Dietary Guidelines for Americans

Fate of multi-residue insecticides and their metabolites in the process of vinification: Analytical method validation, dissipation kinetics, processing factor, and risk assessment

In viticulture, the use of synthetic chemical formulations introduces insecticide residues into harvested grapes and further into processed grape products, posing a safety concern to consumers. This study investigated the fate of ten insecticide residues and their metabolites from vine to wine. A rapid validated multi-residue approach using QuEChERS extraction and LC-MS/MS configuration was employed for targeted analysis in grape, pomace, and wine. The targeted insecticides showed satisfactory mean recoveries (76.03-111.95%) and precision (RSD = 0.75-7.90%) across the three matrices, with a matrix effect ranging from -16.88 to 35.18%, particularly higher in pomace. Preliminary grape washing effectively removed 15.52-61.31% of insecticide residues based on water solubility and systemic nature. Residue dissipation during fermentation ranged from 73.19% to 87.15% with a half-life spanning from 1 to 5.5 days. The mitigation rate was observed at 12.85-26.81% for wine and 17.76-51.55% for pomace, with the highest transfer rate for buprofezin (51.55%) to pomace and fipronil (25.72%) to wine. Calculated processing factors (PF) for final wine ranged from 0.16 to 0.44, correlating strongly with the octanol-water partition ratio of targeted insecticides. The reported PF, calculated hazard quotient (HQ) (0.003-5.800%), and chronic hazard index (cHI) (2.041-10.387%) indicate reduced residue concentrations in wine and no potential chronic risk to consumers, ensuring a lower dietary risk to wine consumers.

Healthy dietary patterns and risk of prostate cancer in men at high genetic risk

Prostate cancer has high heritability. Healthy lifestyle has been associated with lower lethal prostate cancer risk among men at increased genetic susceptibility, but the role of healthy dietary patterns remains unknown. We prospectively followed 10,269 genotyped men in the Health Professionals Follow-up Study (1993-2019). Genetic risk was quantified using an established polygenic risk score (PRS). Five dietary patterns were investigated: healthy eating index, Mediterranean, diabetes risk-reducing, hyperinsulinemic and inflammatory diet. Overall and lethal prostate cancer rates (metastatic disease/prostate cancer-specific death) were analyzed using multivariable Cox proportional hazards models. During 26 years of follow-up, 2133 overall and 253 lethal prostate cancer events were documented. In the highest PRS quartile, higher adherence to a diabetes risk-reducing diet was associated with lower rates of overall (top vs. bottom quintile HR [95% CI], 0.74 [0.58-0.94]) and lethal prostate cancer (0.43 [0.21-0.88]). A low insulinemic diet was associated with similar lower rates (overall, 0.76 [0.60-0.95]; lethal, 0.46 [0.23-0.94]). Other dietary patterns showed weaker, but similar associations. In the highest PRS quartile, men with healthy lifestyles based on body weight, physical activity, and low insulinemic diet had a substantially lower rate (0.26 [0.13-0.49]) of lethal prostate cancer compared with men with unhealthy lifestyles, translating to a lifetime risk of 3.4% (95% CI, 2.3%-5.0%) among those with healthy lifestyles and 9.5% (5.3%-16.7%) among those with unhealthy lifestyles. Our findings indicate that lifestyle modifications lowering insulin resistance and chronic hyperinsulinemia could be relevant in preventing aggressive prostate cancer among men genetically predisposed to prostate cancer.

Dietary Patterns Among US Children: A Cluster Analysis

BACKGROUND

Most children in the United States consume low-quality diets. Identifying children's dietary patterns and their association with sociodemographic characteristics is important for designing tailored youth dietary interventions.

OBJECTIVE

This study's objective was to use cluster analysis to investigate children's dietary patterns and these patterns' associations with sociodemographic characteristics.

DESIGN

Data from two cycles (2015-2016 and 2017-2018) of the National Health and Nutrition Examination Survey were evaluated to examine dietary patterns.

PARTICIPANTS AND SETTING

Participants included 3,044 US youth aged 2 to 11 years who completed at least 1 valid 24-hour diet recall.

MAIN OUTCOME MEASURES

The main outcome measures were Healthy Eating Index (HEI) 2015 component and composite scores.

STATISTICAL ANALYSES PERFORMED

A cluster analysis was performed on standardized scores of 11 components of the HEI-2015 to identify dietary patterns. One logistic analysis combined the two higher-HEI score clusters and the 2 lower-HEI score clusters to form a 3-category variable of higher-, medium-, and lower-HEI score clusters. Another logistic analysis contrasted 2 higher- and then the 2 lower-HEI clusters with each other to examine sociodemographic factors contributing to cluster membership.

RESULTS

Five clusters were identified, each displaying a distinct dietary pattern. Older, non-Hispanic Black, and overweight children had higher odds of being in the higher-HEI clusters than the medium-HEI cluster. Being older and non-Hispanic Black were linked to higher odds of being in the lower-HEI clusters than the medium-HEI cluster. Conversely, being Mexican American and living with a college-educated reference person were associated with lower odds of being in the lower-HEI clusters compared with the medium-HEI cluster. Among the higher-HEI clusters, Mexican American and Asian American children had higher odds of being in the Pescatarian cluster. Among the lower-HEI clusters, children who were racially or ethnically minoritized had lower odds of being in the Excess Sugar cluster.

CONCLUSIONS

Children in this study displayed different dietary patterns, with key sociodemographic variation.

Primary-school-aged children inspire their peers and families to eat more vegetables in the KiiDSAY project: a qualitative descriptive study

BACKGROUND

While vegetable intakes in Australia remain sub-optimal across all age groups, children are rarely consulted about their ideas on how to increase consumption. Qualitative research involving children provides an opportunity to consider their views. The aim of the Kids initiative inspires Dietary Success in Adults and Youth (KiiDSAY) project was to explore the views of school-aged children, who had participated in a school-based nutrition education program, about inspiring their peers and families to eat more vegetables.

METHODS

A total of 26 children (15 boys) aged 10-12 years from four primary schools in New South Wales, Australia, participated in seven focus group interviews. Purposeful sampling was used to recruit participants. The study involved open-ended semi-structured questions conducted via Zoom that were audio-recorded, transcribed verbatim and analysed using thematic analysis with deductive and inductive coding in NVivo.

RESULTS

Four major themes emerged: (i) taste; (ii) family environment; (iii) healthy eating; and (iv) change makers; with subthemes that were embedded within Social Cognitive Theory and Ecological Model of Health Behaviour theoretical frameworks.

CONCLUSIONS

Children's inputs hold great potential for informing future interventions, particularly when designing or refining school-based nutrition programs. Children offered suggestions on how to inspire increased vegetable consumption among their peers and families that could be taken into consideration for future research and practice. These included: cooking activities in the home and school settings using recipes that creatively hide/mask/enhance the flavour of vegetables, involving positive role models and supportive school environments. Additionally, children recommended a sequential approach to the delivery of recipes starting from fruit-based and transitioning to vegetable-based recipes. Given the challenges faced in increasing children's vegetable consumption, particular focus on future research in this area is warranted.

TRIAL REGISTRATION

FEAST Trial registered 14th December 2020 with the Australian and New Zealand Clinical Trials Registry (ACTRN12620001347954).

An overview of the nutritional status of childbearing age women, children and adolescents living in a rural area of Madagascar: preliminary results of the Tany Vao project

OBJECTIVE

To describe the food consumption, nutrition knowledge and nutritional assessment of childbearing age women and their children, living in rural villages in Madagascar. The results presented are related to the Tany Vao research study.

DESIGN

A cross-sectional pilot study.

SETTING

The study was carried out in Ampanitosoha village on Nosy Mitsio island in Madagascar.

PARTICIPANTS

32 women (14-49 years) and 36 children and adolescents (2-17 years).

RESULTS

70 % of the women lacked nutrition knowledge and did not reach the Minimum Dietary Diversity Index for Women cut-off. The median BMI was 21·1 kg/m2 but 55·2 % of the women exceeded the cut-off for waist-to-hip ratio, 51·7 % for waist-to-height ratio and 81·2 % for mid-upper arm circumference (MUAC). Almost all had adequate intake of energy, protein and carbohydrates, while 27·6 % had excessive fat intake and 75·9 % of added sugars. Over half of the women did not meet the micronutrients Reference Daily Intake (RDI). For children, the MUAC z-score was lower for boys than for girls (P-value = 0·041).

CONCLUSIONS

These results underline the importance of increasing women's nutritional knowledge to promote healthy pregnancy and lactation. Moreover, it is fundamental to provide people living in rural areas with sustainable tools to improve dietary diversity and support long-term health.

Does hazelnut consumption affect brain health and function against neurodegenerative diseases?

INTRODUCTION

A healthy daily diet and consuming certain nutrients, such as polyphenols, vitamins, and unsaturated fatty acids, may help neuronal health maintenance. Polyphenolic chemicals, which have antioxidant and anti-inflammatory properties, are involved in the neuroprotective pathway. Because of their nutritional value, nuts have been shown in recent research to be helpful in neuroprotection.

OBJECTIVE

Hazelnut is often consumed worldwide in various items, including processed foods, particularly in bakery, chocolate, and confectionery products. This nut is an excellent source of vitamins, amino acids, tocopherols, phytosterols, polyphenols, minerals, and unsaturated fatty acids. Consuming hazelnut may attenuate the risk of neurodegenerative disorders including Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, and Huntington's disease due to its anti-inflammatory and anti-oxidant qualities.

RESULTS

Many documents introduce hazelnut as an excellent choice to provide neuroprotection against neurodegenerative disorders and there is some direct proof of its neuroprotective effects.

DISCUSSION

So hazelnut consumption in daily diet may reduce neurodegenerative disease risk and be advantageous in reducing the imposed costs of dealing with neurodegenerative diseases.

Investigating the effects of rurality on stress, subjective well-being, and weight-related outcomes

Purpose

Rates of obesity are significantly higher for those living in a rural versus urban setting. High levels of stress and low levels of subjective well-being (SWB) have been linked to poor weight-related behaviors and outcomes, but it is unclear if these relationships differ as a function of rurality. This study investigated the extent to which living in a rural versus urban county ("rurality") moderated associations between stress / subjective wellbeing (predictors) and diet quality, dietary intake of added sugars, physical activity, and BMI (outcomes).

Methods

Participants were recruited from urban (n = 355) and rural (n = 347) counties in Washington State and self-reported psychological, demographic, and food frequency questionnaires while physical activity behavior was measured objectively.

Findings

After controlling for relevant covariates, levels of stress were positively associated with added sugar intake for those living in the urban county while this relationship was non-significant for those residing in the rural county. Similarly, SWB was negatively associated with added sugar intake, but only for urban residents. County of residence was also found to moderate the relationship between SWB and BMI. Higher SWB was inversely associated with BMI for those living in the urban county while no relationship was observed for rural county residents.

Conclusions

These findings support the hypothesis that the relationships between stress / SWB and weight function differentially based on the rurality of the residing county. This work adds to the growing body of literature highlighting the role stress and SWB play in the rural obesity disparity.

The association between diet quality and chronic obstructive pulmonary disease: a case-control study

BACKGROUND

Previous investigations have primarily examined the relationship between various dietary patterns and the risk of chronic obstructive pulmonary disease (COPD); however, there have been limited studies that have evaluated the association between diet quality presented by Healthy Eating Index 2010 (HEI-2010) and COPD. The aim of this study was to investigate this association in Iranian population.

METHODS

This case-control study recruited 84 cases and 252 healthy controls who were randomly selected. Diet, smoking, and physical activity were assessed using validated questionnaires. The HEI-2010 score ranged from zero to hundred twenty, with zero indicating an unhealthy diet and hundred twenty indicating a healthy diet. Logistic regression models were utilized to analyze the association between HEI-2010 and the odds of COPD.

RESULTS

Results from logistic regression showed that individuals with higher HEI scores had a significantly lower odds of COPD (OR: 0.34; 95% CI: 0.16-0.72). After adjusting for confounders, individuals with the highest HEI score were 82% less likely to have COPD (OR: 0.18; 95% CI: 0.03-0.96). This association remained significant after adjusting for smoking and physical activity (OR: 0.08; 95% CI: 0.01-0.93) and with additional adjustment for BMI (OR: 0.08; 95% CI: 0.01-0.92).

CONCLUSIONS

This study found a significant association between a higher HEI-2010 score and a lower odd of COPD in the Iranian population. These results suggest that a healthy diet may play a crucial role in reducing the odds of COPD and in improving the function of the lungs. However, further prospective studies are warranted to elucidate this relationship.

Dietary Diversity and Mild Cognitive Impairment in Middle-Aged and Older Chinese People: A Cross-Sectional Study

Background

The evidence concerning dietary diversity and cognitive function remains insufficient.

Objective

To investigate the association of dietary diversity score (DDS) with mild cognitive impairment (MCI) and cognitive performance in different domains.

Methods

Data from The Lifestyle and Healthy Aging of Chinese Square Dancer Study was used in this study. DDS was constructed based on the intake frequencies of 9 food groups assessed by a validated food frequency questionnaire. MCI was diagnosed by Petersen's criteria. A neuropsychological test battery was used to assess the performance on cognitive domains, and test scores were standardized to Z scores. Multiple linear regression models and logistic regression models were used to estimate the β and odds ratios and their 95% CIs, respectively.

Results

Among 1,982 participants, the mean (SD) age was 63.37 (5.00) years, 1,778 (89.71%) were women, and 279 (14.08%) had MCI. Compared to the DDS quartile (0, 6], the multivariable-adjusted odds ratios (95% CI) were 0.74 (0.48, 1.15) for DDS quartile (6, 7], 0.65 (0.43, 0.97) for DDS quartile (7, 8], and 0.55 (0.37, 0.84) for DDS quartile (8, 9]. Furthermore, higher DDS was positively associated with better performance of cognitive domains, including global cognitive function (β= 0.20, 95% CI: 0.12, 0.30), episodic memory (β= 0.21, 95% CI: 0.07, 0.35), attention (β= 0.15, 95% CI: 0.03, 0.26), language fluency (β= 0.24, 95% CI: 0.10, 0.38), and executive function (β= - 0.24, 95% CI: - 0.38, - 0.10).

Conclusions

This study indicated that higher DDS was associated with better cognitive function among middle-aged and older Chinese people.

Association between dietary supplement use and mortality among US adults with diabetes: a longitudinal cohort study

BACKGROUND

Despite the popularity of dietary supplements, their effectiveness and safety in patients with diabetes remain controversial. Furthermore, evidence from clinical trials may not be generalizable to real-world settings. This study examined the association between dietary supplement use and mortality outcomes among patients with diabetes based on a nationally representative sample of US adults.

METHODS

This study analyzed data from National Health and Nutrition Examination Survey (NHANES) 1999-2018. Supplement users referred to adults with diabetes who reported the use of any dietary supplements in the last 30 days, and with a cumulative duration of ≥ 90 days. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between supplement use and all-cause mortality, and mortality from cardiovascular diseases (CVD), diabetes, and cancer. Subgroup analysis of different supplement classes (vitamins, minerals, botanicals, amino acids, fatty acids, probiotics and glucosamine) were also conducted.

RESULTS

We included 8,122 adults with diabetes (mean age: 59.4 years; 48.7% female), of whom 3,997 (54.0%) reported using supplements regularly. Vitamins (87.3%), minerals (75.3%) and botanicals (51.8%) were the most popular supplements. At a median follow-up of 6.9 years, 2447 all-cause deaths had occurred. Overall supplement use was not associated with risk of all-cause mortality among patients with diabetes (HR = 0.97, 95% CI: 0.87 to 1.08, P = 0.56). Subgroup analyses suggested that amino acid use was associated with a lower all-cause mortality (HR = 0.66, 95% CI: 0.46 to 0.96, P = 0.028), while the use of fatty acids (HR = 0.62, 95% CI: 0.42 to 0.92, P = 0.018) and glucosamine (HR = 0.69, 95% CI: 0.51 to 0.95, P = 0.022) supplements were significantly associated with lower CVD mortality.

CONCLUSIONS

Our results derived from real-world data suggested that overall supplement use was not associated with any mortality benefit in patients with diabetes. However, there is preliminary evidence that suggests a protective effect of amino acid use on all-cause mortality, and a benefit of fatty acids and glucosamine supplement use on CVD mortality. Future large-scale longitudinal studies are needed to investigate the association between dietary supplement use and other intermediate diabetes-related outcomes, such as glucose control and reducing diabetes-related complications.

Effects of probiotic administration on overweight or obese children: a meta-analysis and systematic review

BACKGROUND

This paper aimed to examine the effects of probiotics on eight factors in overweight or obese children by meta-analysis, namely, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), adiponectin, leptin and tumor necrosis factor-α (TNF-α) and summarize the mechanisms of action of probiotics based on the existing researches.

METHODS

Six databases (PubMed, Web of Science, Embase, Cochrane Library, SinoMed and CNKI) were searched until March 2023. Review Manager 5.4 was used for meta-analysis. The data were analysed using weighted mean differences (WMDs) or standardized mean differences (SMDs) under a fixed effect model or random effect model to observe the effects of probiotic administration on the included indicators.

RESULTS

Four publications with a total of 206 overweight or obesity children were included. According to the meta-analysis, probiotics were able to significantly decrease the levels of HDL-C (MD, 0.06; 95% CI 0.03, 0.09; P = 0.0001), LDL-C (MD, - 0.06; 95% CI - 0.12, - 0.00; P = 0.04), adiponectin (MD, 1.39; 95% CI 1.19, 1.59; P < 0.00001), leptin (MD, - 2.72; 95% CI - 2.9, - 2.54; P < 0.00001) and TNF-α (MD, - 4.91; 95% CI - 7.15, - 2.67; P < 0.0001) compared to those in the placebo group. Still, for BMI, the palcebo group seemed to be better than the probiotic group (MD, 0.85; 95% CI 0.04, 1.66; P = 0.04). TC (MD, - 0.05; 95% CI - 0.12, 0.02; P = 0.14) and TG (MD, - 0.16; 95% CI - 0.36, 0.05; P = 0.14) were not different between two groups.

CONCLUSIONS

This review drew that probiotics might act as a role in regulating HDL-C, LDL-C, adiponectin, leptin and TNF-α in overweight or obesity children. Additionally, our systematic review yielded that probiotics might regulate lipid metabolism and improve obese associated symptoms by some paths. This meta-analysis has been registered at PROSPERO with ID: CRD42023408359.

Personalized Flexible Meal Planning for Individuals With Diet-Related Health Concerns: System Design and Feasibility Validation Study

BACKGROUND

Chronic diseases such as heart disease, stroke, diabetes, and hypertension are major global health challenges. Healthy eating can help people with chronic diseases manage their condition and prevent complications. However, making healthy meal plans is not easy, as it requires the consideration of various factors such as health concerns, nutritional requirements, tastes, economic status, and time limits. Therefore, there is a need for effective, affordable, and personalized meal planning that can assist people in choosing food that suits their individual needs and preferences.

OBJECTIVE

This study aimed to design an artificial intelligence (AI)-powered meal planner that can generate personalized healthy meal plans based on the user's specific health conditions, personal preferences, and status.

METHODS

We proposed a system that integrates semantic reasoning, fuzzy logic, heuristic search, and multicriteria analysis to produce flexible, optimized meal plans based on the user's health concerns, nutrition needs, as well as food restrictions or constraints, along with other personal preferences. Specifically, we constructed an ontology-based knowledge base to model knowledge about food and nutrition. We defined semantic rules to represent dietary guidelines for different health concerns and built a fuzzy membership of food nutrition based on the experience of experts to handle vague and uncertain nutritional data. We applied a semantic rule-based filtering mechanism to filter out food that violate mandatory health guidelines and constraints, such as allergies and religion. We designed a novel, heuristic search method that identifies the best meals among several candidates and evaluates them based on their fuzzy nutritional score. To select nutritious meals that also satisfy the user's other preferences, we proposed a multicriteria decision-making approach.

RESULTS

We implemented a mobile app prototype system and evaluated its effectiveness through a use case study and user study. The results showed that the system generated healthy and personalized meal plans that considered the user's health concerns, optimized nutrition values, respected dietary restrictions and constraints, and met the user's preferences. The users were generally satisfied with the system and its features.

CONCLUSIONS

We designed an AI-powered meal planner that helps people create healthy and personalized meal plans based on their health conditions, preferences, and status. Our system uses multiple techniques to create optimized meal plans that consider multiple factors that affect food choice. Our evaluation tests confirmed the usability and feasibility of the proposed system. However, some limitations such as the lack of dynamic and real-time updates should be addressed in future studies. This study contributes to the development of AI-powered personalized meal planning systems that can support people's health and nutrition goals.

Oxidative Stress and Inflammatory Biomarkers Are Related to High Intake of Ultra-Processed Food in Old Adults with Metabolic Syndrome

In the last few decades the consumption of ultra-processed foods (UPFs) worldwide has substantially augmented. Increasing evidence suggests that high UPF consumption is associated with an increase in non-communicable diseases, being overweight, and obesity. The aim of this study was to assess how UPF consumption affects oxidative and inflammatory status in the plasma, neutrophils, and urine of old adults with metabolic syndrome. Participants (n = 92) were classified into two groups according to UPF consumption. Dietary intakes were measured by a validated semi-quantitative 143-item food frequency questionnaire and UPF consumption was determined according to the NOVA classification system. Low UPF consumers showed higher adherence to the Mediterranean diet than high UPF consumers. A high intake of fiber and a high concentration of polyphenols in urine were also observed in subjects with low UPF consumption. Despite the absence of differences in biochemical profile, oxidative and inflammatory biomarkers showed some significant changes. Catalase and superoxide dismutase activities were lower in high UPF consumers, whereas myeloperoxidase activity was higher. ROS production in neutrophils stimulated with zymosan was higher in high UPF consumers than in low UPF consumers. Biomarkers such as xanthine oxidase, tumor necrosis factor α (TNFα), interleukin (IL)-6, IL-15, and leptin levels were higher in participants with high intake of UPF. No differences were found in malondialdehyde and other inflammatory cytokines. The current study evidenced that MetS participants with high UPF consumption have a more pro-oxidant and inflammatory profile than those with low UPF consumption, despite showing similar blood biochemical profiles.

The balanced unsaturated fatty acid supplement constituted by woody edible oils improved lipid metabolism and gut microbiota in high-fat diet mice

The dietary intervention has demonstrated effectiveness in improving hyperlipidemia and obesity. Woody edible oils are rich in unsaturated fatty acids (UFAs) that could positively affect lipid metabolism. In this study, the blended oil (BLO), a balanced UFA supplement, constituted by Zanthoxylum bungeanum (Chinese Red Pepper) seed oil, walnut (Juglans regia) oil, camellia (Camema oleifera) seed oil and perilla (Perilla frutescens) seed oil was established referring to the Chinese dietary reference intakes, in which the ratios of monounsaturated/polyunsaturated fatty acids and ω-6/ω-3 polyunsaturated fatty acids were 1:1 and 4:1, respectively. The BLO was administrated to KM mice fed a high-fat diet (HFD) by gavage every day at a dose of 3.0 mL/kg·bw for 10 weeks to assess its effects on serum lipid levels, liver antioxidant activities and gut microbial composition. The results showed that the BLO improved hepatic steatosis, liver oxidative stress, and serum lipid levels. Additionally, there was an increased abundance of Lactobacillus, Allobaculum, and Blautia, along with a decreased abundance of Staphylococcus in cecal contents. These changes were found to be positively correlated with the metabolic improvements, as indicated by Spearman's correlation analysis. These findings implied the practicality of the balanced unsaturated fatty acid consumption in preventing hyperlipidemia and obesity.

Association of Diet Quality with Metabolic (Dysfunction) Associated Fatty Liver Disease in Veterans in Primary Care

BACKGROUND

Diet is associated with metabolic (dysfunction)-associated fatty liver disease (MAFLD), but the dietary composition associated with MAFLD risk has not been well-examined.

AIM

The purpose of this study was to assess the association of two healthy eating indices with the presence and severity of MAFLD in a sample of Veterans in a primary care setting.

METHODS

This was a single center cross-sectional study using a random stratified sample of Veterans enrolled in primary care. Participants underwent a Fibroscan and completed an interviewer-administered Diet History Questionnaire II from which we calculated the Healthy Eating Index-2015 and Alternate Mediterranean Diet Score. We used multivariable logistic regression models to assess associations of dietary quality with MAFLD.

RESULTS

We analyzed data from 187 participants, 53.5% of whom were female. On average, participants were 50.2 years of age (SD, 12.3 years) with an average BMI of 31.7 kg/m2. MAFLD was detected in 78 (42%) and at least moderate fibrosis in 12 (6%) participants. We found that the Alternate Mediterranean Diet Score was inversely associated with MAFLD (adjusted OR = 0.85, 95%CI 0.72-1.00), but controlling for BMI and total energy intake attenuated the association (adjusted OR = 0.92, 95%CI 0.74-1.15). We found no statistically significant associations between the Healthy Eating Index-2015 and MAFLD or advanced fibrosis.

DISCUSSION

We found that the Alternate Mediterranean Diet Score was significantly associated with lower MAFLD risk in Veterans; however, the association was mediated by BMI and total energy intake. A Mediterranean-style diet could potentially help reduce the risk of MAFLD, particularly if it helps control total energy intake and weight.

Evaluation of Cerebral Vasomotor Reactivity by Transcranial Doppler Ultrasound in Patients with Diabetic Retinopathy

The aim of this study was to assess the correlation between cerebral vasomotor reactivity (CVR) and the grade of diabetic retinopathy. A total of 43 diabetic patients with matched severity of diabetic retinopathy between their right and left eyes were included in this study. Diabetic retinopathy was graded in three groups. Right and left middle cerebral artery CVR was assessed by the breath-holding index (BHI) using transcranial Doppler ultrasound (TCD). The mean age of the patients was 56.51 ± 9.34 years with a mean duration of having diabetes mellitus of 14.49 ± 8.06 years. Diabetic retinopathy was graded as mild, moderately severe, and severe in 27.9%, 34.9%, and 37.2% of the patients, respectively. The grade of diabetic retinopathy was associated with the HbA1c level (p < .049), microalbuminuria (p < .024), and BHI (p = .001). In patients with severe diabetic retinopathy, the right-sided BHI was significantly lower as compared to those with mild or moderately severe retinopathy (p = .001 and p = .008, respectively). The left-sided BHI value in patients with severe diabetic retinopathy was significantly lower as compared to those with mild or moderately severe retinopathy (p = .001 and p = .012, respectively). In subjects with moderately severe diabetic retinopathy, both-sided BHI was significantly reduced compared to those with mild retinopathy (p = .001). Our results indicate that the grade of diabetic retinopathy was associated with impaired CVR.

Western diet influences on microbiome and carcinogenesis

The intestinal microbiota composition and associated bioactivities are sensitive to various modifier cues such as stress, inflammation, age, life-style and nutrition, which in turn are associated with susceptibility to developing cancer. Among these modifiers, diet has been shown to influence both microbiota composition as well as being an important source of microbial-derived compounds impacting the immunological, neurological and hormonal systems. Thus, it is necessary to take a holistic view when considering effect of diet on health and diseases. In this review, we focus on the interplay between western diet, the microbiota and cancer development by dissecting key components of the diet and leveraging data from human interventions and pre-clinical studies to better understand this relationship. We highlight key progress as well as stressing limitations in this field of research.

The Role of Diet as a Modulator of the Inflammatory Process in the Neurological Diseases

Neurological diseases are recognized as major causes of disability and mortality worldwide. Due to the dynamic progress of diseases such as Alzheimer’s disease (AD), Parkinson’s Disease (PD), Schizophrenia, Depression, and Multiple Sclerosis (MD), scientists are mobilized to look for new and more effective methods of interventions. A growing body of evidence suggests that inflammatory processes and an imbalance in the composition and function of the gut microbiome, which play a critical role in the pathogenesis of various neurological diseases and dietary interventions, such as the Mediterranean diet the DASH diet, or the ketogenic diet can have beneficial effects on their course. The aim of this review was to take a closer look at the role of diet and its ingredients in modulating inflammation associated with the development and/or progression of central nervous system diseases. Presented data shows that consuming a diet abundant in fruits, vegetables, nuts, herbs, spices, and legumes that are sources of anti-inflammatory elements such as omega-3 fatty acids, polyphenols, vitamins, essential minerals, and probiotics while avoiding foods that promote inflammation, create a positive brain environment and is associated with a reduced risk of neurological diseases. Personalized nutritional interventions may constitute a non-invasive and effective strategy in combating neurological disorders.

The associations of plant-based food and metabolic syndrome using NHANES 2015-16 data

BACKGROUND

Consuming a diet rich in plant-based foods (PBFs) may be protective for risk of metabolic syndrome (MetS) and chronic disease. However, the impact of consuming healthy versus all types of PBF on MetS is unknown.

METHODS

The relationship between consumption of PBF (both healthy and all) was examined using data from the 2015 to 2016 National Health and Nutrition Examination Survey (NHANES). The amount of PBFs consumed was calculated as average daily servings, whereas dichotomous MetS variables were based on the National Cholesterol Education Adult Program Treatment Panel III (2005). After weighting and multiple imputation, adjusted associations were examined using logistic regression and marginal probabilities.

RESULTS

Consumption of healthy PBF was significantly associated with reduced risk for elevated waist circumference (P = 0.017; odds ratio, OR 0.96, 95% confidence interval, CI 0.94-0.98) and MetS (P = 0.006; OR 0.96, 95% CI 0.93-0.99). Interactions revealed significant protective effects for females who were $\ge$ 60 years.

CONCLUSIONS

In the adjusted model, a 1-unit increase in daily servings of healthy PBF was associated with a 4% lower risk for prevalence of elevated waist circumference and a 4% decrease in risk for prevalence of MetS. Increasing consumption of PBF may offer a viable strategy for reducing risk of MetS.

An Exploratory Research to Assess Total Nutritional Knowledge of Students at the University of Lahore, Pakistan

Background: Good nutrition is imperative to achieve a better health status. The rate of obesity and related comorbidities is increasing all over the world. The main reasons behind this worse situation are the overconsumption of food groups or exceeding the recommended portion sizes. University life is a period when students are independent in making their food choices. The chances of adopting unhealthy eating behaviors are increased during this tenure. Nutritional knowledge is an important tool in assessing the nutritional status of an individual, group, and community. Objectives: The main objective of the current study was to assess the nutritional knowledge of university-going students. Methods: The pre-tested questionnaire was used to collect the data from the students of the University of Lahore, Pakistan. A total of 300 students participated in this study (150 from the Nutrition Department and 150 from the non-nutrition departments). Demographic data, anthropometric measurements, and total nutritional knowledge (TNK) scores were measured during the 4-month study duration. Additionally, gender-and department-based comparisons of various parameters were performed. The mean TNK of the Nutrition Department students was higher (34.89 ± 0.95/58) than non-nutrition departments (24.05 ± 1.00/58) (P = 0.01). Additionally, the mean TNK of female students was higher (28.53 ± 1.28/58) than male students (27.05 ± 1.27/58) (P = 0.03). Moreover, 61% and 63% of nutrition students were familiar with the relationship between high intake of salt and fats with chronic diseases, respectively. Results: A statistically significant relationship was not observed between gender (P = 0.78) and departments (P = 0.10) with body mass index (BMI). This finding shows that nutritional knowledge alone is not a predictor of the nutritional status (BMI) of an individual. Students, even from the Nutrition Department, failed to transform their knowledge about nutrition into healthy food choices and eating practices. Conclusions: It is necessary to initiate nutrition education programs emphasizing making healthy food choices. Moreover, nutritional knowledge related to dietary guidelines should be incorporated into daily life to remove the disease burden associated with obesity.

A Cross-Sectional Analysis of Products Marketed as Plant-Based Across the United States, United Kingdom, and Canada Using Online Nutrition Information

Background

The food industry is responding to a rising demand for plant-based foods by developing and marketing an ever-wider range of vegan and vegetarian products under the banner of "plant-based." Understanding the nutritional properties of these products is critical.

Objectives

To assess the number, meal type, and nutritional content of products marketed as plant-based (MaPB) from the perspective of the consumer across multiple sectors in the United States, United Kingdom, and Canada.

Methods

An online search for products MaPB was performed across supermarkets, restaurants, food manufacturers, and plant-based meal delivery companies in the United Kingdom, the United States, and Canada using the terms: "vegan," "vegetarian," and "plant-based." Online nutrition data were extracted, and whole meals that comprised >50% of ingredients such as fruits, vegetables, legumes, nuts, and seeds were identified. The nutritional content of dishes MaPB in restaurants was also directly compared with meat-containing dishes.

Results

Further, 3488 unique products were identified, of which 962 were whole meals and 1137 were a replacement for the main protein component in a meal, including 771 meat alternatives. Across all sectors, 45% of whole meals had >15-g protein, 70% had <10% kcal from saturated fat; 29% had >10-g fiber per meal, and 86% had <1000 mg sodium. At restaurants, 1507 meat-containing dishes were identified and compared with 191 vegetarian and 81 vegan dishes. The meat-containing dishes were higher in protein [35.4 g (24.0-51.4)] compared with vegetarian [19.0 g (13.0-26.1)] and vegan [16.2 g (10.5-23.2) dishes (P < 0.001)]. The vegan dishes were low in saturated fat and sodium (SFA: 6.3 g ± 6.4, Sodium: 800 mg (545.0-1410.0) compared with both meat [SFA: 11.6 g ± 10.0; Sodium: 1280 mg (820.0-1952.0)] and vegetarian [SFA: 9.4 g ± 7.6; Sodium: 1011 mg (603.0-1560.0)] options (P < 0.001 for all comparisons).

Conclusions

Products MaPB tend to have lower concentrations of saturated fat and sodium than their meat-containing counterparts, but improvements are needed to optimize their nutritional composition.

Association of lifestyle behaviors with non-alcoholic fatty liver disease and advanced fibrosis detected by transient elastography among Hispanic/Latinos adults in the U.S

OBJECTIVES

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent liver disease, with the highest prevalence observed in the U.S. among Hispanic/Latino adults. While physical activity and dietary behaviors have established protective associations with NAFLD and its severity, these associations have not been well-characterized in Hispanic/Latino adults. The purpose of this study was to assess the association of lifestyle behaviors with NAFLD and advanced fibrosis in US Hispanic/Latino adults.

DESIGN

We selected all Hispanic/Latino adults from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). NAFLD was defined as CAP ≥285 dB/m, and advanced fibrosis as liver stiffness measurements ≥8.6 kPa. Multivariate-adjusted logistic regression models assessed associations of physical activity and sedentary behavior (Global Physical Activity Questionnaire), as well as diet quality (Healthy Eating Index [HEI]-2015) and total energy intake (24-hour recall) with NAFLD and advanced fibrosis.

RESULTS

In Hispanic/Latino adults, the overall prevalence of NAFLD was 41.5%, while the prevalence of advanced fibrosis among those with NAFLD was 17.2%. We found that higher levels of physical activity and high diet quality were associated with lower risk of NAFLD. Compared to those reporting on average 0 metabolic equivalent (MET) hours/week of physical activity, participants reporting high levels of physical activity (≥32 MET hours/week) had 40% lower risk of NAFLD (Adjusted OR = 0.60, 95%CI 0.38, 0.93). High diet quality (HEI-2015) was associated with a 30% lower risk of NAFLD (Adjusted OR = 0.70, 95% CI 0.51, 0.97) and 72% lower risk of advanced fibrosis (Adjusted OR = 0.28, 95% CI 0.12, 0.66), as compared to those with low diet quality.

CONCLUSIONS

In this population-based study, high levels of physical activity and diet quality were associated with lower risk of NAFLD in Hispanic/Latino adults. Public health and medical professionals need to concentrate efforts on lifestyle behavior change in Hispanic/Latino adults who are at high risk for serious liver disease.

Evidence-Based Lifestyle Guidelines and Self-Management Strategies Utilized by Women with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a complex endocrine disorder, affecting 13% of reproductive-aged women. While lifestyle management is the first-line treatment for improving complications, women experience challenges with implementation. This cross-sectional study aims to identify the types and sources of dietary and physical activity (PA) interventions implemented by women with PCOS and understand how they use self-management strategies to support lifestyle change. An online questionnaire was disseminated via a consumer-based PCOS website (May 2015-2016). Women (n = 1167) were aged 18-45 years and primarily born within the United States (70%). A quarter or less of women (diet 25%, PA 14%) sought lifestyle advice from health professionals (medical clinicians or dietitians) compared to over half (diet 59%, PA 67%) using alternative sources, namely from online platforms. While only 33% and 16% of women reported following formal dietary or PA guidelines, respectively, 57% had implemented a 'special diet' to manage their condition, many of which were inconsistent with evidence-based practice in PCOS. Participants also displayed a low level of engagement with important self-management behaviors, including goal setting and positive self-talk. These findings suggest that online information may promote inaccurate and ineffective lifestyle advice and emphasize the need to increase engagement with qualified health professionals.

Drinking Habits and Physical Activity Interact and Attenuate Obesity Predisposition of TMEM18 Polymorphisms Carriers

The transmembrane protein 18 (TMEM18) gene plays a central and peripheral role in weight regulation. TMEM18 genetic polymorphisms have been identified as an important risk factor for obesity, depending on ethnic population and age. This research aimed to study the association of common TMEM18 polymorphisms with obesity and their interactions with modifiable factors, namely drinking habits (sugar-sweetened beverages (SSBs), flavored water and wine) and physical activity (PA) in the Israeli population. Adults (n = 3089) were analyzed for common TMEM18 polymorphisms and lifestyle and nutrition habits were obtained from questionnaires using adjusted (age, sex) binary logistic regression models. TMEM18 rs939583 and rs1879523 were significantly associated with increased obesity risk (OR = 1.35, 95% CI (1.17−1.57) and OR = 1.66, 95% CI (1.29−2.15), respectively). TMEM18 rs939583 interacted with consumption of 1−3 weekly glasses of wine and PA to attenuate obesity risk (OR = 0.82 95% CI (0.74−0.9; p < 0.001) and OR = 0.74 95% CI (0.68−0.8), respectively), while physical inactivity, SSBs and flavored water consumption significantly enhanced obesity risk (OR = 1.54 95% CI (1.41−1.67), OR = 1.31 95% CI (1.14−1.51) and OR = 1.35 95% CI (1.13−1.62), respectively). PA duration was significantly associated with a lower BMI for rs939583 risk carriers, with a PA cutoff of >30 min/week (p = 0.005) and >90 min/week (p = 0.01). Common TMEM18 SNPs were significantly linked with adult obesity risk and interacted with modifiable lifestyle factors.

Essential Minerals and Metabolic Adaptation of Immune Cells

Modern lifestyles deviated considerably from the ancestral routines towards major shifts in diets and increased sedentarism. The trace elements status of the human body is no longer adequately supported by micronutrient-inferior farmed meats and crop commodities produced by the existing agricultural food systems. This is particular evident in the increased obesogenic adipogenesis and low-grade inflammation that fails to resolve with time. The metabolically restrictive environment of the inflamed tissues drives activation and proliferation of transient and resident populations of immune cells in favor of pro-inflammatory phenotypes, as well as a part of the enhanced autoimmune response. As different stages of the immune activation and resolution depend on the availability of specific minerals to maintain the structural integrity of skin and mucus membranes, activation and migration of immune cells, activation of the complement system, and the release of pro-inflammatory cytokines and chemokines, this review discusses recent advances in our understanding of the contribution of select minerals in optimizing the responses of innate and adaptive immune outcomes. An abbreviated view on the absorption, transport, and delivery of minerals to the body tissues as related to metabolic adaptation is considered.

Edible plant extracellular vesicles: An emerging tool for bioactives delivery

The extracellular vesicles (EVs) in edible food have a typical saucer-like structure and are nanoparticles released by numerous cells. They have different components and interact with other biological samples in diverse ways. Therefore, these nanoparticles could be used to develop bioactives delivery nanoplatforms and anti-inflammatory treatments to meet the stringent demands of current clinical challenges. This review aims to summarize current researches into EVs from edible plants, particularly those that can protect siRNAs or facilitate drug transportation. We will discuss their isolation, characterization and functions, their regulatory effects under various physiological and pathological conditions, and their immune regulation, anti-tumor, regeneration, and anti-inflammatory effects. We also review advances in their potential application as bioactives carriers, and medicinal and edible plants that change their EVs compositions during disease to achieve a therapy propose. It is expected that future research on plant-derived EVs will considerably expand their application.

Light-intensity and moderate-to-vigorous intensity physical activity among older adult breast cancer survivors with obesity: A narrative review

BACKGROUND

With an aging population, rising incidence of breast cancer, improved survival rates, and obesity epidemic, there will be a growing population of older adult breast cancer survivors with obesity. This complex population, often with multimorbidity, is at risk for several poor health outcomes, including recurrence, cardiovascular disease, dementia, and diabetes, and a number of deleterious symptoms, including a worsened inflammatory profile, breast cancer- related lymphedema, mobility disability, cognitive impairment, anxiety, and depressive symptoms. A wealth of meta-analytic and randomized controlled trial evidence show that adherence to World Health Organization and 2018 United States Physical Activity guidelines-based levels of moderate-to-vigorous physical activity (MVPA) reduces risk of all-cause mortality, and improves symptoms. However, few survivors engage in recommended levels of MVPA, and symptoms related to their multimorbidity may preclude engaging in sufficient levels of MVPA. Additional research of MVPA in this population is warranted; however, understudied light-intensity physical activity (LIPA) may be a more pragmatic target than MVPA among this complex population facing extensive challenges meeting MVPA recommendations. Large benefits are likely to occur from increasing these survivors' total activity, and LIPA prescriptions may be a more pragmatic approach than MVPA to aid this transition.

METHODS

We present a broad, narrative review of the evidence for MVPA and LIPA in this population on an array of health outcomes across the translational science spectrum (clinical, implementation, and public health), and identify a number of directions for future research focused on understanding the potential diverse health effects of LIPA.

CONCLUSION

Additional LIPA research is warranted, as LIPA prescriptions may be a pragmatic strategy to effectively promote physical activity to this complex population.

Effects of diets rich in ghee or olive oil on cardiometabolic risk factors in healthy adults: a two-period, crossover, randomised trial

This study aimed to evaluate the cardiovascular health-related effects of consuming ghee in the usual diet. Thirty healthy men and women were studied in a free-living outpatient regimen. The participants were instructed for the isoenergetic inclusion of ghee or olive oil in their diets for 4 weeks using a randomised crossover design. At the end of run-in (baseline), 2-week wash-out and interventions, fasting blood samples were drawn. In addition, 2-h postprandial blood samples were collected after ingestion of a meal containing olive oil or ghee at week 4 of each dietary intervention. Body weight was not different between the two interventions. Compared with the olive oil, the diet with ghee increased fasting plasma apo-B (apo B) (0·09, 95 % CI 0·02, 0·17 g/l, P = 0·018), non-HDL-cholesterol (non-HDL-cholesterol) (0·53, 95 % CI 0·01, 1·05 mmol/l, P = 0·046) and LDL-cholesterol did not differ significantly between diet groups (0·29, 95 % CI -0·05, 0·63 mmol/l, P = 0·092), but had no significant effect on total cholesterol:HDL-cholesterol ratio (0·75, 95 % CI - 0·24 to 1·74 mmol/l, P = 0·118). No significant difference was observed in fasting as well as 2-h postprandial plasma TAG, glucose, insulin and plasminogen activator inhibitor-1 concentrations. This study showed that ghee that is predominantly saturated fats had an increasing effect on plasma apo B and non-HDL-cholesterol compared with olive oil, adding further evidence to the existing recommendations to replace dietary fats high in SFA with dietary fats high in unsaturated fats to reduce CVD risk.

Better Adherence to the Taiwan Daily Food Guide is Associated with a Reduced Risk of Osteoporosis: A Population-Based Study in Taiwan

INTRODUCTION

We conducted a study to examine whether adherence to the Taiwan Daily Food Guide was associated with bone mineral density (BMD).

METHODS

A population-based cross-sectional study was conducted utilizing data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016. A total of seven BMD sites were evaluated, including the head, arms, legs, trunk, ribs, pelvis, and spine BMD. Besides, we further examined the association between the Daily Food Guide adherence score and osteoporosis (T-score of ≤ -2.5 standard deviation (SD) of a measured total BMD). A validated food-frequency questionnaire (FFQ) was used for dietary assessment.

RESULTS

We included a total of 555 participants with osteoporosis and 1977 without osteoporosis in the final analysis. We found negative associations between levels of adherence to the Daily Food Guide and the risk of osteoporosis. The odds ratio (OR) for participants in the highest quartile of the adherence level was 0.61 (95% CI = 0.42-0.88), compared with those in the lowest quartile. When participants had total servings of six food groups higher than the recommendation, the protective effect still existed (OR = 0.59, 95% CI = 0.42-0.84).

CONCLUSION

Better adherence to the Taiwan Daily Food Guide is associated with a lower risk of osteoporosis.

Review on retention of long-chain omega-3 polyunsaturated fatty acids (EPA and DHA) in fish as affected by cooking methods

Fatty acids are essential building blocks for the structural components of the cells, tissues, organs, and certain biologically active substances synthesis. Omega-3 polyunsaturated fatty acids are long-chain fatty acids essential for several biological functions including oxidative stress reduction and cardiovascular safety. Diet rich in omega-3 fatty acids is well acknowledged as beneficial to one's health and well-being. For the development of balanced diets, the nutrient content of raw and cooked foods is crucial. However, cooking method, animal age, and carcass characteristics might affect nutrient retention during cooking, and these factors are often unique to specific countries. This review thus provides a general overview of several cooking effects on long-chain omega-3 retention in fish. It can be concluded that the DHA and EPA's true retention values are correlated to the impact of different cooking treatments.

Association of Non-Steroidal Anti-Inflammatory Drugs, Genetic Risk, and Environmental Risk Factors with Incidence of Colorectal Cancer

Regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with the lower risk of colorectal cancer (CRC). However, whether regular use of NSAIDs could attenuate the effect of genetic risk and environmental risk factors on CRC is unknown. We aimed to evaluate the association of NSAID use, genetic risk, and environmental risk factors with CRC. Using data from a UK Biobank, a Cox proportional hazards model was performed to estimate the risk of CRC according to NSAID use, polygenic risk score, and environmental risk factors. Regular use of NSAIDs was associated with a 36.0% lower risk of CRC. No statistically significant interaction was observed between NSAID use and the genetic risk score (p = 0.190), and between NSAID use and the environmental risk score (p = 0.740). However, regular NSAID use was still associated with lower CRC incidence among subjects with either high environmental risk or high genetic risk. Furthermore, the genetic and environmental risk of CRC were additives. These findings appear to support the chemopreventive effect of regular NSAID use. Furthermore, controlling of modifiable environmental risk factors can reduce the CRC risk, especially among individuals with a moderate or high genetic risk of CRC.

Psychometric properties of the Chinese version of the sugar-sweetened beverages media literacy scale for undergraduates

Specific domains of the Sugar-Sweetened Media Literacy Scale (SSM-ML) have been shown to significantly assess sugar-sweetened beverage (SSB) calorie intake in the US population. This study aimed to describe the psychometric properties of the revised Chinese version of the SSB-ML (C-SSB-ML) and evaluate its validity and reliability. Results from 975 undergraduates at two of the largest universities in a province in southwest China showed that Cronbach's alphas for the overall scale, the three dimensions, and two-halves analysis were satisfactory (0.71-0.92). The criterion-related validity of the C-SSB-ML was positively associated with the e Health literacy scale (eHEALS). Confirmatory factor analysis showed that the three-factor model of the C-SSB-ML had adequate fit indices χ² (153) = 4349.93, p < 0.001; Comparative fit index (CFI), Tucker-Lewis index (TLI), Incremental fit index (IFI) >0.90; Standardized Root Mean Square Residual (SRMR) <0.07; and Root Mean Square Error of Approximation (RMSEA) <0.08. Our findings provide evidence for a valid and reliable tool that can be used to assess sugar-sweetened media literacy in Chinese undergraduates and will help organizations leverage media literacy in strategy formulation to ensure SSB intake is controlled as much as possible through effective efforts on all fronts.

FTO Common Obesity SNPs Interact with Actionable Environmental Factors: Physical Activity, Sugar-Sweetened Beverages and Wine Consumption

Genetic background is estimated to play >50% in common obesity etiology. FTO single nucleotide polymorphisms (SNPs) are strongly associated with BMI, typically in European cohorts. We investigated the interaction of common FTO SNPs with actionable environmental factors, namely physical activity, sugar-sweetened beverages (SSB) and wine consumption, and verified FTO common SNPs predisposition to obesity in the Israeli population. Adults’ (>18 years old, n = 1720) FTO common SNPs data and lifestyle and nutrition habits questionnaires were analyzed using binary logistic regression models, adjusted for confounding variables (age, sex) assuming dominant, recessive and additive genetic models. Eighteen FTO SNPs were associated with significant increased obesity risk and interacted with physical activity (p < 0.001), wine consumption (p < 0.014) and SSB consumption (p < 0.01). Inactive rs9939609 risk-allele carriers had significantly higher obesity risk compared to their active counterparts (OR = 2.54, 95% CI 1.91−3.39 and OR = 3.77, 95% CI 2.47−5.75; p < 0.001 with 3.1 and 3.5 BMI increment for heterozygotes and homozygotes, respectively). SSB consumption (≥1 serving/day) significantly raised obesity risk and wine consumption (1−3 drinks/weekly) significantly lowered obesity risk for rs9939609 risk-allele carriers (OR = 1.54, 95% CI 1.05−2.27; p = 0.028 and OR = 0.61, 95% CI 0.47−0.79; p < 0.001, respectively). Our findings demonstrate that actionable lifestyle factors modify the common FTO obesity risk in predisposed carriers, and they have personal and public health implications.

Adherence to Mediterranean Diet and Soluble Klotho Level: The Value of Food Synergy in Aging

Diets for healthy aging have long been an intriguing issue. The current study makes a head-to-head comparison of four dietary patterns and their associations with soluble Klotho (s-Klotho) levels, an aging-related marker. The dietary data of 7906 subjects were obtained from the National Health and Nutrition Examination Survey 2007−2016. Each participant was given a score or was grouped according to four dietary patterns, namely the Mediterranean adherence diet score (MDS), the low-carbohydrate-diet score, a low-fat diet, and a low-carbohydrate diet. Subsequently, the associations with s-Klotho were examined using linear regression analyses. In addition, we calculated the odds ratio (OR) for aging in different dietary patterns, taking the lowest quartile of s-Klotho as a reference for aging. The MDS was the only dietary pattern that revealed a relationship with s-Klotho levels. The positive association (β coefficient: 9.41, p < 0.001) remained significant when dividing the MDS into tertiles (Tertile 2: β coefficient: 36.87, p < 0.001; Tertile 3: β coefficient: 45.92, p < 0.001) and grouping participants into subsets by sex, age, and BMI. A lower OR for aging was observed in higher MDS groups (Tertile 2: OR = 0.86, p = 0.026; Tertile 3: OR = 0.77, p < 0.001). However, when analyzed separately, merely three out of nine components of the MDS, namely alcohol consumption (β coefficient: 42.54, p < 0.001), fruit (β coefficient: 11.59, p = 0.029), and dairy products (β coefficient: 8.55, p = 0.032), showed a significant association with s-Klotho. The Mediterranean diet adopts a food-based approach, which has the merit of valuing the complex interactions between foods and their constituents, and further brings benefits to healthy aging.

The Effect of Dietary Carbohydrate and Fat Manipulation on the Metabolome and Markers of Glucose and Insulin Metabolism: A Randomised Parallel Trial

High carbohydrate, lower fat (HCLF) diets are recommended to reduce cardiometabolic disease (CMD) but low carbohydrate high fat (LCHF) diets can be just as effective. The effect of LCHF on novel insulin resistance biomarkers and the metabolome has not been fully explored. The aim of this study was to investigate the impact of an ad libitum 8-week LCHF diet compared with a HCLF diet on CMD markers, the metabolome, and insulin resistance markers. n = 16 adults were randomly assigned to either LCHF (n = 8, <50 g CHO p/day) or HCLF diet (n = 8) for 8 weeks. At weeks 0, 4 and 8, participants provided fasted blood samples, measures of body composition, blood pressure and dietary intake. Samples were analysed for markers of cardiometabolic disease and underwent non-targeted metabolomic profiling. Both a LCHF and HCLF diet significantly (p < 0.01) improved fasting insulin, HOMA IR, rQUICKI and leptin/adiponectin ratio (p < 0.05) levels. Metabolomic profiling detected 3489 metabolites with 78 metabolites being differentially regulated, for example, an upregulation in lipid metabolites following the LCHF diet may indicate an increase in lipid transport and oxidation, improving insulin sensitivity. In conclusion, both diets may reduce type 2 diabetes risk albeit, a LCHF diet may enhance insulin sensitivity by increasing lipid oxidation.

A risk prediction model for hepatocellular carcinoma after hepatitis B surface antigen seroclearance

BACKGROUND & AIMS

After hepatitis B surface antigen (HBsAg) seroclearance, the risk of hepatocellular carcinoma (HCC) remains, and the optimal surveillance strategy has yet to be determined. Herein, we aimed to evaluate incidence and risk factors for HCC and establish a novel prediction model for HCC development after HBsAg seroclearance.

METHODS

A total of 1,443 patients with chronic hepatitis B who achieved HBsAg seroclearance between 1991 and 2020 were retrospectively screened for study eligibility. The data from 831 of these patients were included in the final analysis. A prediction model was developed based on multivariable Cox models. Harrell's C-index and a time-dependent AUROC were used for discrimination. Bootstrap analysis was performed for internal validation.

RESULTS

Overall, 40 patients (4.8%) developed HCC after HBsAg seroclearance during a follow-up of 4,644 person-years (0.86%/year). Age at HBsAg seroclearance, presence of cirrhosis, family history of HCC, and more-than-moderate alcohol consumption were independently predictive of HCC, and these 4 independent variables were used to develop the prediction model. The C-index of the model was 0.804. The time-dependent AUROCs of the score for HCC prediction at 5, 10, and 15 years were 0.799, 0.835, and 0.817, respectively. The score also showed good discrimination in the internal validation and sensitivity analysis.

CONCLUSIONS

The novel prediction model based on age, cirrhosis, family history of HCC, and alcohol consumption enables reliable risk estimation of HCC after HBsAg seroclearance and may serve as a useful reference for decision-making in HCC surveillance for HBsAg-cleared patients.

LAY SUMMARY

After spontaneous hepatitis B surface antigen (HBsAg) seroclearance, the risk of hepatocellular carcinoma (HCC) remains. Age at HBsAg seroclearance, presence of cirrhosis, family history of HCC, and more-than-moderate alcohol consumption were independently associated with HCC development after HBsAg seroclearance. The novel prediction model using these 4 variables enables reliable risk estimation of HCC and serves as a useful reference for decision-making in HCC surveillance and management for HBsAg-cleared patients.

Ultra-processed Foods, Weight Gain, and Co-morbidity Risk

PURPOSE OF REVIEW

The purpose of this review is to provide an update on the available data regarding the associations of Ultra-processed food (UPF) consumption with food intake and possible underlying mechanisms relating UPF consumption to weight gain and co-morbidities.

RECENT FINDINGS

In primarily observational studies, UPF consumption is consistently associated with an increased risk for weight gain among adults and children and increased risk for adiposity-related co-morbidities in adults. In a single mechanistic study, consumption of UPFs led to increased energy intake and weight gain relative to whole foods. UPFs tend to be more energy-dense than nutrient-dense, and UPF consumption is associated with increased adiposity and co-morbidity risk. These data suggest that recommendations to limit UPF consumption may be beneficial to health - though further mechanistic studies are needed.

Serum isthmin-1 levels are positively and independently correlated with albuminuria in patients with type 2 diabetes mellitus

INTRODUCTION

Isthmin-1 (Ism-1), as a novel adipokine, plays a role in glucose homeostasis and lipid metabolism. However, the relationship between Ism-1 and type 2 diabetes mellitus (T2DM) remains unclear. This study aims to investigate the association of serum Ism-1 levels with albuminuria and insulin resistance in patients with T2DM and preserved renal function.

RESEARCH DESIGN AND METHODS

A total of 150 patients with T2DM were recruited. The presence of albuminuria was evaluated by urinary albumin:creatinine ratio (UACR) in first morning urine sample. Serum Ism-1 levels were tested by ELISA. Homeostasis model assessments were used to evaluate insulin resistance. Binary logistic regression and multivariable linear regression analyses were used to assess the association of serum Ism-1 levels with albuminuria. Multivariable linear regression analyses were performed to explore the correlation of serum Ism-1 levels with insulin resistance.

RESULTS

Compared with the normal-albuminuria and microalbuminuria groups, serum Ism-1 levels were significantly higher in the macroalbuminuria group (p<0.01). Binary logistic regression analyses showed that serum Ism-1 was positively associated with odds of albuminuria even after multiple adjustments (OR=4.766, p=0.013). Serum Ism-1 was positively associated with log10-transformed UACR (β=0.625, p<0.001). However, the associations between serum Ism-1 levels and insulin resistance were not observed in patients with T2DM.

CONCLUSIONS

Serum Ism-1 levels were positively and independently correlated with the severity of albuminuria in patients with T2DM but not with insulin resistance.

Considerations for the translation of nutrient recommendations as dietary plans for infants, children, and adolescents as reported in Italian Guidelines for healthy eating

Healthy eating in childhood and adolescence is important for proper growth and development and to establish a healthy foundation for future dietary habits. This paper aims to describe the elaboration of dietary plans for pediatric ages highlighting critical points related to the application of the Italian nutrient recommendations. National databases on food composition data were used to compile the dietary plans. Starting from the definition of serving size for adults, the suggested portion size for pediatric ages was shaped to produce appropriate dietary plans according to the different classes of age. Items from “cereals and derivatives,” “milk,” “fruit,” “vegetables,” “olive oil,” and “water” groups were included daily. Pizza was included once a week. Sweets and snacks were gradually introduced, once a week in infants and up to five times a week in adolescents. Legumes were provided three times a week, as a source of vegetable and sustainable proteins. The main critical aspect of the dietary plans was related to the monotony, especially for snacks and breakfasts. This work demonstrated the limits of the translation of Italian nutrient recommendations into dietary plans for pediatric age groups. Keeping the protein intake in the recommended range of 8–12% of daily energy resulted in inadequate provision of calcium and iron. Other critical points were the reference values for body weight and physical activity. The proposed dietary plans are adequate with regard to food composition, the intake of energy and several nutrients, and in terms of food selection. However, their implementations require action, information, and advocacy.

Lipidomic Signatures of Dairy Consumption and Associated Changes in Blood Pressure and Other Cardiovascular Risk Factors Among Chinese Adults

BACKGROUND

Omics data may provide a unique opportunity to discover dairy-related biomarkers and their linked cardiovascular health.

METHODS

Dairy-related lipidomic signatures were discovered in baseline data from a Chinese cohort study (n=2140) and replicated in another Chinese study (n=212). Dairy intake was estimated by a validated food-frequency questionnaire. Lipidomics was profiled by high-coverage liquid chromatography-tandem mass spectrometry. Associations of dairy-related lipids with 6-year changes in cardiovascular risk factors were examined in the discovery cohort, and their causalities were analyzed by 2-sample Mendelian randomization using available genome-wide summary data.

RESULTS

Of 350 lipid metabolites, 4 sphingomyelins, namely sphingomyelin (OH) C32:2, sphingomyelin C32:1, sphingomyelin (2OH) C30:2, and sphingomyelin (OH) C38:2, were identified and replicated to be positively associated with total dairy consumption (β=0.130 to 0.148; P<1.43×10^-4), but not or weakly with nondairy food items. The score of 4 sphingomyelins showed inverse associations with 6-year changes in systolic (-2.68 [95% CI, -4.92 to -0.43]; P=0.019), diastolic blood pressures (-1.86 [95% CI, -3.12 to -0.61]; P=0.004), and fasting glucose (-0.25 [95% CI, -0.41 to -0.08]; P=0.003). Mendelian randomization analyses further revealed that genetically inferred sphingomyelin (OH) C32:2 was inversely associated with systolic (-0.57 [95% CI, -0.85 to -0.28]; P=9.16×10^-5) and diastolic blood pressures (-0.39 [95% CI, -0.59 to -0.20]; P=7.09×10^-5).

CONCLUSIONS

The beneficial effects of dairy products on cardiovascular health might be mediated through specific sphingomyelins among Chinese with overall low dairy consumption.

Consumption of aquatic products and meats in Chinese residents: A nationwide survey

Objective

To provide the most recent national estimates for the consumption of aquatic products and meats among Chinese residents.

Methods

This study was conducted in 14 provinces of China, using a multi-stage stratified random cluster sampling method and a population-proportional sampling procedure. Aquatic products and meats consumption was measured by a 3-day, 24-h dietary recall. Chinese residents aged 3 years and above (n = 24,106) completed a face-to-face dietary interview.

Results

The average daily consumption of meat and aquatic products for the all-aged population was 70.9 g and 48.0 g, respectively, which aligned with Dietary Guidelines (40–75 g/d) for Chinese Residents (2016). On the one hand, intake of aquatic products among Chinese people was relatively insufficient, especially for adolescents and elder people (<40 g/d). On the other hand, males, mainly aged 19–60, generally consumed too much meat (>80 g/d), and 19–44 grouping consumed more than 70 g/d of red meat. Besides, urban residents and individuals with higher socioeconomic status (SES) have exhibited comprehensively healthy dietary preferences than rural ones and those with a lower SES do. Women and the higher SES group tend to be closer to the dietary guidelines for the Chinese.

Conclusions

The consumption of meat and aquatic products varied with age, gender, region and SES. Detecting patterns in consumption is particularly relevant for policy makers, researchers and health professionals in the formulation of dietary recommendations and estimating potential health outcomes.

Introductory Chapter: Potassium in Human Health

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Dietary variety relates to gut microbiota diversity and abundance in humans

PURPOSE

We aim to investigate the relationship between gut microbiota and dietary variety in a Chinese population using Dietary Variety Score (DVS), an index of dietary variety, as little has studied the relationship of dietary variety and gut microbiota in a general population.

METHODS

In this cross-sectional study, recruited participants were conducted with face-to-face interview to collect information on 24-h food intake and dietary consumption using a valid food frequency questionnaire. Subjects (n = 128) were divided as high and low DVS groups by the median of DVS after rigorously matching for confounding factors. The gut microbiota was assessed by 16S rRNA sequencing and the correlations between key phylotypes and DVS, Index of Nutritional Quality (INQ) and clinical indices were examined using generalized linear model in negative binomial regression.

RESULTS

Higher score of DVS, INQVB6, INQVE and INQZn exhibited higher α-diversity. DVS was correlated with INQ and six genera. Among the DVS-correlated genera, Turicibacter, Alistipes and Barnesiella were positively correlated with INQVE, INQZn and INQCu, individually or in combination, while Cetobacterium was negatively correlated with INQCu, INQZn and INQVE. The abundance of Coprococcus and Barnesiella increased with the elevated cumulative scores of INQVE, INQVB6 and INQZn. The combination of Alistipes, Roseburia and Barnesiella could moderately predict dietary variety status.

CONCLUSION

Higher DVS was correlated with higher microbial diversity and more abundance of some potentially beneficial bacteria but with less some potentially pathogenic bacteria. A high variety dietary, therefore, should be recommended in our daily life.

Vegetarianism, Microbiota and Cardiovascular health: Looking back, and forward

Cardiovascular diseases (CVD) are the leading cause of death globally, with over 17.9 million attributed deaths in 2019. Unhealthy diet is an often-overlooked major modifiable risk factor for CVD. Global Burden of Disease (GBD) estimates suggest that unhealthy diets account for nearly 26% of all deaths, of which 84% were attributed to CVD. Plant-based diets (PBDs), which are a diverse group of dietary patterns focused on plant produce, with flexibility for varying levels of vegetarianism, have been suggested to decrease the incidence of various cardiovascular and cardiometabolic diseases. In this review, we aim to delve into the spectrum of PBDs, revisit objective definitions and classifications, and compare them with standard non-vegetarian diets. We examine plausible mechanisms underlying the cardiovascular benefits of PBDs with a particular focus on the dietary manipulation of gut microbiota-host interaction and its effect on energy metabolism, and local and systemic inflammation. In addition, we explore the evidence on the impact of PBDs on cardiovascular disease, examine the challenges and limitations associated with dietary intervention studies, and devise strategies to draw valid conclusions. Dietary interventions, such as PBDs are one of the most powerful, attainable, cost-effective tools for health and environmental protection at the population level. We conclude with a clear appreciation for PBDs in environmental sustainability, climate change, and animal welfare.

Egg and Dietary Cholesterol Intake and Risk of All-Cause, Cardiovascular, and Cancer Mortality: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies

Objective

This systematic review and meta-analysis of prospective cohort studies examined the associations between egg and dietary cholesterol intake and the risk of mortality from all causes, including cardiovascular disease (CVD) and cancer.

Methods

We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar until April 2021, as well as references to the relevant articles retrieved. Random-effects models were used to calculate summary relative risk (RR) and 95% confidence intervals (CIs) for the highest vs. lowest categories of egg and dietary cholesterol intake. Also, linear and non-linear dose–response analyses were conducted to examine the dose-response relationships.

Results

We included 55 studies, comprising data from 2,772,486 individuals with 228,425, 71,745, and 67,211 cases of all-cause, CVD, and cancer mortality, respectively. Intake of each additional egg per day was associated with a 7% higher risk of all-cause (1.07, 95% CI: 1.02–1.12, I² = 84.8%) and a 13% higher risk of cancer mortality (1.13, 95% CI: 1.06–1.20, I² = 54.2%), but was not associated with CVD mortality (1.00, 95% CI: 0.92–1.09, I² = 81.5%). Non-linear analyses showed increased risks for egg consumption of more than 1.5 and 0.5 eggs/day, respectively. Each 100 mg/day increment in dietary cholesterol intake was associated with a 6% higher risk of all-cause mortality (1.06, 95% CI: 1.03–1.08, I² = 34.5%) and a 6% higher risk of cancer mortality (1.06, 95% CI: 1.05–1.07, I² = 0%), but was not associated with CVD mortality (1.04, 95% CI: 0.99–1.10, I² = 85.9%). Non-linear analyses demonstrated elevated risks of CVD and cancer mortality for intakes more than 450 and 250 mg/day, respectively.

Conclusions and Relevance

High-dietary intake of eggs and cholesterol was associated with all-cause and cancer mortality. Little evidence for elevated risks was seen for intakes below 0.5 egg/day or 250 mg/day of dietary cholesterol. Our findings should be considered with caution because of small risk estimates and moderate between-study heterogeneity.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252564, PROSPERO, identifier: CRD42021252564.

Effect of beetroot or beetroot plus vitamin C supplementation on cardiovascular function in patients with coronary artery disease: protocol for a double-blind, placebo-controlled, randomised trial

INTRODUCTION

Coronary artery disease (CAD), classified into the atherosclerosis category, is a prevalent cardiovascular disease worldwide that is associated with serious comorbidities and death. The purpose of this study was to evaluate the effect of beetroot/beetroot plus vitamin C on cardiovascular health status and function in patients with CAD.

METHOD AND ANALYSIS

A randomised, placebo-controlled, double-blind clinical trial to recruit 90 patients with CAD at the cardiac outpatient clinic and Imam Reza Hospital, Mashhad, Iran. Participants will be divided into three groups: (1) Those who receive 500 mg three times a day of beetroot capsules, (2) Those who receive 500 mg three times a day of beetroot plus vitamin C capsules, and (3) Those who receive placebo capsules three times a day for 4 weeks. Pulse wave velocity, Augmentation Index, heart rate, volume of oxygen (VO₂) max/VO₂ peak, peak heart rate, blood pressure, interleukin 6 (IL-6), high sensitivity C reactive protein, intercellular adhesion molecule, vascular cell adhesion molecule, lipid profile and anthropometry will be measured at the beginning and end of the intervention.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.MEDICAL.REC.1399.717). All participants will be asked to complete the consent form at the beginning of the study. The results will be actively disseminated through peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

Iranian Registry of Clinical Trials, IRCT20210217050393N1 (registered 16 May 2021).

Causal language use in systematic reviews of observational studies is often inconsistent with intent: A systematic survey

OBJECTIVE

We systematically evaluated causal language use in systematic reviews of observational studies and explored the relation between language use and the intent of the investigation.

STUDY DESIGN AND SETTING

We searched Embase, Medline, and Epistemonikos. We randomly selected 199 reviews published in 2019, stratified in a 1:1 ratio by use and non-use of the GRADE approach to rating quality of evidence.

RESULTS

Of 199 reviews of observational studies 56.8% had causal intent. Reviews with causal intent were more likely to investigate therapeutic clinical intervention (33.6% vs 12.8%). While 78.8% of those with causal intent used causal language in one or more sections of the title, abstract, or main text, only 4.4% consistently used causal language throughout the manuscript, and 21.2% did not use causal language at all. Of reviews without causal intent, 51.2% used causal language somewhere in the manuscript.

CONCLUSION

Systematic reviews of observational studies sometimes do and sometimes do not have causal intent. Both those are inconsistent in causal language use and often use language inconsistent with the intent. Journal policies would better serve clarity of thinking and appropriateness of inferences by demanding authors clearly specify their intent and consistently use language consistent with that intent.

Application of a Validated Method for the Identification and Quantification of Mycotoxins in Wines Using UPLC-MS/MS

The aim of the present study was to develop a rapid, simple and reliable method for the identification and quantification of six mycotoxins in wine using liquid chromatography with electrospray ionization tandem mass spectrometry. The analytical method was fully validated, and calibration curves were made with correlation coefficients >0.9970. A short analysis time and acceptable extraction efficiency were achieved by a direct extraction method of analytes (ochratoxin A, aflatoxin B1, B2, G1, G2 and Zearalenone) with acetonitrile. LOD values were from 0.03 to 0.27 μg kg−1, and LOQ values were from 0.08 to 0.81 μg kg−1, with recoveries at various values from 77 to 108%. The expanded uncertainty was 5–21% expressed at a coverage level of k = 2, at a confidence level of approximately 95%. The performance criteria of the method were fully met according to European legislation (EC) 401/2006. The method was successfully applied to wine samples from Cyprus. The method was simple, low cost, quick, accurate, and sensitive.

The 2018 Revision of Italian Dietary Guidelines: Development Process, Novelties, Main Recommendations, and Policy Implications

The fourth edition of the Italian Dietary Guidelines (IDGs) for Healthy Eating was published in 2019. The objective of this paper is to describe the developmental process of IDGs, the main recommendations, the differences with previous revisions, and the concordance and differences with international guidance on a healthy diet. A National Commission oversaw IDG development. A Scientific Dossier (SD), including analysis on nutrition, health, and risk factors status in Italy, was the reference for IDGs preparation. The IDGs are based on the principles of the Mediterranean Diet and are mainly aimed to prevent obesity and nutrition-related non-communicable diseases. The IDGs included 13 directives that were divided into four conceptual blocks: i) how to balance weight; ii) foods to be promoted; iii) foods to be limited; and iv) how to ensure a varied and sustainable diet. Each directive has a box summarizing the key recommendation, myths lists, and false beliefs to be dispelled. The topics of sustainability and the correct approach to food supplementation and weight-loss diet were introduced in the present edition of IDGs. This paper contributes to the debate on the complexity of derivation of Dietary Guidelines and their adaptation to the national context.