Healthy Eating Patterns and Risk of Total and Cause-Specific Mortality

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

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Associations between plant-based diets and cardiovascular disease, frailty, and cognitive dysfunction in middle and old age: a systematic review and meta-analysis of cohort studies

Background: Evidence suggests that plant-based diets are associated with multiple health outcomes. However, in previous pooled studies, the lack of a standardized definition of plant-based diet has led to conflicting evidence regarding its relationship with health outcomes in middle-aged and elderly people. Methods and findings: Searches were conducted on PubMed, Embase, Cochrane Library and Web of Science databases from inception until July 10, 2024. We included studies that examined the association between (1) the standardized healthy plant-based diet index (hPDI) and unhealthy plant-based diet index (uPDI) and (2) cardiovascular disease (CVD), cardiovascular mortality (CVD mortality), frailty, and cognitive dysfunction. Dose-response analysis was performed to assess the relationships between (1) hPDI and uPDI and (2) CVD and frailty. Statistical analyses were performed using an inverse variance random-effects model, and results are reported as risk ratio (RR) with 95% confidence interval (CI) by combining the most adjusted RR, odds ratio (OR) and hazard ratio (HR) under the rare outcome assumption. A total of 25 cohort studies were included. Higher hPDI scores were associated with lower risks of CVD (RR = 0.81, 95% CI 0.71-0.93), CVD mortality (RR = 0.83, 95% CI 0.75-0.90), coronary heart disease (CHD) (RR = 0.79, 95% CI 0.70-0.88), stroke (RR = 0.91, 95% CI 0.86-0.96), ischemic stroke (RR = 0.86, 95% CI 0.79-0.94), cognitive dysfunction (RR = 0.75, 95% CI 0.66-0.84) and frailty (RR = 0.72, 95% CI 0.60-0.86). By contrast, higher uPDI scores were associated with increased risks of CVD (RR = 1.16, 95% CI 1.09-1.24), CVD mortality (RR = 1.14, 95% CI 1.05-1.23), frailty (RR = 1.52, 95% CI 1.10-2.08) and cognitive dysfunction (RR = 1.24, 95% CI 1.11-1.38). Dose-response analyses showed that increasing adherence to hPDI was associated with reduced risks of CVD and frailty, whereas increasing intake of hPDI was linked to increased risk of CVD and frailty. Conclusions: Our study suggests that adherence to hPDI is associated with favourable health outcomes in middle-aged and elderly people, except for hemorrhagic stroke. These findings highlight the potential benefits of hPDI for promoting healthy ageing.

Dietary patterns and mortality risk in geriatric patients with atherosclerotic cardiovascular disease: an analysis of the National Health and Nutrition Examination Survey

Atherosclerotic cardiovascular disease (ASCVD) has a high incidence and a significant impact on quality of life, especially in older adults. Healthy diets potentially improve patient outcomes, but the most beneficial dietary pattern remains unclear. Therefore, we aimed to evaluate the effectiveness of different dietary patterns in improving outcomes for geriatric patients with ASCVD. This study used data from the National Health and Nutrition Examination Survey (NHANES) database (2003-2006) on older adults (≥ 60 years). Scores for the Healthy Eating Index 2015 (HEI-2015) diet, Mediterranean-style diet (MED), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH intervention for neurodegenerative delay (MIND) diet were calculated. Cox proportional hazard models assessed the associations of different dietary patterns with all-cause and cardiovascular (CV) deaths in patients with ASCVD. The total population included 674 patients, including 453 (67.21%) all-cause deaths and 186 (27.60%) CV deaths, with a mean follow-up time of 117.5 months. Greater adherence to the MIND diet was associated with a lower risk of all-cause mortality (adjusted HR = 0.75, 95%CI:0.58, 0.96, P for trend = 0.016), whereas other dietary patterns had no significant associations (all P values > 0.05). No dietary pattern was significantly associated with CV mortality (all P values > 0.05). Moreover, the MIND diet significantly interacted with the inflammatory status in predicting all-cause mortality (P for interaction < 0.05). For older ASCVD patients, higher adherence to the MIND diet is associated with reduced all-cause mortality, with inflammation significantly modulating this effect. The MIND diet may be the most beneficial eating pattern for this population.

Enhancing Nutrition Care in Primary Healthcare: Exploring Practices, Barriers, and Multidisciplinary Solutions in Ireland

Good nutrition promotes a healthy population and mitigates the risk of disease. Integrating nutrition care in the primary healthcare system is considered an essential plan of action to manage poor nutritional status in the population. The role of primary healthcare professionals (HCPs) in the delivery of nutrition care is especially crucial due to a current lack of dietitians and dietary support in the primary care setting in Ireland. This qualitative research explored the current practice, barriers, facilitators, and feasible solutions proposed to optimize the provision of nutrition care by primary HCPs. Twenty semi-structured interviews (pharmacists (n = 14), dietitians (n = 3), a physiotherapist (n = 1), a speech and language therapist (n = 1), and a healthcare assistant (n = 1) were conducted. Six themes were derived from the data: current practice of nutrition care in primary care, perceived role, barriers and facilitators, the importance of a multidisciplinary patient-centred approach, training needs and preferences, and addressing barriers. Participants acknowledged the importance of nutrition care in clinical practice, the principal role of the dietitian as part of the multidisciplinary team, and the essential clinical competencies and nutrition training models that may facilitate the provision of nutrition care in primary practice. A paradigm shift to a multidisciplinary care model that prioritises the integration of nutrition care into primary care practice to ensure optimal dietary counselling is afforded to patients is essential.

Three Decades of the Mediterranean Diet Pyramid: A Narrative Review of Its History, Evolution, and Advances

The Mediterranean Diet Pyramid was officially published in the American Journal of Clinical Nutrition in 1995. Since then, our understanding of the role of the Mediterranean diet (MedDiet) and its role in reducing risk of chronic diseases has grown substantially. The aim of this article is to provide a narrative review of the historical context of the MedDiet and its environmental impact, summarize health-related evidence from the past three decades, and explore its practical applications and cultural adaptations. A large body of evidence from prospective cohort studies, randomized controlled trials, and mechanistic studies consistently supports the benefits of the MedDiet for the prevention of chronic diseases, particularly cardiometabolic diseases and improving healthy aging. Growing evidence demonstrates that the MedDiet promotes favorable changes in circulating metabolites and gut microbiome composition, providing novel insights into biological mechanisms underlying its health benefits and informing the development of precision nutrition strategies. The MedDiet aligns with the principles of the Planetary Health Diet recommended by the EAT-Lancet Commission, which aims to promote both human health and environmental sustainability. The development of the MedDiet pyramid 30 years ago inspired the creation of the Asian, African, and Latin American Heritage Diet Pyramids. Despite robust evidence, further studies are needed to evaluate the long-term effectiveness and adaptability of the MedDiet across diverse populations, cultural settings, and food environments.

Disparities in lifestyle among community-dwelling older adults with or without mild cognitive impairment: a population-based study in north-western China

Background

Evidences indicate that patients with unhealthy lifestyles are at a higher risk of cognitive impairment and dementia. However, uncertainty remains about the association of lifestyles with mild cognitive impairment (MCI) in less-developed areas.

Methods

We used multi-stage stratified sampling method to obtain study population aged ≥65 years, and subsequently a cross-sectional survey was produced including 509 individuals (109 MCI and 400 healthy controls) between March and June 2023. A healthy lifestyle score was defined by scoring six behaviors (non-smoking, non-drinking, exercising, sleeping duration more than 6 h, having a high-quality diet, and controlled BMI). The cognitive function was assessed using the Mini-Mental State Examination (MMSE).

Results

The mean age was 73.8 years, and 57.6% were men of the participates, 21.4% have MCI. Subjects with more healthy lifestyle had significantly lower total score of MMSE, compared to non-MCI subjects. Multivariate logistic regression analysis showed that unhealthy lifestyle behaviors (smoking, drinking, non-compliance diet, harmful sleep, physical inactivity, and harmful BMI) was the significant risk factors for the presence of MCI, independent of factors as sex, age, education level, and family history of AD.

Conclusion

The prevalence of MCI is high, and unhealthy lifestyle is an independent risk factor for MCI in less-developed area. Highlighting the importance of changes in lifestyle behaviors which may influence the cognitive abilities of older adults, specially in settings with approximate conditions.

Optimal dietary patterns for healthy aging

As the global population ages, it is critical to identify diets that, beyond preventing noncommunicable diseases, optimally promote healthy aging. Here, using longitudinal questionnaire data from the Nurses' Health Study (1986-2016) and the Health Professionals Follow-Up Study (1986-2016), we examined the association of long-term adherence to eight dietary patterns and ultraprocessed food consumption with healthy aging, as assessed according to measures of cognitive, physical and mental health, as well as living to 70 years of age free of chronic diseases. After up to 30 years of follow-up, 9,771 (9.3%) of 105,015 participants (66% women, mean age = 53 years (s.d. = 8)) achieved healthy aging. For each dietary pattern, higher adherence was associated with greater odds of healthy aging and its domains. The odds ratios for the highest quintile versus the lowest ranged from 1.45 (95% confidence interval (CI) = 1.35-1.57; healthful plant-based diet) to 1.86 (95% CI = 1.71-2.01; Alternative Healthy Eating Index). When the age threshold for healthy aging was shifted to 75 years, the Alternative Healthy Eating Index diet showed the strongest association with healthy aging, with an odds ratio of 2.24 (95% CI = 2.01-2.50). Higher intakes of fruits, vegetables, whole grains, unsaturated fats, nuts, legumes and low-fat dairy products were linked to greater odds of healthy aging, whereas higher intakes of trans fats, sodium, sugary beverages and red or processed meats (or both) were inversely associated. Our findings suggest that dietary patterns rich in plant-based foods, with moderate inclusion of healthy animal-based foods, may enhance overall healthy aging, guiding future dietary guidelines.

Association between Healthy Eating Index 2015 and metabolic syndrome among US cancer survivors: evidence from NHANES 2005-2016

Our study examined the relationship between diet quality and the prevalence of metabolic syndrome (MetS) among 1779 U.S. cancer survivors using data from the National Health and Nutrition Examination Survey (NHANES, 2005-2016). Diet quality was assessed using the Healthy Eating Index 2015 (HEI-2015). Higher HEI-2015 scores were linked to significantly lower MetS prevalence (OR: 0.51, 95% CI: 0.32-0.80). Specifically, a higher intake of seafood and plant proteins, and fatty acids, coupled with a reduced intake of added sugars, was associated with decreased odds of MetS prevalence (OR: 0.93; 95% CI, 0.86-0.99) in cancer survivors. Additionally, a better diet quality was linked to lower prevalence of high waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL) cholesterol and high fasting glucose levels (OR, 0.44; 95% CI, 0.27-0.72). These results suggest that adopting healthy dietary habits may prevent MetS in cancer survivors.

Healthy dietary patterns in relation to cognitive performance and Alzheimer's disease mortality

BACKGROUND

Dietary factors play a major role in cognitive aging, but few studies have assessed and compared the associations between specific dietary patterns and Alzheimer's disease (AD) mortality.

METHODS

We included 27,773 U.S. participants (mean age = 59.8 years, 51.4 % female) from the National Health and Nutrition Examination Survey (NHANES) between 1998 and 2016, with follow-up for AD mortality until December 2019. Five dietary pattern scores were calculated utilizing one (1999-2002) or two repeated (2003-2016) 24hr dietary recalls, including the Healthy Eating Index (HEI-2015), the healthful plant-based diet index (hPDI), the alternate Mediterranean diet (aMED), the Dietary Approach to Stop Hypertension diet (DASH), and the Mediterranean-DASH Intervention for Neurodegeneration Delay diet (MIND) scores. We utilized Cox proportional hazard models to evaluate the associations of these dietary pattern scores with AD mortality.

RESULTS

A total of 260 AD deaths occurred during a median follow-up of 9.8 years. Higher aMED score was associated with a lower risk of AD mortality (HRT3vs T1: 0.72, 95 % CI, 0.52-1.00, p-trend = 0.041). In a sub-sample of 2,713 participants in NHANES 2011-2014, 432 individuals had prevalent psychometric mild cognitive impairment (p-MCI). Higher aMED, MIND, HEI-2015, and hPDI were associated with lower odds of p-MCI. The potential contributors to these associations included higher intake levels of vegetables and nuts, moderate alcohol consumption, and lower intake level of sweets.

CONCLUSIONS

The Mediterranean dietary pattern was associated with more favorable cognitive outcomes among middle-aged and older adults, underscoring the importance of a healthy diet for long-term benefits in cognitive and brain health.

The Turkish validity and reliability of the Reward-Based Eating Drive (RED-13) Scale

TRIAL REGISTRATION

The study was registered on ClinicalTrials.gov (number: NCT05017506).

Associations Between Sleep, Nutrition, and Health

Poor sleep is highly prevalent, affecting a significant proportion of the global population, and imposing a substantial burden on individuals' health, quality of life, and productivity [...].

Plant-based diets and mortality in Black and low-income Americans: findings from a large prospective cohort study

BACKGROUND

Plant-based diets have been widely promoted for their health and environmental benefits. However, the health benefits may differ by the quality (i.e. healthiness) of plant foods, and few studies have specifically evaluated the association of plant-based diets with mortality in Black and low-income Americans who disproportionately experience poor health outcomes.

OBJECTIVES

We aimed to examine associations of plant-based dietary patterns with all-cause and cause-specific mortality in the Southern Community Cohort Study, a population-based prospective cohort conducted among predominantly Black and low-income Americans.

METHODS

Included in this study were 77,797 participants. Plant-based dietary patterns were assessed by established indices [i.e. overall plant-based diet index (PDI), healthy plant-based diet index (hPDI), unhealthy plant-based diet index (uPDI)] based on dietary intakes collected using a validated food frequency questionnaire at baseline (2002-2009). Mortality data were ascertained through 2022. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of PDI, hPDI, and uPDI with mortality from all, cardiovascular disease (CVD), cancer, and other nonexternal causes, adjusting for potential confounders.

RESULTS

During a median follow-up of 16.6 y, 27,269 deaths were identified. Compared with the lowest quintile, the highest quintile of PDI (HR = 0.87, 95% CI: 0.81, 0.93) and hPDI (HR = 0.82, 95% CI: 0.76, 0.89) was associated with reduced all-cause mortality (both Ptrend < 0.001). In contrast, a high uPDI was linked to elevated all-cause mortality (HR = 1.17, 95% CI: 1.08, 1.26 for the highest compared with lowest quintile, Ptrend < 0.001). Similar associations were observed for mortality from CVD and other causes. We also identified significant multiplicative interactions between hPDI and a composite measure of nondietary lifestyles in reducing all-cause and CVD mortality.

CONCLUSIONS

Adherence to a diet characterized by healthy plant foods and low animal foods may decrease mortality.

Association of dietary inflammatory index, composite dietary antioxidant index and risk of death among adult cancer survivors: findings from the National Health and Nutrition Examination Survey 2001-2018

Background

The development and progression of cancer can be impacted by the nutrients and components contained in the diet. This research seeks to explore the relationship between the antioxidant and pro-inflammatory properties of diet and the risk of all-cause mortality among cancer survivors.

Methods

Adults aged 20 and above who had been diagnosed with cancer and participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018 were selected for this study. Their survival status was verified using death certificate information from the National Death Index. The study employed two established measures, the Composite Dietary Antioxidant Index (CDAI) and the Dietary Inflammatory Index (DII), to evaluate the antioxidant and inflammatory properties of participants' diets. A non-linear association between these two dietary indices and mortality was examined respectively using restricted cubic spline (RCS) regression. To quantify the relationship between the indices and mortality risk, multivariable Cox proportional hazards models were employed, generating hazard ratios and corresponding 95% confidence intervals. Furthermore, the study also explored the connection between the CDAI and DII.

Results

In this study, a total of 3,507 cancer survivors, representing an estimated 20,016,255 cancer survivors in the US, were included in the baseline analysis. The results showed that patients with lower DII or higher CDAI values had better survival rates. RCS regression revealed that both indicators showed linear relationships with all-cause mortality in the crude and adjusted models. It was consistently noted higher CDAI or lower DII was related to a reduced risk of all-cause mortality in cancer survivors in the Cox regression. Moreover, the subgroup analysis demonstrated that these associations hold true across various subgroups, lending credibility to the overall findings of the study. At last, an inverse correlation was observed between CDAI and DII in the diets of cancer survivors.

Conclusion

The research suggests that adopting a diet that low in pro-inflammatory foods and high in antioxidants may lower the all-cause mortality in cancer survivors. However, further prospective cohort studies are necessary to confirm these findings.

The Relationship Between Diet Quality and 21-Year Cumulative Health Care Costs Among Australian Women: A Longitudinal Cohort Study

BACKGROUND

The relationships between diet quality and health care costs have not been explored beyond 15 years.

OBJECTIVE

To investigate relationships between both baseline diet quality and change in diet quality over time with cumulative data on health care claims and costs over 21 years among Australian women.

DESIGN

This is a secondary analysis of data from a cohort study, the Australian Longitudinal Study on Women's Health.

PARTICIPANTS/SETTING

Data for women born between 1946 and 1951 included diet quality data at baseline (2001, n = 8228), change in diet quality (2001-2013, n = 6553), and cumulative administrative health care data (2001-2021).

MAIN OUTCOMES

Diet quality was assessed using the Australian Recommended Food Score (ARFS) and the Fruit and Vegetable Variety Score. Twenty-one-year cumulative Medicare Benefits Schedule data (number of claims; total charges [$USD]), Australia's universal health care coverage, were reported by baseline ARFS quintile and category of diet quality change ("diet quality worsened" [ARFS decrease ≤ -4 points], "remained stable" [-3 ≤ change in ARFS ≤ 3 points] or "improved" [ARFS increase ≥ 4 points]).

STATISTICAL ANALYSIS

Linear regression analyses were conducted and adjusted for socioeconomic, health, and lifestyle factors.

RESULTS

Higher baseline vegetable ARFS were correlated with fewer 21-year cumulative Medicare claims (β = -4.9, 95% CI, -7.3, -2.4) and charges (β = -$214; 95% CI, -$341; -$88). Baseline higher dairy scores were correlated with higher Medicare claims (β = 17.2; 95% CI, 11.1, 23.3) and charges (β = $762; 95% CI, $448, $1076). Compared with women whose diet quality score remained stable, those whose diet quality worsened over time made significantly more claims and higher charges; median (Q1, Q3) 413 (277, 588) claims, $17 868 ($11 037, $27 808) cumulative charges, compared with 387 (259, 559) claims, and $16 953 ($10 033, $26 604) cumulative charges. Change in total ARFS and ARFS subscales were predictors of 21-year cumulative health care claims. For each 1-point increase in ARFS over time, 1.2 fewer health care claims were made (95% CI, 0.3-2.2). Increasing vegetable and dairy ARFS scores were correlated with significantly fewer claims.

CONCLUSIONS

Baseline greater variety of vegetables was correlated with fewer 21-year health care claims and costs. Worsening diet quality over time was correlated with greater cumulative health care claims and costs. Consideration of dietary quality and variety in national policy is suggested to potentially reduce national health care claims and costs.

Active ingredients of blueberry pomace: A comprehensive review of isolation, identification, health benefits and food applications

Blueberry pomace is a valuable source of a wide range of active compounds and nutrients and is receiving increasing research attention. However, limited attention has been paid in the literature to the nutritional properties and practical applications of blueberry pomace. In this paper, we review the methods used to extract bioactive compounds from blueberry pomace, study their health effects and explore the prospects for their application in the food industry, such as fermented beverages, nutritional supplements or natural colors. In addition, recent studies have examined the content of various active ingredients such as flavonoids, vitamins, and dietary fiber and suggested the validity of the corresponding extraction methods. In addition, these compounds have great potential in human health, such as antioxidant, hypoglycemic, improvement of cognitive impairment and gut health. This analysis also highlights the bioavailability of the active ingredients in blueberry pomace. Thus, blueberry pomace offers a wide field of scientific and technological exploration, but significant challenges must be faced in order to optimize its utilization and promote further research on extraction, applications, and innovative methods.

PNPLA3 rs738409, environmental factors and liver-related mortality in the US population

BACKGROUND & AIMS

Little is known about the interplay between patatin-like phospholipase domain-containing protein 3 (PNPLA3 rs738409 C>G), environmental factors, and the risk of liver-related death.

METHODS

A total of 4,361 adults were selected from NHANES III, 1991-1994. All participants were linked to the National Death Index until 2019 (mean follow-up: 23.2 years). Liver-related death was the study outcome. Associations of PNPLA3, diet, light alcohol intake, smoking, and BMI (kg/m2) with liver-related death were examined using competing risk regression models.

RESULTS

The PNPLA3 G-allele was significantly associated with liver-related death (adjusted subhazard ratio [adj.sHR] 2.9, 95% CI 1.4-5.8). Light alcohol intake (adj.sHR 2.2, 95% CI 1.1-4.5), top quartiles of monounsaturated fat (adj.sHR 0.43, 95% CI 0.12-0.99) and cholesterol (adj.sHR 2.6, 95% CI 1.00-8.8), coffee intake ≥3 cups/day (adj.sHR 0.05, 95% CI 0.06-0.10), former/current smoking (adj.sHR 1.8, 95% CI 1.2-2.6), BMI (adj.sHR 1.1, 95% CI 1.03-1.2), and healthy eating index (adj.sHR 0.96, 95% CI 0.93-0.98) were associated with liver-related death. Joint effects between PNPLA3 and environmental factors showed that the risk of liver-related death was significantly increased in carriers of the G-allele with light alcohol intake (adj.sHR 3.7), higher consumption (top quartile) of cholesterol (adj.sHR 4.1), former (adj.sHR 4.3) or current (adj.sHR 3.5) smoking, or BMI ≥30 (adj.sHR 4.0) kg/m2. The effects of the G-allele on the risk of LRD were significantly attenuated in those with top quartile consumption of monounsaturated fat (adj.sHR 0.5) or coffee intake ≥3 cups/day (adj.sHR 0.09). Healthy eating index was inversely associated with liver-related death across all PNPLA3 genotypes (adj.sHR 0.94, 0.96, and 0.97 for CC, CG, and GG, respectively).

CONCLUSIONS

PNPLA3 is associated with liver-related death and this relationship is significantly modified by anthropometric and environmental factors.

IMPACT AND IMPLICATIONS

Light alcohol intake, dietary factors (healthy eating index, monounsaturated fat, cholesterol), coffee intake, smoking status, and BMI are independently associated with the risk of liver-related death. The increased inherited risk of liver-related death associated with PNPLA3 rs738409 appears to be attenuated by healthy eating index, monounsaturated fat, and coffee intake, and exacerbated by light alcohol intake, smoking, and BMI. Reducing harmful environmental exposures and increasing healthy eating habits may help mitigate the risk of liver-specific mortality even in those with high genetic risk.

Are Reproducible Dietary Patterns Consistently Associated With Disease Outcomes or Their Drivers in Italy? A Systematic Review

The strength, direction, and trend of associations between specific diseases and reproducible a posteriori dietary patterns (DPs) based on principal component analysis (PCA) or exploratory factor analysis (EFA) have rarely been investigated across populations. We conducted a systematic review of PCA/EFA-based DPs identified in Italy to explore 2 methodological issues: 1) cross-study reproducibility of Italian DPs; 2) consistency of associations between reproducible DPs and the same/similar disease outcomes/DP drivers/correlates. The systematic review process and findings on DP cross-study reproducibility were published separately. This paper focuses on associations, summarizing the data in figures and tables, with post-hoc criteria for similarity among target variables, statistical methods, and adjustment for confounding. Predefined rules of inference were used to evaluate selected Hill's causal criteria (consistency, strength, and dose-response effects) and draw valid scientific conclusions on the association between PCA/EFA-based DPs and similar/the same target variables. Fifty-two articles, primarily on EFA-based DPs derived from food frequency questionnaires, were included. Regression models were used to explore the relationships between DPs and disease outcomes/DP drivers, aligning with original research questions, study designs, and literature on confounding. When considering similar target variables, 9 groups of reproducible DPs showed >50% statistically significant associations in the same direction across 1-3 groups of target variables, such as socioeconomic characteristics, incidence of chronic diseases, overall/cause-specific mortality, cardiovascular disease risk factors, pregnancy/breastfeeding-related and elderly-related outcomes. Groups targeting dairies/sweets and vegetable sources of fats showed >50% nonsignificant findings across all similar target variables. Overall, 54% of findings were nonsignificant. When considering the same target variable, the median number of DPs per group was equal to 2 (interquartile range: 2-2.5). Together with population comparability issues, this prevented us from reliably performing any meta-analyses. At this stage, valid scientific conclusions cannot be drawn to inform Italian nutritional recommendations. This study was registered at PROSPERO as registration number CRD42022341037.

Fecal Microbiota and Metabolites Predict Metabolic Health Features across Various Dietary Patterns in Adults

BACKGROUND

Consuming healthful dietary patterns reduces risk of developing metabolic diseases and nourishes the intestinal microbiota. Thus, investigating the microbial underpinnings of dietary influences on metabolic health is of clinical interest.

OBJECTIVES

This study aimed to determine the unique contributions of fecal taxa and metabolites in predicting metabolic health markers in adults across various dietary patterns.

METHODS

Dietary, metabolic, and fecal microbiota and metabolome data from 118 adults (25-45 y) were used for these cross-sectional analyses. The Diet History Questionnaire II assessed adherence to the dietary approaches to stop hypertension (DASH), Mediterranean diet, Mediterranean-DASH intervention for neurocognitive delay (MIND), and the Healthy Eating Index-2020 (HEI-2020). Metabolic features included waist circumference, blood pressure, and circulating triglyceride (TG), high-density lipoprotein cholesterol, and glucose concentrations. Microbiota composition was assessed via 16S amplicon sequencing and volatile fatty acid and bile acid concentrations were measured by targeted metabolomics. Analyses of compositions with bias correction 2 (ANCOM-BC2) and correlation analyses were used to screen for microbiota features independently associated with dietary patterns and metabolic health markers. Then, hierarchical linear regression models were used to evaluate the unique contributions of select microbial features on metabolic markers beyond adherence to dietary patterns.

RESULTS

HEI-2020 positively associated with microbiota richness (P = 0.02). Beta diversity varied across all dietary patterns (P < 0.05). DASH diet scores, Eubacteriumxylanophilum abundance, and deoxycholic acid concentration explained the most variance in systolic (R2 = 0.32) and diastolic (R2 = 0.26) blood pressure compared with other dietary patterns and microbial features. TG concentrations were best predicted by MIND diet scores, Eeligens abundance, and isobutyrate concentrations (R2 = 0.24).

CONCLUSIONS

Integrating fecal taxa and metabolites alongside dietary indices improved metabolic health marker prediction. These results point to a potential role of the intestinal microbiota in underpinning physiological responses to diet and highlight potential microbial biomarkers of metabolic health.

Association of dietary health indices with frailty

BACKGROUND

The Healthy Eating Index (HEI-2015) assesses dietary quality, and lower scores may be associated with an increased risk of frailty. However, few epidemiological studies have examined the relationship between HEI-2015 and the Frailty Index (FI). This study explores the association between HEI-2015 and FI using data from the U.S. National Health and Nutrition Examination Survey (NHANES), analyzing how factors such as gender and age influence this relationship.

METHODS

TNHANES data (2007-2018) were analyzed using logistic regression models to assess the HEI-2015-frailty association. Frailty diagnosis was based on physical activity, strength, fatigue, weight change, and gait speed, with FI scores ranging from 0 to 1. A threshold of 0.21 classified frailty. The R package "DALEX" was used for feature importance analysis to enhance the prediction of frailty. From this analysis, we selected 10 key factors to further improve the accuracy of frailty prediction.

RESULT

Of 14,300 participants, 16.2% (2,322) were classified as frail. Frail participants had lower income, higher BMI, lower physical activity, and lower HEI-2015 scores. Higher HEI-2015 scores were associated with reduced frailty risk (adjusted OR: 0.69, 95% CI: 0.56-0.87, P < 0.01). The negative association was stronger in women, higher-income groups, and those with higher education (P < 0.01). Feature importance analysis showed HEI-2015 was the top predictor of frailty.

CONCLUSION

Higher HEI-2015 scores are linked to lower frailty risk. Promoting healthy eating may prevent frailty, especially in high-risk groups, with education and demographic factors influencing this relationship.

The association between overall, healthy, and unhealthy plant-based diet indexes and risk of all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective cohort studies

Background: recent dietary guidelines recommend a diet that mainly includes plant-based foods and a moderate amount of animal products. Therefore, we hypothesized that plant-based diet indices (overall plant-based diet index (oPDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI)) might be associated with risk of all-cause and cause-specific mortality. Methods: a systematic review was conducted using PubMed, Web of Science, Scopus, and Embase databases until December 2024. Meta-analysis was performed utilizing random-effects models to calculate relative risk (RR) with the corresponding 95% confidence intervals (95% CIs). Results: from 436 initial records, 25 prospective studies met the inclusion criteria. The findings of our study indicated a modest inverse association between the adherence to oPDI and risk of all-cause mortality (RR [95% CI]: 0.89 [0.83-0.94]; n = 15 studies) as well as mortality related to cardiovascular diseases, chronic heart disease, and total cancer. Also, adherence to hPDI was found to reduce risk of all-cause (RR [95% CI]: 0.86 [0.82-0.90]; n = 21 studies), cardiovascular disease, chronic heart disease, total-cancer, and prostate cancer mortality, whereas uPDI was associated with higher risk of all-cause (RR [95% CI]: 1.20 [1.13-1.27]; n = 19 studies), cardiovascular disease, chronic heart disease, and total-cancer mortality. Our dose-response meta-analysis showed a monotonic inverse association between adherence to oPDI and hPDI and a positive linear association between adherence to uPDI and risk of all-cause mortality. Conclusion: our findings highlight the importance of evaluating the quality of plant-based foods as either healthy or unhealthy in relation to the risk of all-cause and cause-specific mortality.

Association of dietary quality indicators with gallstones in the US: NHANES 2017-2020

BACKGROUND

While dietary factors are known to influence gallstone development, the specific relationships between comprehensive dietary quality indicators and gallstone risk remain poorly understood. This study aimed to explore the association between dietary quality indicators and gallstones using data from the 2017 to 2020 US National Health and Nutrition Examination Survey (NHANES).

METHODS

A total of 6,623 US adults were extracted from the 2017-2020 NHANES, of which 734 participants self-reported having gallstones. Dietary quality indicators were assessed using 24-hour dietary recall data. We used multivariate logistic regression analysis to evaluate the association between dietary quality indicators and the likelihood of gallstones. To delineate the non-linear relationships and threshold effects, we utilized a restricted cubic spline (RCS) regression model. Subgroup analyses were also performed.

RESULTS

After adjusting for sex, age, race, education, poverty-to-income ratio, body mass index, large weight loss, alcohol use, smoking, physical activity, diabetes, hypertension, heart failure, coronary heart disease, angina pectoris, heart attack, total calories, total cholesterol, estrogen use, antihyperglycemic drug use, statin use, and glucocorticosteroid use (Model 4), a higher Dietary Inflammatory Index (DII) and lower Alternative Healthy Eating Index (AHEI), Healthy Eating Index (HEI-2020), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean Diet (MED) were all significantly associated with gallstones. Further RCS analysis revealed a nonlinear relationship between the DII and gallstones, with a threshold value of 1.842. Above this threshold, for each unit increase in the DII score, the odds of developing gallstones increased by 27.5%. Subgroup analysis demonstrated that this association was consistent across all subgroups.

CONCLUSION

Participants with gallstones exhibited poor dietary habits. Adopting a diet that reduces inflammation and supports overall health may help lower the risk of gallstone development, with potential implications for dietary recommendations in clinical practice.

Plant-based diets and all-cause and cause-specific mortality among patients with cardiovascular disease: a population-based cohort study

The role of plant-based diets in preventing premature death among patients with cardiovascular disease (CVD) has remained unknown. We aim to explore the association of plant-based dietary patterns with all-cause and cause-specific mortality among patients with CVD. A total of 10 824 participants with CVD at the baseline were followed up in the UK Biobank. We constructed three types of plant-based diet indexes [an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI)] by assigning different weights to various food groups from web-based 24 h dietary recall questionnaires. The national death registry documented the primary causes of death. The Cox proportional hazards regression models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Over a median of 9.5 years follow-up, 1273 death cases were ascertained. After multivariable adjustment, PDI had an inverse correlation with all-cause mortality [HRT3 vs. T1: 0.81 (0.70-0.94), Ptrend = 0.005] and marginal inverse association with CVD mortality [HRT3 vs. T1: 0.78 (0.61-0.99), Ptrend = 0.038], while uPDI displayed a positive correlation with all-cause mortality [HRT3 vs. T1: 1.33 (1.16-1.53), Ptrend < 0.001], CVD, and cancer mortality. Additionally, in mediation analyses, serum concentration of C-reactive protein (CRP) accounted for 6.2%, 4.0%, and 5.1% of the relationship between uPDI and all-cause, CVD, and cancer mortality, respectively. No significant associations were detected between hPDI and mortality. Our findings support dietary guidelines that recommend limiting the consumption of unhealthy plant-based foods.

Association between Mediterranean diet and metabolic syndrome: analysis of NHANES 2007-2020

Changing poor dietary habits is effective for treating metabolic syndrome (MetS). Despite the global reputation of the Mediterranean diet (MD) for health, research on its link to MetS is limited, especially in non-Mediterranean regions. This study aimed to investigate the relationship between the MD and MetS. Data from the 2007 to 2020 NHANES were analysed using multiple logistic regression, restricted cubic spline (RCS) regression, and subgroup analysis. Among 20,991 participants, a negative association between Mediterranean diet score (MDS) and MetS prevalence was observed. RCS regression indicated a linear relationship. Subgroup analysis revealed a significant negative association in most groups, except those with high school education, other Hispanics, and non-Hispanic blacks. In the American population, greater adherence to the Mediterranean diet is associated with a reduced risk of metabolic syndrome, emphasising its protective effects and relevance in public health strategies. Future research should focus on promoting its adoption and investigating causal mechanisms and the impact of specific dietary components through longitudinal studies.

"Food Is Medicine" Strategies for Respiratory Health: Evidence From NHANES 2005-2012

OBJECTIVE

Compared with other diseases with similar global burdens, little is known about how lifestyle factors other than smoking affect respiratory health, and few studies have systematically investigated the combined associations between diet and respiratory health. The aim of this research was to examine the Dietary Inflammation Index (DII), Healthy Eating Index (HEI)-2015, and individual food and nutrient associations with multiple respiratory outcomes.

METHODS

This study combined a cross-sectional study with a prospective cohort study to systematically evaluate data from adults aged 40 years or older (N = 13,227) from 4 National Health and Nutrition Examination Survey cycles (2005-2006 through 2011-2012) with lung function measures in a subset (n = 6337). DII, HEI-2015, and individual foods and nutrients were evaluated for their associations with respiratory symptoms (cough, phlegm problem, wheezing, and exertional dyspnea), chronic lung disease (asthma, chronic bronchitis, and emphysema), lung function (percentage of predicted forced expiratory volume in 1 second [FEV1pp], percentage of predicted forced vital capacity [FVCpp], forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), obstructive or restrictive spirometry patterns), respiratory cancer, all-cause mortality, and respiratory disease mortality.

RESULTS

For each point increase in DII, the odds of cough (adjusted odds ratio [aOR], 1.036; 95% CI, 1.002-1.071), wheezing (aOR, 1.044; 95% CI, 1.013-1.075), exertional dyspnea (aOR, 1.042; 95% CI, 1.019-1.066), emphysema (aOR, 1.096; 95% CI, 1.030-1.166), and restrictive spirometry patterns (aOR, 1.066; 95% CI, 1.007-1.128) increased and FEV1pp (adjusted mean difference [aMD], -0.525%; 95% CI, -0.747% to -0.303%) and FVCpp (aMD, -0.566%; 95% CI, -0.762% to -0.371%) decreased. HEI-2015 scores were similarly associated with these respiratory outcomes. Each point increase in the DII was associated with an increased risk of all-cause mortality (adjusted hazard ratio [aHR], 1.048; 95% CI, 1.025-1.071) and respiratory disease mortality (aHR, 1.097; 95% CI, 1.013-1.189); each increase in the HEI-2015 score was associated with a decreased risk of all-cause mortality (aHR, 0.994; 95% CI, 0.991-0.997). The multiple adequacy components recommended in the HEI (fruits, vegetables, whole grains, seafood and plant proteins, and monounsaturated fatty acids) were associated with better respiratory outcomes; the moderation components of restricting refined grains, sugars, and saturated fats were associated with better respiratory outcomes, but restricting sodium intake was associated with increased respiratory symptoms.

CONCLUSIONS

The results of this study suggest that a low-inflammatory diet and a healthy diet are consistently associated with better respiratory outcomes. These findings support the potential benefits of a "Food Is Medicine" strategy for respiratory health.

Specific macronutrient clusters associated with lower mortality risk: Evidence from NHANES 1999-2018

INTRODUCTION

Accumulating evidence suggest that imbalanced macronutrient composition would increase the risk of chronic diseases. However, previous studies that predominantly focused on individual macronutrients often failed to thoroughly elucidate this complex association.

OBJECTIVES

This study aimed to comprehensively analyze the relationship between macronutrient clusters and all-cause mortality.

METHODS

The study included 26,615 adults aged 20-75 years from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. A three-dimensional cube method was employed to categorize clusters of macronutrients intake. The association between dietary macronutrient clusters and all-cause mortality was investigated using Cox proportional hazards modeling and restricted cubic spline (RCS) analysis.

RESULTS

Over a weighted median follow-up duration of 7.58 years, 3,998 deaths were recorded. After adjusting for potential confounders, compared with the reference Cluster Pm:Fm:Cmh, 4 specific Clusters were associated with reduced all-cause mortality: Cluster Pm:Fm:Cm (HR: 0.79, 95 % CI: 0.67-0.92), Cluster Pm:Fmh:Cml (HR: 0.76, 95 % CI: 0.61-0.95), Cluster Pm:Fmh:Cm (HR: 0.86, 95 % CI: 0.75-0.97), and Cluster Pl:Fm:Cmh (HR: 0.73, 95 % CI: 0.60-0.89). Three-node RCS analysis revealed non-linear relationships between carbohydrate within Cluster Pm:Fm:Cm and protein within Cluster Pl:Fm:Cmh and overall mortality. Subgroup and sensitivity analyses corroborated the robustness of these associations across different age, gender, and energy intake levels.

CONCLUSIONS

This study employed a three-dimensional cube approach to categorize the human macronutrients intake into 24 clusters. Cluster Pm:Fm:Cm, Clusters Pm:Fmh:Cml, Cluster Pm:Fmh:Cm, and Cluster Pl:Fm:Cmh exhibited a lower mortality risk. Different clusters of macronutrients could be a precondition in nutrition intervene strategy.

Healthy dietary patterns and the incidence of chronic kidney disease: results from a prospective cohort study

BACKGROUND

Unhealthy diets contribute to the onset and progression of chronic kidney disease (CKD), with poor dietary habits identified as significant lifestyle factors that elevate CKD risk.

METHODS

Data from the UK Biobank cohort, which included over 500,000 participants aged 40-69 from diverse regions of England, Wales, and Scotland, were analyzed. Participants, who completed at least one online 24-hour dietary recall assessment, were included in the study. The baseline for analysis was the first 24-hour dietary recall in 2011, with follow-up extending until the earliest occurrence of CKD diagnosis, death, or the end of the study period.

RESULTS

A total of 207,268 British individuals who completed at least one online 24-hour dietary recall assessment were included in this study. Four healthy dietary pattern scores were evaluated: the Healthy Plant-based Diet Index (hPDI), the Healthy Eating Index (HEI)-2015, the Mediterranean Diet (MED) Score, and the Alternative Mediterranean Diet (AMED) Score. These scores assessed the association between dietary patterns and the incidence of CKD. Relative to the lowest dietary scores, the HR for CKD was 0.79 (95% CI, 0.73-0.87) for the hPDI, 0.80 (95% CI, 0.73-0.87) for the HEI-2015, 0.86 (95% CI, 0.81-0.93) for the MED, and 0.84 (95% CI, 0.78-0.90) for the AMED (all p < 0.001).

CONCLUSION

This study provides robust evidence linking healthy dietary patterns to a reduced risk of CKD. Further clinical trials are needed to confirm whether adherence to such diets can lower the risk of CKD.

Adherence to the Mediterranean Diet and Obesity-Linked Cancer Risk in EPIC

Importance

Adherence to the Mediterranean Diet (MedDiet) has been associated with a lower incidence of cancer and reduced weight gain. These associations suggest a potential role for the MedDiet in lowering the risk of obesity-related cancers (ORCs). Obesity is a known risk factor for various cancers and shows an inverse association with MedDiet adherence.

Objective

To examine the association between adherence to the MedDiet and the risk of ORCs, considering the possible mediating role of adiposity.

Design, Setting, and Participants

This prospective cohort study analyzed data from the European Prospective Investigation Into Cancer and Nutrition (EPIC) study, which enrolled participants aged 35 to 70 years from 1992 to 2000 across 23 centers in 10 countries. The data analysis was conducted from March 1 to May 31, 2023.

Exposures

Dietary intake before baseline was evaluated using country-specific, validated questionnaires administered at recruitment. Adherence to the MedDiet was scored on a 9-point scale and categorized as low (0-3 points), medium (4-6 points), or high (7-9 points).

Main Outcomes and Measures

The primary outcome was the incidence of ORCs, classified according to the 2015 International Agency for Research on Cancer criteria. Multivariable Cox proportional hazards regression models were used to assess the association between MedDiet adherence and ORC incidence. Mediation analyses were conducted to evaluate the role of waist to hip ratio and body mass index in this association.

Results

A total of 450 111 participants were included in the study (mean [SD] age, 51.1 [9.8] years; 70.8% women) and followed up during a median (IQR) time of 14.9 (4.1) years. Among participants, 4.9% experienced an ORC (rates, 0.053, 0.049, and 0.043 per person-year in the low, medium, and high MedDiet adherence groups, respectively). Participants with high adherence to the MedDiet (7-9 points) had a lower risk of ORC compared with those with low adherence (0-3 points) (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98). A similar inverse association was observed for participants with medium adherence (4-6 points vs 0-3 points). However, mediation analyses did not show associations of waist to hip ratio or body mass index between MedDiet adherence and ORC risk.

Conclusions and Relevance

These findings indicate that higher adherence to the MedDiet is associated with a modest reduction in the risk of ORCs, independent of adiposity measures. Further research is needed to clarify the mechanisms by which the MedDiet may contribute to cancer prevention.

Plant-based diets and the risk of lung cancer: a large prospective cohort study

PURPOSE

Plant-based diets are increasingly recognized for cancer prevention, yet their specific impact on lung cancer (LC) risk remains insufficiently examined. This study aims to assess the relationship between plant-based diets adherence and the incidence of LC.

METHODS

Data from the Prostate, Lung, Colorectal, and Ovarian cancer screening trial were analyzed. The plant-based diet index (PDI) was developed to assess adherence to plant-based diets. Multivariable Cox regression model was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Restricted cubic spline (RCS) model was performed to examine risk across the PDI spectrum. Prespecified subgroup analyses identified potential modifiers, and sensitivity analyses tested the association's robustness.

RESULTS

Of the 98,459 participants included, 1,642 developed LC over an average follow-up of 8.83 years. Higher PDI scores were associated with a lower LC risk (HR quartile 4 vs. 1: 0.75, 95% CI: 0.65-0.87, P trend < 0.001), evident in both non-small cell lung cancer (HR quartile 4 vs. 1: 0.76, 95% CI: 0.65-0.88, P trend < 0.001) and small cell lung cancer (HR quartile 4 vs. 1: 0.73, 95% CI: 0.49-1.09, P trend = 0.046). RCS analyses further confirmed these relationships. The association was stronger among participants with lower BMI, smokers, those without a history of emphysema or diabetes, those without a family history of LC, and those with lower physical activity (all P trend < 0.001). Sensitivity analyses consistently supported these findings.

CONCLUSION

Our findings reveal an inverse correlation between PDI and LC risk, supporting the potential benefits of plant-based diets in LC prevention.

CLINICAL TRIAL REGISTRY NUMBER

ClinicalTrials.gov ID: NCT00339495 (URL: https://www.

CLINICALTRIALS

gov/study/NCT00339495 ).

Plant-based diets and total and cause-specific mortality: a meta-analysis of prospective studies

Objective

The adherence to plant-based diets has been shown to positively impact longevity by reducing the incidence and severity of lifestyle-related diseases. Previous studies on the association of plant-based dietary pattern, as evaluated by plant-based dietary index (PDI), healthy plant-based dietary index (hPDI) and unhealthy plant-based dietary index (uPDI), with mortality risk have reported inconsistent results. We performed the present meta-analysis to summarize evidence on this association and to quantify the potential dose-response relationship based on all available cohort studies.

Methods

A comprehensive literature search and systematic review of relevant articles up to October 2024 was performed in PubMed and Scopus. The summary risk estimates (RR) with 95% confidence interval (CI) for the highest versus the lowest category of PDIs, hPDIs and uPDIs were calculated. Dose-response meta-analysis was also performed for studies reporting categorical risk estimates for at least three quantitative levels of PDIs, hPDIs and uPDIs.

Results

A total of 11 eligible cohort studies (13 datasets) were eventually included in this meta-analysis. Participants in the highest quintile of both the PDI and hPDI had a significantly decreased risk of all-cause mortality (pooled HRPDI = 0.85; 95% CI: 0.80-0.90; pooled HRhPDI = 0.86; 95% CI: 0.81-0.92) compared to participants in the lowest quintile. In contrast, the highest uPDI was associated with an increased risk of mortality (pooled HRuPDI = 1.20; 95% CI: 1.11-1.31). Dose-response meta-analysis showed that there was a non-linear relationship between PDI or hPDI level and all-cause mortality (p = 0.001 and p < 0.001 for non-linearity, respectively). No evidence of a non-linear relationship was observed for uPDI (p = 0.596 for non-linearity).

Conclusion

Greater adherence to PDI or hPDI dietary pattern was associated with a lower risk of mortality, whereas uPDI dietary pattern was positively associated with mortality risk. Thus, promoting a plant-based dietary pattern may be a key strategy in improving public health and reducing the burden of diet-related mortality.

Associations of healthy lifestyle and family income to poverty ratio with all-cause mortality among people with prediabetes and diabetes: a prospective cohort study

BACKGROUND

Family income to poverty ratio (PIR) may have independent effects on diet and lifestyle factors and the development of prediabetes and diabetes, as well as on mortality. It is unclear how the protective effect of a healthy lifestyle against death differs between individuals with different glucose metabolic profiles and whether PIR mediates this effect. This study aimed to explore whether healthy lifestyle and family PIR reduced the risk of all-cause mortality in participants with different metabolic status and the mediating role of PIR.

SUBJECTS AND METHODS

In total, 21,411 participants from the 2001-2018 National Health and Nutrition Examination Survey (NHANES) and follow-up until 2019 were included. The weighted healthy lifestyle score was constructed based on smoking, alcohol consumption, physical activity, diet (HEI-2015), and body mass index. Generalized linear regression models were used to analyze the association between healthy lifestyle, PIR, and all-cause mortality. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals, Kaplan-Meier survival curve was used to analyze the all-cause mortality associated with PIR and lifestyle. Furthermore, the mediation proportion of PIR in all-cause mortality attributed to healthy lifestyle was analyzed among participants with normal glucose regulation, prediabetes, or diabetes after multivariable adjustment.

RESULTS

There were significant differences in healthy lifestyle and PIR among people with normal glucose regulation, prediabetes and diabetes. During a mean follow-up of 92 months, participants with prediabetes or diabetes were also likely to have a higher mortality rate, respectively 583 (8.3%) and 263 (12.7%). More than 2 healthy lifestyles were associated with 42% (HR, 0.58; 95% CI, 0.35-0.95) to 76% (HR, 0.24; 95% CI, 0.12-0.44) reduced risk of all-cause mortality among participants with prediabetes, but among those with diabetes, who had ≥ 4 healthy lifestyles were associated with 72% reduced risk of all-cause mortality (HR, 0.28; 95% CI, 0.09-0.90). The middle and high PIR were associated with at least a 37% (HR, 0.63; 95% CI, 0.47-0.83) to 65% (HR, 0.35; 95% CI, 0.18-0.68) lower risk of all-cause mortality in participants with prediabetes and diabetes. Furthermore, PIR mediated 5.81-14.93% and 7.72-10.10% of the association between healthy lifestyle and all-cause mortality among normal glucose regulation and prediabetic participants, respectively. However, the mediating effect of PIR was not significant among diabetic participants.

CONCLUSIONS

Our findings highlight the importance of promoting adherence to a healthy lifestyle and improving PIR in prediabetic patients to reduce the risk of all-cause mortality, and the protective effect is more significant with more healthy lifestyles and higher PIR. This study can help clinicians and health systems develop more targeted treatments for people with different metabolic levels.

The comprehensive relationship between combined anti-inflammatory and healthy diets and all-cause mortality in rheumatoid arthritis: results from NHANES 2003-2018

BACKGROUND

Rheumatoid arthritis (RA) is a chronic, systemic autoimmune inflammatory disorder. Diet is recognized as a modifiable factor that may influence inflammation and potentially accelerate RA progression. Nevertheless, the effects of diverse dietary patterns and their combined impact on RA progression and long-term mortality remain inadequately understood. This study examined the association between dietary patterns and mortality in patients with RA, focusing on the Healthy Eating Index (HEI-2015) and Dietary Inflammatory Index (DII) and evaluating their combined effects.

METHODS

The analysis included 2,069 patients with RA from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2018. Weighted multi-variable Cox regression models estimated the relationship between the DII, HEI-2015, combined dietary patterns, and all-cause mortality in patients with RA. Linear associations between the DII, HEI-2015, and all-cause mortality were analyzed using restricted cubic splines (RCS). Dietary factors associated with mortality were identified through the Least Absolute Shrinkage and Selection Operator (LASSO) method, and subgroup and sensitivity analyses were conducted to strengthen the findings.

RESULTS

Participants had a median age of 59 years (IQR: 48-69), with 42.1% male. Adjusting for potential confounders, the hazard ratio (HR) for individuals adhering to healthy and anti-inflammatory dietary patterns, as opposed to unhealthy and pro-inflammatory patterns, was 0.70 (95% CI: 0.53-0.92; adjusted P = 0.01; trend P = 0.02). In weighted Cox analyses of the DII and HEI-2015, higher quartiles showed no significant mortality risk difference from the lowest quartiles. The LASSO-Cox model identified 12 dietary components predictive of all-cause mortality in patients with RA, with an AUC of 0.749 (0.682-0.815) at 1 year, 0.763 (0.724-0.802) at 3 years, 0.783 (0.749-0.802) at 5 years, and 0.868 (0.712-0.938) for all death events. Kaplan-Meier analysis revealed that the low-risk dietary group exhibited significantly lower mortality compared to the high-risk group (P < 0.001).

CONCLUSIONS

These findings suggest that combining a higher HEI-2015 with a lower DII score correlates with reduced all-cause mortality risk among patients with RA, supporting dietary modification as a potential strategy to prevent premature death in this population.

Healthy eating patterns associated with reduced risk of inflammatory bowel disease by lowering low-grade inflammation: evidence from a large prospective cohort study

BACKGROUND

Limited epidemiological evidence exists regarding the role of healthy eating patterns in reducing the risk of Crohn's disease (CD) and ulcerative colitis (UC). This study aimed to investigate the association between adherence to four established healthy eating patterns and subsequent CD or UC risk, and further examined whether these associations are linked to anti-inflammatory mechanisms.

METHODS

We conducted a prospective cohort study of 197,391 participants from the UK Biobank who completed at least one dietary questionnaire and were free from inflammatory bowel disease or cancer at baseline. Four dietary patterns were assessed, including Alternate Mediterranean Diet (AMED), Healthy Eating Index 2015 (HEI-2015), Healthful Plant-based Diet Index (HPDI), and EAT-Lancet. Cox proportional models with restricted cubic splines were applied to explore the associations. The potential role of low-grade inflammation in these associations was examined through mediation analysis.

RESULTS

During 2,193,436 person-years follow-up, 260 CD and 601 UC cases were identified. Higher AMED and HEI-2015 scores were associated with a reduced risk of CD but no UC, with no evidence against nonlinearity. These associations remained consistent across multiple sensitive and subgroup analyses. For dietary components, the fruits and monounsaturated fatty acids: saturated fatty acids ratio in AMED, and total fruits, total protein foods and fatty acid in HEI-2015 were linked to a decreased CD risk. Both diets were also associated with lower plasma inflammation biomarkers. Mediation analysis indicated that 7.66% and 13.40% of the reductions in CD risk attributed to AMED and HEI-2015 diets, respectively, were mediated by low-grade inflammation scores.

CONCLUSIONS

Higher adherence to AMED and HEI-2015 might significantly reduce CD risk, partly due to their anti-inflammatory properties.

Chrononutrition behaviors and cardiometabolic risk in adolescence: an ecological momentary assessment study

PURPOSE

To investigate the potential associations between unhealthy chrononutrition behaviors (meal timing, frequency, and regularity) and their combined impact on cardiometabolic risk in adolescence.

METHODS

Chrononutrition behaviors were assessed using a 7-day ecological momentary assessment (EMA). The unhealthy chrononutrition score (ranging from 0 to 8) was determined based on late meal timing, low meal frequency, and meal irregularity. The cardiometabolic (CM)-risk z score was calculated utilizing age- and sex-specific reference values for waist circumference (WC), mean arterial pressure (MAP), homeostatic model assessment of insulin resistance (HOMA-IR), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C). Restricted cubic splines were employed to estimate the dose-response relationships between the unhealthy chrononutrition score and outcomes.

RESULTS

Among 458 participants [mean (SD) age, 17.9 (0.7) years; 340 (74.2%) Female], 14.3% had an unhealthy chrononutrition score ≥ 6, who exhibited higher MAP (β = 3.86; 95% CI 1.24, 6.47), higher CM-risk scores (β = 1.80; 95% CI 0.70, 2.90), and lower HDL-C (β = 0.18; 95% CI - 0.30, - 0.06), as opposed to those with a healthy score ≤ 2 (n = 136, 31.4%). Moreover, late breakfast (later than 9AM compared to earlier than 8AM), low meal frequency (eating two or fewer meals versus three meals a day), and meal irregularity (score of 3-5 compared to a good score of 6-9) were associated with an increased risk of CM-risk outcomes.

CONCLUSION

The findings suggest a clustering of unhealthy chrononutrition behaviors that collectively impact cardiometabolic health in adolescence. Further prospective and interventional investigations is necessary to validate these findings and explore the underlying mechanisms.

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

INTRODUCTION AND OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Maternal smoking during pregnancy could accelerate aging in the adulthood: evidence from a perspective study in UK Biobank

BACKGROUND

Maternal smoking during pregnancy (MSDP) is significantly linked to the short- or long-term health of offspring. However, little research has examined whether MSDP affect the aging rate of offspring.

METHODS

This study used questionnaires to determine out whether the participants' mothers smoked when they were pregnant. For evaluating aging rate, we used the following several outcome measures: telomere length, frailty index, cognitive function, homeostatic dysregulation score, KDM-age, age-related hospitalization rate, premature death, and life expectancy.

RESULT

After adjusting for covariates, we found that the offspring of the MSDP group had significantly shorter telomere length in adulthood by 0.8 % (β = -0.008,95%CI:-0.009 to -0.006) compared with non-MSDP group. Compared to the non-MSDP group, participants in MSDP group showed higher levels of homeostatic dysregulation (β = 0.015,95%CI: 0.007-0.024) and were frailer (β = 0.008,95%CI:0.007-0.009). The KDM age increased by 0.100 due to MSDP (β = 0.100,95 % CI:0.018-0.181), and the age acceleration of KDM algorithm also increases significantly (β = 0.101, 95%CI:0.020-0.183). Additionally, we found that the risk of aging-related hospitalizations was significantly higher than the non-MSDP group by 10.4 %(HR = 1.104,95%CI:1.066-1.144). Moreover, MSDP group had a 12.2 % increased risk of all-cause premature mortality (HR = 1.122,95%CI:1.064-1.182) and a significant risk of lung cancer-specific premature mortality increased by 55.4 %(HR = 1.554,95%CI:1.346-1.793). In addition, participants in the MSDP group had significantly decreased cognitive function and shorter life expectancies than those in non-MSDP group.

CONCLUSION

Our findings indicated a significant association between MSPD and accelerated aging, elevated hospitalization rates, increased premature mortality rates, and reduced life expectancies in offspring.

Oral microbiome diversity and diet quality in relation to mortality

AIM

To examine the independent and joint associations of oral microbiome diversity and diet quality with risks of all-cause and cause-specific mortality.

MATERIALS AND METHODS

We included 7,055 eligible adults from the U.S. National Health and Nutrition Examination Survey (NHANES). Oral microbiome diversity was measured with α-diversity, including the Simpson Index, observed amplicon sequence variants (ASVs), Faith's phylogenetic diversity, and Shannon-Weiner index. Dietary quality was assessed using the Healthy Eating Index-2015 (HEI-2015). Cox proportional hazard models were used to assess the corresponding associations.

RESULTS

During a mean follow-up of 9.0 years, we documented 382 all-cause deaths. We observed independent associations of oral microbiome diversity indices and dietary quality with all-cause mortality (hazard ratio [HR] = 0.63; 95% confidence interval [CI]: 0.49-0.82 for observed ASVs; HR = 0.68, 95% CI: 0.52-0.89 for HEI-2015). Jointly, participants with the highest tertiles of both oral microbiome diversity (in Simpson index) and HEI-2015 had the lowest hazard of mortality (HR = 0.37, 95% CI: 0.23-0.60). In addition, higher oral microbiome diversity was associated with lower risks of deaths from cardiometabolic disease and cancer.

CONCLUSIONS

Higher oral microbiome α-diversity and diet quality were independently associated with lower risk of mortality.

Ultra-Processed Foods and the Impact on Cardiometabolic Health: The Role of Diet Quality

The consumption of ultra-processed foods (UPFs) has surged globally, raising significant public health concerns due to their associations with a range of adverse health outcomes. This review aims to elucidate potential health impacts of UPF intake and underscore the importance of considering diet quality when interpreting study findings. UPF group, as classified by the Nova system based on the extent of industrial processing, contains numerous individual food items with a wide spectrum of nutrient profiles, as well as differential quality as reflected by their potential health effects. The quality of a given food may well misalign with the processing levels so that a UPF food can be nutritious and healthful whereas a non-UPF food can be of low quality and excess intake of which may lead to adverse health consequences. The current review argues that it is critical to focus on the nutritional content and quality of foods and their role within the overall dietary pattern rather than only the level of processing. Further research should dissect health effects of diet quality and food processing, investigate the health impacts of ingredients that render the UPF categorization, understand roles of metabolomics and the gut microbiome in mediating and modulating the health effects of food processing, and consider environmental sustainability in UPF studies. Emphasizing nutrient-dense healthful foods and dietary patterns shall remain the pivotal strategy for promoting overall health and preventing chronic diseases.

Plant-based diet and risk of all-cause mortality: a systematic review and meta-analysis

Objective

A systematic analysis was conducted to determine the relationship between a plant-based diet and all-cause mortality.

Methods

The PubMed, Embase and Web of Science databases were searched. Two authors selected English documents from the database. Then the other two authors extracted the data and evaluated the Newcastle-Ottawa Scale (NOS). This study adhered to the guidelines of the Preferred Reporting Project (PRISMA) and the PROSPERO Registry protocols. A mixed-effects model combined maximum adjusted estimates, with heterogeneity measured using the I2 statistic. The sensitivity analysis validated the analysis's robustness, while publication bias was assessed.

Results

The results of the meta-analysis of 14 articles revealed that a plant-based diet (PDI) can reduce cancer mortality (RR = 0.88, [95% CI 0.79-0.98], τ2: 0.02, I2: 84.71%), cardiovascular disease (CVD) mortality (RR = 0.81, [95% CI 0.76-0.86], τ2: 0.00, I2: 49.25%) and mortality (RR = 0.84, [95% CI 0.79-0.89], τ2: 0.01, I2: 81.99%) risk. Adherence to a healthy plant-based diet (hPDI) was negatively correlated with cancer mortality (RR = 0.91, [95% CI 0.83-0.99], τ2:0.01, I2:85.61%), CVD mortality (RR = 0.85, [95% CI 0.77-0.94], τ2: 0.02, I2: 85.13%) and mortality (RR = 0.85, [95% CI 0.80-0.90], τ2: 0.01, I2: 89.83%). An unhealthy plant-based diet (uPDI) was positively correlated with CVD mortality (RR = 1.19, [95% CI 1.07-1.32], τ2: 0.02, I2: 80.03%) and mortality (RR = 1.18, [95% CI 1.09-1.27], τ2: 0.01, I2: 89.97%) and had a certain correlation with cancer mortality (RR = 1.10, [95% CI 0.97-1.26], τ2: 0.03, I2: 93.11%). Sensitivity analysis showed no contradictory results.

Conclusion

The hPDI was negatively associated with all-cause mortality, and the uPDI was positively associated with all-cause mortality.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/#loginpage.

Correlation of dietary flavonoid intake with chronic bronchitis, emphysema, and asthma in U.S. adults: A large, national, cross-sectional study

OBJECTIVE

To explore the relationship between dietary flavonoids and bronchitis, emphysema and asthma.

METHOD

A total of 11743 United States adults were extracted from the National Health and Nutrition Examination Survey (NHANES) in 2007-2008, 2009-2010 and 2017-2018. Of these, 47.7% were male and 52.3% female. Dietary flavonoid intake assessed using FDNNS and 24-hour dietary recall data. Inclusion of demographics (gender, age, education, family income), behavioral factors (BMI, smoking, drinking status, diet), chronic disease information (diabetes, hypertension) as covariates to eliminate confounding. Stepwise logistic regression was used to analyze the association between total dietary flavonoid intake and the risk of chronic respiratory disease. Weighted quantile sum regression (WQS) was used to analyze the association between 29 dietary flavonoids and the risk of chronic respiratory disease. Restricted cubic spline was used to analyze the dose-response relationship between dietary flavonoid intake and risk of chronic respiratory disease.

RESULTS

Stepwise logistic regression results showed that higher flavonoid intake in men was associated with a lower risk of CB and asthma (OR of CB: 0.55(0.31-0.97); OR of asthma: 0.72(0.52-0.99)), and WQS results showed a mixed health effect for total flavonoids and chronic respiratory tract in response to the 29 flavonoid fractions (OR of asthma: 0.97(0.94-0.99); OR of emphysema: 0.95(0.90-0.99)). Glycitein had the highest health contribution of 26.2% for emphysema; Eriodictyol had the highest health contribution of 32.13% for asthma, respectively. The RCS showed a dose-response relationship between flavonoids and respiratory tract health. The maximum dose for ingesting flavonoids to gain respiratory health benefits is 1500 mg/d.

CONCLUSION

Higher dietary flavonoid intake was associated with lower chronic respiratory risk in adult U.S. men. Also 29 dietary flavonoid components have an overall health effect on respiratory health. Glycitein and Eriodictyol may have potential health effects on the respiratory system. 1500 mg/day may be the Tolerable Upper Intake Level of dietary flavonoids for respiratory health in U.S. adults.

The association between dietary knowledge based on the Chinese Dietary Guidelines and adherence to healthy dietary habits: a large-scale cross-sectional study

Introduction

Previous systematic review has shown that individuals with more comprehensive dietary knowledge tend to engage in healthier eating patterns among American or European population. However, research on the association between dietary knowledge based on the Chinese Dietary Guidelines and healthy dietary behaviors, particularly among adolescents and college students in China, is lacking. This study aimed to examine the association between dietary knowledge based on the Chinese Dietary Guidelines and adherence to healthy dietary behaviors among adolescents and college students in China.

Methods

A cross-sectional study was conducted in China in August and October 2023. The study involved 527 adolescents and 11,856 college students. A convenience and cluster sampling methodology was employed to select one or two grades from 33 different university majors. The dietary behaviors of college students were evaluated by assessing their consumption of nine food groups: water, eggs, milk and milk products, vegetables, fruit, red meat, soy and soy products, seafood, and sugar-sweetened beverages. The dietary behaviors of adolescents were evaluated by assessing their consumption of five food groups: fast food, salty snack foods, fruits, vegetables, and soft drinks and sugared fruit beverages. The participants' dietary knowledge was assessed using the Chinese Dietary Guidelines. The relationship between dietary knowledge and behaviors was examined using a multivariate logistic regression analysis.

Results

The questionnaire response rate was 100.0%. Multivariate logistic regression analysis revealed a significant positive association between dietary knowledge and the likelihood of exhibiting diverse dietary behaviors among college students. After adjusting for gender, age, family income, place of residence, and parents' education levels, the results demonstrated a positive association between dietary knowledge and adherence to 4-8 eating habits among college students. In contrast, similar association was not observed among adolescent.

Conclusion

This study revealed a significant association between dietary knowledge based on the Guidelines and adherence to healthy dietary behaviors among college students in China. That is to say, the higher the level of dietary knowledge based on the Guidelines among college students, the healthier the dietary behaviors they tend to adopt in their daily lives. These findings indicate the necessity of developing educational interventions based on the Guidelines to enhance dietary knowledge among individuals with limited dietary knowledge. Such interventions could facilitate the acquisition of essential health-related knowledge and strengthen motivation to engage in healthy dietary behaviors. Future studies should employ longitudinal prospective designs or randomized controlled trials in order to establish a causal association between dietary knowledge based on the Guidelines and healthy dietary behaviors.

Adherence to a healthful plant-based diet and risk of mortality among individuals with chronic kidney disease: A prospective cohort study

BACKGROUND

Plant-rich dietary patterns may protect against negative health outcomes among individuals with chronic kidney disease (CKD), although aspects of plant-based diet quality have not been studied. This study aimed to examine associations between healthful and unhealthful plant-based dietary patterns with risk of all-cause mortality among CKD patients for the first time.

METHODS

This prospective analysis included 4807 UK Biobank participants with CKD at baseline. We examined associations of adherence to both the healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI), calculated from repeated 24-h dietary assessments, with risk of all-cause mortality using multivariable Cox proportional hazard regression models.

RESULTS

Over a 10-year follow-up, 675 deaths were recorded. Participants with the highest hPDI scores showed a 34% lower risk of mortality [HRQ4vsQ1 (95% CI): 0.66 (0.52-0.83), ptrend <0.001]. Those with the highest uPDI scores had a 52% [1.52 (1.20-1.93), ptrend = 0.002] higher risk of mortality compared to participants with the lowest respective scores. In food group-specific analyses, higher wholegrain intakes were associated with a 29% lower mortality risk, while intakes of refined grains, and sugar-sweetened beverages were associated a 30% and 34% higher risk, respectively.

CONCLUSIONS

In CKD patients, a higher intake of healthy plant-based foods was associated with a lower risk of mortality, while a higher intake of less healthy plant-based foods was associated with a higher risk of mortality. These results underscore the importance of plant food quality and support the potential role of healthy plant food consumption in the treatment and management of CKD to mitigate unfavourable outcomes.

Association between pre-diagnosis and post-diagnosis Alternate Mediterranean Diet and ovarian cancer survival: evidence from a prospective cohort study

BACKGROUND

There is currently a lack of comprehensive evidence regarding the correlation between Alternate Mediterranean Diet (AMED) and the survival of patients with ovarian cancer (OC). This prospective cohort study first assessed the association of AMED, not only pre-diagnosis and post-diagnosis but also the change from pre-diagnosis to post-diagnosis with OC survival.

METHODS

A total of 560 OC patients were included in the study, and their dietary intake was assessed using a reliable 111-item food frequency questionnaire. The overall survival (OS) of the patients was monitored through active follow-up and review of medical records until February 16th, 2023. Cox proportional hazard regression models were utilized to compute the hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs).

RESULTS

Out of the total 560 patients with OC, 211 (37.68%) succumbed during a median follow-up period of 44.40 months (interquartile range: 26.97-61.37). Comparative analysis indicated a significant association between the highest tertiles of pre-diagnosis (HR = 0.59; 95% CI 0.38-0.90; Ptrend < 0.05) and post-diagnosis (HR = 0.61; 95% CI 0.41-0.91; Ptrend < 0.05) AMED intake and improved OS as opposed to the lowest tertile. Additionally, a significant linear trend was observed for AMED and OC survival. Notably, decreased intake (more than 5% change) and significantly increased intake (more than 15% change) of AMED from pre-diagnosis to post-diagnosis were linked to worse and better OS, respectively, when compared to the stable intake group (change within 5%). Furthermore, patients displaying consistently higher AMED intake both before and after diagnosis experienced enhanced OS in comparison to those with consistently low AMED intake (HRHigh-High vs. Low-Low = 0.47; 95% CI 0.31-0.70).

CONCLUSION

High pre-diagnosis and post-diagnosis AMED was associated with an improved OS in patients with OC, suggesting that maintaining a consistently high intake of AMED could potentially benefit the prognosis of OC.

Association of healthy eating index-2015 and overactive bladder: a cross-sectional study

Objective

The aim of this cross-sectional study was to investigate the association of HEI-2015 and overactive bladder (OAB) in a large population.

Methods

Data were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2005-2020 datasets. Univariate and multivariate logistic regression were performed to evaluate the association between HEI-2015 and OAB. The restricted cubic spline (RCS) model was conducted to investigate the dose-response relationship.

Results

Totally, this study included 29,206 participants with 6,184 OAB patients among them. The higher continuous HEI-2015 value was independently associated with lower OAB incidence (OR: 0.87; 95%CI: 0.78, 0.98). Similarly, the highest quartile categorical HEI-2015 was significantly associated with a lower OAB odds (OR: 0.72; 95%CI: 0.52, 0.99) when compared with the lowest quartile. The RCS curve also showed a favorable non-linear dose-response relationship between HEI-2015 and OAB.

Conclusion

A higher HEI-2015 had a favorable association with OAB and there was a non-linear dose-response relationship between them. We suggest adherence to the United States diet recommendation as a potential behavioral prevention of OAB. Large-scale long term prospective cohort studies across various regions are needed to verify the findings of this paper.

Analysis of dietary inflammatory potential and mortality in cancer survivors using NHANES data

Background

In the United States, cancer is a leading cause of mortality, with inflammation playing a crucial role in cancer progression and prognosis. Diet, with its capacity to modulate inflammatory responses, represents a potentially modifiable risk factor in cancer outcomes.

Methods

This study utilized data from the National Health and Nutrition Examination Survey (NHANES, 1999-2018) to investigate the association between the Dietary Inflammatory Index (DII), which reflects dietary-induced inflammation, and mortality among cancer survivors. A total of 3,011 participants diagnosed with cancer were included, with DII scores derived from dietary recall data. All-cause and cancer-related mortalities served as primary endpoints.

Results

The study identified a significant linear positive correlation between higher DII scores and all-cause mortality among cancer survivors. Each unit increase in DII was associated with a 10% higher risk of all-cause mortality (hazard ratio [HR] per 1-unit increase, 1.10; 95% confidence interval [CI], 1.04-1.15). Similarly, a unit increase in DII was associated with a 13% higher risk of cancer-related mortality (HR per 1-unit increase, 1.13; 95% CI, 1.02-1.25). Kaplan-Meier analyses demonstrated higher all-cause mortality rates in individuals with elevated DII scores. Sensitivity analyses confirmed the robustness of these findings.

Conclusion

Adoption of an anti-inflammatory diet, characterized by lower DII scores, may improve survival outcomes in cancer survivors. These results emphasize the critical role of dietary interventions in post-cancer care.

Nutritional considerations with antiobesity medications

The improved efficacy and generally favorable safety profile of recently approved and emerging antiobesity medications (AOMs), which result in an average weight reduction of ≥15%, represent significant advancement in the treatment of obesity. This narrative review aims to provide practical evidence-based recommendations for nutritional assessment, management, and monitoring of patients treated with AOMs. Prior to treatment, clinicians can identify preexisting nutritional risk factors and counsel their patients on recommended intakes of protein, dietary fiber, micronutrients, and fluids. During treatment with AOMs, ongoing monitoring can facilitate early recognition and management of gastrointestinal symptoms or inadequate nutrient or fluid intake. Attention should also be paid to other factors that can impact response to treatment and quality of life, such as physical activity and social and emotional health. In the context of treatment with AOMs, clinicians can play an active role in supporting their patients with obesity to improve their health and well-being and promote optimal nutritional and medical outcomes.

Dietary inflammation, sleep and mental health in the United Kingdom and Japan: A comparative cross‐sectional study

Diet has been repeatedly shown to affect mental and sleep health outcomes. However, it is well known that there are cross‐cultural differences in dietary practices as well as the prevalence of mental and sleep health outcomes. Given that the dietary inflammatory potential of diets has been linked to mental and sleep health outcomes, in the current study we sought to assess the inflammatory status of habitual diets and examine its relationship with mental and sleep health outcomes in both the United Kingdom and Japan. Our aim was to determine if the associations between the dietary inflammation index (DII) score and these health outcomes could elucidate any potential cross‐cultural differences in health. Online survey data was collected from 602 participants (aged 18–40 years) in the United Kingdom (n = 288) and Japan (n = 314). Participants self‐reported their dietary intakes, as well as current mental health and sleep patterns. The DII score was calculated (score range − 2.79 to 3.49) We found that although participants in the United Kingdom reported better overall mental wellbeing, participants in Japan reported less severe depression, anxiety and stress and better subjective sleep quality, less sleep disturbances and daytime dysfunction, despite sleeping shorter, and a better adherence to an anti‐inflammatory diet. Moreover, across the United Kingdom and Japan, adherence to more anti‐inflammatory diets predicted higher levels of subjective sleep quality, fewer sleep disturbances, less use of sleep medicine and less daytime dysfunction. In conclusion, there are several differences between mental and sleep health outcomes in the United Kingdom and Japan, which could be attributable to the inflammatory potential of respective regional diets. Future studies are warranted to examine the mental and sleep health benefits of adhering to anti‐inflammatory traditional Japanese diets in clinical and subclinical cohorts.

Sex differences in association of healthy eating pattern with all-cause mortality and cardiovascular mortality

BACKGROUND

Although the Healthy Eating Index (HEI) is widely recommended to reduce the risk of cardiovascular disease and all-cause death, there are significant differences in physiological and nutritional factors between the sexes. The potential impact of sex on adult dietary health is still poorly understood. The study was designed to assess whether the health benefits of diet differed by sex.

METHODS

In a prospective study of 39,567 U.S. adults (51.2% female, age 46.8 ± 17.6 years), we examined sex-specific, multivariable-adjusted associations of HEI with all-cause mortality and cardiovascular disease mortality. Restricted cubic splines (RCS), subgroup analysis, propensity score matching (PSM), random forest feature importance, and sensitivity analysis were also used.

RESULTS

During 328,403 person-years of follow-up, a total of 4754 all-cause deaths were recorded, including 1481 cardiovascular deaths. Compared to the lowest quartile of HEI, the all-cause mortality rate of females and males in the highest quartile array decreased by 34% (HR 0.66 [95% CI 0.55-0.8]) and 15% (HR 0.85 [95% CI 0.73-0.99]), respectively. The restricted cubic spline showed a linear inverse association between baseline HEI and all-cause mortality and CVD mortality, with similar sex-specific results. Similarly, component scores were sex-specific for mortality risk, with females benefiting more from diet. The benefits of dairy products, vegetables, and sodium scores on the risk of all-cause death were higher in males and females. However, the benefits of vegetable, sodium, and fatty acid scores on the risk of cardiovascular death were different.

CONCLUSIONS

In the adult population of the U.S., there are more opportunities for females to reduce the risk of all-cause mortality and cardiovascular mortality from the same dose of healthy dietary intake than males. These findings could reduce the risk of death by motivating the population, especially females, to consume healthy dietary components, especially vegetables and dairy products.

Association between cardiovascular health and all-cause mortality risk in patients with osteoarthritis

BACKGROUND

This study was to explore the relationship between cardiovascular health (CVH) and the risk of all-cause mortality in patients with osteoarthritis (OA).

METHODS

This cohort study retrieved the data of 3642 patients with OA aged ≥ 20 years from the 2007-2018 National Health and Nutrition Examination Survey (NHANES). CVH was evaluated based on Life's Essential 8 (LE8) includes diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. The outcome of all-cause mortality was assessed using the death certificate records of participants from the National Death Index. Variables that might affect all-cause mortality were used as covariates. The weighted univariate COX proportional hazards model was used to explore the association between each covariate and all-cause mortality. The weighted univariate and multivariate COX proportional hazards models were used to explore the association between different CVH levels and all-cause mortality. A restricted cubic spline (RCS) curve was plotted to show the association between different CVH levels and all-cause mortality in OA patients. Hazard ratio (HR) and 95% confidence interval (CI) were calculated.

RESULTS

Findings show that people with moderate CVH (HR = 0.67, 95% CI = 0.45-0.98) and high CVH (HR = 0.47, 95% CI = 0.26-0.87) were associated with reduced risk of all-cause mortality in patients with OA. The HR of all-cause mortality in patients with OA decreased by 0.12 as per 10 points increase of LE8 score (HR = 0.81, 95% CI = 0.73-0.90). The RCS curve revealed that the HR of all-cause mortality decreased with the increase in LE8 score. The survival probability of patients in the high CVH group was higher than the moderate CVH group and low CVH group (p = 0.002).

CONCLUSION

Moderate-to-high CVH is associated with a decreased risk of all-cause mortality in patients with OA. These findings might provide a reference for the formulation of prognosis improvement strategies for the management of patients with OA.