Dietary fiber and health outcomes: an umbrella review of systematic reviews and meta-analyses

Relationship between dietary fiber and all-cause mortality, cardiovascular mortality, and cardiovascular disease in patients with chronic kidney disease: a systematic review and meta-analysis

BACKGROUND

The potential protective effects of dietary fiber against all-cause mortality, cardiovascular mortality, and cardiovascular disease in patients with chronic kidney disease have not been definitively established. To verify this relationship, a systematic review and a meta-analysis were undertaken.

METHODS

PubMed, The Cochrane Library, Web of Science, Embase, ProQuest, and CINAHL were used to systematically search for prospective cohort studies that investigate the association between dietary fiber and all-cause mortality, cardiovascular mortality, and cardiovascular disease in individuals with chronic kidney disease (CKD). This search was conducted up to and including March 2023.

RESULTS

The analysis included 10 cohort studies, with a total of 19,843 patients who were followed up for 1.5-10.1 y. The results indicated a significant negative correlation between dietary fiber and all-cause mortality among patients with CKD (HR 0.80, 95% CI 0.58-0.97, P < 0.001). Subgroup analysis further revealed that the study population and exposure factors were significantly associated with all-cause mortality (P < 0.001). Increased dietary fiber intake was associated with a reduced risk of cardiovascular mortality (HR 0.78; 95% CI 0.67-0.90) and a reduced incidence of cardiovascular disease (HR 0.87; 95% CI 0.80-0.95) among patients with CKD.

CONCLUSIONS

The pooled results of our meta-analysis indicated an inverse association between dietary fiber intake and all-cause mortality, cardiovascular mortality, and cardiovascular disease.

Dietary fiber intake and all-cause and cause-specific mortality: An updated systematic review and meta-analysis of prospective cohort studies

BACKGROUND

Accumulating evidence supports the effects of dietary fiber on the risk of non-communicable diseases (NCDs). However, there is no updated systematic review and meta-analysis that compares and pools the effect of different types of fiber on mortality.

METHODS

In this systematic review and meta-analysis, all prospective cohort studies that evaluated the relationship between dietary fiber intake and all-cause or cause-specific mortality were included. The PubMed, SCOPUS, and Web of Science databases were searched up to October 2022. Data extraction and quality assessment were performed by two researchers independently. Heterogeneity between studies was assessed using Chi-square based test. Random/fixed effect meta-analysis was used to pool the hazard ratios (HR) or relative risks (RR) and 95 % confidence intervals (CI) for the association between different types of fiber and mortality.

RESULTS

This systematic review included 64 eligible studies, with a total sample size of 3512828 subjects, that investigated the association between dietary fiber intake and mortality from all-cause, cardiovascular disease (CVD), and cancer. Random-effect meta-analysis shows that higher consumption of total dietary fiber, significantly decreased the risk of all-cause mortality, CVD-related mortality, and cancer-related mortality by 23, 26 and 22 % (HR:0.77; 95%CI (0.73,0.82), HR:0.74; 95%CI (0.71,0.77) and HR:0.78; 95%CI (0.68,0.87)), respectively. The consumption of insoluble fiber tended to be more effective than soluble fiber intake in reducing the risk of total mortality and mortality due to CVD and cancer. Additionally, dietary fiber from whole grains, cereals, and vegetables was associated with a reduced risk of all-cause mortality, while dietary fiber from nuts and seeds reduced the risk of CVD-related death by 43 % (HR:0.57; 95 % CI (0.38,0.77)).

CONCLUSION

This comprehensive meta-analysis provides additional evidence supporting the protective association between fiber intake and all-cause and cause-specific mortality rates.

Vegetarian Nutrition in Chronic Kidney Disease

There is rising interest globally with respect to the health implications of vegetarian or plant-based diets. A growing body of evidence has demonstrated that higher consumption of plant-based foods and the nutrients found in vegetarian and plant-based diets are associated with numerous health benefits, including improved blood pressure, glycemic control, lipid levels, body mass index, and acid-base parameters. Furthermore, there has been increasing recognition that vegetarian and plant-based diets may have potential salutary benefits in preventing the development and progression of chronic kidney disease (CKD). While increasing evidence shows that vegetarian and plant-based diets have nephroprotective effects, there remains some degree of uncertainty about their nutritional adequacy and safety in CKD (with respect to protein-energy wasting, hyperkalemia, etc.). In this review, we focus on the potential roles of and existing data on the efficacy/effectiveness and safety of various vegetarian and plant-based diets in CKD, as well as their practical application in CKD management.

Increasing fibre in white flour and bread: Implications for health and processing

Dietary fibre is beneficial for human health, but dietary intakes are below recommended levels in most countries. Cereals are the major source of dietary fibre in Western diets, with bread providing about 20% of the daily intake in the United Kingdom. Despite the promotion of fibre-rich wholegrain products, white bread (which has a lower fibre content) remains dominant in many countries due to cultural preferences. Increasing the fibre content of white bread and other products made from white flour is therefore an attractive strategy for increasing fibre intake. This can be achieved by exploiting genetic variation in wheat without major effects on the processing quality or the consumer acceptability of products. Modelling data for food consumption in the United Kingdom shows that increasing the fibre content of white flour by 50% (from about 4% to 6% dry weight) and in wholegrain by 20% will increase total fibre intake by 1.04 g/day and 1.41 g/day in adult females and males, respectively. Furthermore, in vitro studies indicate that the increased fibre content of white bread should reduce the rate of starch digestion and glucose release in the human gastrointestinal tract.

Plant-based diets: a fad or the future of medical nutrition therapy for children with chronic kidney disease?

Plant-based diets are growing in popularity worldwide due to the importance of reducing the population's ecological footprint as well as an emerging role in the prevention and treatment of chronic human diseases. In adults, plant-based diets have been shown to be beneficial for preventing and controlling conditions that are common in patients with chronic kidney disease (CKD), such as obesity, hypertension, type 2 diabetes, dyslipidemia, and metabolic acidosis. Emerging evidence suggests that the higher fiber content of plant-based diets may help to modulate production of uremic toxins through beneficial shifts in the gut microbiome. The effects of the plant-based diet on progression of CKD remain controversial, and there are no data to support this in children. However, knowledge that the bioavailability of potassium and phosphorus from plant-based foods is reduced has led to recent changes in international kidney-friendly diet recommendations for children with CKD. The new guidelines advise that high potassium fruits and vegetables should no longer be automatically excluded from the kidney-friendly diet. In fact, a plant-based diet can be safely implemented in children with CKD through building the diet around whole, high fiber foods, avoiding processed foods and using recommended cooking methods to control potassium. The health benefits of the plant-based diet compared to omnivorous diets in children with CKD need investigation.

Pancreatic Ductal Adenocarcinoma and Nutrition: Exploring the Role of Diet and Gut Health

The incidence of pancreatic cancer is increasing worldwide. The most common form is represented by pancreatic ductal adenocarcinoma (PDAC) which has been shown to be linked to chronic inflammation. Notably, the gut microbiota has emerged as a critical player in regulating immune responses and inflammation. Indeed, intestinal dysbiosis, characterized by an imbalance in the gut microbiota composition, can contribute to the initiation of chronic inflammation. Sterile chronic inflammation can occur, probably activated by the translocation of bacterial components, such as lipopolysaccharide (LPS), the major component of Gram-negative microbiota, with the consequent induction of innate mucosal immunity, through the activation of Toll-like receptors (TLRs). Furthermore, the interaction between LPS and TLRs could enhance cancer progression. Recent research has shed light on the pivotal role of nutrition, as a modifiable risk factor, in PDAC immunological processes, particularly focusing on the immuno-modulatory effects of the gut microbiota. Different dietary regimens, fiber intake, immunonutrients, and antioxidants have the potential to either exacerbate or mitigate chronic inflammation, thereby influencing the pathogenesis and natural history of PDAC. These dietary components may affect the gut microbiota composition and, consequently, the level of inflammation, either promoting or protecting against PDAC. In this review of reviews, we discuss the modulatory role of nutrition and the gut microbiota in PDAC's immunological processes to explore a translational therapeutic approach that could improve the survival and quality of life of these patients.

Dietary fiber - a scoping review for Nordic Nutrition Recommendations 2023

Dietary fiber is a term crudely defined as carbohydrates (CHOs) that escape digestion and uptake in the small intestine. Lignin, which is not a CHO, is also a part of the dietary fiber definition. Dietary fibers come in different sizes and forms, with a variety of combinations of monomeric units. Health authorities worldwide have for many years recommended a diet rich in dietary fibers based on consistent findings that dietary fibers are associated with reduced incidences of major non-communicable diseases, including obesity, type 2 diabetes, cardiovascular disease, and colorectal cancer. Most fibers come from common edible foods from the plant kingdom, but fibers are also found in food additives, supplements, and breast milk. The recommended intake in Nordic Nutrition Recommendations 2012 (NNR2012) is 25 g/d for women and 35 g/d for men, whereas the actual intake is significantly lower, ranging from 16 g/d to 22 g/d in women and 18 g/d to 26 g/d in men. New studies since NNR2012 confirm the current view that dietary fiber is beneficial for health, advocating intakes of at least 25 g/day.

Transarterial Chemoembolization Plus Sorafenib versus Transarterial Chemoembolization Alone for Advanced Hepatocellular Carcinoma: An Umbrella Review of Meta-Analyses and Systematic Reviews

BACKGROUND

Sorafenib is the standard treatment for most cases of advanced hepatocellular carcinoma (HCC), based on Western and Eastern clinical guidelines. Thus, an increasing number of transarterial chemoembolization (TACE) plus sorafenib combination therapies have been used in clinical practice. In addition, several systematic reviews and meta-analyses have explored the efficacy and safety of the combination of TACE and sorafenib. Therefore, we performed an umbrella review to summarize and evaluate these evidence-based studies.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to June 1, 2023. All meta-analyses that evaluated the effect of TACE plus sorafenib on HCC were considered eligible. The quality of the included meta-analyses was evaluated by AMSTAR2 (A Measurement Tool to Assess Systematic Reviews). The quality of evidence per association provided in the meta-analyses was rated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). This study was registered with PROSPERO (Registration ID: CRD42023420417).

RESULTS

We included 12 meta-analyses, including randomized clinical trials, cohort studies, and observational studies. A total of 44 associations with overall survival, survival rate, time to disease progression, overall response rate, disease control rate, and adverse events were evaluated in this umbrella review. The quality of most associations ranged from low to very low, indicating that flaws were significant in the current meta-analyses.

CONCLUSION

This umbrella review identified beneficial associations between TACE and sorafenib combination therapy in advanced HCC. However, owing to the low certainty of the evidence, clinicians should interpret our results with caution when applying them in clinical practice, and high-quality studies are required in the future to confirm our results.

Dietary intake of total vegetable, fruit, cereal, soluble and insoluble fiber and risk of all-cause, cardiovascular, and cancer mortality: systematic review and dose-response meta-analysis of prospective cohort studies

Objectives

To conduct a systematic review and meta-analysis of prospective cohort studies to investigate the association between total, vegetable, fruit, cereal, soluble and insoluble fiber intake and risk of all causes, cardiovascular disease (CVD), and cancer mortality and quantitatively assess the dose-response relation.

Methods

Eligible studies were identified by searching PubMed, Embase and Web of science before August 2023. Random effects models were used to calculate summary relative risk (RR) and 95% confidence intervals (CI) and restricted cubic splines to model the linear/non-linear association.

Results

The summary RR for all-cause, CVD and cancer mortality of dietary fiber was 0.90 (95% CI: 0.86,0.93), 0.87 (0.84,0.91), 0.91 (0.88,0.93), respectively. Significant association was observed for all-cause and CVD mortality with fruit, vegetable cereal and soluble fiber intake and cancer mortality with cereal fiber intake. No significant association was found for insoluble fiber, vegetable or fruit fiber intake and cancer mortality. Dose-response analysis showed a significant non-linear relation of dietary fiber intake with all-cause mortality, and linear relation for others.

Conclusions

Higher dietary fiber including different type and food sources of fiber intake were associated with lower risk of mortality. Our findings provide more comprehensive evidence on dietary fiber intake with mortality.

Systematic review registration

https://www.crd.york.ac.uk/prospero, identifier: CRD42022338837.

Dietary glycemic index, glycemic load and all-cause and cause-specific mortality: A meta-analysis of prospective cohort studies

BACKGROUND & AIMS

The findings of previous studies investigating the association between dietary glycemic index, glycemic load, and the risk of mortality have been inconsistent. We performed a meta-analysis to evaluate this association.

METHODS

A systematic search in PubMed and Web of Science databases was conducted to identify prospective cohort studies on dietary glycemic index and load with risk of mortality through January 2023. Study-specific relative risks (RR) were combined by using random effects models.

RESULTS

Fifteen prospective cohort studies with a total of 527,650 participants and 48,598 all-cause and cause-specific deaths were included in the current meta-analysis. Pooled analyses indicated a higher risk of all-cause mortality (RR = 1.10, 95% CI: 1.00-1.20) and stroke mortality (RR = 1.30, 95% CI: 1.04-1.62) for the highest versus lowest levels of glycemic index. A significant non-linear association was found between glycemic index and mortality of all-causes (P for non-linearity = 0.02) and CVD (P for non-linearity <0.001), indicating increased risk at high levels of glycemic index (≥63.1 for all-cause mortality; ≥72.8 for CVD mortality). Glycemic load was positively associated with risk of CVD mortality (RR = 1.18, 95% CI: 1.09-1.27) and stroke mortality (RR = 1.30, 95% CI: 1.05-1.60) in the highest versus lowest meta-analysis. For cancer mortality, there was no significant association with glycemic index, but the association with glycemic load differed by sex.

CONCLUSIONS

Our results indicated that high glycemic index and glycemic load was associated with an increased risk of mortality from CVD and stroke. Further large prospective studies are warranted to provide definitive evidence in subgroups.

Associations between Normal-Weight Obesity and Disturbances in the Lipid Profile of Young Adults

BACKGROUND

Normal-weight obesity (NWO) is characterized by normal body mass index (BMI) but high body fat percentage (%BF) that increases the risks of cardiometabolic comorbidities. Accurate assessment and interpretation of body composition data are necessary to reduce these risks.

OBJECTIVES

To compare the cardiometabolic profile of individuals with NWO and normal %BF and evaluate the associated risk factors.

METHODS

A cross-sectional study was conducted with 222 Brazilian adults from a university community, of whom 157 had NWO and 65 had normal BMI and %BF (non-NWO). All participants reported being asymptomatic and without underlying health conditions. Socioeconomic, lifestyle, food intake, anthropometry, body composition measures (using dual-energy radiological absorptiometry), and lipid and glycemic profiles were evaluated. A p < 0.05 was established as significant.

RESULTS

The median age of the participants was 23 years (interquartile range: 21 to 25), and most were female (67.1%). No significant differences were found in blood pressure, age, or physical activity levels between the NWO and non-NWO groups. However, the frequency of lipid profile disturbances was higher in the NWO group (54%) compared to the non-NWO group (34%) (p < 0.006). Neck circumference, %BF, and lipid profile disturbances were positively associated with NWO.

CONCLUSION

Individuals with NWO have a worse cardiometabolic profile than those without NWO, and this condition is associated with important biomarkers. Addressing these outcomes is important for preventing long-term cardiometabolic complications. Accurate assessment and interpretation of body composition data, regardless of BMI, are crucial in this scenario.

Dietary Models and Cardiovascular Risk Prevention in Pediatric Patients

Nutritional intervention is worldwide recognized as a first step treatment for subjects with increased cardiovascular risk and it is of utmost importance especially for children and adolescents. Currently scientific evidence supports the role of dietary patterns instead of simple single nutrients or foods in cardiovascular risk prevention. Indeed, the American Heart Association dietary guidelines have expanded beyond nutrients to dietary pattern, that comprise not only single food items but also behavioral or cultural habits of specific populations. The aim of our narrative review is to analyze the most frequently adopted dietary patterns in children and adolescents and to evaluate their effect on cardiovascular risk factors and in cardiovascular risk prevention. Literature review showed that children cannot be considered as little adults: nutritional intervention must always grant adequate growth and neurodevelopment before reaching the proposed goals, therefore dietary patterns considered heart-healthy for adult subjects might not be suitable for pediatric patients. Mediterranean diet, DASH diet, Nordic diet and some plant-based diets seem to be the most promising dietary patterns in terms of cardiovascular health in the developmental age, even if further studies are needed to better standardize and analyze their effect on growing up individuals.

The relative role of soil, climate, and genotype in the variation of nutritional value of Annona senegalensis fruits and leaves

Annona senegalensis Pers is a multipurpose tree species valued for food and medicinal uses in Africa. Although there have been attempts to document the proximate composition of fruits and leaves, little is known about the relative role of soil, climate, and genotype on the nutritional quality. The present study evaluated the variation of the proximate composition of fruits and leaves in populations from Benin and Mozambique. It further assessed the impact of soil, climate and genotype on the proximate composition. Data were collected from four populations genetically different and analyzed using descriptive statistics, analysis of variance (ANOVA), principal component analysis, redundancy analysis (RDA), and variance partitioning. Results revealed significant variation in the proximate composition of fruits and leaves among the studied populations. Ashes and fibers in fruits, and lipids in leaves were 4.8-fold, 2.5- fold, and 1.25-fold higher respectively, in populations from Mozambique. Fruits moisture and lipids content were rather 1.4-fold and 1.10-fold higher in populations from Benin. Moisture and lipids were respectively 6-fold and 1.27-fold higher in fruits than in leaves, while ashes, fibers and proteins were approximately twice higher in the leaves than in the fruits. Genetic groups, climate and soils were found to influence this variation. All three factors explained 74.4% of the variation of nutritional value of fruits and leaves, 31.9% of which was exclusively due to genetic variation, 2.8% to the interaction of climate and soils, 24.1% to the interaction of soil and genetic variation, and 15.5% to the interaction of all three factors. Our study shows that genetic variation and soil properties better than climate, explain the variation of nutritional value of A. senegalensis fruits and leaves and further provides essential information that could be harnessed in the domestication and breeding program of the species for its edible parts.

Maternal dietary fiber intake during pregnancy and child development: the Japan Environment and Children's Study

Background

Animal studies have shown that maternal low-fiber diets during pregnancy may impair brain development and function in offspring, but this has not been validated by epidemiological studies. The aim of this study was to investigate the link between maternal dietary fiber intake during pregnancy and neurodevelopmental delay in offspring using a large birth cohort.

Methods

A total of 76,207 mother-infant pairs were analyzed using data from the Japan Environment and Children's Study, a nationwide prospective cohort study. Maternal dietary fiber intake was estimated using the food frequency questionnaire in mid-pregnancy. Maternal dietary fiber intake was adjusted for energy and classified into quintiles. Developmental delay was assessed in five domains using the Japanese version of the Ages and Stages Questionnaire, Third Edition at the age of 3 years. The logistic regression analysis was performed to estimate the odds ratio (OR) and 95% confidence interval (CI) for the link between dietary fiber intake during pregnancy and developmental delay at the age of 3 years.

Results

The lowest intake group of total dietary fiber had a higher risk of delayed communication [adjusted OR (aOR), 1.51; 95% CI, 1.32-1.74], fine motor (aOR, 1.45; 95% CI, 1.32-1.61), problem-solving (aOR, 1.46; 95% CI, 1.32-1.61), and personal-social skills (aOR, 1.30; 95% CI, 1.12-1.50) than did the highest intake group. An analysis that excluded the effects of insufficient folic acid intake during pregnancy also showed a similar trend.

Conclusion

This study showed that maternal dietary fiber deficiency during pregnancy might influence an increased risk of neurodevelopmental delay in offspring.

A case-control study on the association between adherence to a Mediterranean-style diet and breast cancer

Background

Previous studies on the association between diet and breast cancer are mostly from Western populations, and data from Middle East countries are scarce, where the prevalence of breast cancer is high; therefore, it ranks first among other cancers. This population-based case-control study aimed to investigate the relationship between a Mediterranean-style diet and breast cancer among Iranian women.

Methods

In the current study, 350 new cases of breast cancer and 700 age- and socioeconomic status-matched controls were enrolled. We evaluated the dietary intakes of participants by using a 106-item Willett-format semi-quantitative dish-based food frequency questionnaire (SQ-FFQ). We calculated the Mediterranean diet score according to the dietary intakes of participants. In addition, using pre-tested questionnaires, we collected information on potential confounding variables.

Results

In this study, we found a significant inverse association between the Mediterranean diet and breast cancer so that after controlling for potential confounders, individuals in the highest tertile of the Mediterranean diet score compared with those in the lowest tertile were 57% less likely to have breast cancer [odds ratio (OR): 0.43, 95% confidence interval (CI): 0.28-0.67]. Such an inverse association was also observed for postmenopausal women. Similarly, after controlling for potential confounding variables, high adherence to the Mediterranean dietary pattern was associated with lower odds of breast cancer (OR: 0.37, 95% CI: 0.23-0.60). However, this relationship was not significant among premenopausal women.

Conclusion

We found that adherence to Mediterranean dietary pattern was associated with reduced odds of breast cancer. Studies with prospective design are needed to further examine this association.

The Association between Dietary Fiber Intake and Serum Klotho Levels in Americans: A Cross-Sectional Study from the National Health and Nutrition Examination Survey

BACKGROUND

Klotho is an aging-related marker closely associated with a number of diseases. A growing body of evidence suggests that dietary factors and lifestyle habits can impact serum Klotho levels. The effect of dietary fiber, a key component of a healthy diet, on the body's serum Klotho levels has not been fully elucidated.

OBJECTIVE

The aim of this study was to explore the relationship between dietary fiber intake and serum Klotho levels in people aged 40-79 years in the United States.

METHODS

A total of 11,282 participants were included in this study, all from the National Health and Nutrition Examination Survey from 2007 to 2016. Dietary fiber intake was assessed by uniformly trained interviewers using the 24 h dietary recall method. Serum Klotho was quantified using commercially available ELISA kits manufactured by IBL International, Japan. The relationship between dietary fiber intake and serum Klotho levels was analyzed using a multiple linear regression model. Subsequently, the non-linear dose-response relationship between the two was further explored using a restricted cubic spline (RCS) model.

RESULTS

After adjusting for potential confounders, serum Klotho levels increased by 1.9% (95% confidence interval [CI]: 0.8%, 3.0%) for each interquartile range increase in dietary fiber intake in all participants. Considering dietary fiber intake as a categorical variable, serum Klotho levels were found to be 4.7% higher in participants in the highest quartile of dietary fiber intake than in those in the lowest quartile (95% CI: 1.8%, 7.6%). RCS plots depicted a non-linear positive correlation between dietary fiber intake and serum Klotho levels. Subgroup analysis revealed that the relationship between dietary fiber intake and serum Klotho levels was more pronounced in older (percentage change: 7.0%; 95% CI: 2.5%, 11.7%) and overweight and obese participants (percentage change: 4.9%; 95% CI: 1.5%, 8.4%).

CONCLUSIONS

The results of this study showed that dietary fiber intake was significantly associated with serum Klotho levels in participants. This finding is yet to be further confirmed by prospective studies.

Dietary Recommendations for Ethiopians on the Basis of Priority Diet-Related Diseases and Causes of Death in Ethiopia: An Umbrella Review

Food-based dietary guidelines (FBDG) need to be evidence-based. As part of the development of Ethiopian FBDG, we conducted an umbrella review to develop dietary recommendations. Protein-energy malnutrition (PEM), deficiencies of vitamin A, zinc, calcium, or folate, cardiovascular diseases (CVD), and type 2 diabetes mellitus (T2DM) were selected as a priority. Systematic reviews were eligible if they investigated the impact of foods, food groups, diet, or dietary patterns on priority diseases. After a search, 1513 articles were identified in PubMed, Scopus, and Google Scholar published from January 2014 to December 2021. The results showed that 19 out of 164 systematic reviews reported the impact of diet on PEM or micronutrient deficiencies. Daily 30-90 g whole-grain consumption reduces risk of CVD and T2DM. Pulses improve protein status, and consuming 50-150 g/d is associated with a reduced incidence of CVD and T2DM. Nuts are a good source of minerals, and consuming 15-35 g/d improves antioxidant status and is inversely associated with CVD risk. A daily intake of 200-300 mL of milk and dairy foods is a good source of calcium and contributes to bone mineral density. Limiting processed meat intake to <50 g/d reduces CVD risk. Fruits and vegetables are good sources of vitamins A and C. CVD and T2DM risks are reduced by consuming 200-300 g of vegetables plus fruits daily. Daily sugar consumption should be below 10% of total energy to lower risk of obesity, CVD, and T2DM. Plant-based fat has favorable nutrient profiles and modest saturated fat content. The association of saturated fatty acids with CVD and T2DM is inconclusive, but intake should be limited because of the low-density lipoprotein cholesterol-raising effect. Plant-based diets lower risk of CVD and T2DM but reduce micronutrient bioavailability. The review concludes with 9 key dietary recommendations proposed to be implemented in the Ethiopian FBDG. This review was registered at PROSPERO (CRD42019125490).

Perspective: Plant-Based Meat Alternatives Can Help Facilitate and Maintain a Lower Animal to Plant Protein Intake Ratio

The health and environmental advantages of plant-predominant diets will likely lead to increasing numbers of consumers reducing their reliance on animal products. Consequently, health organizations and professionals will need to provide guidance on how best to make this change. In many developed countries, nearly twice as much protein is derived from animal versus plant sources. Potential benefits could result from consuming a higher share of plant protein. Advice to consume equal amounts from each source is more likely to be embraced than advice to eschew all or most animal products. However, much of the plant protein currently consumed comes from refined grains, which is unlikely to provide the benefits associated with plant-predominant diets. In contrast, legumes provide ample amounts of protein as well other components such as fiber, resistant starch, and polyphenolics, which are collectively thought to exert health benefits. But despite their many accolades and endorsement by the nutrition community, legumes make a negligible contribution to global protein intake, especially in developed countries. Furthermore, evidence suggests the consumption of cooked legumes will not substantially increase over the next several decades. We argue here that plant-based meat alternatives (PBMAs) made from legumes are a viable alternative, or a complement, to consuming legumes in the traditional manner. These products may be accepted by meat eaters because they can emulate the orosensory properties and functionality of the foods they are intended to replace. PBMAs can be both transition foods and maintenance foods in that they can facilitate the transition to a plant-predominant diet and make it easier to maintain. PBMAs also have a distinct advantage of being able to be fortified with shortfall nutrients in plant-predominant diets. Whether existing PBMAs provide similar health benefits as whole legumes, or can be formulated to do so, remains to be established.

Association of Eating Pattern, Chronotype, and Social Jetlag: A Cross-Sectional Study Using Data Accumulated in a Japanese Food-Logging Mobile Health Application

Chronotype (morningness-eveningness) and social jetlag (SJL; discrepancy in the sleep pattern between the weekday and weekend) are related to eating behavior and health. The association between sleep behavior and the daily macro- and micronutrient eating pattern of each meal (breakfast, lunch, and dinner) have not been discussed well and need more evidence. Here, meal pattern datasets of Japanese participants aged 20-59 years were obtained as averages over 1 month from the data stored in the food-logging app "Asken". We allocated three groups for each chronotype and SJL. Multiple regression analyses revealed that morning chronotype and small SJL were associated with higher total daily intake of potassium, fiber, magnesium, phosphorus, and vitamin K. Breakfast energy intake and consumption of nutrients, including protein, lipid, carbohydrate, and minerals, were higher in the morning chronotype or small SJL. Lunch intake of potassium, cholesterol, fiber, magnesium, and vitamin K was also higher in the morning chronotype or small SJL. Dinner energy intake and nutrient intake of proteins, lipids, carbohydrates, sodium, and saturated fatty acids were lower in the morning chronotype or small SJL. The current data would help to establish a detailed reference for dietary intake which considers eating patterns over a day.

Ultra-Processed Food, Reward System and Childhood Obesity

Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies.

Cross-Sectional Study to Map Nutritional Quality of Meat, Fish, and Dairy Alternatives in Dutch Supermarkets According to the Dutch Food-Based Dietary Guidelines and Nutri-Score

Due to a growing challenge to feed the world's population and an increased awareness to minimize the impact of our food choices on climate change, a more plant-based diet has gained popularity with a growing number of plant-based products on the market. To stimulate a plant-based diet that also improves long-term health, data are needed to monitor whether these products are healthy alternatives to animal-based foods. Therefore, this study inventoried 916 plant-based meat, fish, and dairy alternatives from eight Dutch supermarkets. The nutritional quality of each product was assessed by (1) the Dutch food-based dietary guidelines and (2) the Nutri-Score. The results show that over 70% of meat, fish, and dairy alternatives have an A/B Nutri-Score (indicating high nutritional quality), but do not comply with the Dutch dietary guidelines. This is mainly due to high salt and low vitamin B12 and iron content (meat and fish alternatives) or low protein and calcium levels (dairy alternatives). In conclusion, the majority of plant-based products are nutritionally not full alternatives of the animal-based equivalents; however, there are still opportunities for reformulation. To aid the consumer in making healthy plant-based food choices, a better alignment between the Nutri-Score and the recommended dietary guidelines is needed.

Are all fibres created equal with respect to lipid lowering? Comparing the effect of viscous dietary fibre to non-viscous fibre from cereal sources: a systematic review and meta-analysis of randomised controlled trials

Although compelling evidence from observational studies supports a positive association between consumption of cereal fibre and CVD risk reduction, randomised controlled trials (RCT) often target viscous fibre type as the prospective contributor to lipid lowering to reduce CVD risk. The objective of our study is to compare the lipids-lowering effects of viscous dietary fibre to non-viscous, cereal-type fibre in clinical studies. RCT that evaluated the effect of viscous dietary fibre compared with non-viscous, cereal fibre on LDL cholesterol and alternative lipid markers, with a duration of ≥ 3 weeks, in adults with or without hypercholesterolaemia were included. Medline, EMBASE, CINAHL and the Cochrane Central Register were searched through October 19, 2021. Data were extracted and assessed by two independent reviewers. The generic inverse variance method with random effects model was utilised to pool the data which were expressed as mean differences (MD) with 95 % CI. Eighty-nine trials met eligibility criteria (n 4755). MD for the effect of viscous dietary fibre compared with non-viscous cereal fibre were LDL cholesterol (MD = -0·26 mmol/l; 95 % CI: -0·30, -0·22 mmol/l; P < 0·01), non-HDL cholesterol (MD = -0·33 mmol/l; 95 % CI: -0·39, -0·28 mmol/l; P < 0·01) and Apo-B (MD = -0·04 g/l; 95 % CI: -0·06, -0·03 g/l; P < 0·01). Viscous dietary fibre reduces LDL cholesterol and alternative lipid markers relative to the fibre from cereal sources, hence may be a preferred type of fibre-based dietary intervention targeting CVD risk reduction.

Habitual low carbohydrate high fat diet compared with omnivorous, vegan, and vegetarian diets

Background

Dietary patterns which exclude whole food groups, such as vegetarian, vegan and low carbohydrate high fat diet (LCHF), are increasingly popular in general public. When carefully planned, all these diets have some known benefits for health, but concerns are also raised in particular for LCHF. The quality of LCHF diet which individuals follow in real life without supervision is not known.

Methods

One hundred thirty healthy individuals with stable body mass following LCHF, vegan, vegetarian and omnivorous diet for at least six months, were compared in a cross-sectional study. Diet was analyzed through 3-day food records and FFQ, anthropometric measurements were performed and serum metabolic biomarkers determined from fasting blood.

Results

Participants on LCHF diet had the intakes of micronutrients comparable to other groups, while the intakes of macronutrients differed in line with the definition of each diet. The intakes of saturated fats, cholesterol and animal proteins were significantly higher and the intakes of sugars and dietary fibers were lower compared to other groups. Healthy eating index 2015 in this group was the lowest. There were no differences in the levels of glucose, triacylglycerols and CRP among groups. Total and LDL cholesterol levels were significantly higher in LCHF group, in particular in participants with higher ketogenic ratio. Fatty acids intakes and intakes of cholesterol, dietary fibers and animal proteins explained 40% of variance in total cholesterol level, with saturated fatty acids being the strongest positive predictor and monounsaturated fatty acids a negative predictor.

Conclusion

None of the self-advised diets provided all the necessary nutrients in optimal levels. Due to the detected increased levels of serum cholesterols, selection of healthy fat sources, higher intake of dietary fibers and partial replacing of animal sources with plant sources of foods should be recommended to the individuals selecting LCFH dietary pattern.Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04347213.

Rs15285, a functional polymorphism located in lipoprotein lipase, predicts the risk and prognosis of gastric cancer

Lipoprotein lipase (LPL), a crucial gene in lipid metabolism, has a significant role in the progression of malignant tumors. The purpose of this research was to investigate the impact of rs15285 found in the LPL gene's 3'UTR region on the risk, biological behavior, and gastric cancer (GC) prognosis as well as to examine its potential function. Genotyping of rs15285 in 888 GC cases and 874 controls was conducted by SNaPshot technology. We used bioinformatics analysis and in vitro experiments to study the role of rs15285. First, this study revealed for the first time that polymorphism rs15285 increases the risk of GC (OR = 1.48, 95%CI = 1.16-1.89, P = 0.002). Although no relationship was found between rs12585 and the pathological features of GC, the prognosis of individuals with the rs12585 TT genotype was poorer than that of patients with the CC or CC+CT genotype (HR = 2.39 for TT vs. CC, P = 0.025; HR = 2.38 for TT vs. CC+CT, P = 0.025). In addition, bioinformatics analysis showed rs12585 may affect the binding of miRNAs to LPL, resulting in an increase of LPL expression to promote cancer progression. Ultimately, in vitro tests revealed that the rs15285 T allele increased LPL expression on the mRNA as well as the protein levels, promoting GC cell proliferation, invasion, and metastasis. The LPL rs12528 TT genotype increased the risk of GC and predicted a poor prognosis. Mechanistically, the rs15285 T allele could improve the expression of LPL, and thus promotes the malignant phenotype of GC. Therefore, our study may provide new biological predictors and a theoretical basis for the prognosis and customized therapy of stomach cancer patients. KEY POINTS: • Rs15285 polymorphism is a risk factor for GC. • Rs12585 TT genotype predicts a bad outcome in GC individuals. • Rs15285 T allele enhances GC cells malignant biological behavior.

Dietary sugar consumption and health: umbrella review

OBJECTIVE

To evaluate the quality of evidence, potential biases, and validity of all available studies on dietary sugar consumption and health outcomes.

DESIGN

Umbrella review of existing meta-analyses.

DATA SOURCES

PubMed, Embase, Web of Science, Cochrane Database of Systematic Reviews, and hand searching of reference lists.

INCLUSION CRITERIA

Systematic reviews and meta-analyses of randomised controlled trials, cohort studies, case-control studies, or cross sectional studies that evaluated the effect of dietary sugar consumption on any health outcomes in humans free from acute or chronic diseases.

RESULTS

The search identified 73 meta-analyses and 83 health outcomes from 8601 unique articles, including 74 unique outcomes in meta-analyses of observational studies and nine unique outcomes in meta-analyses of randomised controlled trials. Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected. Moderate quality evidence suggested that the highest versus lowest dietary sugar consumption was associated with increased body weight (sugar sweetened beverages) (class IV evidence) and ectopic fatty accumulation (added sugars) (class IV evidence). Low quality evidence indicated that each serving/week increment of sugar sweetened beverage consumption was associated with a 4% higher risk of gout (class III evidence) and each 250 mL/day increment of sugar sweetened beverage consumption was associated with a 17% and 4% higher risk of coronary heart disease (class II evidence) and all cause mortality (class III evidence), respectively. In addition, low quality evidence suggested that every 25 g/day increment of fructose consumption was associated with a 22% higher risk of pancreatic cancer (class III evidence).

CONCLUSIONS

High dietary sugar consumption is generally more harmful than beneficial for health, especially in cardiometabolic disease. Reducing the consumption of free sugars or added sugars to below 25 g/day (approximately 6 teaspoons/day) and limiting the consumption of sugar sweetened beverages to less than one serving/week (approximately 200-355 mL/week) are recommended to reduce the adverse effect of sugars on health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022300982.

The global disease burden attributable to a diet low in fibre in 204 countries and territories from 1990 to 2019

OBJECTIVE

The relationship of a diet low in fibre with mortality has not been evaluated. This study aims to assess the burden of non-communicable chronic diseases (NCD) attributable to a diet low in fibre globally from 1990 to 2019.

DESIGN

All data were from the Global Burden of Disease (GBD) Study 2019, in which the mortality, disability-adjusted life-years (DALY) and years lived with disability (YLD) were estimated with Bayesian geospatial regression using data at global, regional and country level acquired from an extensively systematic review.

SETTING

All data sourced from the GBD Study 2019.

PARTICIPANTS

All age groups for both sexes.

RESULTS

The age-standardised mortality rates (ASMR) declined in most GBD regions; however, in Southern sub-Saharan Africa, the ASMR increased from 4·07 (95 % uncertainty interval (UI) (2·08, 6·34)) to 4·60 (95 % UI (2·59, 6·90)), and in Central sub-Saharan Africa, the ASMR increased from 7·46 (95 % UI (3·64, 11·90)) to 9·34 (95 % UI (4·69, 15·25)). Uptrends were observed in the age-standardised YLD rates attributable to a diet low in fibre in a number of GBD regions. The burden caused by diabetes mellitus increased in Central Asia, Southern sub-Saharan Africa and Eastern Europe.

CONCLUSIONS

The burdens of disease attributable to a diet low in fibre in Southern sub-Saharan Africa and Central sub-Saharan Africa and the age-standardised YLD rates in a number of GBD regions increased from 1990 to 2019. Therefore, greater efforts are needed to reduce the disease burden caused by a diet low in fibre.

Carrot and carotene and multiple health outcomes: an umbrella review of the evidence

In recent years, the benefits of carrots and carotene in different areas of health have been examined. The purpose of this umbrella review was to identify the associations between carrots and carotene and multiple health outcomes. The review considered evidence from meta-analyses of interventional and observational studies of carrots and carotene and any health outcome. We comprehensively searched Web of Science, PubMed, and Embase. For each association, we estimated the summary effect size using random and fixed effects models and the 95% confidence interval. A total of 1329 studies were searched, and 30 meta-analyses with 26 health outcomes were identified that met the eligibility criteria. Carrot intake was associated with a lower risk of multiple cancer outcomes including breast cancer, lung cancer, pancreatic cancer, gastric cancer, urothelial cancer, and prostate cancer. Carotene intake was associated with a lower risk of fracture, age-related cataract, sunburn, Alzheimer's disease, breast cancer, lung cancer, pancreatic cancer, gastric cancer, esophageal cancer, prostate cancer, and head and neck cancer (HNC). Serum carotene was inversely associated with all-cause mortality, breast cancer, and lung cancer. Our study revealed that carrot or carotene intake could reduce the risk of various negative health outcomes. © 2023 Society of Chemical Industry.

The effects of guar gum supplementation on glycemic control, body mass and blood pressure in adults: A GRADE-assessed systematic review and meta-analysis of randomized clinical trials

BACKGROUND

This systematic review and meta-analysis sought to evaluate the effects ofguar gum supplementation on glycemic control, blood pressure, and body mass in adults.

METHODS

Relevant studies were obtained by searching the PubMed, SCOPUS, Embase, and Web of Science databases (from inception to January 2022). Weighted mean differences (WMD) and 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity, sensitivity analysis, and publication bias were reported using standard methods.

RESULTS

Pooled analysis of 14 randomized controlled trials (RCTs) revealed that guar gum supplementation led to significant reductions in hemoglobin A1c (HbA1c) (WMD: -0.47 mg/dL, 95% CI: -0.75, -0.18, p = 0.001). However, there was no effect on fasting blood sugar (FBS), systolic and diastolic blood pressure, and body mass among adults in comparison with the control group. A subgroup analysis demonstrated that intervention in patients with type 2 diabetes (T2DM), and high supplementation dosages (>15 g/d) significantly decreased FBS concentrations, but not in other subgroups.

CONCLUSION

Guar gum supplementation may yield a beneficial effect on glycemic control in T2DM patients. However, the extant clinical trials, thus far, are not sufficient enough to form guidelines for clinical practice.

Determination of the level of evidence for the association between different food groups/items and dietary fiber intake and the risk of cardiovascular diseases and hypertension: An umbrella review

Evidence has suggested that nutrition is a preventive factor against cardiovascular disease (CVD) risk. Because of a sharp growth in published meta-analyses and pooled analyses in recent years, a reassessment of old evidence is needed. We aimed to determine the level of evidence for the association between the consumption of different food groups/items and dietary fiber and the incidence risk of CVDs, hypertension, and atrial fibrillation from meta-analyses and pooled analyses of observational studies. Databases Scopus, PubMed/Medline, and Web of Science were searched for related studies. Fifty-eight articles met the inclusion criteria for evidence grading. In summary, grading the level of evidence showed a suggestive inverse association between the higher consumption of fruits, whole grains, fish, legumes, nuts, and dietary fibers with the incidence risk of hypertension and different types of CVD. Also, there was a probable inverse association between the higher consumption of total and low-fat dairy products and the risk of hypertension. Higher red meat consumption had a probable association with the increased risk of ischemic stroke. Higher consumption of processed meat and poultry also had a suggestive direct association with the incidence risk of stroke and hypertension. We have tried to present a comprehensive and useful overview of the level of evidence based on the most updated findings. The summary of results in the current umbrella review can be a helpful tool for nutritionists, dietitians, and researchers to establish new studies and identify research gaps in related issues.

Serum metabolomics combined with 16S rRNA sequencing to reveal the effects of Lycium barbarum polysaccharide on host metabolism and gut microbiota

Gut microbes and microbial metabolites derived from polysaccharides mediate beneficial effects related to polysaccharides consumption. Lycium barbarum polysaccharide (LBP) is the main bioactive components in L. barbarum fruits and possesses considerable health-promoting effects. In the present study, we aimed to investigate whether LBP supplementation influenced host metabolic responses and gut microbiota in healthy mice, and to identify bacterial taxa associated with the observed beneficial effects. Our results indicated that mice supplied with LBP at 200 mg/kg BW showed lower serum total cholesterol (TC), triglyceride (TG), and liver TG levels. LBP supplementation strengthened the antioxidant capacity of liver, supported the growth of Lactobacillus and Lactococcus, and stimulated short-chain fatty acids (SCFAs) production. Serum metabolomic analysis revealed that fatty acid degradation pathways were enriched, and RT-PCR further confirmed that LBP up-regulated the expression of liver genes involved in fatty acid oxidation. The Spearman's correlation analysis indicated that some serum and liver lipid profiles and hepatic SOD activity were associated with Lactobacillus, Lactococcus, Ruminococcus, Allobaculum and AF12. Collectively, these findings provide new evidence for the potential preventive effect of LBP consumption on hyperlipidemia and nonalcoholic fatty liver disease.

A FOUR-YEAR CYCLE COMPARISON OF THE NUTRITIONAL AND CARDIOVASCULAR HEALTH STATUS OF AN ELITE-LEVEL FEMALE ARTISTIC GYMNAST: CASE STUDY REPORT FROM SLOVENIA

Regular monitoring of body composition, nutrition, health, and motor skills are crucial for further training process planning and performance progress. With the same protocol and methods, we evaluated a four-year change (2018 vs. 2022) in the nutritional and cardiovascular health status of the currently most successful elite-level adult female artistic gymnast in Slovenia. Detailed body composition and dietary intake were assessed using dual-energy X-ray absorptiometry and a standardized food questionnaire FFQ. The blood lipids and safety factors, blood pressure, and serum micronutrients (e.g., B12, 25-hydroxyvitamin D (25(OH)D), potassium, calcium, phosphorus, magnesium, and iron) status were measured. The four-year comparison showed an improved body composition status: decreased body fat mass/percentage, android fat percentage, and android/gynoid ratio, while other anthropometrical and body composition parameters remained essentially unchanged. We also measured an improvement of some and worsening of other cardiovascular health serum variables (i.e., decreased total cholesterol but increased low-density lipoprotein cholesterol and S-glucose), most likely due to the differences in assessed dietary intake (i.e., lower total fat, mono- and polyunsaturated fatty acid intake but higher cholesterol intake and still high free sugar and saturated fat intake, despite higher fiber). Notably, nutrient intakes that are generally of concern (fiber (borderline low intake), eicosapentaenoic omega-3 fatty acids and docosahexaenoic omega-3 fatty acids, vitamin B12 and D, calcium (borderline low intake), iron, and zinc) were within recommended ranges. However, the athlete’s vitamin E and potassium intakes were not adequate. Furthermore, in 2018, the athlete did not consume dietary supplements, while she now regularly uses several dietary supplements, including enriched plant-based protein powder, isolated vitamin B12, C, D, and iron. Moreover, the athlete had significantly lower than recommended serum levels of 25(OH)D, probably due to insufficient regular intake of vitamin D in the form of a dietary supplement (1000 IU/d). Moreover, from the micronutrient serum, phosphorus, and iron levels that deviated from the reference values in the 2018 study, in the current study, they were found to be within referenced ranges (i.e., iron status was markedly improved). This kind of screening toolbox, using valid, sensitive, and affordable methods and with rapid organizational implementation, may be a viable format for regular monitoring.

β(2 → 1)-β(2 → 6) branched graminan-type fructans and β(2 → 1) linear fructans impact mucus-related and endoplasmic reticulum stress-related genes in goblet cells and attenuate inflammatory responses in a fructan dependent fashion

Dietary fibers such as fructans have beneficial effects on intestinal health but it is unknown whether they impact goblet cells (GCs). Here we studied the effects of inulin-type fructans (ITFs) and graminan-type fructans (GTFs) with different molecular weights on mucus- and endoplasmic reticulum (ER) stress-related genes in intestinal GCs. To that end, GCs were incubated in the presence of ITFs or GTFs, or ITFs and GTFs + TNFα or the N-glycosylation inhibitor tunicamycin (Tm). IL-8 production by GCs was studied as a marker of inflammation. Effects between ITFs and GTFs were compared. We found a beneficial impact of GTFs especially on the expression of RETNLB. GTF II protects from the TNFα-induced gene expression dysregulation of MUC2, TFF3, GAL3ST2, and CHST5. Also, all the studied fructans prevented Tm-induced dysregulation of GAL3ST2. Interestingly, only the short chain fructans ITF I and GTF I have anti-inflammatory properties on GCs. All the studied fructans except ITF I decreased the expression of the ER stress-related HSPA5 and XBP1. All these benefits were fructan-structure and chain length dependent. Our study contributes to a better understanding of chemical structure-dependent beneficial effects of ITFs and GTFs on gut barrier function, which could contribute to prevention of gut inflammatory disorders.

Health Benefits of a 16-Week Whole Food, High Fiber, Plant Predominant Diet among U.S. Employees

PURPOSE

To assess improvements in eating behaviors and health measures among adults participating in a whole food plant predominant diet, Full Plate Living (FPL) program.

DESIGN

Retrospective, post hoc analysis of self-reported 16-week pre-post participant data obtained over a 3 year program period (2017-19).

SETTING

Wellness offering for employees in Southwest U.S.

SUBJECTS

Of 6,820 enrollees, 4,477 completed the program, further segmented by generational cohorts.

INTERVENTION

FPL program materials and weekly online video lessons.

MEASURES

Baseline and follow-up measures included eating behaviors, self-perceived health status and energy, body weight, and confidence in healthy eating and weight loss.

ANALYSIS

Paired t-tests were used to examine changes in eating behaviors and health measures. Mixed-effects models were used to examine whether changes among generational cohorts differed.

RESULTS

Significant pre-post improvements were demonstrated for all measures, including servings of fruits (1.54 to 2.34), vegetables (2.05 to 2.87), beans (.63 to .99), and weight loss (3.5) (P < .001). Self-perceived health and energy values, and confidence in making healthy food choices and losing weight improved (P < .001). Improvements were observed across generational cohorts (P < .001).

CONCLUSION

The FPL healthy eating approach has a beneficial impact on health measures across generational cohorts, and may be an effective addition to lifestyle medicine and corporate wellness offerings. Longer-term program evaluation is warranted.

Exposure to Commonly Used Drugs and the Risk of Gastric Cancer: An Umbrella Review of Meta-Analyses

Recently, attention has been paid to some medications and gastric cancer (GC) risk. This review aimed to evaluate associations between commonly used drugs and GC risk and to grade evidence from published systematic reviews and meta-analyses. This umbrella review was registered in PROSPERO (CRD42022320276). The systematic reviews and meta-analyses of observational studies were retrieved by searching Embase, PubMed, and Web of Science. The evidence strength of commonly used drugs and GC risk was categorized into four grades: weak, suggestive, highly suggestive, and strong. Of 19 associations between commonly used drugs and GC risk and its subtypes, none was supported by convincing or highly suggestive evidence. The risk of GC related to non-steroidal anti-inflammatory drugs (NSAIDs), non-aspirin NSAIDs, and acid-suppressive drugs, as well as the risk of non-cardia GC related to NSAIDs and aspirin, was supported by suggestive evidence. The results showed that a reduced GC risk was associated with two drug types (NSAIDs and non-aspirin NSAIDs), and an increased GC risk was associated with acid-suppressing drugs at the suggestive evidence level. Moreover, NSAIDs and aspirin reduced non-cardia GC risk as supported by suggestive evidence. However, the evidence supporting statins or metformin in reducing GC risk was weak, and thus future studies are required to clarify these associations.

The association between dietary fiber intake and severe headaches or migraine in US adults

Background

The data on the effect of dietary fiber on severe headaches or migraine are limited. Therefore, this study aimed to investigate the association between dietary fiber intake and the prevalence of severe headaches or migraine.

Methods

We conducted a cross-sectional study involving 12,710 participants, all data collected from NHANES 1999-2004. A multivariable logistic regression model was used to analyze the relationship between dietary fiber intake (as an independent variable) and severe headaches or migraine (as outcome variable). We also performed sensitivity analyses, including multiple sensitivity analyses.

Results

The overall incidence of severe headache or migraine in the study was 2527/12,710 (19.9%). After adjusting for correlation covariates, we found a significant inverse association between dietary fiber intake and severe headache or migraine, with lowest prevalence in the fifth quintile (OR: 0.74, 95% CI: 0.61-0.90). Our study also revealed that for every 10 g/day increase in dietary fiber intake, the prevalence of severe headache or migraine decreased by 11%. However, no such inverse association was found among Mexican Americans, other races, or those with a body mass index (BMI) of 25-30. E-value analysis suggested robustness to unmeasured confounding.

Conclusion

Increasing the intake of fiber-rich foods might protect from severe headache or migraine. More prospective studies should be conducted to confirm their association before dietary recommendations.

Risk factors for gastric cancer: A comprehensive analysis of observational studies

Background

Multifarious factors have a causal relationship with gastric cancer (GC) development. We conducted a comprehensive analysis to evaluate the strength of the evidence examining non-genetic risk factors for gastric cancer.

Methods

PubMed, Web of Science, and the Cochrane Library were searched from inception to November 10, 2021 to identify meta-analyses of observational studies examining the association between environmental factors and GC risk. For each meta-analysis, the random effect size, 95% confidence interval, heterogeneity among studies, and evidence of publication bias were assessed; moreover, the evidence was graded using predefined criteria, and the methodological quality was evaluated using AMSTAR 2.

Results

A total of 137 associations were examined in 76 articles. Among these meta-analyses, 93 associations yielded significant estimates (p < 0.05). Only 10 associations had strong epidemiologic evidence, including 2 risk factors (waist circumference and bacon), and 8 protective factors (dietary total antioxidant capacity, vegetable fat, cruciferous vegetable, cabbage, total vitamin, vitamin A, vitamin C, and years of fertility); 26 associations had moderate quality of evidence; and the remaining 57 associations were rated as weak. Ninety-four (68.61%) associations showed significant heterogeneity. Twenty-five (18.25%) associations demonstrated publication bias.

Conclusions

In this comprehensive analysis, multiple associations were found between environmental factors and GC with varying levels of evidence. Healthy dietary habits and lifestyle patterns could reduce the risk for GC. However, further high-quality prospective studies are still necessary to draw more definitive conclusions.

Increased dietary fiber is associated with weight loss among Full Plate Living program participants

Introduction

Prior studies have demonstrated that an intake of foods rich in dietary fiber is associated with a favorable impact on health status and body weight. However, the association between fiber intake and weight loss has not been well-studied in employer settings. This research aimed to assess the relationship between dietary fiber and weight loss among individuals participating in the Full Plate Living (FPL) program.

Methods

The 16-week plant-predominant fiber-rich eating program was delivered to 72 employers, primarily in the Southwest U.S., over 3 years (2017-2019). Participants received weekly video lessons, FPL materials, and additional online resources. A retrospective analysis of repeated measures was conducted using participant data obtained from 4,477 participants, of which 2,792 (62.5%) reduced body weight. Analysis of variance with post hoc analysis was used to assess the statistical significance of the changes between baseline and follow-up measures of dietary fiber intake in each of the food categories, specifically the relationship between changes in individual and combined (composite) daily servings of fruits, vegetables, whole grains, beans, and nuts on body weight measures among three groups at follow-up: those who lost, maintained, or gained weight. Multilevel modeling was used to test the hypothesis that increased intake of fiber was associated with greater weight loss.

Results

The mean weight loss for the weight loss group was 3.28 kg. As compared to the two other groups, the intake of whole fiber-rich foods at follow-up was significantly higher among the weight loss group with fruits (2.45 servings), vegetables (2.99 servings), beans (1.03 servings), and total fiber composites (9.07 servings; P < 0.001). A significant increase in servings of grains was also noted (P < 0.05). Multilevel modeling demonstrated that a higher total fiber composite (Model 1), as well as higher intakes of either vegetables or fruits (Model 2), resulted in greater weight loss.

Discussion

Our findings indicate that the FPL program can be a part of a lifestyle medicine approach to healthy eating and weight loss. Delivering the program in clinical, community, and workplace settings can increase its reach as an effective and low-cost offering.

Red ginseng dietary fiber promotes probiotic properties of Lactiplantibacillus plantarum and alters bacterial metabolism

Korean red ginseng has been widely used as an herbal medicine. Red ginseng dietary fiber (RGDF) is a residue of the processed ginseng product but still contains bioactive constituents that can be applied as prebiotics. In this study, we evaluated changes on fermentation profiles and probiotic properties of strains that belong to family Lactobacillaceae with RGDF supplementation. Metabolomic analyses were performed to understand specific mechanisms on the metabolic alteration by RGDF and to discover novel bioactive compounds secreted by the RGDF-supplemented probiotic strain. RGDF supplementation promoted short-chain fatty acid (SCFA) production, carbon source utilization, and gut epithelial adhesion of Lactiplantibacillus plantarum and inhibited attachment of enteropathogens. Intracellular and extracellular metabolome analyses revealed that RGDF induced metabolic alteration, especially associated with central carbon metabolism, and produced RGDF-specific metabolites secreted by L. plantarum, respectively. Specifically, L. plantarum showed decreases in intracellular metabolites of oleic acid, nicotinic acid, uracil, and glyceric acid, while extracellular secretion of several metabolites including oleic acid, 2-hydroxybutanoic acid, hexanol, and butyl acetate increased. RGDF supplementation had distinct effects on L. plantarum metabolism compared with fructooligosaccharide supplementation. These findings present potential applications of RGDF as prebiotics and bioactive compounds produced by RGDF-supplemented L. plantarum as novel postbiotic metabolites for human disease prevention and treatment.

Associations between diabetic retinopathy, mortality, disease, and mental health: an umbrella review of observational meta-analyses

BACKGROUND

Diabetic retinopathy is a complication of diabetes affecting the eyes and can lead to blindless if left untreated. Several significant risk factors have been reported for DR, of which several can be classified as some form of disease. Furthermore, several systematic reviews have reported associations between several types of mortality and DR. Numerous meta-analyses have pooled the data on these factors, however, a systematic evaluation of these meta-analytic relationships is lacking. In this study, therefore, we performed an umbrella review of systematic reviews of meta-analyses for mortality, diseases and DR, grading the credibility of evidence.

METHODS

A comprehensive database search for observational meta-analyses was conducted from inception until 29/04/2022 against pre-published inclusion criteria. For each meta-analytic outcome, a random-effects meta-analysis was re-conducted, stratifying by study design (and type of DR where possible) of included studies. Several statistical variables, including publication bias, heterogeneity, excess significance bias, and prediction intervals were used to grade the credibility of significant evidence from I to IV, using the recommendations from the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria.

RESULTS

Of the 1,834 initial results, 11 systematic reviews with meta-analyses were included covering 16 independent outcomes (total participants = 299,655; median participants per outcome: 7,266; median individual studies per outcome = 5). Overall, 10/16 outcomes (62.5%) yielded significant results, most of which were graded as 'highly suggestive' (Grade II) evidence. DR was associated with all-cause and cardio-vascular mortality, obstructive sleep apnoea, depression eating disorders, and several forms of cognitive impairment.

CONCLUSIONS

Results show highly suggestive evidence for associations between health outcomes and/or conditions and DR. Public health professionals and practitioners should note these findings when developing and/or reviewing public health polices.

Longitudinal trends in produce purchasing behavior: a descriptive study of transaction level data from loyalty card households

BACKGROUND

Household food purchases (HFP) are in the pathway between the community food environment and the foods available in households for consumption. As such, HFP data have emerged as alternatives to monitor population dietary trends over-time. In this paper, we investigate the use of loyalty card datasets as unexplored sources of continuously collected HFP data to describe temporal trends in household produce purchases.

METHODS

We partnered with a grocery store chain to obtain a loyalty card database with grocery transactions by household from January 2016-October 2018. We included households in an urban county with complete observations for head of household age group, household income group, and family size. Data were summarized as weighted averages (95% CI) of percent produce purchased out of all foods purchased by household per month. We modeled seasonal and linear trends in the proportion of produce purchases by age group and income while accounting for repeated observations per household using generalized estimating equations.

RESULTS

There are 290,098 households in the database (88% of all county households). At baseline, the smallest and largest percent produce purchases are observed among the youngest and lowest income (12.2%, CI 11.1; 13.3) and the oldest and highest income households (19.3, CI 18.9; 19.6); respectively. The seasonal variations are consistent in all age and income groups with an April-June peak gradually descending until December. However, the average linear change in percent produce purchased per household per year varies by age and income being the steepest among the youngest households at each income level (from 1.42%, CI 0.98;1.8 to 0.69%, CI 0.42;0.95) while the oldest households experience almost no annual change.

CONCLUSIONS

We explored the potential of a collaboration with a food retailer to use continuously collected loyalty card data for public health nutrition purposes. Our findings suggest a trend towards a healthier pattern in long-term food purchases and household food availability among the youngest households that may lessen the population chronic disease burden if sustained. Understanding the foods available for consumption within households allows public health advocates to develop and evaluate policies and programs promoting foods and nutrients along the life course.

Does a Plant-Based Diet Stand Out for Its Favorable Composition for Heart Health? Dietary Intake Data from a Randomized Controlled Trial

A plant-based diet (PBD) can provide numerous health benefits for patients with cardiovascular risk factors. However, an inadequately planned PBD also bear the potential for deficiencies in certain macro- and micronutrients. The present study analyzed nutrient profiles of individuals who adopted a PBD as part of the CardioVeg study. Participants with cardiovascular risk factors were randomly assigned to either a whole-food PBD intervention (n = 36; eight 90 min group meetings including two 120 min cooking sessions) or a control group asked to maintain an omnivorous diet (n = 34) for eight weeks. Food intake data were collected using three-day weighed food records and analyzed with NutriGuide software, including the German Nutrient Data Base (German: Bundeslebensmittelschlüssel). Nutrient intake was compared before and after eight weeks as well as between the groups. The results for both groups were then contrasted to the current dietary recommendations published by the societies for nutrition in Germany, Austria, and Switzerland. Moreover, anthropometric/laboratory data and ambulatory blood pressure monitoring were determined at baseline and after 8 weeks. Data of a subsample (n = 18 in the PBD group and n = 19 in the control group) were used for the present analyses of the dietary intake data. A PBD yielded several benefits including (but not limited to) a lower energy density, a lower intake of cholesterol and saturated fat, an increased consumption of fiber, and a lower intake of salt. Recommended intakes of most vitamins and minerals were generally met, except for vitamin B12 in the PBD group. A low intake of several other critical nutrients (vitamin D, iodine) was observed in both groups. Compared with the control group, PBD resulted in a significant decrease in body weight, body mass index, waist circumference, HbA1c, and fasting blood glucose after 8 weeks. Overall, it can be concluded that a PBD had a more favorable nutrient composition for cardiovascular health than the omnivorous dietary pattern of the control group.

Effectiveness of Technology Interventions in Addressing Social Isolation, Connectedness, and Loneliness in Older Adults: Systematic Umbrella Review

BACKGROUND

The global population of older adults (aged >60 years) is expected to triple to 2 billion by 2050. Proportionate rises in older adults affected by loneliness and social isolation (or social connectedness) are expected. Rapid deployability and social changes have increased the availability of technological devices, creating new opportunities for older adults.

OBJECTIVE

This study aimed to identify, synthesize, and critically appraise the effectiveness of technology interventions improving social connectedness in older adults by assessing the quality of reviews, common observations, and derivable themes.

METHODS

Following the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), 4 databases (PsycINFO, PubMed, Embase, and MEDLINE) were searched between February 2020 and March 2022. We identified reviews with adults aged ≥50 years in community and residential settings, reporting outcomes related to the impact of technologies on social disconnectedness with inclusion criteria based on the population, intervention, context, outcomes, and study schema-review-type articles (systematic, meta-analyses, integrative, and scoping)-and with digital interventions included. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to measure the strength of outcome recommendations including the risk of bias. The reviews covered 326 primary studies with 79,538 participants. Findings were extracted, synthesized, and organized according to emerging themes.

RESULTS

Overall, 972 publications met the initial search criteria, and 24 met our inclusion criteria. Revised Assessment of Multiple Systematic Reviews was used to assess the quality of the analysis. Eligible reviews (3/24, 12%) were excluded because of their low Revised Assessment of Multiple Systematic Reviews scores (<22). The included reviews were dedicated to information and communications technology (ICT; 11/24, 46%), videoconferencing (4/24, 17%), computer or internet training (3/24, 12%), telecare (2/24, 8%), social networking sites (2/24, 8%), and robotics (2/27, 8%). Although technology was found to improve social connectedness, its effectiveness depended on study design and is improved by shorter durations, longer training times, and the facilitation of existing relationships. ICT and videoconferencing showed the best results, followed by computer training. Social networking sites achieved mixed results. Robotics and augmented reality showed promising results but lacked sufficient data for informed conclusions. The overall quality of the studies based on GRADE was medium low to very low.

CONCLUSIONS

Technology interventions can improve social connectedness in older adults. The specific effectiveness rates favor ICT and videoconferencing, but with limited evidence, as indicated by low GRADE ratings. Future intervention and study design guidelines should carefully assess the methodological quality of studies and the overall certainty of specific outcome measures. The lack of randomized controlled trials in underlying primary studies (<28%) and suboptimal methodologies limited our findings. Robotics and augmented or virtual reality warrant further research. Low GRADE scores highlight the need for high-quality research in these areas.

TRIAL REGISTRATION

PROSPERO CRD42022363475; https://tinyurl.com/mdd6zds.

Hypertension, dietary fiber intake, and cognitive function in older adults [from the National Health and Nutrition Examination Survey Data (2011–2014)]

Background

Dietary fiber was associated with hypertension (HYP) and cognitive function, but it was unknown whether the effect of HYP on cognitive function in older adults was modified by dietary fiber intake.

Methods

We recruited 2,478 participants from the 2011–2012 and 2013–2014 National Health and Nutrition Examination Survey (NHANES), with cognitive performance measured by Registry for Alzheimer's disease (CERAD), the Animal Fluency test (AFT), and the Digit Symbol Substitution test (DSST). Multivariate General linear model was used to estimate the interaction between dietary fiber intake and HYP status in association with low cognitive performance.

Results

Among 2,478 participants, 36% was Controlled HYP, 25% was Low uncontrolled HYP, 11% was High uncontrolled HYP, and 86% was low dietary fiber intake. The association between HYP status and DSST impairment differed by dietary fiber intake for those with high uncontrolled HYP compared to those without HYP. Among participants with low dietary fiber intake, those with uncontrolled HYP had higher risk of DSST impairment compared to those without HYP [HYP ≥ 90/140: OR (95% CI), 1.68 (1.15–2.45); HYP ≥ 100/160: OR (95%CI), 2.05 (1.29–3.23)]; however, there was no association between HYP status and DSST impairment among participants with high dietary fiber intake. Moreover, the interaction of HYP status and dietary fiber intake on DSST was close to statistical significance (P for interaction = 0.057).

Conclusions

Uncontrolled HYP was associated with poorer cognitive performance in older adults with low, but not high dietary fiber intake. Sufficient dietary fiber intake might be as a new nutrition strategy for the prevention of cognitive impairment in older adults with uncontrolled HYP.

The role of dietary fibers in regulating appetite, an overview of mechanisms and weight consequences

Dietary fibers prevent obesity through reduction of hunger and prolongation of satiety. A number of mechanical and endocrine signals from gastrointestinal tract are stimulated by fibers and their fermentation products, reach regions of brain involved in the regulation of appetite, and ultimately reduce food intake. Gastric distention, delayed gastric emptying, prevention of hypoglycemic, increased amounts of unabsorbed nutrients reaching to the ileum, and stimulation of enteroendocrine cells for secretion of cholecystokinin, glucagon-like peptide-1 (GLP-1), and peptide YY are among mechanisms of fibers in decreasing hunger and prolongation of satiety. Fermentation of fibers produces short-chain fatty acids that also stimulates enteroendocrine cells to secrete GLP-1 and PYY. Randomized controlled trials have shown reductions in energy intake and body weight along with increased satiation and reduced hunger following consumption of fibers. Prospective cohort studies have confirmed these results but the extent of weight loss in some studies has been small. Controversies exist between studies particularly for the effect of fibers on the gastrointestinal hormones, subsequent food intake, and the resultant weight loss. More studies are needed before a clear conclusion can be drawn especially for the effect of fibers on appetite-related hormones and weight loss.

Fiber-enriched botanicals: A therapeutic tool against certain metabolic ailments

Plant-based foods are natural sources including vegetables, fruits, cereals and legumes. These foods consist of various types of nutrients in which carbohydrate is the basic component. However, some plant-based diets contain carbohydrates in the form of fiber. The fiber is usually a nondigestible polysaccharide that is not digested in the human body. It is present in the form of soluble or insoluble in different part of foods like peel, bran, pulp and grain. Pectin, beta-glucan, mucilage, psyllium, resistant starch and inulin are soluble fiber, and cellulose, hemicellulose and lignin are insoluble fiber attained from plant foods. The major function enhances immunity by creating gastrointestinal barrier, mucus production, immune cell activity and IgA level. Previous evidences showed that peoples with strong immunity have fewer chances of viral disease. A recent viral disease named COVID-19 spread in the world and millions of peoples died due to this viral disease. Coronavirus mostly attacks humans that suffer with weak immune system. It is due chronic diseases like diabetes and CVD (cardiovascular disease). The current review shows that fiber-containing plant-based foods boost immunity and aid human against COVID-19. The therapeutic role of fiber in the human body is to control the risk of hypertension and diabetes because a high-fiber diet has the ability to lower cholesterol, blood pressure and blood sugar. Fibers aid in GIT (gastrointestinal tract) and prevent constipation because it absorbs water and adds bulk to stool.

Associations between dietary fiber intake and cardiovascular risk factors: An umbrella review of meta-analyses of randomized controlled trials

Although several meta-analyses have revealed the beneficial effects of dietary fiber intake on human health, some have reported inconsistent findings. The purpose of this work was to perform an umbrella meta-analysis to evaluate the relevant evidence and elucidate the effect of dietary fiber intake on glycemic control, lipid profiles, systematic inflammation, and blood pressure. Eligible studies were searched in several electronic databases, including Web of Science, PubMed, Scopus, and the Cochrane Library, up to March 2022. A total of 52 meta-analyses involving 47,197 subjects were identified to assess the pooled effect size. Overall, higher dietary fiber intake was significantly associated with reductions in parameters involving glycemic control, including fasting plasma glucose (ES = -0.55, 95% CI: -0.73, -0.38, P < 0.001), fasting plasma insulin (ES = -1.22, 95% CI: -1.63, -0.82, P < 0.001), homeostasis model assessment of insulin resistance (HOMA-IR) (ES = -0.43, 95% CI: -0.60, -0.27, P < 0.001), and glycosylated hemoglobin (HbA1c) (ES = -0.38, 95% CI: -0.50, -0.26, P < 0.001). In terms of lipid profiles, higher dietary fiber intake was associated with significant reductions in the serum level of total cholesterol (ES = -0.28, 95% CI: -0.39, -0.16, P < 0.001) and low-density lipoprotein cholesterol (ES = -0.25, 95% CI: -0.34, -0.16, P < 0.001), but not triglycerides (ES = -0.001, 95% CI: -0.006, 0.004, P = 0.759) and high-density lipoprotein cholesterol (ES = -0.002, 95% CI: -0.004, 0.000, P = 0.087). Higher dietary fiber intake was also significantly associated with improved tumor necrosis factor-alpha serum levels (ES = -0.78, 95% CI: -1.39, -0.16, P = 0.013), while no significant effect was observed for C-reactive protein (ES = -0.14, 95% CI: -0.33, 0.05, P = 0.156). Finally, blood pressure was also significantly improved following higher dietary fiber intake (systolic blood pressure: ES = -1.72, 95% CI: -2.13, -1.30, P < 0.001; diastolic blood pressure: ES = -0.67, 95% CI: -0.96, -0.37, P < 0.001). Subgroup analysis revealed that the study population and type of dietary fiber could be partial sources of heterogeneity. In conclusion, the present umbrella meta-analysis provides evidence for the role of dietary fiber supplementation in the improvement of established cardiovascular risk factors.

Aldehyde dehydrogenase 2 rs671 polymorphism and multiple diseases: protocol for a quantitative umbrella review of meta-analyses

BACKGROUND

The mutant allele (*2) of aldehyde dehydrogenase type 2 (ALDH2) caused by a single nucleotide variant (rs671) inhibits enzymatic activity and is associated with multiple diseases. In recent years, an explosive number of original studies and meta-analyses have been conducted to examine the associations of ALDH2 rs671 polymorphism with diseases. Due to conflicting results, the overall associations of ALDH2 rs671 polymorphism and multiple diseases remain unclear.

METHODS

A quantitative umbrella review will be conducted on meta-analyses of genetic association studies to examine the pleiotropic effects of ALDH2 rs671, mainly including cardio-cerebral vascular disease, diabetes mellitus, cancer, neurodegenerative disease, and alcohol-induced medical disease. A search of relevant literature according to comprehensive search strategies will be performed on studies published before July 1st, 2022 in PubMed, MEDLINE Ovid, Embase, Cochrane Database of Systematic Reviews, and Web of Science. Study selection, data extraction, methodology quality assessment, and strength of evidence assessment will be conducted by two reviewers independently and in duplicate. Included meta-analyses will be grouped by outcomes. Data conflicts and overlap between meta-analyses will be managed through updated standardized and customized methods including the calculation of CCA for study selection reference, application of Doi plots to assess small-study effects and others. Evidence from included meta-analyses will be quantitatively synthesized by overlap-corrected analyses and meta-analysis using primary studies.

DISCUSSION

This umbrella review is expected to generate systematic evidence on the association between ALDH2 rs671 and diseases. Specific approaches were developed to address key challenges in conducting an umbrella review, including assessment tools of methodology and evidence quality of meta-analyses, methods to manage overlap between meta-analyses, a "stop-light" plot to summarize key findings. These approaches provide applicable methods for future umbrella reviews of meta-analyses on genetic association studies.

TRIAL REGISTRATION

CRD42021223812.