Region-specific nutrient intake patterns exhibit a geographical gradient within and between European countries

Impact of Mediterranean Diet on Lipid Composition in the Colaus-PsyColaus Study

High adherence to the Mediterranean diet (MD) has been associated with lower incidence of cardiovascular disease, increased HDL-cholesterol levels, and decreased triglycerides (TG), and total and LDL cholesterol levels. We aimed to assess the association of MD adherence at baseline with the lipid profile both cross-sectionally and prospectively in a sample of apparently healthy community-dwelling subjects. We conducted three cross-sectional studies using data from follow-ups 1 (FU1, 2009-2012), 2 (FU2, 2014-2017), and 3 (FU3, 2018-2021) of CoLaus|PsyCoLaus, a population-based sample from Lausanne, Switzerland. Dietary intake was assessed with a food frequency questionnaire. Two MD scores (Trichopoulou and Vormund) were computed, ranging from 0 (low) to 9 (high). In total, LDL and HDL cholesterol and TG were assessed. Incident dyslipidemia was defined as hypolipidemic treatment at FU2 or FU3. Overall, 4249 participants from FU1 (53.7% women, 57.6 ± 10.5 years, Trichopoulou 4.0 ± 1.5, Vormund 4.7 ± 1.9) were included. Neither MD score correlated significantly with the lipid markers and similar results were obtained according to the hypolipidemic status. Among the 3092 untreated FU1 participants with FU2 and FU3 data, 349 (11.3%) developed dyslipidemia by FU2 or FU3. No difference in MD scores was found between participants who developed dyslipidemia and those who did not (4.1 ± 1.5 vs. 4.0 ± 1.5 and 4.8 ± 1.8 vs. 4.8 ± 1.9 for Trichopoulou and Vormund, respectively, p > 0.05). Finally, no associations were found between MD score and lipid changes at 5 or 10 years. Contrary to other studies, adherence to MD at baseline did not show any significant effects on lipid composition/incident dyslipidemia in Colaus|PsyCoLaus participants.

Association between patterns of nutrient intake and circulating vitamin D with sleep status among Iranian adults

Nutrient pattern analysis is an easy way to compare nutrient intakes across different nations due to the universality of nutrients nature. The purpose of this study was to examine the relationship between dietary nutrient patterns (NPs) and circulating 25(OH)D concentrations with sleep duration and sleep quality among Iranian adults. We used a multistage cluster random sampling method to enroll 535 adults in this cross-sectional investigation. A validated food frequency questionnaire was applied to evaluate typical dietary intakes. Fasting blood samples were obtained to determine levels of circulating 25(OH)D. Sleep characteristics were assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants had a mean age of 42.57 years and 51.2% of them had insufficient or deficient levels of serum vitamin D. Three NPs were identified: "high animal protein", "high vegetable" and "high carbohydrate". After adjustments for potential confounders, no significant associations were observed between "high animal protein" pattern and short sleeping or sleep quality. Greater adherence to "high vegetable" NP was associated with lower odds of short sleeping (OR 0.24; 95% CI 0.10, 0.54) and poor sleep quality (OR 0.45; 95% CI 0.20, 1.05). Stratified analysis revealed that these associations were stronger in normal-weight participants. Greater adherence to "high carbohydrate" NP, on the other hand, was connected to higher odds of short sleeping (OR 2.83; 95% CI 1.20, 6.72). Low adherence to "high vegetable" pattern and vitamin D insufficiency/deficiency were jointly associated with increased odds of short sleeping (OR 3.42, 95% CI 1.42, 6.64). High adherence to pattern comprising mainly of vegetable nutrients was associated with a reduced likelihood of being short sleepers and having poor sleep quality in Iranian adults, especially among those with a normal weight. Lower adherence to vegetable NP and insufficient/deficient vitamin D levels were synergistically associated with greater likelihood of being short sleepers. Greater adherence to carbohydrate NP was associated with an increased likelihood of short sleeping.

Dietary vitamin D intake and sun exposure are not associated with type 1 diabetic schoolchildren and adolescents: A first report in Algeria

BACKGROUND: A large number of children and adolescents worldwide suffer from physiological vitamin D (VD) deficiency, which has been associated with sun exposure and, consequently, the risk of developing various autoimmune diseases, including type 1 diabetes (T1D). However, the association of the disease with VD intake and sun exposure has yet to be explored. MATERIALS AND METHODS: We conducted a food frequency questionnaire and a 24-hour food recall survey, using “Ciqual table 2016” in 335 type 1 diabetic and age- and gender-matched healthy Algerian school children and adolescents from sunny Saharan and relatively less sunny Northern regions, aged between 5 and 19 years. RESULTS: Both dietary VD intake and VD levels were similar in T1D patients when comparing northern and southern regions (for both comparisons, p > 0.05). Neither sun exposure nor VD intake was associated with the disease (respectively, relative risk [RR] = 1.050, p = 0.680; RR = 1.082, p = 1.000. For Cochran and Mantel-Haenszel analysis; RR = 0.841, p = 0.862). VD intake showed a significant difference between diabetics and non-diabetics in the sunny region (p = 0.022). Additionally, significant differences were found between normal and T1D schoolboys (p = 0.038), and when comparing the two groups according to the dry areas (p = 0.016). Moreover, in contrast to circulating VD levels, which were lower in T1D patients than in healthy controls, those of VD intake were significantly higher (p < 0.05), especially in male patients and in those with balanced diet, low protein or carbohydrate consumption, specific food intolerances, and regular meals (p < 0.05), as well as in patients with a moderate or low consumption of cooked meals or steamed foods (p < 0.01). Conversely, VD intake was markedly lower in type 1 diabetics than in controls for dry and sunny areas, including the region of Adrar, as well as for consumption of low-fat foods and eggs (p < 0.05 for all comparisons). Nevertheless, the relative risk of sun exposure and dietary vitamin D intake according to the World Health Organization (WHO) standard did not show a significant association with T1D (common Mantel-Haenszel estimation, RR = 0.841, 95% CI 0.118–5.973, p > 0.05). CONCLUSIONS: T1D does not appear to be associated with VD intake and sun exposure in the Algerian Sahara region. Therefore, the consumption of VD in T1D patients in the Algerian Sahara would suspect that its association with the disease would be related to its synthesis alteration.

Mapping the nutritional value of diets across Europe according to the Nutri-Score front-of-pack label

Background

Front-of-pack labels, such as Nutri-Score, aim to offer clear information on the overall nutritional quality of foods and beverages to consumers, allowing them to make healthier food choices. Using the European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database, the present study aims to map out European food consumption patterns by applying the Nutri-Score as a benchmark for nutritional value.

Methods

Country-specific food consumption data, collected by multiple 24-h dietary recalls or food records available from EFSA, were linked to the Dutch Food Composition Database (NEVO). Foods and beverages consumed by adolescents (10-17 years), adults (18-64 years), and the elderly (65-74 years) were graded following the modified Food Standard Agency Nutrient Profiling System (FSAm-NPS) and classified according to Nutri-Score grading, from A to E. Subsequently, a dietary index score (FSAm-NPS-DI) was calculated for each country-specific diet by age-groups and sex as an energy-weighted mean of the FSAm-NPS score of all foods and beverages consumed, with lower scores for a diet of greater overall nutritional quality.

Results

On average, the daily energy intake of adults across the European countries studied is distributed in 27.6% of A-, 12.9% of B-, 17% of C-, 30.0% of D-, and 12.5% of E-classified foods and beverages. This energy distribution, according to the Nutri-Score, corresponded to a median FSAm-NPS-DI score of 6.34 (interquartile range: 5.92, 7.19). For both adult males and females, Estonia reported the highest energy share from A-classified products, scoring the lowest on the FSAm-NPS-DI. On the other hand, Latvia reported the highest energy share from E-classified products, along with the highest FSAm-NPS-DI. Females and the elderly group reported, in general, a greater energy share from A- and a lower share from E-classified products, and had the lowest FSAm-NPS-DI scores. No sex-related difference was observed for adolescents whose share of energy was predominantly from A- and D-classified products, such as for adults and the elderly.

Conclusion

Our analyses leveraging the secondary use of country-specific databases on dietary intakes found considerable variation in the nutritional value of European diets, with an overall agreement across all countries on a modestly healthier dietary profile for the elderly and among females.

Regional Living Conditions and Individual Dietary Characteristics of the Russian Population

The goal of our study was to examine the effects of the regional characteristics of the living environment on individual a priori and a posteriori dietary patterns of the Russian population. For the analysis, we used cross-sectional data from the Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation study from 2013-2014. The sample included 18,054 men and women 25-64 years of age from 12 regions. Based on the frequency of consumption of basic foods, four a posteriori empirical dietary patterns (EDPs), along with an a priori cardioprotective dietary pattern (CPDP), were identified. To describe the regional living environment, five regional indices were used. Adherence to the meat-based EDP was directly associated with deterioration of social living conditions and a more northerly location for the region of residence. The probability of a CPDP increased with greater deterioration of social living conditions, aggravation of demographic crises, and higher industrial development in the region, as well as with declines in the economic development of the region, income, and economic inequality among the population. We detected several gender-dependent differences in the associations established. The patterns revealed reflect the national dietary preferences of Russians, and the regional indices characterize the effect of the living environment.

Vitamin D intake and bone mineral density in Korean adults: analysis of the 2009-2011 Korea National Health and Nutrition Examination Survey

BACKGROUND/OBJECTIVES

The prevalence of vitamin D deficiency in Koreans is quite high; however, until recently, Korean National Health and Nutrition Survey (KNHANES) had not analyzed the vitamin D intake among Koreans. Additionally, the Korean Dietary Reference Intake for vitamin D was established based on insufficient evidence. Therefore, we investigated vitamin D intake and its relationship with bone mineral density (BMD) in Korean adults using the combined data from the 2009-2011 KNHANES.

MATERIALS AND METHODS

This study was conducted in 11,949 healthy adults. Vitamin D intake was assessed using a 24-h recall method, and the BMD was measured using dual-energy X-ray absorptiometry.

RESULTS

The prevalence of vitamin D deficiency (< 20 ng/mL) was 64% in men and 77% in women. In women aged ≥ 50 yrs and men aged < 50 yrs, there was a significant positive correlation between vitamin D intake and serum 25-hydroxyvitamin D level after sun exposure adjustment. The BMD of postmenopausal women aged ≥ 50 yrs with a vitamin D intake of 5 µg/day or more was significantly higher than that of women with intake less than 5 µg/day. After adjusting for age, energy, and calcium intake, the vitamin D intake of the osteoporotic group was significantly lower than that of the osteopenia group in women.

CONCLUSIONS

Since the relationship between vitamin D intake and BMD was observed in women aged ≥ 50 yrs, further research is needed to clarify these findings using cohort or randomized controlled trials.

Transitions to food democracy through multilevel governance

Food systems in Europe are largely unjust and not sustainable. Despite substantial negative consequences for individual health, the environment and public sector health and care services, large multi-national corporations continue to benefit from the way food systems are designed—perpetuating “Lose–Lose–Lose–Win” food systems that see these large corporations benefit at the expense of health, the environment and public sector finances. Transitioning to “Win–Win–Win–Win” food systems is challenging because of the heterogeneity, complexity and unpredictable nature of food systems—one-size fits-all solutions to correct imbalances and injustices cannot exist. To address these challenges, we propose the use of heuristics—solutions that can flexibly account for different contexts, preferences and needs. Within food systems, food democracy could be a heuristic solution that provides the processes and can form the basis for driving just transitions. However, ensuring that these transition processes are fair, equitable, sustainable and constructive, requires an approach that can be used across vertical and horizontal governance spheres to ensure the voices of key stakeholders across space, time and spheres of power are accounted for. In this manuscript we outline a new Horizon project, FEAST, that aims to use multilevel governance approaches across vertical and horizontal spheres of governance to realize constructive food democracy. We envisage this as a means to inform just processes that can be used to design and implement policies, in line with food democracy, to facilitate transitions to “Win–Win–Win–Win” food systems across Europe that makes it easy for every European to eat a healthy and sustainable diet.

Association of dietary and nutrient patterns with systemic inflammation in community dwelling adults

Purpose

Evidence investigating associations between dietary and nutrient patterns and inflammatory biomarkers is inconsistent and scarce. Therefore, we aimed to determine the association of dietary and nutrient patterns with inflammation.

Methods

Overall, 1,792 participants from the North-West Adelaide Health Study were included in this cross-sectional study. We derived dietary and nutrient patterns from food frequency questionnaire data using principal component analysis. Multivariable ordinal logistic regression determined the association between dietary and nutrient patterns and the grade of inflammation (normal, moderate, and severe) based on C-reactive protein (CRP) values. Subgroup analyses were stratified by gender, obesity and metabolic health status.

Results

In the fully adjusted model, a plant-sourced nutrient pattern (NP) was strongly associated with a lower grade of inflammation in men (OR_Q5vsQ1 = 0.59, 95% CI: 0.38–0.93, p-trend = 0.08), obesity (OR_Q5vsQ1 = 0.43; 95% CI: 0.24–0.77, p-trend = 0.03) and metabolically unhealthy obesity (OR_Q5vsQ1 = 0.24; 95% CI: 0.11–0.52, p-trend = 0.01). A mixed NP was positively associated with higher grade of inflammation (OR_Q5vsQ1 = 1.35; 95% CI: 0.99–1.84, p-trend = 0.03) in all participants. A prudent dietary pattern was inversely associated with a lower grade of inflammation (OR_Q5vsQ1 = 0.72, 95% CI: 0.52–1.01, p-trend = 0.14). In contrast, a western dietary pattern and animal-sourced NP were associated with a higher grade of inflammation in the all participants although BMI attenuated the magnitude of association (OR_Q5vsQ1 = 0.83, 95% CI: 0.55–1.25; and OR_Q5vsQ1 = 0.94, 95% CI: 0.63–1.39, respectively) in the fully adjusted model.

Conclusion

A plant-sourced NP was independently associated with lower inflammation. The association was stronger in men, and those classified as obese and metabolically unhealthy obese. Increasing consumption of plant-based foods may mitigate obesity-induced inflammation and its consequences.

Dietary vitamin D intake and sun exposure are not associated with type 1 diabetic schoolchildren and adolescents: a first report in Algerian Sahara.. [DOI: 10.1101/2022.07.17.22276883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background

A great number of children and adolescents worldwide suffer from physiological Vitamin D (VD) deficiency, which has been associated to the sun exposure and, consequently, to the risk of the development of various autoimmune diseases, including type 1 diabetes (T1D). However, the association of the disease with VD intake and sun exposure have yet to be explored.

Materials and methods

We conducted a food frequency questionnaire and 24-hour recall food survey, using “Ciqual table 2016” in 335 type 1 diabetic and age- and gender-matched healthy Algerian school children and teenager pupils from sunny Saharan and relatively less sunny Northern regions, aged between 5 and 19 years old.

Results

Both dietary VD intake and VD levels were similar in T1D patients when comparing between North and South regions (for the two comparisons, p > 0.05). Neither sun exposure, nor VD intake was associated with the disease (respectively, relative risk [RR] = 1.050, p = 0.680; RR = 1.082, p = 1.000. For Cochran and Mantel-Haenszel analysis; RR = 0.841, p = 0.862). VD intake showed a significant difference between diabetics and non-diabetics in sunny region (p = 0.022). Additionally, significant differences were highlighted between normal and T1D schoolboys (p = 0.038), and when comparing the two groups according to the dry areas (p = 0.016). Moreover, in contrast with the levels of circulating VD, which is decreased in T1D patients than in healthy controls, those of VD intake was significantly higher (p < 0.05), especially in male patients and in those with balanced diet, poor protein or carbohydrate consumption, a particular food intolerance, and a regular meal (p < 0.05), as well as in patients with a moderate or low consumption of cooked meals or steamed food (p < 0.01). Conversely, VD intake was markedly lower in type 1 diabetics than in controls regarding dry sunny region, including Adrar area, as well as in low fatty foods and eggs consumption (p < 0.05 for all comparisons). Nevertheless, relative risk of sun exposure and dietary vitamin D intake according to the WHO standard showed no significant association with T1D (common Mantel-Haenszel estimation, RR = 0.841, 95% CI 0.118-5.973, p > 0.05).

Conclusions

T1D seems to be not associated with VD intake and sun exposure in the Algerian Sahara region. Therefore, the consumption of VD in T1D patients from the Algerian Sahara would suspect that its association with the disease would be related to its synthesis alteration.

Gender, Age, Family and Territorial Features of Dietary and Physical Activity Patterns in Russian Youths

OBJECTIVE

Identifying dietary and physical activity (PA) patterns in Russian youths and examining their dependence on gender, age, family characteristics and area of residence features. The research involved 783 school students 10-17 years of age and their parents living in the cities of Moscow and Murmansk. Using the principal component analysis, four integral indices were identified that characterized the habits and dietary patterns, PA and lifestyle. Boys, compared with girls, were more likely to consume unhealthy foods but less likely to practice malnutrition. Within the age ranges of 13-15 years old and 16-17 years old, the proportions of school students with a poor sleep pattern and low PA were higher than in children 10-12 years of age. In smoking families, children were less likely to consume healthy foods and more likely to eat unhealthy foods. In Murmansk school students, compared with their Moscow peers, a reduction in both sleep time and PA was observed less often. Our study demonstrated that the most significant factors of a balanced and healthy diet, rational daily routine and lifestyle in school students were their gender and age characteristics, as well as some contextual factors.

Nutrient patterns and their relation to obesity and metabolic syndrome in Iranian overweight and obese adult women

PURPOSE

Nutrient patterns have been associated with an increased risk for chronic disease. Evidence to confirm a direct relationship between nutrient patterns and obesity and metabolic syndrome (MetS) throughout population-based differences including cultural contexts add complexity is not well established yet. The aim of this study is to investigate the association between nutrient patterns and MetS among overweight and obese Iranian women.

METHODS

Three hundred and sixty obese and overweight women (25 < BMI < 40) were included in this cross-sectional analysis. Dietary intake of 19 nutrients was evaluated by a semi-quantitative standard food frequency questionnaire (FFQ). MetS was determined by abdominal obesity > 88 (cm) in females, Triglycerides ≥ 150 (mg/dL), dyslipidemia (HDL < 50 mg/dL), systolic blood pressure > 130/85 (millimeters), and glucose > 100 (mg/dL). Body composition was assessed by a multi-frequency bioelectrical impedance analyzer, InBody 770 scanner. Principle components analysis was applied and four nutrient patterns were identified as following: Pattern 1 (thiamin, iron, carbohydrate, zinc, niacin, protein, magnesium, phosphorus, riboflavin), represented the carbo-vitamin group. Lipid group was showed in pattern 2 (PUFAs, MUFA, vitamin E, trans fatty acids, and Pattern 3 (beta-carotene, vitamin K, vitamin A, vitamin C) represented the anti-oxidant group, finally Pattern 4 was the indicator of the milk group (vitamin D, calcium).

RESULTS

A significant positive association was observed between the anti-oxidant group and obesity (OR 1.40; 95% CI 1.09-1.8; P = 0.01). No relationship between other nutrient pattern and MetS was observed.

CONCLUSIONS

The nutrient patterns that are highly loading of beta-carotene, vitamin K, vitamin A, and vitamin C in nutrient patterns may be associated to higher risk of obesity in overweight and obese Iranian women.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Correlates of Calcidiol Deficiency in Adults-Cross-Sectional, Observational, Population-Based Study

The prevalence, determinants, and clinical significance of vitamin D deficiency in the population are debated. The population-based study investigated the cross-sectional associations of several variables with serum 25-hydroxyvitamin D (calcidiol) measured using standardized calibrators. The study cohort consisted of 979 persons of the Moli-sani study, both sexes, ages ≥35 years. The correlates in the analyses were sex, age, education, local solar irradiance in the month preceding the visit, physical activity, anthropometry, diabetes, kidney function, albuminuria, blood pressure, serum cholesterol, smoking, alcohol intake, calorie intake, dietary vitamin D intake, and vitamin D supplement. The serum calcidiol was log transformed for linear regression because it was positively skewed (skewness = 1.16). The prevalence of calcidiol deficiency defined as serum calcidiol ≤12 ng/mL was 24.5%. In multi-variable regression, older age, lower solar irradiance, lower leisure physical activity, higher waist/hip ratio, higher systolic pressure, higher serum cholesterol, smoking, lower alcohol intake, and no vitamin D supplement were independent correlates of lower serum calcidiol (95% confidence interval of standardized regression coefficient ≠ 0) and of calcidiol deficiency (95% confidence interval of odds ratio > 1). The data indicate that low serum calcidiol in the population could reflect not only sun exposure, age, and vitamin D supplementation but also leisure physical activity, abdominal obesity, systolic hypertension, hypercholesterolemia, smoking, and alcohol intake.

Genetic, sociodemographic and lifestyle factors associated with serum 25-hydroxyvitamin D concentrations in Brazilian adults: the Pró-Saúde Study

This study aims to investigate factors associated with serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian adults considering sociodemographic and lifestyle factors, as well as vitamin D-related single nucleotide polymorphisms (SNPs). This is a cross-sectional study (n = 491; 34-79y; 251 women), nested within a prospective cohort (Pró-Saúde Study). Associations between serum 25(OH)D and sociodemographic characteristics, diet, use of supplement, physical activity, season of blood collection, body fat, skin type, sun exposure index, and SNPs CYP2R1-rs10741657 and GC-rs2282679 were explored by multiple linear regression. The prevalence of serum 25(OH)D < 50nmol/L was 55%. Serum 25(OH)D was lower among women (β = -4.38; 95%CI: -8.02; -0.74), those with higher visceral fat (β = -4.02; 95%CI: -5.92; -2.12), and those with AC and CC genotypes for GC-rs2282679 (β = -6.84; 95%CI: -10.09; -3.59; β = -10.63; 95%CI: -17.52; -3.74, respectively). Factors directly associated with serum 25(OH)D included summer (β = 20.14; 95%CI: 14.38; 25.90), intermediate skin type (β = 6.16; 95%CI: 2.52; 9.80), higher sun exposure (β = 0.49; 95%CI: 0.22; 0.75), vitamin D intake (β = 0.48; 95%CI: 0.03; 0.93), and physical activity (β = 4.65; 95%CI: 1.54; 7.76). Besides physical activity, diet, and sun exposure, non-modifiable factors, such as GC genotypes must be considered when evaluating vitamin D insufficiency in mixed-race populations. Moreover, high visceral fat in association with poorer vitamin D status deserve attention given that both conditions are unfavorably related with chronic and acute health outcomes.

Nutrition, Physical Activity, and Dietary Supplementation to Prevent Bone Mineral Density Loss: A Food Pyramid

Bone is a nutritionally modulated tissue. Given this background, aim of this review is to evaluate the latest data regarding ideal dietary approach in order to reduce bone mineral density loss and to construct a food pyramid that allows osteopenia/osteoporosis patients to easily figure out what to eat. The pyramid shows that carbohydrates should be consumed every day (3 portions of whole grains), together with fruits and vegetables (5 portions; orange-colored fruits and vegetables and green leafy vegetables are to be preferred), light yogurt (125 mL), skim milk (200 mL,) extra virgin olive oil (almost 20 mg/day), and calcium water (almost 1 l/day); weekly portions should include fish (4 portions), white meat (3 portions), legumes (2 portions), eggs (2 portions), cheeses (2 portions), and red or processed meats (once/week). At the top of the pyramid, there are two pennants: one green means that osteopenia/osteoporosis subjects need some personalized supplementation (if daily requirements cannot be satisfied through diet, calcium, vitamin D, boron, omega 3, and isoflavones supplementation could be an effective strategy with a great benefit/cost ratio), and one red means that there are some foods that are banned (salt, sugar, inorganic phosphate additives). Finally, three to four times per week of 30-40 min of aerobic and resistance exercises must be performed.

Vitamin D Intake in Slovenian Adolescents, Adults, and the Elderly Population

Vitamin D is involved in calcium and phosphorus metabolism, and is vital for numerous bodily functions. In the absence of sufficient UV-B light-induced skin biosynthesis, dietary intake becomes the most important source of vitamin D. In the absence of biosynthesis, the recommended dietary vitamin D intake is 10-20 µg/day. Major contributors to dietary vitamin D intake are the few foods naturally containing vitamin D (i.e., fish), enriched foods, and supplements. The present study aimed to estimate the vitamin D intake in Slovenia, to identify food groups that notably contribute to vitamin D intake, and to predict the effects of hypothetical mandatory milk fortification. This study was conducted using data collected by the national cross-sectional food consumption survey (SI.Menu) in adolescents (n = 468; 10-17 years), adults (n = 364; 18-64 years), and the elderly (n = 416; 65-74 years). Data collection was carried out between March 2017 and April 2018 using the EU Menu Methodology, which included two 24-h recalls, and a food propensity questionnaire. Very low vitamin D intakes were found; many did not even meet the threshold for very low vitamin D intake (2.5 µg/day). Mean daily vitamin D intake was 2.7, 2.9, and 2.5 µg in adolescents, adults, and the elderly, respectively. Daily energy intake was found to be a significant predictor of vitamin D intake in all population groups. In adolescents and adults, sex was also found to be a significant predictor, with higher vitamin D intake in males. The study results explained the previously reported high prevalence of vitamin D deficiency in Slovenia. An efficient policy approach is required to address the risk of vitamin D deficiency, particularly in vulnerable populations.

Vitamin D Fortification of Consumption Cow's Milk: Health, Nutritional and Technological Aspects. A Multidisciplinary Lecture of the Recent Scientific Evidence

Vitamin D is essential in assuring bone health at all stages of life, but its non-skeletal effects are also essential: This vitamin impacts the physiology of the immune system, skeletal muscles and adipose tissue, glucose metabolism, skin, cardiovascular and reproductive systems, neuro-cognitive functions and cell division. The incidence of vitamin D deficiency is widespread worldwide, at any age, in young and healthy subjects, as well as in pregnant women and the elderly population, due to several factors, including inadequate sunlight exposure, skin pigmentation and coverage, adiposity, lifestyle and low dietary intakes. To overcome this problem, the fortification of foods that are consumed on a daily basis, such as milk, is strongly advisable. This opinion paper aims to discuss, in a multidisciplinary way, the current evidence supporting the importance of vitamin D in health and disease and the role of milk as an optimal carrier of this vitamin, to promote adequate intakes, highlighting its unique physico-chemical characteristics linked to both fat globule membrane and casein micelle structure. Moreover, it addresses the impact of industrial processing and storage of consumption milk on the stability of these structures, thus in determining vitamin D bioavailability and the achievement of adequate intakes.

Socio-Demographic and Knowledge-Related Determinants of Vitamin D Supplementation in the Context of the COVID-19 Pandemic: Assessment of an Educational Intervention

Vitamin D is a pro-hormone, essential for musculo-skeletal health, normal immune system, and numerous other body functions. Vitamin D deficiency is considered as a risk factor in many conditions, and there is growing evidence of its potential role in the severity of COVID-19 outcomes. However, an alarmingly high prevalence of vitamin D deficiency is reported in many regions, and vitamin D supplementation is commonly recommended, particularly during wintertime. To reduce the risk for vitamin D deficiency in the Slovenian population during the COVID-19 pandemic, we conducted mass media intervention with an educational campaign. The objective of this study was to investigate vitamin D supplementation practices in Slovenia before and during the COVID-19 pandemic, and to determine the effects of the educational intervention on supplementation practices. Two data collections were conducted using an online panel with quota sampling for age, sex, and geographical location. A pre-intervention (N = 602, April 2020) and post-intervention (N = 606, December 2020) sampling were done during the first and second COVID-19 lockdown, respectively. We also focused on the identification of different factors connected to vitamin D supplementation, with a particular emphasis on vitamin D-related knowledge. Study results showed significant increase in vitamin D supplementation in the population. Penetration of the supplementation increased from 33% in April to 56% in December 2020. The median daily vitamin D intake in supplement users was 25 μg, with about 95% of supplement users taking safe vitamin D levels below 100 μg/daily. Vitamin D-related knowledge (particularly about dietary sources of vitamin D, the health-related impact of vitamin D, and the prevalence of deficiency) was identified as a key independent predictor of vitamin D supplementation. Based on the study findings, we prepared recommendations to support the development of effective awareness campaigns for increasing supplementation of vitamin D.

Hidrox® Counteracts Cyclophosphamide-Induced Male Infertility through NRF2 Pathways in a Mouse Model

BACKGROUND

Every year, men use cyclophosphamide to treat various cancers and autoimmune diseases. On the one hand, this chemotherapy often has the beneficial effect of regressing the tumor, but on the other hand, it leads to infertility due to excessive oxidative stress and apoptosis in the testes caused by its metabolite, acrolein.

METHODS

The objective of this study was to evaluate the beneficial power of a new compound called Hidrox^®, containing 40-50% hydroxytyrosol, in counteracting the damage related to fertility induced by cyclophosphamide. The study was conducted using a single intraperitoneal injection of cyclophosphamide at a dose of 200 mg/kg b.w, in distilled water at 10 mL/kg b.w. The treatment was administered via the oral administration of Hidrox^® at a dose of 50 mg/kg.

RESULTS

Our study confirms that the use of cyclophosphamide causes a series of sperm and histological alterations strongly connected with oxidative stress, lipid peroxidation, and apoptosis.

CONCLUSION

Our results demonstrate for the first time that Hidrox^® protects testes from CYP-induced alterations by the modulation of physiological antioxidant defenses.

Association between nutrient patterns and fatty liver index: Baseline survey of the Japan Multi-Institutional Collaborative Cohort Study in Tokushima, Japan

BACKGROUNDS

The fatty liver index (FLI) is a good non-invasive approach for fatty liver disease diagnosis. The objective of this study was to examine the associations of nutrient patterns with nonalcoholic fatty liver disease (NAFLD) in a Japanese population.

METHODS

A total of 1,588 subjects (789 men and 799 women) aged 35 to 69 years were recruited in the baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study in Tokushima Prefecture. Factor analysis was applied to energy-adjusted intake of 21 nutrients, and nutrient patterns were extracted. Multiple logistic regression analysis was used to analyze the relationships between nutrient patterns and the high FLI category (≥60).

RESULTS

Four nutrient patterns were extracted: Factor 1, vitamins, dietary fiber, iron and potassium pattern; Factor 2, fats and fat-soluble vitamins pattern; Factor 3, saturated fat, calcium, vitamin B₂ and low carbohydrate pattern; and Factor 4, sodium, protein and vitamin D pattern. After adjustment for sex, age, and other potential confounding variables, higher Factor 1 scores were significantly associated with lower odds ratios of NAFLD (P for trend <0.05). Analysis of each component of FLI showed that there were significant inverse associations between Factor 1 scores and high body mass index and large waist circumference.

CONCLUSION

The present findings suggest that a nutrient pattern rich in vitamins, fiber, iron, and potassium was associated with lower prevalence of NAFLD in a Japanese population. Obesity and abdominal obesity may be intermediate variables for the association between this nutrient pattern and NAFLD.

Association of Nutrient Patterns and Their Relation with Obesity in Iranian Adults: a Population Based Study

In the present research, we have evaluated the association between patterns of nutrient intake and obesity. The present cross-sectional study recruited 850 adults aged between 20–59 years old. Dietary intakes were assessed with three 24-hour recalls. As well, data on anthropometric measures were collected. General obesity was specified as body mass index ≥ 30 kg/m². Factor analysis was conducted, and followed by a varimax rotation, was performed to extract major nutrient patterns. Our analysis identified three major nutrient patterns: The first nutrient pattern was characterized by the high consumption of saturated fatty acids (SFAs), protein, vitamins B₁, B₂, B₆, B₅, B₃, B₁₂, Zinc, and iron. The second nutrient pattern was rich in total fat, polyunsaturated fatty acids, monounsaturated fatty acids, SFAs, oleic acid, linolenic acid, zinc, vitamin E, α-tocopherol, and β-carotene. The third one was greatly loaded with protein, carbohydrate, potassium, magnesium, phosphorus, calcium, vitamin C, and folate. Women in the third quintile of the first pattern were less likely to be generally obese in the fully adjusted model (odds ratio, 0.44; 95% confidence interval, 0.25–0.75). None of the other nutrient patterns had a significant association with obesity, even after adjusting for confounders. Adherence to a nutrient pattern rich in water-soluble vitamins was significantly associated with a greater chance of general obesity among women. Further studies in other populations, along with future prospective studies, are required to confirm these findings.

Development of a short food frequency questionnaire to assess diet quality in UK adolescents using the National Diet and Nutrition Survey

BACKGROUND

UK adolescents consume fewer fruits and vegetables and more free sugars than any other age group. Established techniques to understand diet quality can be difficult to use with adolescents because of high participant burden. This study aimed to identify key foods that indicate variation in diet quality in UK adolescents for inclusion in a short food frequency questionnaire (FFQ) and to investigate the associations between adolescent diet quality, nutritional biomarkers and socio-demographic factors.

METHODS

Dietary, demographic and biomarker data from waves 1-8 of the National Diet and Nutrition Survey rolling programme were used (n=2587; aged 11-18 years; 50% boys; n=≤997 biomarker data). Principal component analysis (PCA) was applied to 139 food groups to identify the key patterns within the data. Two diet quality scores, a 139-group and 20-group, were calculated using the PCA coefficients for each food group and multiplying by their standardised reported frequency of consumption and then summing across foods. The foods with the 10 strongest positive and 10 strongest negative coefficients from the PCA results were used for the 20-group score. Scores were standardised to have a zero mean and standard deviation of one.

RESULTS

The first PCA component explained 3.0% of variance in the dietary data and described a dietary pattern broadly aligned with UK dietary recommendations. A correlation of 0.87 was observed between the 139-group and 20-group scores. Bland-Altman mean difference was 0.00 and 95% limits of agreement were - 0.98 to 0.98 SDs. Correlations, in the expected direction, were seen between each nutritional biomarker and both scores; results attenuated slightly for the 20-group score compared to the 139-group score. Better diet quality was observed among girls, non-white populations and in those from higher socio-economic backgrounds for both scores.

CONCLUSIONS

The diet quality score based on 20 food groups showed reasonable agreement with the 139-group score. Both scores were correlated with nutritional biomarkers. A short 20-item FFQ can provide a meaningful and easy-to-implement tool to assess diet quality in large scale observational and intervention studies with adolescents.

Vitamin D Intake in a Population-Based Sample of Young Polish Women, Its Major Sources and the Possibility of Meeting the Recommendations

The recommendations of vitamin D intake are commonly not met, which results from the fact that fish, being its major sources, are commonly rarely consumed. Consequently, a reliable estimation of its habitual intake is also difficult, as its daily intake is highly variable. The aim of the study was to analyze vitamin D intake from food, its major sources and the possibility to meet its recommendations in a population-based sample of young Polish women. The study was conducted in a sample of Polish women aged 15–30 years, recruited in cooperation with local students’ and youth organizations from all regions of Poland (convenience sampling with the snowball effect), while the stratified sampling procedure was applied with a random quota sampling for voivodeships (an administrative subdivision), to obtain an adequate distribution regarding the general population of young Polish women (n = 1,032). The vitamin D intake was assessed while using the validated Vitamin D Estimation Only—Food Frequency Questionnaire (VIDEO-FFQ) and was compared with the recommended 10 µg. The median vitamin D intake in the study group was 3.09 µg (0.00–24.52 µg) and in 95% of participants was lower than recommended, while the highest vitamin D intake was observed for the following sources: eggs (0.50 µg), meat and meat products (0.49 µg), herring, sardine and tuna products (0.41 µg) and dairy products (0.40 µg). The correlation between total vitamin D intake and its intake from its sources was strongest for eggs (p < 0.0001; R = 0.5989) and for herring, sardine and tuna products (p < 0.0001; R = 0.5314), while the correlation between total vitamin D intake and the number of servings was strongest for herring, sardine and tuna products (p < 0.0001; R = 0.5314). At the same time, while compared with other fish species, consuming herring was the strongest predictor of meeting the recommended vitamin D level of 10 µg (p = 0.0292; odds ratio (OR) = 1.94; 95% confidence interval (CI) 1.07–3.52), but also of 5 µg (p < 0.0001; OR = 2.54; 95% CI 1.85–3.47). Therefore, taking into account the relatively low prices of herring, its high vitamin D content, as well as its influence on total vitamin D intake, it could be beneficial to recommend young women to increase herring intake in order to increase dietary vitamin D intake and to meet its recommendations.

The association between nutrient patterns and metabolic syndrome among Iranian adults: cross-sectional analysis of Shahedieh cohort study

OBJECTIVE

To assess the association between patterns of nutrient intake and metabolic syndrome (MetS) in a large sample of Iranian adults.

DESIGN

Baseline data from the Shahedieh cohort study were used in the current cross-sectional study. Dietary intakes were assessed through the use of a validated semi-quantitative FFQ. Nutrient patterns (NP) were derived using factor analysis. The MetS was defined according to criteria introduced from the National Cholesterol Education Program Adult Treatment Panel III, modified for Iranian adults.

SETTING

Yazd, Iran.

PARTICIPANTS

A total of 7325 Iranian adults aged between 30 and 75 years.

RESULTS

Three NP were identified. A significant positive association was found between adherence to semi-plant NP (characterised by the high intakes of P; vitamins B1, B3, B6 and B5; Se; Mg; Fe; protein; Cr; Cu; fibre; biotin; Mn; Zn and Na) and odds of MetS (OR 1·68, 95 % CI 1·43, 1·98). However, after adjusting for potential confounders, this association became non-significant. In addition, after taking potential confounders into account, individuals in the highest quintile of the semi-animal NP, rich in Ca; K; vitamins B2, B12, A, D, K and C; SFA; dietary cholesterol and trans-fatty acid, were 26 % more likely to have MetS compared with those in the lowest quintile (OR 1·26, 95 % CI 1·05, 1·51). No significant association was seen between adherence to the high-carbohydrate/low-fat NP and odds of MetS.

CONCLUSIONS

We found that adherence to a semi-animal NP was associated with increased odds of MetS.

Nutrient patterns and depressive symptoms among Australian adults

PURPOSE

Much of the current literature on the associations between diet and depression focus on single nutrients rather than nutrient patterns (NPs). We investigated the association between NPs and depressive symptoms (DepS) in an Australian adult population.

METHODS

DepS were examined at two different time points, in 2010 (Stage 3, n = 1743, 49.0% males) and 2015 [North West 2015 (NW15), n = 1,024, 46.6% males] of the North West Adelaide Health Study (NWAHS). Dietary habits were evaluated using a food frequency questionnaire (FFQ) at Stage 3. DepS were assessed using the Center for Epidemiological Studies Depression (CES-D) scale at Stage 3 and NW15. Principal component analysis was used to identify NPs as well as the factor structure of the CES-D. Log- and negative binomial regression analyses were used to assess the association between NPs and DepS scores. Ordinal logistic regression analysis was undertaken between the NPs and identified factors of the CES-D score.

RESULTS

Three NPs (from the FFQ) and two-factors (from the CES-D score) were obtained. After adjusting for known confounding variables, a 'plant-sourced' NP (β-carotene, fibre, vitamin C, potassium and α-carotene) was inversely associated with DepS at Stage 3 [prevalence ratio (PR)_Q4VsQ1, 0.78; 95% CI 0.66-0.92; p = 0.003], whereas an 'animal-sourced' (ω-3 fatty acid, monounsaturated fat, vitamin E and cholesterol) or 'mixed-source' (phosphorous, protein, vitamin B2, iodine and zinc) NP was not associated with DepS. There was an inverse relationship between the 'plant-sourced' NP and the '(absence of) positive-affect' factor from the CES-D in both stages.

CONCLUSION

The 'plant-sourced' NP is consistently and inversely associated with DepS; however, longitudinal studies are recommended to confirm these results.

Sociodemographic and Regional Determinants of Dietary Patterns in Russia

An empirical assessment of diets using a posteriori analysis allows us to define actual dietary patterns (DPs) in the food consumption structure of a population. This study represents an a posteriori assessment of DPs for the Russian population in general as well as their dependence on socio-demographic and regional parameters. The data were obtained from 21,923 individuals aged 25-64 years old from a Russian multicenter study of "Epidemiology of Cardiovascular Diseases in the Regions of the Russian Federation" conducted in 2013-2014. Cross-sectional study subjects were interviewed face-to-face in order to obtain data on their diet. DPs were defined using principal component analysis. Four DPs were specified as "Rational", "Salt", "Meat", and "Mixed"; all these variants together accounted for 55.9% of variance. Diets in gender and age groups corresponded to those for an all-Russian population; in several regions, the defined diets differed from the all-Russian ones. More favorable diet trends were observed among women, people with no family, people not working, and urban dwellers, and diet trends were more favorable with an increase in age, level of education, and material wealth. Thus, a posteriori DPs were defined for the Russian population, which were stable in sex/age groups and were mediated by the socio-demographic characteristics of the population.

Intake and contribution of food groups to vitamin D intake in a representative sample of adult Greek population

OBJECTIVES

Globally, vitamin D intake from food and supplements is low, consistent with the high prevalence of low serum 25-hydroxyvitamin D concentration. The aims of this study were to assess vitamin D intake and major relevant food contributors among Greek adults and to propose subsequent policies for intervention.

METHODS

Vitamin D from diet and supplements was estimated in adults (≥19 y of age) from two 24-h recalls using the Automated Multiple-Pass Method (vitamin D from food intake) and a drug and supplement questionnaire (vitamin D supplements). Over- and underreporters were identified using the Goldberg cutoff. The final analysis included 2218 individuals. The National Research Council method was used to account for within- and between-person variation. Vitamin D food intake adequacy was estimated based on the estimated average requirement (EAR) of 10 mcg/d, set by the Institute of Medicine. Major foods contributing to intake were identified and the effect on meeting EAR, of a potential food fortification example was examined.

RESULTS

Median vitamin D intake from food ranged from 1.16 to 1.72 and 1.01 to 1.26mcg/d in different age groups in men and women, respectively. Major food sources of vitamin D were fish (46%), meat (15%), and cereals (12%); however, >90% of the population in all age groups failed to meet the EAR, even when supplemental use was accounted for (~5% of the population consumed supplements).

CONCLUSION

Overall vitamin D intake is below the average requirements. Public health policies to increase the consumption of foods high in vitamin D or food fortification may significantly reduce the percentage of individuals who do not meet the recommendations.

Environmental Sustainability Perspectives of the Nordic Diet

"The Nordic diet" is an umbrella term that encompasses any interpretation that combines Food-Based Dietary Guidelines (FBDGs) with local Nordic foods. The five Nordic countries have collaborated on Nordic Nutrition Recommendations for forty years, including FBDGs, so their national guidelines are similar. The countries also share similar public health issues, including widespread nonconformity to the guidelines, although in different ways. The aim of this concept paper is to discuss environmental sustainability aspects of the Nordic diet, describe the status of and make suggestions for the inclusion of sustainability in future work on the Nordic diet. We exploit the sustainability-health synergy. A food intake more in line with the current FBDGs, which emphasises more plant-based and less animal-based foods, is necessary for high environmental sustainability. In turn, sustainability is an important motivator for health-promoting dietary shifts. Policy development requires long-term efforts. Since the Nordic diet can be considered a further development and improvement of old, traditional diets, there is huge potential to formulate a Nordic diet that benefits both human and planetary health. It is time for concerted engagement and actions-a new Nordic nutrition transition.

Changes in dietary intake, plasma carotenoids and erythrocyte membrane fatty acids in breast cancer survivors after a lifestyle intervention: results from a single-arm trial

BACKGROUND

The influence of nutrition on breast cancer prognosis is still inconclusive and therefore dietary interventions incorporating dietary biomarkers are needed to confirm compliance with dietary goals and clarify biological mechanisms. The present study assessed whether a lifestyle intervention in breast cancer survivors could affect dietary biomarkers of fruit and vegetables and fatty acids.

METHODS

In this phase II single-arm trial, 37 overweight/obese early stage breast cancer patients completed a 12-week diet and exercise intervention. The intervention involved 1-h weekly diet sessions delivered by a dietician and 75-min bi-weekly physical activity sessions of moderate-to-high intensity led by trained monitors. Before and after the intervention, three 24-h dietary recalls were carried out to calculate nutrient intakes and, in addition, blood samples were taken to measure plasma carotenoids, vitamin E and retinol concentrations and erythrocyte membrane fatty acid (EFA) composition. Wilcoxon signed rank tests were used to assess changes in dietary and biomarkers measurements over the intervention period.

RESULTS

After the intervention, there was a significant increase in the intake of dietary carotenoids (+15.1% compared to baseline) but not plasma carotenoids levels (+6.3%). Regarding the EFA levels, we observed a significant decrease in percentage of saturated fatty acids (-1.4%) and n-6 polyunsaturated fatty acids (-2.9%) and an increase in monounsaturated fatty acids (1.7%) and total and long-chain n-3 polyunsaturated fatty acids (by 13.1% and 13.7%, respectively). A favourable decrease in the ratio of long-chain n-6 to n-3 polyunsaturated fatty acids (-9.1%) was also observed.

CONCLUSIONS

After a short-term diet and exercise intervention in overweight/obese breast cancer survivors, we observed significant changes in dietary nutrients and fatty acid biomarkers, suggesting positive dietary changes that could be relevant for breast cancer prognosis.

Association between nutrient patterns and serum lipids in Chinese adult women: A cross-sectional study

AIM

To investigate the association between patterns of nutrient intake and serum lipids in Chinese women aged 18-80 years.

METHODS

In the present study, cross-sectional data were analysed from 2886 female participants aged 18-80 years from the China Health and Nutrition Survey wave 2009. Nutrient patterns were identified using factor analysis combined with cluster analysis based on the data of nutrient intake for three consecutive days. Multivariate linear regression models were used to estimate the association of nutrient patterns with serum lipids.

RESULTS

Four nutrient patterns were identified in Chinese adult women, which were the plant-based pattern, carbohydrate and animal fat pattern, plant fat and sodium pattern, and the animal-based pattern. Participants following different patterns varied significantly in sociodemographic characteristics, lifestyle behaviours and food consumption. Compared with the plant-based pattern, the carbohydrate and animal fat pattern was positively associated with low-density lipoprotein cholesterol (β = 4.57, 95% CI: 0.29-8.85, P = 0.036) and total cholesterol (β = 4.89, 95% CI: 0.34-9.44, P = 0.035). The corresponding rises for the animal-based pattern were 4.91 (95% CI: 0.99-8.82, P = 0.014) and 4.98 (95% CI: 0.82-9.15, P = 0.019), respectively.

CONCLUSIONS

Nutrient patterns with a high intake of animal fat and a low intake dietary fibre and with high intakes of animal fat, animal protein and cholesterol may increase the serum cholesterol in Chinese women.

Cultural Differences in Diet and Determinants of Diet Quality in Switzerland: Results from the National Nutrition Survey menuCH

Sociodemographic differences in dietary consumption were observed in different populations. The current study aimed to identify sociodemographic and lifestyle determinants of diet quality and to investigate the differences in diet quality between the three main language regions of Switzerland. Using data of the Swiss National Nutrition Survey menuCH (n = 2057), two diet quality scores—Alternate Healthy Eating Index and Mediterranean Diet Score—were computed. Linear regression models were used to investigate the determinants of diet quality and chi-square tests were used to test for differences in single score components between language regions. Significantly higher diet quality scores were observed for individuals who were female, older, normal weight, non-Swiss, with tertiary education or moderate-to-high physical activity level. Additionally, residents of the French- and Italian-speaking parts of Switzerland scored higher than residents of the German-speaking region. More specifically, the higher diet quality observed in the French- and Italian-speaking regions was mediated by higher scores in the components of alcohol, dairy products, fat, fish, sugar-sweetened beverages and whole grains. The present results may help to better characterize population groups requiring specific dietary recommendations, enabling public health authorities to develop targeted interventions.

Dietary Patterns and Their Sociodemographic and Lifestyle Determinants in Switzerland: Results from the National Nutrition Survey menuCH

From a public health perspective, determinants of diets are crucial to identify, but they remain unclear in Switzerland. Hence, we sought to define current dietary patterns and their sociodemographic and lifestyle determinants using the national nutrition survey menuCH (2014⁻2015, n = 2057). First, we applied multiple factorial analysis and hierarchical clustering on the energy-standardised daily consumption of 17 food categories. Four dietary patterns were identified ("Swiss traditional": high intakes of dairy products and chocolate, n = 744; "Western 1": soft drinks and meat, n = 383; "Western 2": alcohol, meat and starchy, n = 444; and "Prudent": n = 486). Second, we used multinomial logistic regression to examine the determinants of the four dietary patterns: ten sociodemographic or lifestyle factors (sex, age, body mass index, language region, nationality, marital status, income, physical activity, smoking status, and being on a weight-loss diet) were significantly associated with the dietary patterns. Notably, belonging to the French- and Italian-speaking regions of Switzerland increased the odds of following a "Prudent" diet (Odds ratio [95% confidence interval]: 1.92 [1.45⁻2.53] and 1.68 [0.98⁻2.90], respectively) compared to the German-speaking regions. Our findings highlight the influence of sociodemographic and lifestyle parameters on diet and the particularities of the language regions of Switzerland. These results provide the basis for public health interventions targeted for population subgroups.

Association between breakfast composition and abdominal obesity in the Swiss adult population eating breakfast regularly

BACKGROUND

Evidence from experimental and observational studies is limited regarding the most favorable breakfast composition to prevent abdominal fat accumulation. We explored the association between breakfast composition (a posteriori derived dietary patterns) and abdominal obesity among regular breakfast eaters from a Swiss population-based sample.

METHODS

The cross-sectional survey assessed diet using two 24-h dietary recalls in a nationally representative sample of adults aged 18 to 75 years. We derived dietary patterns using principal component analysis based on the intake of 22 breakfast-specific food groups. All regular breakfast eaters were predicted an individual score for each identified pattern, and then classified into tertiles (T1, T2, T3). We defined abdominal obesity as waist-to-hip ratio (WHR) ≥ 0.9 in men and ≥ 0.85 in women. Logistic models were adjusted for sociodemographic characteristics, relevant nutrition- and health-related behaviors, and diet quality during the rest of the day.

RESULTS

Of the 2019 included survey participants, 1351 (67%) were regular breakfast eaters. Among them, we identified three breakfast types: 1) 'traditional' - white bread, butter, sweet spread, 2) 'prudent' - fruit, unprocessed and unsweetened cereal flakes, nuts/seeds, yogurt, and 3) 'western' - processed breakfast cereals, and milk. The 'prudent' breakfast was negatively associated with abdominal obesity. After full adjustment, including diet quality during the rest of the day, the association was weaker (T3 vs. T1: OR 0.72, 95% CI: 0.47 to 1.08). People taking a 'prudent' breakfast (in T3) had 1.2% lower WHR compared to people taking a breakfast distant from 'prudent' (in T1) (P = 0.02, fully adjusted model with continuous log-WHR). We found no association between 'traditional' or 'western' breakfasts and WHR (OR 1.00, 95% CI: 0.67 to 1.50 and OR 1.16, 95% CI: 0.79 to 1.71, respectively). Findings were in the same directions for the three breakfast types when defining obesity with waist circumference, waist-to-height ratio, or body mass index (≥ 30 kg/m2, for 'prudent' breakfast: OR 0.51, 95% CI: 0.31 to 0.85).

CONCLUSIONS

Regular breakfast consumers had less abdominal obesity if their breakfast was composed of fruit, natural cereal flakes, nuts/seeds and yogurt. This association was partly explained by their healthier diet during the rest of the day.

TRIAL REGISTRATION

ISRCTN16778734 .

Assessment of Nutrient and Food Group Intakes across Sex, Physical Activity, and Body Mass Index in an Urban Brazilian Population

The burden of preventable diet-related diseases is significant and becoming worse. Thus, accurately assessing food intake is crucial to guide public health policies and actions. Using food dietary recalls, we evaluated usual dietary intake according to physical activity and nutritional status in an adult urban population from Brasília, Brazil. The usual nutrient and energy intakes distributions were estimated using the Iowa State University (ISU) method. Energy and nutrient intakes were stratified by gender, age group, body mass index (BMI), and physical activity (PA). The prevalence of inadequate intake was highest for vitamins E and D. Both men and women had excessive sodium intake. The percentage of intakes below daily serving recommendations for food groups were 96% for cereals, 74% for vegetables, and 87% for dairy products, whereas percentage of intakes above daily serving recommendations were 97% for meat, 93% for pulses, and 99% for fat/oils. Energy and nutrient intakes were highest in overweight and physically active individuals within the categories of BMI and physical activity, respectively. Our study found that high-income urban Brazilians consume large quantities of meat, beans, fat/oils, and exhibit a low prevalence of nutrient inadequacies but have excessive sodium intake. Energy and nutrient intakes are highest among men, as well as overweight and physically active individuals.

Dietary Intake of Vitamin D in the Czech Population: A Comparison with Dietary Reference Values, Main Food Sources Identified by a Total Diet Study

The usual dietary intake of vitamin D was studied in 10 subgroups of the Czech population. Food consumption data was collected using repeated 24 h recall in a national cross-sectional survey (the Study of Individual Food Consumption, SISP04), and the vitamin D content in marketed foods was quantified within the national Total Diet Study (2014⁻2015). The Monte Carlo Risk Assessment computational model (version MCRA 8.2) was used to assess usual intake. The median vitamin D intakes for the Czech population (aged 4⁻90 years, both genders) were within a range of 2.5⁻5.1 μg/day. The highest median intake, excluding dietary supplements, was observed in men aged 18⁻64, and the lowest was observed in children aged 4⁻6 and girls aged 11⁻17. The main sources in the diet were hen eggs (21⁻28% of usual dietary intake), fine bakery wares (11⁻19%), cow's milk and dairy products (7⁻23%), meat and meat products (4⁻12%), fish (6⁻20%), and margarines (7⁻18%). The dietary intake of vitamin D for more than 95% of the Czech population was below the recommended Dietary Reference Values (DRVs). These findings should encourage public health authorities to support interventions and education and implement new regulatory measures for improving intake.

Mediterranean Diet Reduces Risk of Incident Stroke in a Population With Varying Cardiovascular Disease Risk Profiles

Background and Purpose—

Although some evidence has found that the Mediterranean diet (MD) is protective for stroke risk, few studies have investigated whether this relationship differs by sex or cardiovascular disease risk.

Methods—

We investigated the relationship between adherence to the MD score, estimated using 7-day dietary diaries and risk of incident stroke in an observational prospective population-based cohort study of 23 232 men and women (54.5% women) aged 40 to 77 years who participated in the European Prospective Investigation into Cancer study in Norfolk, United Kingdom. Risk of incident stroke was calculated using multivariable Cox regression, in the whole population, and also stratified by sex and cardiovascular disease risk profile, using the Framingham risk score.

Results—

During 17.0 years of follow-up (395 048 total person-years), 2009 incident strokes occurred. Risk of stroke was significantly reduced with greater adherence to the MD score (quartile 4 versus quartile 1 hazard ratio [HR], 0.83; 95% CI, 0.74-0.94; P-trend <0.01) in the whole population and in women (quartile 4 versus quartile 1 HR, 0.78; 95% CI, 0.65, 0.93; P-trend <0.01) but not in men (quartile 4 versus quartile 1 HR, 0.94; 95% CI, 0.79-1.12; P-trend =0.55). There was reduced risk of stroke in those at high risk of cardiovascular disease and across categories of the MD score (quartile 4 versus quartile 1 HR, 0.87; 95% CI, 0.76-0.99; P-trend =0.04). However, this was driven by the associations in women (quartile 4 versus quartile 1 HR, 0.80; 95% CI, 0.65-0.97; P-trend =0.02).

Conclusions—

Greater adherence to the MD was associated with lower risk of stroke in a UK white population. For the first time in the literature, we also investigated the associations between the MD score in those at both low and high risk of cardiovascular disease. Although the findings in our study were driven by the associations in women, they have implications for the general public and clinicians for prevention of stroke.

A new food-composition database for 437 polyphenols in 19,899 raw and prepared foods used to estimate polyphenol intakes in adults from 10 European countries

BACKGROUND

Accurate assessment of polyphenol intakes is needed in epidemiologic research in order to study their health effects, and this can be particularly challenging in international study settings.

OBJECTIVE

The purpose of this work is to describe the procedures to prepare a comprehensive polyphenol food-composition database that was used to calculate standardized polyphenol intakes from 24-h diet recalls (24HDRs) and dietary questionnaires (DQs) in the European Prospective Investigation into Cancer and Nutrition (EPIC).

Design

With the use of the comparable food classification and facet-descriptor system of the computerized 24HDR program EPIC-Soft (renamed GloboDiet), foods reported in the 24HDR (n = 74,626) were first aggregated following a stepwise process. Multi-ingredient and generic foods were broken down into ingredients or more-specific foods with consideration of regional consumption habits before matching to foods in the Phenol-Explorer database. Food-composition data were adjusted by using selected retention factors curated in Phenol-Explorer. DQ foods (n = 13,946) were matched to a generated EPIC 24HDR polyphenol-composition database before calculation of daily intakes from the 24HDR and DQ.

RESULTS

Food matching yielded 2.0% and 2.7% of foods with missing polyphenol content in the 24HDR and DQ food data sets, respectively. Process-specific retention factors for 42 different polyphenol compounds were applied to adjust the polyphenol content in 35 prioritized Phenol-Explorer foods, thereby adjusting the polyphenol content in 70% of all of the prepared 24 food occurrences. A detailed food-composition database was finally generated for 437 polyphenols in 19,899 aggregated raw and prepared foods reported by 10 EPIC countries in the 24HDR.

Conclusions

An efficient procedure was developed to build the most-comprehensive food-composition database for polyphenols, thereby standardizing the calculations of dietary polyphenol intakes obtained from different dietary assessment methods and European populations. The whole database is accessible online. This procedure could equally be used for other food constituents and in other cohorts.

Micronutrient dietary patterns associated with type 2 diabetes mellitus among women of the E3N-EPIC (Etude Epidémiologique auprès de femmes de l'Education Nationale) cohort study

BACKGROUND

Micronutrients play a key role in type 2 diabetes mellitus (T2DM), but methodological difficulties arise from their collinearity and interdependencies with foods. The aim of the present study was to identify micronutrient dietary patterns in the E3N-EPIC (Etude Epidémiologique auprès de femmes de l'Education Nationale) cohort and to investigate their association with risk of T2DM.

METHODS

Principal component analysis was used to identify micronutrient patterns among 71 270 women from the E3N-EPIC cohort. Associations between micronutrient patterns and risk of T2DM were quantified by hazard ratios (HRs) and 95% confidence intervals (CIs) from Cox proportional hazards regression models, adjusted for potential confounders.

RESULTS

Six micronutrient patterns were identified explaining 78% of the total variance in micronutrient intake. A positive association was found between T2DM and a pattern highly correlated with intake of vitamins B₂ and B₅ (HR 1.34; 95% CI 1.16-1.56). Similarly, a positive association was found with a pattern characterized by high intakes of vitamin B₁₂ and retinol, and a low intake of vitamin C (HR 1.30; 95% CI 1.15-1.48). An inverse association was observed between T2DM and another two patterns: one correlated with magnesium and vitamin B₃ (HR 0.75; 95% CI 0.66-0.86), and the other correlated with manganese intake (HR 0.82; 95% CI 0.72-0.94).

CONCLUSIONS

The findings of the present study identify micronutrients that have an effect on the risk of T2DM, and enable better understanding of the complexity of the diet when investigating the association between micronutrients and T2DM.

Prediagnostic Serum Vitamin D Levels and the Risk of Crohn's Disease and Ulcerative Colitis in European Populations: A Nested Case-Control Study

Background

A low vitamin D status has been put forward as a potential risk factor for the development of inflammatory bowel disease (IBD). This study investigated the association between prediagnostic circulating vitamin D concentrations and dietary intakes of vitamin D, and the risk of Crohn's disease (CD) and ulcerative colitis (UC).

Methods

Among 359,728 participants of the European Prospective Investigation into Cancer and Nutrition cohort, individuals who developed CD or UC after enrollment were identified. Each case was matched with2 controls by center, gender, age, date of recruitment, and follow-up time. At cohort entry, blood samples were collected and dietary vitamin D intakes were obtained from validated food frequency questionnaires. Serum 25-hydroxyvitamin D levels were measured using liquid chromatography-tandem mass spectrometry. Conditional logistic regression was performed to determine the odds of CD and UC.

Results

Seventy-two participants developed CD and 169 participants developed UC after a median follow-up of 4.7 and 4.1 years, respectively. Compared with the lowest quartile, no associations with the 3 higher quartiles of vitamin D concentrations were observed for CD (p trend = 0.34) or UC (p trend = 0.66). Similarly, no associations were detected when serum vitamin D levels were analyzed as a continuous variable. Dietary vitamin D intakes were not associated with CD (p trend = 0.39) or UC (p trend = 0.83).

Conclusions

Vitamin D status was not associated with the development of CD or UC. This does not suggest a major role for vitamin D deficiency in the etiology of IBD, although larger studies are needed to confirm these findings.

Major Differences in Diet across Three Linguistic Regions of Switzerland: Results from the First National Nutrition Survey menuCH

Switzerland is a multilingual country located between Germany, France and Italy, which differ by dietary habits and related outcomes. We explored differences in food consumption as well as compliance to the Swiss food-based dietary guidelines (FBDG) across the German-, French-, and Italian-speaking regions. The 2014-2015 nationwide cross-sectional survey was conducted among a stratified random sample of 2057 adults aged 18 to 75 years. Trained dietitians assessed food consumption via two non-consecutive 24-h dietary recalls using the international validated software GloboDiet®. Recorded foods and beverages were classified into six groups and 31 subgroups relevant for assessing compliance to the FBDG (Swiss Food Pyramid). Usual daily intake distributions were modelled and weighted for sampling design, non-response, weekdays and season. Participation rate was 38%. Significant differences across regions were observed in 18 of 31 food subgroups (p ≤ 0.01). Weighted mean daily intakes in the German-, French- and Italian-speaking regions were, respectively, 245 g, 155 g, 140 g for soft drinks, 273 g, 214 g, 135 g for coffee, 127 g, 72 g, 109 g for milk, 32 g, 45 g, 43 g for red meat, 18 g, 29 g, 34 g for fish/seafood, 8.1 g, 6.4 g, 3.7 g for butter, and 206 g, 214 g, 168 g for vegetables. The seven FBDGs were followed by <1% of the population. Four in 10 participants met ≥3 FBDG. Eighteen percent of participants ate ≥5 portions of fruit and vegetables a day, without regional differences. Food consumption substantially differed across the three linguistic regions of Switzerland. Adherence to FBDG was uniformly low. This highlights the potential influence of culture on diet. Nutritional education along with public health interventions are needed and may be most efficient if regionally targeted.

Hydroxytyrosol in the Prevention of the Metabolic Syndrome and Related Disorders

Virgin olive oil (VOO) constitutes the main source of fat in the Mediterranean diet. VOO is rich in oleic acid, displaying health-promoting properties, but also contains minor bioactive components, especially phenolic compounds. Hydroxytyrosol (HT), the main polyphenol of olive oil, has been reported to be the most bioactive component. This review aims to compile the results of clinical, animal and cell culture studies evaluating the effects of HT on the features of Metabolic Syndrome (MetS) (body weight/adiposity, dyslipidemia, hypertension, and hyperglycemia/insulin resistance) and associated complications (oxidative stress and inflammation). HT was able to improve the lipid profile, glycaemia, and insulin sensitivity, and counteract oxidative and inflammatory processes. Experimental studies identified multiple molecular targets for HT conferring its beneficial effect on health in spite of its low bioavailability. However, rodent experiments and clinical trials with pure HT at biologically relevant concentrations are still lacking. Moreover, the roles of intestine and its gut microbiota have not been elucidated.

Decreasing the overall environmental impact of the Dutch diet: how to find healthy and sustainable diets with limited changes

OBJECTIVE

To find diets optimised on nutrition and environmental impact close to the current Dutch diet and to identify the most effective and acceptable options for mitigating environmental impact.

DESIGN

Linear programming was used to optimise diets of Dutch men and women aged 9-69 years, divided into ten age-gender groups. The analysis included nutrient composition, a metric for popularity and life cycle assessments of 207 food products. Greenhouse gas emissions, fossil energy use and land occupation were used to calculate a weighted score for the overall environmental impact. Optimised diets were solutions that minimised changes to the current diet while satisfying all nutritional constraints, with stepwise reductions in environmental impact.

SETTING

The Netherlands.

SUBJECTS

Dutch children and adults aged 9-69 years.

RESULTS

Meat was always reduced. Vegetable, fruit and dairy contents remained similar, while bread, fatty fish and legumes increased. The extent of changes depended on age and gender. Beverages were not heavily reduced. Nutrients critical for the outcome were α-linoleic acid, retinol, Ca, Na, Se, dietary fibre, SFA, thiamin and Fe (women of childbearing age). Total protein, essential amino acids and carbohydrates were not critical.

CONCLUSIONS

Reducing meat is the most effective option for lowering the environmental impact of diets in all age-gender groups. Reducing alcoholic and non-alcoholic beverages is another option. Leaving out fish and dairy products are not. The differences in nutritional requirements related to age and gender have a significant effect on the composition of the optimised diets.

Prevalence of Vitamin D Deficiency and Its Associations with Skin Color in Pregnant Women in the First Trimester in a Sample from Switzerland

Vitamin D deficiency in pregnancy has negative clinical consequences, such as associations with glucose intolerance, and has been shown to be distributed differently in certain ethnic groups. In some countries, a difference in the rate of vitamin D deficiency was detected in pregnant women depending on their skin color. We examined the prevalence of vitamin D deficiency (<20 ng/mL) in women in early pregnancy in Switzerland and evaluated the association of skin color with vitamin D deficiency. In a single-center cohort study, the validated Fitzpatrick scale and objective melanin index were used to determine skin color. Of the 204 pregnant women included, 63% were vitamin D deficient. The mean serum 25-hydroxyvitamin D concentration was 26.1 ng/mL (95% confidence interval (CI) 24.8-27.4) in vitamin D-sufficient women and 10.5 ng/mL (95% CI 9.7-11.5) in women with deficiency. In the most parsimonious model, women with dark skin color were statistically significantly more often vitamin D deficient compared to women with light skin color (OR 2.60; 95% CI 1.08-6.22; adjusted for age, season, vitamin D supplement use, body mass index, smoking, parity). This calls for more intense counseling as one policy option to improve vitamin D status during pregnancy, i.e., use of vitamin D supplements during pregnancy, in particular for women with darker skin color.

Inflammatory potential of the diet and mortality in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain)

SCOPE

Low-grade chronic inflammation is associated with several chronic conditions, and diet is known to play a role in chronic inflammation. We aimed to evaluate the association between the inflammatory potential of the diet and mortality in the Spanish population from the European Prospective Investigation into Cancer and Nutrition (EPIC-Spain).

METHODS AND RESULTS

The study included 41 199 participants (62% female) aged 29-69 years from five Spanish regions. During 18 years of follow-up 3316 deaths were identified. The dietary inflammatory potential was assessed by means of an inflammatory score of the diet (ISD), calculated using 30 dietetic components and their corresponding inflammatory scores (weights). The association between the ISD and mortality was analyzed by multivariate Cox regression models. There was a significant association between ISD and mortality: subjects classified in the fifth quintile of the ISD (more proinflammatory diets) had a hazard ratio of 1.42 (95%-confidence interval 1.25-1.60) as compared with those in the first quintile; the corresponding figures were 1.89 (1.48-2.40) for cardiovascular diseases mortality and 1.44 (1.22-1.69) for death by cancer.

CONCLUSION

Consuming more proinflammatory diets, expressed by means of the ISD, is associated with higher mortality; this effect seems to be stronger for deaths by cardiovascular diseases.

Nutrient Patterns Associated with Fasting Glucose and Glycated Haemoglobin Levels in a Black South African Population

Type 2 diabetes (T2D) burden is increasing globally. However, evidence regarding nutrient patterns associated with the biomarkers of T2D is limited. This study set out to determine the nutrient patterns associated with fasting glucose and glycated haemoglobin the biomarkers of T2D. Factor analysis was used to derive nutrient patterns of 2010 participants stratified by urban/rural status and gender. Principal Component Analysis (PCA) was applied to 25 nutrients, computed from the quantified food frequency questionnaires (QFFQ). Three nutrient patterns per stratum, which accounted for 73% of the variation of the selected nutrients, were identified. Multivariate linear regression models adjusted for age, BMI, smoking, physical activity, education attained, alcohol intake, seasonality and total energy intake were computed. Starch, dietary fibre and B vitamins driven nutrient pattern was significantly associated with fasting glucose (β = −0.236 (−0.458; −0.014); p = 0.037) and glycated haemoglobin levels (β = −0.175 (−0.303; −0.047); p = 0.007) in rural women. Thiamine, zinc and plant protein driven nutrient pattern was associated with significant reductions in glycated haemoglobin and fasting glucose ((β = −0.288 (−0.543; −0.033); p = 0.027) and (β = −0.382 (−0.752; −0.012); p = 0.043), respectively) in rural men. Our results indicate that plant driven nutrient patterns are associated with low fasting glucose and glycated haemoglobin levels.

Multiple Sclerosis Epidemiology in Europe

Multiple sclerosis is characterized by a non-homogeneous distribution around the world. Some authors in past described a latitude gradient, with increasing risk from the equator to North and South Poles, but this theory is still controversial. Regarding Europe, there are many articles in the literature concerning the epidemiology of this disease but, unfortunately, they are not always comparable due to different methodologies, they do not cover all countries in the continent, and most of them reported data of small areas and rarely at a national level. In 2012 there were 20 national registries that could help to describe the epidemiology of the disease and, in addition, there is an European Register for Multiple Sclerosis that collect data from already existing national or regional MS registries and databases. Another valid alternative to obtain epidemiological data, also at national level, in a routinely and cost-saving way is through administrative data that are of increasing interest in the last years.