBS), which reflects diet and lifestyle impact on oxidative stress, and cognitive function in older adults.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) from 2011-2014, including 2716 participants aged 60 and older. Cognitive outcomes measured were the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning test, Animal Fluency test, and Digit Symbol Substitution test. Linear regression models were used to assess the relationship between the OBS and cognitive performance, with stratification and sensitivity analyses conducted to explore these associations further.

Results

Among 2716 participants, higher dietary OBS scores were linked to better cognitive test performance after adjusting for confounders. For example, the highest OBS quartile had a 4.35-point increase in CERAD immediate recall compared to the lowest quartile (OR: 4.35, 95% CI: 2.14-8.84, p = 0.001). Subgroup analyses showed this positive association across age groups and genders, though it was stronger among non-Hispanic white participants compared to other racial groups.

Conclusions

Our findings indicate a positive correlation between OBS and cognitive function in older adults, suggesting that an antioxidant-rich diet and lifestyle may help prevent cognitive decline in this population. However, since this study is cross-sectional, further prospective research is needed to confirm these results.

Nutritional quality and climate impact of Norwegian adults' diet classified according to the NOVA system

Information about how ultra-processed foods (UPF) contribute to the intake of energy and nutrients and environmental impact is important for future food policies and dietary recommendations. This study assessed the contribution of the four NOVA food groups, including UPF, to energy intake, nutritional quality, and climate impact in Norwegian adults' diet. We used dietary data from 348 participants in the Norkost 4 pilot study, collected through two non-consecutive 24-h dietary recalls. Foods, beverages, and dietary supplements were classified using the NOVA system. The NOVA system has four groups; NOVA 1: Unprocessed or minimally processed foods, NOVA 2: Processed culinary ingredients, NOVA 3: Processed foods, and NOVA 4: UPF. UPF contributed to 48% of the total energy intake, NOVA 3 with 19%, and NOVA 1 with 28%. Within UPF, bread contributed the most to energy intake. Foods in NOVA 1 had the highest nutrient density (expressed as amount of nutrients provided per unit of energy) for protein, fiber, and several essential micronutrients. UPF had the highest nutrient density for added sugar, fats, and sodium. UPF contributed to 32% of total GWP from the diet, while NOVA 1 contributed to 38%. In conclusion, UPF contributed to about half of the energy intake of Norwegian adults, and had lower nutritional quality compared to NOVA 1. UPF also accounted for about one-third of the GWP from the total diet. These findings emphasize the importance of addressing the intake of UPF in dietary policies and recommendations to improve nutritional quality and reduce environmental impact.

The Relationship Between the Mediterranean Dietary Pattern and Exercise and Sport Performance-A Scoping Review

Background/Objectives: Athletes seek healthy diets for their health and performance. The Mediterranean Diet (MedDiet) has been widely studied for its health benefits. We conducted a scoping review of the scientific literature for studies reporting on the relationship between MedDiet adherence and performance and health outcomes in athletes. Methods: Five bibliographic databases were searched from inception to December 2023. We included studies with any competing, recreational, professional, elite, or occupational athlete (of any age) who played a physical sport as part of a team or as an individual, in which the MedDiet was used as an intervention, or adherence was measured. A total of 7993 unique records were identified, screened, and assessed for eligibility. Results: A total of 32 studies were included: 23 observational studies, 6 randomised controlled trials, and 3 quasi-experimental studies. Almost all studies (n = 31) were conducted in Mediterranean countries. Anthropometrics (n = 19) and body composition (n = 12) were the two most measured outcomes. There was a wide range of athlete ages and calibres and great variability in the outcomes reported; however, there were limited reports for each outcome. Only one RCT reported on specific sport-related performance outcomes. Three RCTs provided individualised dietary recommendations for macronutrients based on sports nutrition guidelines, but only two of them assessed macronutrient intake. Conclusions: This is the first scoping review of MedDiet adherence on outcomes related to sport. We found a limited evidence base across different sports and athletes, with few studies conducted outside of Mediterranean countries. Importantly, more intervention studies are needed to provide high-level causal evidence on the impact of the MedDiet pattern on performance and health outcomes in athletes.

Adherence to the healthy and sustainable dietary recommendations for the Spanish population and all-cause mortality

INTRODUCTION AND OBJECTIVES

The healthy and sustainable dietary recommendations for the Spanish population have recently been launched. We aimed to develop a food-based dietary index to measure adherence to these guidelines and assess its association with all-cause mortality.

METHODS

Data were drawn from 11 904 individuals, representative of the Spanish population aged 18 and older, recruited between 2008 and 2010, and followed-up until 2022. The healthy and sustainable dietary recommendations for the Spanish population index (HS-DRSI) includes 20 food components, scored dichotomously to reflect adherence to the recommendations. The association between the HS-DRSI and all-cause mortality was examined using Cox proportional hazard models adjusted for sociodemographic, lifestyle, and morbidity factors, within a retrospective cohort design.

RESULTS

The mean±SE age of participants was 46.9±0.3 years and 50.5% were female. After a median follow-up of 12.9 years, 939 all-cause deaths were recorded. Compared with participants in the lowest quartile of adherence (HS-DRSI range: 1-5), those in the highest quartile (HS-DRSI range: 9-17) had a lower risk of mortality (HR, 0.76; 95%CI, 0.60-0.96; P for trend=.02). A 2-point increase in the HS-DRSI was associated with a 7% lower risk of mortality (HR, 0.93; 95%CI, 0.86-1.00; P=.04). This protective association was also observed among participants without chronic diseases at baseline (HR per 2-point increment: HR, 0.80; 95%CI, 0.70-0.92; P=.002). Results were robust in sensitivity analyses.

CONCLUSIONS

Higher adherence to the healthy and sustainable dietary recommendations for the Spanish population was associated with lower all-cause mortality.

Adherence to Mediterranean diet and prevalence of differentiated thyroid cancer: a single-center Unit of Thyroid Surgery experience in a Southern-Italy cohort

BACKGROUND

The Mediterranean diet (MD) is recognized as a cultural heritage by UNESCO, thus, is a nutritional model widely spread in all Mediterranean countries. As already demonstrated by several studies, high adherence to MD is a protective factor against many chronic diseases. Conversely, poor adherence to the diet is correlated with an increased prevalence of these pathologies. The aim of the current study was to investigate the relationship between the adherence to MD and the prevalence of benign and malignant thyroid disease.

METHODS

We analyzed the health status of 60 patients, referred to total thyroidectomy and histological examination, due to nodular thyroid disease. Eating habits were evaluated according to the PREDIMED questionnaire, and patients' results were evaluated according to histological findings of benign or malignant disease.

RESULTS

PREDIMED Score was lower in patients with malignant thyroid disease (MTD) than those with benign thyroid disease (BTD) (5.27±0.87 vs. 7.00±1.23, respectively; P value <0.001). A significant correlation was found between poor adherence to MD and diagnosis of MTD (r=0.454; P<0.001). Excessive consumption of butter and sugary drinks, along with low consumption of pasta, white meat, and rice were found to be predictive factors of MTD.

CONCLUSIONS

In our cohort, a PREDIMED Score ≤7 resulted significantly related to MTD diagnosis, while a good adherence to MD resulted associated with BTD. Moreover, high consumption of sweetened beverages seemed to predict MTD histologic diagnosis, while, conversely, low consumption resulted predictor of BTD. Nevertheless, more studies are needed to evaluate the effective impact of MD on MTD incidence on larger cohorts.

The role of diet in the management of psoriasis: a scoping review

Psoriasis is a chronic, systemic, immune-mediated, inflammatory skin disease associated with significant comorbidities. Globally, there are an estimated 60 million people living with psoriasis (PLwP). There is a growing body of evidence on the role of diet in psoriasis management, and demand for dietary advice is high. However, there are no specific, evidence-based dietary guidelines. This scoping review summarises the literature on use and effectiveness of diet in the management of psoriasis to improve understanding of the evidence and assist PLwP and healthcare professionals (HCPs) to discuss diet. The findings were categorised into three themes: (1) dietary intakes of PLwP, (2) the perceived role of diet in psoriasis management and (3) dietary approaches to manage psoriasis symptoms. In cross-sectional studies PLwP were reported to have higher fat and lower fibre intakes compared with controls, and lower psoriasis severity was associated with higher fibre intake. However, research is limited. PLwP perceive diet to have an impact on symptoms and make dietary modifications which are often restrictive. Systematic reviews and RCTs found certain dietary approaches improved symptoms, but only in specific populations (e.g. PLwP with obesity and PLwP with coeliac disease), and evidence for supplement use is inconclusive. The grey literature provides limited guidance to PLwP; focusing on weight loss and associated comorbidities. Larger, controlled trials are required to determine dietary approaches for psoriasis management, especially in PLwP without obesity and non-coeliac PLwP. Further understanding of diet modification, information acquisition and experiences among PLwP will enhance holistic care for psoriasis management.

Dietary inflammatory index is not associated with bone mineral density in functionally able community-dwelling older adults

BACKGROUND

Osteoporosis poses a significant health and quality-of-life burden on older adults, particularly with associated fractures after a fall. A notable increase in pro-inflammatory cytokines associated with aging contributes to a decline in bone mineral density (BMD). Certain food components have been shown to influence an individual's inflammatory state and may contribute to optimal bone health as a modifiable risk factor, particularly later in life. This study aims to explore the relationship between the dietary inflammatory index (DII) and dietary intake with BMD in community-dwelling older adults.

METHODS

Heathy community-dwelling older adults aged 65-85 years. DII scores were calculated using 24-h dietary recalls, and lumbar spine (L1-L4) and femoral neck (ward's triangle) BMD was assessed via dual-energy x-ray absorptiometry.

RESULTS

A total of 94 participants were recruited (72.9 ± 4.9 years, 76.6% female) with 61.7% identified having an anti-inflammatory diet (average DII = - 0.50 ± 1.6), 88.3% were physically active, 47.8% were osteopenic and 27.7% osteoporotic. There was no significant difference between DII scores, nutrient or food group intake in groups stratified by BMD T-Score except for lean meats and alternatives food group (p = 0.027). Multiple regression analysis found no associations between DII and lumbar spine (unadjusted model β = 0.020, p = 0.155) or femoral neck BMD (unadjusted model β = - 0.001, p = 0.866).

CONCLUSION

Most of this cohort of functionally able community-dwelling older adults followed an anti-inflammatory diet. DII and dietary intake were not associated with BMD. This research underlines the complex interplay between modifiable and non-modifiable risk factors on the BMD of older, physically active adults.

Advances in body composition and gender differences in susceptibility to frailty syndrome: Role of osteosarcopenic obesity

There is general consensus that an improper diet negatively impacts health and that nutrition is a primary tool for the prevention of non-communicable diseases. Unfortunately, the importance of studying body composition, which can reveal early predictors of gender-related diseases, is still not well understood in this context. Currently, individuals are still classified as obese based solely on their body mass index, without considering the amount of fat, its distribution, and the quantity of muscle and bone mass. In this regard, the body composition phenotype defined as "osteosarcopenic obesity" affects approximately 6-41 % of postmenopausal women, with prevalence increasing with age due to the hormonal and metabolic changes that occur during this period. This particular phenotype arises from the strong relationship between visceral fat, muscle, bone, and gut microbiota and predispose postmenopausal women to frailty. Frailty is a complex clinical phenomenon with significant care and economic implications for our society. Recent studies suggest that women have a higher prevalence of frailty syndrome and its individual components, such as osteoporosis, fractures and sarcopenia, compared to men. Here, we provide a comprehensive overview of recent advances regarding the impact of gender on body composition and frailty. Furthermore, we reflect on the crucial importance of personalized nutritional interventions, with a focus on reducing visceral fat, increasing protein intake and optimizing vitamin D levels. A review of the scientific literature on this topic highlights the importance of studying body composition for a personalized and gender-specific approach to nutrition and dietetics, in order to identify frailty syndrome early and establish personalized treatments. This new method of researching disease predictors could likely help clarify the controversial results of studies on vitamin D, calcium and proteins, translate into practical wellness promotion across diverse elderly populations.

The Interplay of Persistent Organic Pollutants and Mediterranean Diet in Association With the Risk of Gestational Diabetes Mellitus

OBJECTIVE

Certain foods characterizing the alternate Mediterranean diet (aMED) are high in persistent organic pollutants (POPs), which are related to greater gestational diabetes mellitus (GDM) risk. We examined the associations of combined aMED and POP exposure with GDM.

RESEARCH DESIGN AND METHODS

aMED score of 1,572 pregnant women was derived from food frequency questionnaires at early pregnancy within the U.S. Fetal Growth Study and plasma concentrations of 76 POPs, including organochlorine pesticides, polybrominated diphenyl ethers, polychlorinated biphenyls (PCBs), and per- and polyfluoroalkyl substances, were measured. Associations of combined aMED score and exposure to POPs with GDM risk were examined by multivariable logistic regression models.

RESULTS

In 61 of 1,572 (3.88%) women with GDM, 25 of 53 included POPs had a detection rate >50%. Higher POP levels appeared to diminish potential beneficial associations of aMED score with GDM risk, with the lowest GDM risk observed among women with both high aMED score and low POP concentrations. Specifically, adjusted log-odds ratios of GDM risk comparing women with low PCB and high aMED score with those with low aMED score and high PCB concentrations was -0.74 (95% CI -1.41, -0.07). Inverse associations were also observed among women with low aMED score and high TransNo_chlor, PCB182_187, PCB196_203, PCB199, and PCB206. These associations were more pronounced among women with overweight or obesity.

CONCLUSIONS

Pregnant women who consumed a healthy Mediterranean diet but had a low exposure to POP concentrations had the lowest GDM risk. Future endeavors to promote a healthy diet to prevent GDM may consider concurrent POP exposure.

Chronic Obstructive Pulmonary Disease: The Role of Healthy and Unhealthy Dietary Patterns-A Comprehensive Review

Chronic obstructive pulmonary disease (COPD) is a progressive and irreversible disease affecting many people worldwide. Recent evidence suggests that diet and lifestyle play a vital role in COPD progression. We aimed to provide a comprehensive review of the effect of healthy and unhealthy dietary patterns on preventing and treating COPD. For this reason, Scopus, EMBASE, Web of Science, and PubMed were searched. Based on our findings, it appears that adhering to a healthy dietary pattern rich in vegetables, legumes, fruit, nuts, and whole grains may have advantageous impacts on preventing and treating COPD while following an unhealthy dietary pattern rich in red and processed meat, saturated fats, sweets, and sugary drinks affect COPD negatively. Adhering to Mediterranean, dietary approaches to stop hypertension (DASH), Prudent, Ketogenic, and High-protein diet may be related to a lower risk of COPD and improved pulmonary function. Conversely, Western and Ramadan Intermittent Fasting diets may elevate the prevalence of COPD. Proposing a nutritious diet that enhances pulmonary function could potentially be an effective approach to preventing and managing COPD. A comprehensive knowledge of the relationship between dietary factors and COPD can provide healthcare professionals with properly supported approaches to advise patients and empower individuals to make informed lifestyle decisions that are beneficial to improve their pulmonary health.

A Scoping Review of the Causal Pathways and Biological Mechanisms Linking Nutrition Exposures and Health Outcomes

BACKGROUND/AIM

Building on the evidence for multifaceted effects of different nutrients, foods and dietary patterns is a new priority for nutrition science. This review aims to describe the causal pathways and biological mechanisms that elucidate the associations between different nutrition exposures (nutrients, foods and dietary patterns) and health outcomes.

METHODS

A scoping review was conducted in two stages: 1) review of nutrition science textbooks; and 2) a review of reviews of empirical literature using a systematic approach to elucidate causal pathways and biological mechanisms for nutrition exposures and health outcomes. Reviews were eligible for inclusion if they reported biological mechanistic pathways between exposures and outcomes of interest among free-living healthy adults and/or children. Causal pathways within and between the exposures and the outcomes were identified and summarised visually.

RESULTS

A total of seven core textbooks and 1,934 reviews of relevant empirical literature were included. The complexity of the causal pathways and the number of biological mechanisms progressively increases as the nutrition exposure changes from nutrients to foods to dietary patterns. The biological mechanisms demonstrate that associations with beneficial or adverse health outcomes are determined by the contrasting chemical composition and physical structure of the different types and forms of nutrition exposures, and that contextual factors (e.g., food processing) can influence these chemical and physical factors for food and dietary pattern exposures.

CONCLUSION

This review provides models that can guide future research, and has several implications for the generation and interpretation of the nutrition evidence, and its synthesis and translation to inform nutrition guidelines and policies.

Fundamentals of a healthy and sustainable diet

BACKGROUND

A healthy and sustainable diet is a prerequisite for population and planetary health. The evidence of associations between dietary patterns and health outcomes has now been synthesised to inform more than 100 national dietary guidelines. Yet, people select foods, not whole dietary patterns, even in the context of following specific diets such as a Mediterranean diet, presenting challenges to researchers, policymakers and practitioners wanting to translate dietary guideline recommendations into food-level selection guidance for citizens. Understanding the fundamentals that underpin healthy and sustainable diets provides a scientific basis for helping navigate these challenges. This paper's aim is to describe the fundamentals of a healthy and sustainable diet.

RESULTS

The scientific rationale underpinning what is a healthy and sustainable diet is universal. Everyone shares a physiological need for energy and adequate amounts, types and combinations of nutrients. People source their energy and nutrient needs from foods that are themselves sourced from food systems. The physiological need and food systems' sustainability have been shaped through evolutionary and ecological processes, respectively. This physiological need can be met, and food systems' sustainability protected, by following three interlinked dietary principles: (i) Variety - to help achieve a nutritionally adequate diet and help protect the biodiversity of food systems. (ii) Balance - to help reduce risk of diet-related non-communicable diseases and excessive use of finite environmental resources and production of greenhouse gas emissions. (iii) Moderation - to help achieve a healthy body weight and avoid wasting finite environmental resources used in providing food surplus to nutritional requirements.

CONCLUSION

The fundamentals of a healthy and sustainable diet are grounded in evolutionary and ecological processes. They are represented by the dietary principles of variety, balance and moderation and can be applied to inform food-level selection guidance for citizens.

Impact of a Nutrition Knowledge Intervention on Knowledge and Food Behaviour of Women Within a Rural Community

INTRODUCTION

The influence of women in shaping household dietary habits is undeniable, with their maternal nutritional knowledge significantly impacting the overall well-being of their families. The study objective was to evaluate the impact of maternal nutritional knowledge on household dietary habits, emphasising the improvement in women's nutrition knowledge and food-related behaviours.

PURPOSE

This study aimed to assess the immediate and long-term effects of a nutrition education intervention on the nutrition knowledge and food-related behaviours of women.

METHODOLOGY

A quasi-experimental research design was employed to assess the effects of a Nutrition Education Programme (NEP) on female caregivers' nutrition knowledge and food-related behaviours. This study followed a four-phase approach: baseline survey, programme formulation, implementation and evaluation. Data were collected at various stages of this study using two measurement tools: a Dietary Diversity Questionnaire and a Nutrition Knowledge Questionnaire.

RESULTS

Statistical analysis was performed to answer the research questions and to test the null hypotheses at a significance level of 0.05. The intervention positively affected nutrition knowledge, with the mean percentage increasing from 49.1% to 63.7% and reaching 64.4% at follow-up, indicating long-term knowledge retention. The findings of this study suggest a positive shift towards increased consumption of nutrient-rich food groups. There were significant improvements in the food groups' consumption of the meat group (7.15 ± 2.35), eggs (1 ± 0), dairy (3.76 ± 1.19), cereal (8.78 ± 2.09), legumes (2.86 ± 0.95) and fats and oils (2.12 ± 0.55). Additionally, the variety of food groups consumed significantly improved (p = 0.012) post-intervention, with an increasing trend in the consumption of a variety of food groups (7-9).

RECOMMENDATION

Tailored nutrition education (NE) programs, in conjunction with addressing socioeconomic barriers positively impact nutritional behaviours, promote healthier food consumption patterns and assist in long-term knowledge retention in disadvantaged communities.

Dietary patterns and bone density among school-aged children: a cross-sectional study in China

BACKGROUND

Diet is an essential modifiable determinant of bone health, yet the associations between dietary patterns (DPs) and bone mineral density (BMD) in Chinese children remain limited.

OBJECTIVE

This study aimed to investigate the relationship between overall diet and low BMD risk among school-aged children in China.

METHODS

A total of 1,099 children aged 9-12 in China were recruited for this cross-sectional study. A semi-quantified food frequency questionnaire (FFQ) was used to assess dietary intake. A priori numerical index, the Chinese Dietary Guidelines Index for Children and Adolescents [CDGI (2021)-C] was utilized to assess dietary quality. Specific DPs were identified by using principal components analysis (PCA). The BMD of the left forearm was assessed using dual-energy X-ray absorptiometry (DXA). Spearman correlation test was conducted to investigate the associations between DPs. Multivariate logistic regression analysis and restricted cubic spline models (RCS) were applied to explore the associations between DPs and BMD.

RESULTS

Three distinct DPs were identified: the plant-animal balanced pattern, the grain-tuber-meat pattern, and the bean-dairy pattern. We found a weak but significant positive correlation of the CDGI (2021)-C with the plant-animal balanced pattern (R = 0.318, P < 0.001), and with the bean-dairy pattern (R = 0.266, P < 0.001), respectively. After adjusting for covariates, adherence to the CDGI (2021)-C (Q4 vs. Q1, OR = 0.45, 95% CI: 0.27-0.75), the plant-animal balanced pattern (Q4 vs. Q1, OR = 0.50, 95% CI: 0.31-0.81), and the bean-dairy pattern (Q3 vs. Q1, OR = 0.57, 95% CI: 0.33-0.96) were associated with a lower risk of low BMD. No significant association was observed between the grain-tuber-meat pattern and low BMD (Q4 vs. Q1, OR = 1.09; 95% CI: 0.90-1.31).

CONCLUSION

Adherence to the CDGI (2021)-C and the plant-animal balanced pattern is advantageous for bone health and inversely correlated with the risk of low BMD among school-aged children in China. Additionally, moderate adherence to the bean-dairy pattern may also confer benefits to bone health. A balanced and overall healthy diet should be recommended in our daily life.

Dietary diversity contributes to delay biological aging

Aims

As aging is a major risk factor for chronic diseases, strategies to promote healthy aging are essential. Dietary diversity has been reported to be beneficial for human health, however, the role in the biological aging process remains underexplored. Our aim was to analyse the potential link between diet diversity and aging.

Methods

Twenty-two thousand six hundred participants from the National Health and Nutrition Examination Survey (NHANES) were included in this study. Dietary diversity was assessed by the dietary diversity score (DDS), which aggregated data on participants' self-reported dietary categories for the 5 major food groups (18 subgroups) over 2 rounds. Biological age was determined using the phenotypic age, with the residual between biological age and chronological age, phenotypic age acceleration, representing biological aging advance. Weighted multivariate regressions analysis were used to examine the relationship between DDS and phenotypic age acceleration. Sensitivity, subgroup interaction and mediation analyses were employed for further analysis.

Results

Higher DDS was consistently associated with slower phenotypic age acceleration (β < 0, p < 0.001). Subgroup analyses revealed that the inverse relationship persisted across categories, with minimal interaction effects. Sensitivity analyses confirmed the robustness of results. The oxidative stress indicator glutamyltransferase partially mediated the relationship between DDS and aging [4.9% (3.6, 6.0%), p < 0.001].

Conclusion

Dietary diversity is associated with a slower rate of biological aging, which may be due in part to reduced oxidative stress. These findings underscore the potential of a rich, broad-spectrum diet to promote healthy aging and reduce the burden of age-related diseases.

Association of childhood food consumption and dietary pattern with cardiometabolic risk factors and metabolomics in late adolescence: prospective evidence from 'Children of 1997' birth cohort

BACKGROUND

Healthy diet might protect against cardiometabolic diseases, but uncertainty exists about its definition and role in adolescence.

METHOD

In a subset of Hong Kong's 'Children of 1997' birth cohort (n=2844 out of 8327), we prospectively examined sex-specific associations of food consumption and dietary pattern, proxied by the Global Diet Quality Score (GDQS) at~12.0 years, with cardiometabolic risk factors and metabolomics at~17.6 years.

RESULT

Higher vegetable (-0.04 SD, 95% CIs: -0.09 to 0.00) and soy consumption (-0.05 SD, 95% CI: -0.09 to -0.01) were associated with lower waist-to-hip ratio. Higher fruit and vegetable consumption were associated with lower fasting glucose (p<0.05). Higher fish consumption was associated with 0.06 SD (95% CI: 0.01 to 0.10) high-density lipoprotein cholesterol and -0.07 SD (95% CI: -0.11 to -0.02) triglycerides. After correcting for multiple comparisons (p<0.001), higher fish, fruit and vegetable consumption were associated with higher fatty acid unsaturation, higher concentration and percentage of omega-3 and a lower ratio of omega-6/omega-3. At nominal significance (p<0.05), higher fish consumption was associated with lower very-low-density lipoprotein and triglycerides relevant metabolomics. Higher vegetable and fruit consumption were associated with lower glycolysis-related metabolomics. Lower sugar-sweetened beverages (SSBs) consumption was associated with lower branched-chain amino acids. Similar associations with adiposity and metabolomics biomarkers were observed for GDQS.

CONCLUSIONS

Higher consumption of fruit, vegetables and fish and lower ice cream and SSBs consumption were associated with lower cardiometabolic risk in adolescents.

Macronutrient quality and its association with micronutrient adequacy in children

BACKGROUND & AIMS

The double burden of malnutrition compels us to reconsider macronutrients from a diet quality perspective. The Macronutrient Quality Index (MQI) has been designed to reflect overall macronutrient quality and is based on three sub-indexes: the carbohydrate quality index (CQI), the healthy plate protein quality index (HPPQI) and the fat quality index (FQI). Nutritional adequacy is an essential aspect of diet quality that should be captured by reliable dietary indexes.

METHODS

We analyzed the association between the Macronutrient Quality Index (MQI) and micronutrient adequacy. Participants were children aged 4 and 5 years, recruited in the SENDO cohort. Baseline information was collected through a self-administered online questionnaire, which included information on sociodemographic, dietary, and lifestyle variables. Dietary information was obtained using a 147-item validated semi-quantitative food frequency questionnaire. Participants were categorized into tertiles based on their MQI score. We evaluated the intake of 20 micronutrients and assessed the probability of micronutrient adequacy using the Estimated Average Requirement cut-off point.

RESULTS

Children in the highest tertile of MQI had 0.33-fold lower odds (95%CI 0.17-0.66) of having ≥3 inadequate micronutrient intakes than their peers in the lowest tertile, after adjusting for potential confounders. The adjusted proportions of children with inadequate intake of ≥3 micronutrients were 18%, 14% and 11% in the first, second, and third tertiles of MQI respectively. The MQI appears to be capable of capturing nutrient adequacy in children, although our results suggest that a modified MQI, with eggs and dairy products weighted positively, might be more adequate for the pediatric population.

Dietary patterns, genetic predisposition, and risk of cholelithiasis: a large-scale prospective cohort study

Background

Limited epidemiological evidence exists concerning the impact of healthy dietary patterns on reducing the risk of cholelithiasis. We aimed to examine the association of seven established dietary patterns with subsequent cholelithiasis risk and whether this association was modified by genetic risk.

Methods

We conducted a prospective cohort study from the UK Biobank, including 155,323 participants initially free of cholelithiasis and cholecystectomy. Dietary patterns were assessed using a validated food frequency questionnaire (Oxford WebQ), covering Mediterranean Diet Score (MED), alternate Mediterranean Diet Score(aMED), overall Plant-based Diet Index (PDI), healthy Plant-based Diet Index (hPDI), unhealthy Plant-based Diet Index (uPDI), Healthy Eating Index 2015 (HEI-2015) and EAT-lancet Score. Genetic risk was quantified and stratified by a polygenic risk score (PRS) incorporating 13 known cholelithiasis-associated loci. Cox proportional hazards regression was employed to estimate the association between dietary patterns, PRS, and cholelithiasis incidence, adjusting for potential confounders.

Results

During a median follow-up of 13.3 years, 5,056 cases of cholelithiasis were identified. After adjusting for potential confounders, adherence to aMED and HEI-2015 dietary patterns reduced cholelithiasis risk by 10% (HR: 0.90; 95%CI: 0.83-0.98) and 11% (HR: 0.89; 95%CI: 0.82-0.96), respectively. A significant decrease in cholelithiasis risk was observed across PRS quintiles, low PRS was associated with a 16% reduced risk (HR: 0.84; 95%CI: 0.77-0.92). Participants with both high dietary scores and low genetic risk had the lowest cholelithiasis risk, with an HR of 0.76 (95%CI: 0.64-0.91) for aMED and 0.73 (95%CI: 0.61-0.88) for HEI-2015.

Conclusion

Higher adherence to aMED and HEI-2015 might significantly decrease the risk of cholelithiasis, irrespective of genetic risk. Our results highlighted the potential of diet intervention for cholelithiasis prevention in the general population.

A comparison of principal component analysis, reduced-rank regression, and partial least-squares in the identification of dietary patterns associated with cardiometabolic risk factors in Iranian overweight and obese women

BACKGROUND

According to epidemiological studies, unhealthy dietary patterns and lifestyle lead to rising obesity and cardiometabolic diseases in Iran. Hybrid techniques were used to identify a dietary pattern characterized by fiber, folic acid, and carotenoid intake due to their association with cardiometabolic risk factors such as anthropometric measurements, blood pressure, lipid profile, C-Reactive Protein (CRP), Plasminogen Activator Inhibitor (PAI), Homeostatic Model Assessment Index (HOMA Index), cardiometabolic index (CMI), and monocyte chemoattractant protein (MCP-1). So, the objective of the recent study is to compare the reduced-rank regression (RRR) and partial least-squares (PLS) approaches to principal component analysis (PCA) for estimating diet-cardiometabolic risk factor correlations in Iranian obese women.

METHODS

Data on dietary intake was gathered from 376 healthy overweight and obese females aged 18 to 65 years using a 147-item food frequency questionnaire (FFQ). In this cross-sectional study, participants were referred to health centers of Tehran. Dietary patterns were developed using PCA, PLS, and RRR, and their outputs were assessed to identify reasonable patterns connected to cardiometabolic risk factors. The response variables for PLS and RRR were fiber, folic acid, and carotenoid intake.

RESULTS

In this study, 3 dietary patterns were identified by the PCA method, 2 dietary patterns by the PLS method, and one dietary pattern by the RRR method. High adherence to the plant-based dietary pattern identified by all methods were associated with higher fat free mass index (FFMI) (P < 0.05). Women in the highest tertile of the plant-based dietary pattern identified by PLS had 0.06 mmol/L (95% CI: 0.007,0.66, P = 0.02), 0.36 mmHg (95% CI: 0.14,0.88, P = 0.02), and 0.46 mg/l (95% CI: 0.25,0.82, P < 0.001), lower FBS, DBP, and CRP respectively than women in the first tertile. Also, PLS and RRR-derived patterns explained greater variance in the outcome (PCA: 1.05%; PLS: 11.62%; RRR: 25.28%), while the PCA dietary patterns explained greater variance in the food groups (PCA: 22.81%; PLS: 14.54%; RRR: 1.59%).

CONCLUSION

PLS was found to be more appropriate in determining dietary patterns associated with cardiometabolic-related risk factors. Nevertheless, the advantage of PLS over PCA and RRR must be confirmed in future longitudinal studies with extended follow-up in different settings, population groups, and response variables.

The Effect of Dietary Types on Gut Microbiota Composition and Development of Non-Communicable Diseases: A Narrative Review

INTRODUCTION

The importance of diet in shaping the gut microbiota is well established and may help improve an individual's overall health. Many other factors, such as genetics, age, exercise, antibiotic therapy, or tobacco use, also play a role in influencing gut microbiota.

AIM

This narrative review summarizes how three distinct dietary types (plant-based, Mediterranean, and Western) affect the composition of gut microbiota and the development of non-communicable diseases (NCDs).

METHODS

A comprehensive literature search was conducted using the PubMed, Web of Science, and Scopus databases, focusing on the keywords "dietary pattern", "gut microbiota" and "dysbiosis".

RESULTS

Both plant-based and Mediterranean diets have been shown to promote the production of beneficial bacterial metabolites, such as short-chain fatty acids (SCFAs), while simultaneously lowering concentrations of trimethylamine-N-oxide (TMAO), a molecule associated with negative health outcomes. Additionally, they have a positive impact on microbial diversity and therefore are generally considered healthy dietary types. On the other hand, the Western diet is a typical example of an unhealthy nutritional approach leading to an overgrowth of pathogenic bacteria, where TMAO levels rise and SCFA production drops due to gut dysbiosis.

CONCLUSION

The current scientific literature consistently highlights the superiority of plant-based and Mediterranean dietary types over the Western diet in promoting gut health and preventing NCDs. Understanding the influence of diet on gut microbiota modulation may pave the way for novel therapeutic strategies.

Nutrient-delivery and metabolism reactivation therapy for melanoma

To fulfil the demands of rapid proliferation, tumour cells undergo significant metabolic alterations. Suppression of hyperactivated metabolism has been proven to counteract tumour growth. However, whether the reactivation of downregulated metabolic pathways has therapeutic effects remains unexplored. Here we report a nutrient-based metabolic reactivation strategy for effective melanoma treatment. L-Tyrosine-oleylamine nanomicelles (MTyr-OANPs) were constructed for targeted supplementation of tyrosine to reactivate melanogenesis in melanoma cells. We found that reactivation of melanogenesis using MTyr-OANPs significantly impeded the proliferation of melanoma cells, primarily through the inhibition of glycolysis. Furthermore, leveraging melanin as a natural photothermal reagent for photothermal therapy, we demonstrated the complete eradication of tumours in B16F10 melanoma-bearing mice through treatment with MTyr-OANPs and photothermal therapy. Our strategy for metabolism activation-based tumour treatment suggests specific nutrients as potent activators of metabolic pathways.

Joint association of physical activity and dietary quality with survival among US cancer survivors: a population-based cohort study

BACKGROUND

Limited studies have explored the joint effect of physical activity (PA) and dietary quality (DQ) on the mortality outcomes of the cancer population. The authors aim to investigate the separate and joint prognostic effect of PA and DQ on the survival of US cancer survivors.

METHODS

Data of cancer survivors ( n =3007, representing 22 million cancer survivors) were from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. PA was assessed using the self-reported Global Physical Activity Questionnaire (GPAQ) and DQ was evaluated through the Health Eating Index-2015 (HEI-2015). Kaplan-Meier (KM) curves and the Cox proportional hazard model were used to evaluate the associations between separate and joint prognostic effects of PA and DQ with mortality outcomes among cancer survivors.

RESULTS

In the joint analyses, cancer survivors with sufficiently active PA (≥600 MET-min/week) and qualified DQ (≥60) presented reduced risks of all-cause mortality (HR 0.45, 95% CI: 0.35-0.59) as compared with each lifestyle intervention separately. Meanwhile, the joint effects of either insufficiently or sufficiently active PA (>0 MET-min/week) and qualified DQ (≥60) were associated with lower risks for cancer (HR 0.60, 95% CI: 0.40-0.90) and noncancer mortality (HR 0.43, 95% CI: 0.32-0.59).

CONCLUSIONS

Our study highlights the combination of active PA and qualified DQ was strongly associated with reduced mortality risk of cancer survivors. Our findings might help to refine the lifestyle intervention recommendations for this population.

Is bone mineral density in middle-aged and elderly individuals associated with their dietary patterns? A study based on NHANES

Introduction

Bone mineral density (BMD) is a crucial index for predicting fracture risk and diagnosing osteoporosis. With the global rise in osteoporosis prevalence, understanding the relationship between dietary patterns and BMD is vital for public health. This study aimed to explore the association between various dietary patterns and BMD among adults using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

Data were analyzed from 8,416 NHANES participants aged 40 years and older across three non-consecutive survey cycles from 2013 to 2020. Dietary patterns were identified using a combination of factor analysis and cluster analysis. BMD measurements were then assessed, and associations with the identified dietary patterns were analyzed, with adjustments made for demographic variables.

Results

The analysis identified three distinct dietary patterns: "Low protein-High Dietary fiber-Vitamin A-Magnesium (LP-HDF-Vit A-Mg)", "High macronutrient-Choline-Selenium (HM-Cho-Se)", and "Low macronutrient-Vitamin D-Calcium (LM-Vit D-Ca)", and then we found that women, older adults, and certain ethnic groups were at higher risk for low BMD. Participants adhering to the "HM-Cho-Se" and "LP-HDF-Vit A-Mg" dietary patterns exhibited significantly higher BMD compared to those following the "LM-Vit D-Ca" pattern. After adjusting for demographic variables, the "HM-Cho-Se" pattern remained positively associated with BMD, while the "LM-Vit D-Ca" pattern showed no significant association with BMD or the risk of low BMD.

Discussion

The findings suggest that adherence to the "HM-Cho-Se" dietary pattern may reduce the risk of low BMD, indicating potential synergies between these nutrients for bone health. However, the study has limitations, including the cross-sectional design and potential subjectivity in factor analysis. Future research should focus on longitudinal studies involving diverse age groups to better understand the causal relationship between dietary patterns and BMD. Despite these limitations, the study highlights the importance of dietary factors in maintaining bone health and suggests potential dietary interventions to reduce the risk of low BMD and osteoporosis.

Ultra-Processed Food Intake and Increased Risk of Obesity: A Narrative Review

The prevalence of obesity has become a global health concern, with significant impacts on quality of life and mortality rates. Recent research has highlighted the role of ultra-processed foods (UPFs) in driving the obesity epidemic. UPFs undergo extensive processing, often containing high levels of sugars, fats, and additives, while lacking essential nutrients. Studies have linked UPF consumption to obesity and cardiometabolic diseases, underscoring the importance of dietary patterns rich in whole foods. Thus, the aim of this narrative review is to elucidate the correlation between ultra-processed foods and the increased trend of obesity and its related complications. These foods, prevalent in modern diets, contribute to nutritional deficiencies and excessive caloric intake, exacerbating obesity rates. Lifestyle factors such as busy schedules and quick meal management further drive UPF consumption, disrupting hunger regulation and promoting overeating. UPF consumption correlates with adverse health outcomes, including dyslipidemia, hypertension, and insulin resistance. Promoting whole, minimally processed foods and implementing school-based nutrition education programs are crucial steps. Also, numerous challenges exist, including unequal access to healthy foods, the industry's influence, and behavioral barriers to dietary change. Future research should explore innovative approaches, such as nutrigenomics and digital health technologies, to personalize interventions and evaluate policy effectiveness. Collaboration across disciplines and sectors will be vital to develop comprehensive solutions and improve public health outcomes globally.

Associations of five dietary indices with metabolic dysfunction-associated steatotic liver disease and liver fibrosis among the United States population

Background and aims

The role of dietary factors in metabolic dysfunction-associated steatotic liver disease (MASLD)-which represents a new definition of liver steatosis and metabolic dysfunction- remains unclear. This study aimed to explore the relationships between dietary indices and MASLD.

Methods

We analyzed data from the United States National Health and Nutrition Examination Survey (NHANES) 2017-2020 cycle, including 4,690 participants with complete vibration-controlled transient elastography (VCTE) data. Multivariate logistic regression models adjusted for covariates were used to assess the association between dietary indices, MASLD, and MASLD-associated liver fibrosis (MASLD-LF). Restricted cubic spline (RCS) models and subgroup analyses were also performed.

Results

The Alternative Healthy Eating Index (AHEI), Healthy Eating Index-2020 (HEI-2020), Dietary Approaches to Stop Hypertension Index (DASHI), and Mediterranean Diet Index (MEDI) were found to be negatively associated with MASLD risk, while the Dietary Inflammatory Index (DII) had a positive association. The highest quartile of MEDI was linked to a 44% reduction in MASLD risk [Q1 vs. Q4 odds ratio (OR): 0.56; 95% confidence interval (CI): 0.34-0.94, P for trend: 0.012]. DASHI was uniquely associated with a reduced risk of MASLD-LF (continuous OR: 0.79; 95% CI: 0.64-0.97; p for trend: 0.003). Our RCS curves indicated a nonlinear association with DASHI-MASLD (p-overall: 0.0001, p-nonlinear: 0.0066). Subgroup analyses showed robust associations among the non-Hispanic White and highly educated populations.

Conclusion

Specific dietary patterns were associated with reduced risks of MASLD and MASLD-LF. The DASHI, in particular, showed a significant protective effect against MASLD-LF. These findings suggest potential dietary interventions for managing MASLD and MASLD-LF, although large-scale randomized controlled trials are warranted to validate these findings.

Association of dietary patterns with sarcopenia in adults aged 50 years and older

PURPOSE

Although numerous studies have investigated the impact of dietary factors on the prevention of decreased muscle mass and function, limited research has examined the relationship between dietary patterns and sarcopenia. This study aimed to assess the associations between dietary patterns, and sarcopenia, muscle strength, and mass in adults following a Mediterranean diet residing in southern Italian cities.

METHODS

This cross-sectional study utilized data from an existing database, comprising 528 individuals aged 50 years or older who underwent health-screening tests at the Clinical Nutrition Unit of the "R.Dulbecco" University Hospital. Strength was assessed through handgrip strength, and appendicular skeletal muscle mass was estimated using bioelectrical impedance analysis. Dietary intake information was collected through a food frequency questionnaire linked to the MetaDieta 3.0.1 nutrient composition database. Principal Component Analysis, a statistical technique identifying underlying relationships among different nutrients, was employed to determine dietary patterns. Multinomial logistic regression analysis was conducted to estimate the odds ratio for sarcopenia or low handgrip strength in relation to the lowest tertile of dietary pattern adherence compared to the highest adherence.

RESULTS

The participants had a mean age of 61 ± 8 years. Four dietary patterns were identified, with only the Western and Mediterranean patterns showing correlations with handgrip strength and appendicular skeletal muscle mass. However, only the Mediterranean pattern exhibited a correlation with sarcopenia (r =  - 0.17, p = 0.02). The highest tertile of adherence to the Mediterranean dietary pattern demonstrated significantly higher handgrip strength compared to the lowest tertile (III Tertile: 28.3 ± 0.5 kg vs I Tertile: 26.3 ± 0.5 kg; p = 0.01). Furthermore, even after adjustment, the highest tertile of adherence to the Mediterranean pattern showed a significantly lower prevalence of sarcopenia than the lowest adherence tertile (4% vs 16%, p = 0.04). The lowest adherence to the Mediterranean dietary pattern was associated with increased odds of having low muscle strength (OR = 2.38; p = 0.03; 95%CI = 1.05-5.37) and sarcopenia (OR = 9.69; p = 0.0295; %CI = 1.41-66.29).

CONCLUSION

A high adherence to the Mediterranean dietary pattern, characterized by increased consumption of legumes, cereals, fruits, vegetables, and limited amounts of meat, fish, and eggs, is positively associated with handgrip strength and appendicular skeletal muscle mass. The highest adherence to this dietary model is associated with the lowest odds of low muscle strength and sarcopenia. Despite the changes brought about by urbanization in southern Italy compared to the past, our findings continue to affirm the superior benefits of the Mediterranean diet in postponing the onset of frailty among older adults when compared to other dietary patterns that are rich in animal foods.

Is there an "optimal" diet for prevention of inflammatory bowel disease?

Nutritional epidemiological studies have evolved from a focus of single nutrients to diet patterns to capture the protective role of healthy diets on chronic disease development. Similarly, in inflammatory bowel disease (IBD), a healthy diet may be protective against its development in individuals with genetic susceptibility, but the definitions of the optimal diet pattern deserve further exploration. Hence, this review article presents evidence, mainly from prospective cohort studies, for the role of diet quality based on adherence to dietary guidelines, traditional and modern diet patterns in the prevention of IBD. Findings from a limited number of studies on diet quality suggest that high diet quality scores are associated with lower risk of developing Crohn's disease, but the data are inconsistent for ulcerative colitis (UC). There are signals that a Mediterranean diet pattern reduces the risk of Crohn's disease but, again, the data are inconsistent and further studies are much needed. Finally, the evidence is conflicting regarding the role of food additives, with difficulties in the assessment of their intake, namely non-nutritive sweeteners and emulsifiers, precluding accurate assessment of a relationship with IBD risk. In contrast, emerging evidence for a role of ultra-processed food in the development of Crohn's disease but not UC is identified. Given the potential influence of diet quality, a Mediterranean diet and ultra-processed food intake on the risk of Crohn's disease, assessment and implementation of dietary advice for these patients need to be tailored. The search for an optimal diet for UC remains elusive and further research for increasing the evidence in the area is greatly needed.

Dietary inflammatory potential and arterial stiffness in a French cohort: Insights from the STANISLAS study

BACKGROUND AND AIMS

Chronic inflammation plays a key role in arterial stiffness pathogenesis. Dietary components can display anti- or pro-inflammatory properties. Nonetheless, the association between the diet's overall inflammatory potential and arterial stiffness is unclear. This study aimed to assess the association between the diet's overall inflammatory potential and arterial stiffness assessed by carotid-femoral pulse wave velocity (cfPWV).

METHODS AND RESULTS

This cross-sectional study included 1307 participants from the STANISLAS family cohort study. Dietary data were collected using a validated food frequency questionnaire. The adapted dietary inflammatory index (ADII) score was calculated to assess the inflammatory potential of the participants' diet. The association of ADII score quartile with cfPWV was assessed using IPW-weighted linear mixed models with random family effect. The median (Q1-Q3) ADII score was 0.45 (-1.57, 2.04). Participants exhibiting higher ADII scores demonstrated elevated energy intake, dietary saturated fat, and ultra-processed foods. Conversely, individuals with lower ADII scores exhibited higher vitamins and omega intakes, and a higher diet quality, as assessed by the DASH score. Despite these observations from the descriptive analyses, ADII score quartiles were not significantly associated with cfPWV (β(95% CI) were 0.01 (-0.02,0.04) for Q2, 0.02 (-0.01,0.05) for Q3, and 0.02 (-0.01,0.05) for Q4 compared to Q1).

CONCLUSION

In this cross-sectional study, participants had a relatively modest consumption of pro-inflammatory foods, no substantial associations were observed between the diet inflammatory potential and arterial stiffness. Further longitudinal studies in larger cohorts are needed to better understand the link between inflammatory diet and arterial stiffness.

Association between dietary magnesium intake, inflammation, and neurodegeneration

BACKGROUND

Consistent evidence shows that magnesium (Mg) intake is associated with lower blood pressure (BP), and that lower BP is associated with improved cerebral health. However, recent findings indicate that the positive effect of dietary Mg intake on cerebral health is not mediated by a decrease in BP. As Mg's anti-inflammatory action is a plausible alternative mechanism, the objective of this study was to investigate the associations between Mg intake and inflammation to determine whether it mediates any neuroprotective effect.

METHODS

Participants from the UK Biobank (n = 5775, aged 40-73 years, 54.7% female) were assessed for dietary magnesium using an online food questionnaire, brain and white matter lesion (WML) volumes were segmented with FreeSurfer software, and inflammation markers including high-sensitivity C-reactive protein (hs-CRP), leukocyte, erythrocyte count, and Glycoprotein acetylation (GlycA) were measured using specific laboratory techniques such as immunoturbidimetry, automated cell counting, and nuclear magnetic resonance. Hierarchical linear regression models were performed to investigate the association between dietary Mg, and inflammatory markers and between dietary Mg, brain and WMLs volumes. Mediation analysis was performed to test a possible mediation role of inflammation on the association between dietary Mg and brain and WMLs volumes.

RESULTS

Higher dietary Mg intake was associated with lower inflammation: hs-CRP level (- 0.0497%; 95% confidence interval [CI] - 0.0497%,  - 0.0199%) leukocytes count (- 0.0015%; 95%CI - 0.00151%,  - 0.0011%), and GlycA (- 0.0519%; 95%CI - 0.1298%,  - 0.0129%). Moreover, higher dietary Mg intake was associated with larger grey matter volume (0.010%; 95%CI 0.004%, 0.017%), white matter volume (0.012%; 95%CI 0.003,  0.022) and right hippocampal volume (0.002%; 95%CI 0.0007, -0.0025%). Lower hs-CRP levels mediated the positive association between higher dietary Mg intake and larger grey matter volume.

CONCLUSIONS

The anti-inflammatory effects of dietary Mg intake in the general population, appears to mediate its neuroprotective effect.

Healthy eating index and risk of diminished ovarian reserve: a case-control study

Diminished ovarian reserve (DOR) is associated with reduced fertility and poor reproductive outcomes. The association between dietary patterns and DOR was not well studied. The purpose of this study was to evaluate the relationship between adhering to the healthy eating index (HEI-2015) and the risk of DOR. In this case-control study, 370 Iranian women (120 with DOR and 250 age- and BMI-matched controls) were examined. A reliable semi-quantitative food frequency questionnaire was used to collect diet-related data. We analyzed the HEI-2015 and their dietary intake data to determine major dietary patterns. The multivariable logistic regression was used in order to analyze the association between HEI-2015 and risk of DOR. We found no significant association between HEI-2015 score and risk of DOR in the unadjusted model (OR 0.78; 95%CI 0.59, 1.03). After controlling for physical activity and energy intake, we observed that women in the highest quartile of the HEI-2015 score had 31% decreased odds of DOR (OR 0.69; 95%CI 0.46, 0.93). This association remained significant even after adjusting for all potential confounders. Overall, increased adherence to HEI may lead to a significant reduction in the odds ratio of DOR. Clinical trials and prospective studies are needed to confirm this association.