The role of diet quality and dietary patterns in predicting muscle mass and function in men over a 15-year period

The risk associated with ultra-processed food intake on depressive symptoms and mental health in older adults: a target trial emulation

BACKGROUND

Longitudinal cohort studies across the lifespan suggest an association between ultra-processed food (UPF) and depression. However, the effect of UPF on depression and mental health in older adults has not been determined. Therefore, this study investigated the effect of UPF on depressive symptoms and mental health in community-dwelling older adults.

METHODS

A pragmatic target trial was designed and emulated using the ASPirin in Reducing Events in the Elderly longitudinal data. Participants were community-dwelling older adults (≥ 70 years) in Australia. We specified and emulated the protocol of a two-arm randomised pragmatic clinical trial using the level of UPF consumption as the intervention. Greater than or equal to 4 servings of UPF per day was considered the intervention, with less than 4 servings per day the control. Dietary consumption was assessed using a mail-based diet screening questionnaire, and the level of food processing was classified based on the NOVA classification. The study outcomes were depressive symptoms, defined as a score of ≥ 8 on the Center for Epidemiological Studies Depression 10-item scale, and general mental health, defined by the mental component summary score of the Short Form-12. We applied inverse probability treatment weighting to balance confounders. Marginal structural models were employed to estimate the population-level average effect of intervention using generalised estimated equations.

RESULTS

A total of 11,192 participants (3415 intervention and 7777 control) were eligible for the emulation. High UPF consumption at time zero was associated with an increased risk of depressive symptoms at follow-ups (RR: 1.10; CI: 1.04-1.18). The finding was consistent with sensitivity analyses; after excluding participants on antidepressants at time zero, the risk of depressive symptoms in the intervention group was increased by 11% compared to the control (RR: 1.11; 95% CI: (1.04-1.20)). Consumption of UPF adversely affected the mental component quality of life (β: - 0.40; CI: - 0.65 to - 0.15).

CONCLUSIONS

A higher level of UPF consumption was associated with a higher risk of depressive symptoms and adversely affected mental health among older adults.

Diet quality from mid-life and body composition in older age: findings from a British birth cohort

We investigated associations between 'healthy dietary pattern' scores, at ages 36, 43, 53 and 60-64 years, and body composition at age 60-64 years among participants from the MRC National Survey of Health and Development (NSHD). Principal component analyses of dietary data (food diaries) at age 60-64 years were used to calculate diet scores (healthy dietary pattern scores) at each age. Higher scores indicated healthier diets (higher consumption of fruit, vegetables and wholegrain bread). Linear regression was used to investigate associations between diet scores at each age and height-adjusted dual-energy X-ray absorptiometry-measured fat and lean mass measures at age 60-64 years. Analyses, adjusting for sex and other potential confounders (age, smoking history, physical activity and occupational class), were implemented among 692 men and women. At age 43, 53 and 60-64 years, higher diet scores were associated with lower fat mass index (FMI) and android:gynoid fat mass ratio; for example, in fully adjusted analyses, a standard deviation (sd) increase in diet score at age 60-64 years was associated with an SD difference in mean FMI of -0·18 (95 % CI: -0·25, -0·10). In conditional analyses, higher diet scores at ages 43, 53 and 60-64 years (than expected from diet scores at younger ages) were associated with lower FMI and android:gynoid fat mass ratio in fully adjusted analyses. Diet scores at age 36 years had weaker associations with the outcomes considered. No associations regarding appendicular lean mass index were robust after full adjustment. This suggests that improvements in diet through adulthood are linked to beneficial effects on adiposity in older age.

Elevated risk of possible sarcopenia and weak muscle strength with higher dietary inflammatory index in Iranian breast cancer survivors: a cross-sectional study

BACKGROUND

Increased levels of inflammation in cancer patients and survivors can make them more prone to muscle wasting and sarcopenia. Diet can be an appropriate treatment for alleviating patient complications. Therefore, this study was performed to determine the association between sarcopenia and its components with the dietary inflammatory index (DII) among breast cancer survivors.

METHODS

A total of 223 female breast cancer survivors were included in this research at the Cancer Prevention Research Center of Seyyed Al-Shohada Hospital and the Iranian Cancer Control Charity Institute (MACSA). Forty-three items of dietary inflammatory index (DII) were extracted from the Food Frequency Questionnaire. Sarcopenia detection was performed according to the Asian criteria. The linear and binary logistic regression was used to assess the association between sarcopenia and its components with DII.

RESULTS

Participants in the highest DII quartile had significantly elevated risk of impaired hand grip strength and calf circumference in both crude and adjusted models. Moreover, individuals consuming a more pro-inflammatory diet displayed a greater risk of abnormal appendicular skeletal muscle index in the crude model. After controlling for potential confounders, participants in the top quartile of DII had a 2.992-fold greater risk of possible sarcopenia than those in the bottom quartile (P value = 0.035). In addition, a decreasing linear trend was observed between higher DII score and 0.059 and 0.349- units lower in appendicular skeletal muscle mass index and hand grip strength variables in the crude Model (P-value < 0.05).

CONCLUSION

Diets with more pro-inflammatory features might be associated with increased risk of possible sarcopenia, as well as its components especially muscle mass and strength in women recovering from breast cancer.

Appendicular Skeletal Muscle Index Is Positively Related to Mediterranean Diet Adherence in University Students

Skeletal muscle is associated with cardiometabolic health. The appendicular skeletal muscle index (aSMI) represents the skeletal muscle mass "corrected" for height and constitutes a clinically applicable feature of sarcopenia. The relation of the aSMI with dietary habits is not clear, especially in young adults. The present pilot study aimed to investigate the relationship between the aSMI and Mediterranean diet adherence in young adults. A cross-sectional study of 151 university students was conducted. Anthropometry and bioimpedance analysis (TANITA-MC780) were performed. The aSMI was calculated as the sum of the upper and lower extremity muscle masses divided by height squared. The HPAQ questionnaire was used for physical activity evaluation. A validated food frequency questionnaire was used for dietary assessment, and the Mediterranean Diet Score (MedDietScore) was calculated. Multivariate linear regression models with log-aSMI as a dependent variable were applied. The MedDietScore was positively related to log-aSMI in the total sample (B = 0.009, SE = 0.004, p = 0.05, R2 for total model = 71%) irrespective of gender, age, ΒΜΙ, smoking, physical activity, and academic year and in males (B = 0.027, SE = 0.011, p = 0.023 R2 for total model = 37%) irrespective οf age and ΒΜΙ. The positive association of the MedDietScore with aSMI supports the importance of the adoption of a Mediterranean dietary pattern-rich in plant proteins and antioxidant/anti-inflammatory compounds-in maintaining/attaining muscle mass in young subjects.

Exercise and nutrition benefit skeletal muscle: From influence factor and intervention strategy to molecular mechanism

Sarcopenia is a progressive systemic skeletal muscle disease induced by various physiological and pathological factors, including aging, malnutrition, denervation, and cardiovascular diseases, manifesting as the decline of skeletal muscle mass and function. Both exercise and nutrition produce beneficial effects on skeletal muscle growth and are viewed as feasible strategies to prevent sarcopenia. Mechanisms involve regulating blood flow, oxidative stress, inflammation, apoptosis, protein synthesis and degradation, and satellite cell activation through exerkines and gut microbiomes. In this review, we summarized and discussed the latest progress and future development of the above mechanisms for providing a theoretical basis and ideas for the prevention and treatment of sarcopenia.

Association of low carbohydrate diet score with the risk of type 2 diabetes in an Australian population: A longitudinal study

AIMS

We aimed to assess the association of a low carbohydrate diet score (LCD) with the incidence of type 2 diabetes (T2D) using Melbourne Collaborative Cohort Study (MCCS) data.

METHODS

Between 1990 and 1994, the MCCS recruited 41,513 people aged 40-69 years. The first and second follow-ups were conducted in 1995-1998 and 2003-2007, respectively. We analyzed data from 39,185 participants. LCD score was calculated at baseline as the percentage of energy from carbohydrate, fat, and protein. The higher the score the less percentage of carbohydrates contributed to energy intake. The association of LCD quintiles with the incidence of diabetes was assessed using modified Poisson regression, adjusted for lifestyle, obesity, socioeconomic and other confounders. Mediation of the association by adiposity (BMI) was assessed.

RESULTS

LCD was positively associated with diabetes risk. Higher LCD score (p for trend = 0.001) was associated with increased risk of T2D. Quintile 5 (38 % energy from carbohydrates) versus quintile 1 (55 % energy from carbohydrates) showed a 20 % increased diabetes risk (incidence risk ratio (IRR) = 1.20 (95 % CI: 1.05-1.37)). A further adjustment for BMI (Body Mass Index) and WHR (Waist-to-Hip-Ratio) eliminated the association. Mediation analysis demonstrated that BMI mediated 76 % of the LCD & diabetes association.

CONCLUSIONS

Consuming a low carbohydrate diet, reflected as a high LCD score, may increase the risk of T2D which is largely explained by obesity. Results highlight the need for further studies, including clinical trials investigating the effects of a low carbohydrate diet in T2D.

Association of Dietary Vegetable and Fruit Consumption with Sarcopenia: A Systematic Review and Meta-Analysis

Previous studies have shown contradictory results regarding the association between vegetable and fruit consumption and the risk of sarcopenia. We aimed to evaluate this association using a meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, EMBASE, and the Cochrane Library through July 2023 using related keywords. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated based on the random-effects model. We included 14 observational studies with 11 cross-sectional and three cohort studies involving 6436 sarcopenias among 33,801 participants. Vegetable and fruit consumption were significantly associated with reduced sarcopenia risk (OR, 0.61; 95% CI, 0.48 to 0.79; I2 = 59.8%). The association was significant in cross-sectional studies (OR, 0.64; 95% CI, 0.49 to 0.84; I2 = 56.3%; n = 11) but not in cohort studies (OR, 0.50; 95% CI, 0.22 to 1.11; I2 = 76.4%; n = 3). Moreover, the association was significant in age ≥60 (OR, 0.64; 95% CI, 0.49 to 0.83; I2 = 58.0%; n = 10). This meta-analysis suggests that eating vegetables and fruit reduces sarcopenia risk. However, as cohort studies provide a higher level of evidence than case-control studies, further prospective cohort studies should be conducted.

Dietary Inflammatory Index and Dietary Diversity Score Associated with Sarcopenia and Its Components: Findings from a Nationwide Cross-Sectional Study

Little is known about the independent and joint effects of the energy-adjusted dietary inflammatory index (E-DII) and dietary diversity score (DDS) on sarcopenia and its components (low muscle mass, low muscle strength, and low physical performance). A total of 155,669 UK Biobank participants with ≥1 (maximum 5) 24 h dietary assessments were included in this cross-sectional analysis. We used logistic regression models to investigate the associations of E-DII and DDS with sarcopenia and its three components. We further examined the joint effects of E-DII and DDS on sarcopenia and its components using additive and multiplicative interaction analyses. We observed that lower E-DII and higher DDS were associated with lower odds of sarcopenia and its components. There were significant joint associations of E-DII and DDS with sarcopenia and low physical performance (p-interaction < 0.05) on the multiplicative interactive scale. Our study suggests that lower dietary inflammatory potential and higher dietary diversity might be important protective factors against sarcopenia and its components. More cases of sarcopenia and low physical performance might be preventable by adherence to a more anti-inflammatory diet combined with a higher dietary diversity.

Association of Physical Activity with Phenotypic Age among Populations with Different Breakfast Habits

BACKGROUND

The global aging situation has reached a serious stage, and healthy lifestyles, like regular physical activity and eating breakfast, could slow the process. Phenotypic age (PhenoAge) is regarded as a novel measure of aging. Therefore, our study aimed to quantify the impact of physical activity and eating breakfast on aging via PhenoAge and phenotypic age acceleration (PhenoAgeAccel).

METHODS

A total of 3719 adults who participated in the National Health and Nutrition Examination Survey were involved in this study. Physical activity was divided into an active group and an inactive group. According to the number of reported breakfast recalls, eating breakfast was divided into the no recalls group, one recall group, and both recalls group. Sensitivity analysis was performed by stratified analysis.

RESULTS

Active physical activity was a protective factor for PhenoAge and PhenoAgeAccel. Compared to the inactive group, the β values of the active group were -8.36 (-10.09, -6.62) for PhenoAge and -1.67 (-2.21, -1.14) for PhenoAgeAccel. The stratified analysis results showed that in the groups reporting breakfast in both recalls, one recall, and no recalls, the β values of the active group were -8.84 (-10.70, -6.98), -8.17 (-12.34, -4.00), and -3.46 (-7.74, 0.82), respectively, compared to the inactive group.

CONCLUSIONS

Active physical activity was strongly correlated with lower values of PhenoAge and PhenoAgeAccel, but the association was no longer statistically significant when combined with not regularly eating breakfast.

Higher ultra processed foods intake is associated with low muscle mass in young to middle-aged adults: a cross-sectional NHANES study

Design

Ultra-processed foods (UPFs) have become a pressing global health concern, prompting investigations into their potential association with low muscle mass in adults.

Methods

This cross-sectional study analyzed data from 10,255 adults aged 20-59 years who participated in the National Health and Nutritional Examination Survey (NHANES) during cycles spanning from 2011 to 2018. The primary outcome, low muscle mass, was assessed using the Foundation for the National Institutes of Health (FNIH) definition, employing restricted cubic splines and weighted multivariate regression for analysis. Sensitivity analysis incorporated three other prevalent definitions to explore optimal cut points for muscle quality in the context of sarcopenia.

Results

The weighted prevalence of low muscle mass was 7.65%. Comparing the percentage of UPFs calories intake between individuals with normal and low muscle mass, the values were found to be similar (55.70 vs. 54.62%). Significantly linear associations were observed between UPFs consumption and low muscle mass (P for non-linear = 0.7915, P for total = 0.0117). Upon full adjustment for potential confounding factors, participants with the highest UPFs intake exhibited a 60% increased risk of low muscle mass (OR = 1.60, 95% CI: 1.13 to 2.26, P for trend = 0.003) and a decrease in ALM/BMI (β = -0.0176, 95% CI: -0.0274 to -0.0077, P for trend = 0.003). Sensitivity analysis confirmed the consistency of these associations, except for the International Working Group on Sarcopenia (IWGS) definition, where the observed association between the highest quartiles of UPFs (%Kcal) and low muscle mass did not attain statistical significance (OR = 1.35, 95% CI: 0.97 to 1.87, P for trend = 0.082).

Conclusion

Our study underscores a significant linear association between higher UPFs consumption and an elevated risk of low muscle mass in adults. These findings emphasize the potential adverse impact of UPFs on muscle health and emphasize the need to address UPFs consumption as a modifiable risk factor in the context of sarcopenia.

Diet quality is associated with adipose tissue and muscle mass: the Coronary Artery Risk Development in Young Adults (CARDIA) study

BACKGROUND

Aging is associated with changes in body composition, and preventing loss of muscle mass and accumulation of excess adipose tissue in middle-aged adults may reduce age-related conditions at older ages. Dietary intake is one lifestyle factor shown to improve or maintain body composition. However, few studies have examined the Healthy Eating Index2015 (HEI2015), a measure of diet quality, and the association with body composition in adult men and women.

METHODS

Participant data (n = 3017) from the Coronary Artery Risk Development in Young Adults (CARDIA) study were used to examine the associations of the HEI2015 with body composition measures at Year 25 (Y25), including (1) 25 year-change in weight, body mass index (BMI), and waist circumference and (2) a computed tomography (CT) scan at Y25 measured muscle mass, muscle quality (better quality = less lipid within the muscle), and adipose tissue depots visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and adipose within skeletal muscle (intermuscular adipose tissue; IMAT). Dietary intake was assessed by a diet history three times over 20 years, at years 0, 7, and 20. HEI2015, averaged over three exams, was created and categorized into quintiles. Multiple regression analysis evaluated the associations of body composition stratified across quintiles of HEI2015 adjusted for demographic characteristics, energy intake, lifestyle factors, and baseline anthropometric measures as appropriate. Race-sex interaction was tested (Pinteraction  > 0.30).

RESULTS

Over 25 years of follow-up, averaged HEI2015 was significantly and inversely associated with weight gain (Quintile 1 (Q1) 37.3 lb vs. 32.9 in Q5; Ptrend  = 0.01), change in BMI (Q1 5.8 kg/m2 vs. 5.0 in Q5; Ptrend  = 0.005), and change in waist circumference (Q1 17.5 cm vs. 15.2 cm in Q5; Ptrend  < 0.001). By Y25, HEI2015 was inversely associated with VAT Q1 136.8 cm3 vs. 116.6 in Q5; Ptrend  < 0.001) and IMAT volumes (Q1 9.52 vs. 8.12 cm3 in Q5; Ptrend  < 0.001). Although total muscle volume declined (Ptrend  = 0.03), lean muscle mass volume was similar across quintiles (Ptrend  = 0.55). The IMAT/total muscle mass ratio declined across HEI2015 quintiles (Ptrend  < 0.001). Finally, higher HEI2015 was associated with better muscle quality at Y25 (higher value = less lipid within the muscle; Q1 41.1 vs. 42.2 HU in Q5; Ptrend  = 0.002). HEI2015 was nonlinearly, but inversely, associated with SAT (nonlinear P = 0.011).

CONCLUSIONS

Improving diet quality in young to middle-aged adults is a recommended strategy to promote better measures of body composition. Our study findings suggest that healthier food choices may influence body composition.

Calf circumference as a screening tool for low skeletal muscle mass: Cut-off values in independent Thai older adults

BACKGROUND

Calf circumference is recommended as a marker for low muscle mass and as a case finding in the diagnosis of sarcopenia. However, the cut-off value differed by ethic and region. Currently there is no study among Thai population. Therefore, we aimed to identify the optimal cutoff value of calf circumference as a screening tool for low skeletal muscle mass in independent Thai older adults. Subgroup analysis was performed for obesity and adults over 75 years.

METHODS

This cross-sectional cohort studied in an outpatient geriatric check-up clinic. Participants, aged 60 and above, needed to be independent in basic activities of daily living to meet the inclusion criteria. Exclusion criteria comprised active malignancy, cardiac, pulmonary, or neurovascular diseases necessitating hospitalization in the preceding three months, chronic renal diseases requiring renal replacement therapy, and unstable psychiatric disorders. We measured the maximum calf circumference and appendicular skeletal muscle mass (ASMI) using bioelectrical impedance analysis (BIA). Low muscle mass is defined according to the Asian Working Group of Sarcopenia (AWGS) 2019 consensus.

RESULTS

We enrolled 6,404 elderly adults (mean age 67.3 ± 5.1 years), with a 47% prevalence of low muscle mass in women and 25% in men. Lower muscle mass significantly correlated with reduced BMI and waist circumference in both genders (p < 0.001). Optimal cut-off values for low muscle mass screening were < 33 cm (sensitivity 80.1%, specificity 60.5%) for women and < 34 cm (sensitivity 85.4%, specificity 70.2%) for men. Subgroup analysis for those with BMI ≥ 25 kg/m² suggested raising the cut-off for women to < 34 cm (sensitivity 80.6%, specificity 54.0%) and for men to < 35 cm (sensitivity 88.7%, specificity 55.2%) to enhance specificity without substantial sensitivity loss. In the older-old adult subgroup (≥ 75 years), optimal cut-off values were < 33 cm (sensitivity 84.6%, specificity 79.9%) for women and < 34 cm (sensitivity 75.6%, specificity 87.0%) for men.

CONCLUSIONS

There is a strong correlation between calf circumference and ASMI in independent Thai older adults. Calf circumference can serve as a screening tool for identifying low muscle mass. The recommended cut-off values for men and women are 34 cm and 33 cm, respectively in alignment with AWGS 2019 recommendation. Incorporating a 1-cm higher cut-off value for obese older adults improves the accuracy of muscle mass screening.

TRIAL REGISTRATION

Thai clinical trial registry: TCTR20200511003.

The role of nutrition in the prevention of sarcopenia

Sarcopenia is a common skeletal muscle disorder characterized by a loss of muscle mass and impaired muscle function that is associated with poor health outcomes. Although nutrition is considered an important factor in the etiology of sarcopenia, the preventive potential of diet, specifically the extent to which differences in habitual patterns of diet and/or nutrient intakes impact risk of its development, is poorly understood. This narrative review considered research evidence on dietary patterns and nutrient intakes in mid- (<60 y) and young-older (60-70 y) adulthood to evaluate how they relate to age-related changes in muscle mass and function. A key finding was that current evidence on adult diet and sarcopenia risk in older age is limited and fragmented, with different outcomes reported across studies (for example, lean mass, strength) and few reporting links to incident diagnosed sarcopenia. As these outcomes are not interchangeable, it challenges collation of the evidence, leaving many gaps in understanding. There is also limited information about adult (<70 y) diet and few longitudinal studies with repeated dietary assessments to enable definition of cumulative exposures across adulthood. However, despite these limitations, findings from studies of dietary patterns already provide reasonably consistent messages about the benefits of diets of higher quality in earlier adulthood for later physical performance, although whole-diet intervention trials are urgently needed to understand their potential. In comparison, there is little evidence of benefits of higher intakes of individual nutrients in earlier adulthood for later muscle mass and function. Although these gaps need to be addressed in future research, there may already be sufficient data to promote messages about diet quality more widely - that healthier diets of higher quality across adulthood, with known benefits for a range of health outcomes, are also linked to the effective preservation of muscle mass and function.

Association of diet quality with the risk of Sarcopenia based on the Chinese diet balance index 2016: a cross-sectional study among Chinese adults in Henan Province

BACKGROUND

Sarcopenia can lead to a series of unfavourable health outcomes. Diet is an important factor influencing sarcopenia. In this study, we aimed to evaluate the association of sarcopenia with diet quality assessed by the Chinese Diet Balance Index 2016 (DBI-16).

METHODS

A cross-sectional study was conducted to collect information on nutrition and health in Henan Province, China, and a total of 644 individuals were studied. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria updated in 2019. Diet quality was assessed by using the Chinese Diet Balance Index 2016 (DBI-16), which includes three indicators: the lower bound score (LBS), higher bound score (HBS) and diet quality distance (DQD). Binary logistic regression analysis was used to estimate the risk of sarcopenia associated with diet quality.

RESULTS

A total of 49 of the 644 participants were diagnosed with sarcopenia. Excessive intake (score > 0) of cereals, meat, eggs and salt, inadequate intake (score < 0) of vegetables, fruits, dairy products, soybeans and low diet variety were commonly seen in both groups of participants. The participants with sarcopenia had a more serious inadequate intake of fruit than those without sarcopenia (p < 0.05). The overall LBS, HBS and DQD in both groups were in the interval of low-level problems. Compared with participants with a suitable LBS, those with an unsuitable LBS were more likely to have a low gait speed (OR: 2.58; 95%CI: 1.13-7.04) after multiple adjustments. However, the other two DBI-16 indicators, the HBS and DQD, were not associated with sarcopenia or its related diagnostic variables.

CONCLUSION

Unfavourable diet quality, mainly referring to inadequate dietary intake in this study, may be a risk factor for low gait speed.

The association of dietary patterns with muscle mass and strength in old age: The Hordaland Health Study

PURPOSE

The single nutrient approach in nutrition research lacks the ability to account for synergistic relationships between dietary components. Current evidence suggests that diet quality, reflecting overall dietary intake, may influence muscle health. In a community-based observational study in Western Norway, we examined dietary patterns in relation to muscle mass and strength at age 67-70.

METHODS

The current analysis was conducted in men and women of The Hordaland Health Study (HUSK), who participated in both the second (HUSK2) and third study wave (HUSK3). Dietary patterns were extracted by principal component analysis (PCA) on food frequency questionnaire (FFQ) data. Individual dietary pattern scores (DPS) for HUSK2 (age 46-49) and HUSK3 (age 67-70), and overall DPS (oDPS) were calculated. Outcome variables were appendicular skeletal muscle mass (ASMM) and handgrip strength (HGS) measured in HUSK3. The relationships of HUSK3 DPS and oDPS with ASMM and HGS were assessed by multivariate linear regression analysis adjusted for potential confounding factors.

RESULTS

We identified three distinct dietary patterns, labelled 'Western', 'Healthy', and 'Sweets-focused'. A significant positive association was observed between the oDPS for the 'Healthy' dietary pattern and ASMM in both men and women at age 67-70. No significant associations were found between HUSK3 DPS or oDPS for any of the identified dietary patterns and HGS in our population.

CONCLUSION

Higher oDPS on a dietary pattern predominantly rich in fish, vegetables, nuts and seeds, fruit and berries, and eggs was associated with better ASMM at age 67-70. To establish the influence of diet quality on muscle health, further long-term studies with repeated dietary assessments are warranted.

Obesity and sarcopenic obesity characterized by low-grade inflammation are associated with increased risk for major depression in women

Background

We aimed to determine women's risk of major depressive disorder (MDD) in relation to obesity phenotypes characterized by levels of circulating high-sensitivity C-reactive protein (hsCRP).

Methods

This population-based retrospective cohort study comprised 808 women (ages 20-84 y) recruited 1994-1997 and followed for a median 16.1 y (IQR 11.9-16.8). At baseline, body fat and lean tissue mass were measured by whole body dual-energy x-ray absorptiometry (DXA). Obesity was identified as high fat mass index (>12.9 kg/m2), body fat percentage (≥35%) and body mass index (≥30 kg/m2); sarcopenic obesity referred to a high ratio fat mass/fat-free mass (≥0.80). Systemic inflammation was operationalized as serum hsCRP concentration in the upper tertile (>2.99 mg/L). Obesity phenotypes were: non-obese + lowCRP, non-obese + highCRP, obese + lowCRP, and obese + highCRP. During follow-up, the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP) was used to identify lifetime history of MDD and age of onset. Poisson regression models were used to estimate the MDD rate for each obesity phenotype during follow-up. Demographic, health and lifestyle factors were tested as potential confounders.

Results

During 11,869 p-y of follow-up, 161 (19.9%) women experienced an MDD episode. For obesity phenotypes based on fat mass index, models adjusted for baseline age and prior MDD, and non-obese + lowCRP as reference, RR for non-obese + highCRP was 1.21 (95% CI 0.80, 1.82), obese + lowCRP 1.46 (0.86, 2.47) and obese + highCRP 1.56 (1.03, 2.37). Patterns were similar for obesity by body fat percentage, body mass index and sarcopenic obesity.

Conclusion

Consistently across different obesity definitions, this longitudinal study reports that women with both obesity and systemic inflammation are at increased risk of subsequent MDD. Future research should examine whether tackling this metabolically unhealthy obesity type - through, for example, lifestyle or medication approaches - can reduce depression risk.

High cereal fibre but not total fibre is associated with a lower risk of type 2 diabetes: Evidence from the Melbourne Collaborative Cohort Study

AIM

To assess the associations of total dietary fibre and fibre from different food sources (ie, cereal, fruit and vegetables) with the risk of diabetes.

MATERIALS AND METHODS

The Melbourne Collaborative Cohort Study enrolled 41 513 participants aged 40 to 69 years from 1990 to 1994. The first and second follow-ups were conducted in 1994 to 1998 and 2003 to 2007, respectively. Self-reported diabetes incidence was recorded at both follow-ups. We analysed data from 39 185 participants, with a mean follow-up of 13.8 years. The relationships between dietary fibre intake (total, fruit, vegetable and cereal fibre) and the incidence of diabetes were assessed using modified Poisson regression, adjusted for dietary, lifestyle, obesity, socioeconomic and other possible confounders. Fibre intake was categorized into quintiles.

RESULTS

At total of 1989 incident cases were identified over both follow-up surveys. Total fibre intake was not associated with diabetes risk. Higher intake of cereal fibre (P for trend = 0.003), but not fruit (P for trend = 0.3) and vegetable fibre (P for trend = 0.5), was protective against diabetes. For cereal fibre, quintile 5 versus quintile 1 showed a 25% reduction in diabetes risk (incidence risk ratio [IRR] 0.75, 95% confidence interval [CI] 0.63-0.88). For fruit fibre, only quintile 2 versus quintile 1 showed a 16% risk reduction (IRR 0.84, 95% CI 0.73-0.96). Adjustment for body mass index (BMI) and waist-to-hip ratio eliminated the association and mediation analysis showed that BMI mediated 36% of the relationship between fibre and diabetes.

CONCLUSION

Intake of cereal fibre and, to a lesser extent, fruit fibre, may reduce the risk of diabetes, while total fibre showed no association. Our data suggest that specific recommendations regarding dietary fibre intake may be needed to prevent diabetes.

The association of dietary inflammatory potential with skeletal muscle strength, mass, and sarcopenia: a meta-analysis

Aims

Evidence suggested that dietary inflammatory potential may be associated with age-related skeletal muscle decline, but the results remained controversial. To summarize the evidence for the relationships between dietary inflammatory potential and skeletal muscle strength, mass, and sarcopenia in adults we conducted this meta-analysis.

Methods

Embase, Pubmed, and Web of Science were searched from inception up to 12 March 2023 for studies that evaluated the associations of dietary inflammatory potential [estimated by the Dietary inflammatory index (DII)] with skeletal muscle strength, mass, and sarcopenia. A meta-analysis was then performed to calculate the pooled regression coefficient (β) and odds ratio (OR). The non-linear dose-response relation between DII and sarcopenia was assessed using random-effects dose-response meta-analysis.

Results

This meta-analysis included 24 studies involving 56,536 participants. It was found that high DII was associated with low skeletal muscle strength [OR 1.435, 95% confidence interval (CI) 1.247-1.651, P < 0.001, I² = 4.97%]. There was a negative association of DII with skeletal muscle strength (β-0.031, 95% CI -0.056 to -0.006, P = 0.017, I² = 72.69%). High DII was also associated with low skeletal muscle mass (OR 1.106, 95% CI 1.058-1.157, P < 0.001, I² = 0%). DII had a negative relationship with skeletal muscle mass with high heterogeneity (β-0.099, 95% CI -0.145 to -0.053, P < 0.001, I² = 88.67%); we downgraded the inconsistency in the subgroup analysis of overweight/obese participants (β-0.042, 95% CI -0.065 to -0.019, I² = 12.54%). Finally, the pooled results suggested that high DII was significantly associated with sarcopenia with significant heterogeneity (OR 1.530, 95% CI 1.245-1.880, P < 0.001, I² = 69.46%); age and BMI may contribute partially to the heterogeneity since heterogeneity was decreased in the subgroup of older age (OR 1.939, 95% CI 1.232-3.051, I² = 0%) and the group of overweight/obesity (OR 1.853, 95% CI 1.398-2.456, I² = 0%). There was a non-linear dose-response association between DII and sarcopenia (P = 0.012 for non-linearity).

Conclusion

This meta-analysis suggested that higher dietary inflammatory potential was significantly associated with lower skeletal muscle strength, mass, and risk of sarcopenia. Future studies with consistent assessment and standardized methodology are needed for further analysis.

Association of Macronutrients Intake with Body Composition and Sarcopenic Obesity in Children and Adolescents: A Population-Based Analysis of the National Health and Nutrition Examination Survey (NHANES) 2011-2018

The association of macronutrients intake with body composition and sarcopenic obesity remains uncertain in children and adolescents. We aimed to explore the association between macronutrients intake and body composition, especially sarcopenic obesity, in children and adolescents residing in the United States. The study utilized data from 5412 participants aged 6-17 years who attended NHANES between 2011 and 2018. Body composition was assessed using DXA, and nutrient intake was based on 24-h recall. Multivariable linear regression and multinomial logistic regression were used. The unweighted prevalence of sarcopenic obesity was 15.6%. A higher percentage of energy (5 %E) from fat was inversely associated with muscle mass but positively associated with fat mass and sarcopenic obesity. Substituting carbohydrate (5 %E) with fat decreased muscle mass by 0.03 (95% CI 0.01 to 0.06) but increased fat mass by 0.03 (95% CI 0.01 to 0.06) and increased the prevalence of sarcopenic obesity by 254% (95% CI 15% to 487%). Replacing protein intake with fat intake also increased the OR of sarcopenic obesity (OR, 2.36 [95% CI 1.18 to 3.18]). In conclusion, a high-fat diet, coupled with low carbohydrate/protein intake, is associated with sarcopenic obesity among children and adolescents. The change in children's diet towards a healthy diet with low fat composition may help prevent sarcopenic obesity. However, randomized clinical trials or longitudinal studies are needed to further validate our findings.

Association of the dietary inflammatory index with phenotypic age in the United States adults

OBJECTIVES

One of the underlying mechanisms of aging is chronic inflammation, which has been closely associated with daily diet. Phenotypic age (PhenoAge) has been used as an index to track the aging process before diseases show clinical symptoms. The present study aimed to explore the association between the dietary inflammatory index (DII) and PhenoAge.

METHODS

In total, 9,275 adults aged 20 years old and over in the National Health and Nutrition Examination Survey were involved in this study. Dietary patterns were classified as pro-inflammatory or anti-inflammatory according to the DII. PhenoAge was regarded as a continuous variable, and linear regression was used to explore its association with dietary inflammation. Stratified analyses by sex, age, race, physical exercise, smoking status, drinking status, and body mass index were used to test the sensitivity of these associations.

RESULTS

The median value of PhenoAge was 38.60 years and 39.76 years for the participants with anti-inflammatory and pro-inflammatory diets, respectively. A pro-inflammatory diet was positively associated with PhenoAge (β=0.73; 95% confidence interval, 0.31 to 1.14), compared with participants who had an anti-inflammatory diet. There was an interaction between dietary inflammation and age for PhenoAge (pinteraction<0.001). The strength of the association between a pro-inflammatory diet and PhenoAge was stronger as age increased.

CONCLUSIONS

A pro-inflammatory diet was associated with a higher PhenoAge, and the association was strongest in the elderly. We recommended reducing dietary inflammation to delay phenotypic aging, especially for the elderly.

High ultra-processed food consumption is associated with elevated psychological distress as an indicator of depression in adults from the Melbourne Collaborative Cohort Study

BACKGROUND

Few studies have tested longitudinal associations between ultra-processed food consumption and depressive outcomes. As such, further investigation and replication are necessary. The aim of this study is to examine associations of ultra-processed food intake with elevated psychological distress as a marker for depression after 15 years.

METHOD

Data from the Melbourne Collaborative Cohort Study (MCCS) were analysed (n = 23,299). We applied the NOVA food classification system to a food frequency questionnaire (FFQ) to determine ultra-processed food intake at baseline. We categorised energy-adjusted ultra-processed food consumption into quartiles by using the distribution of the dataset. Psychological distress was measured by the ten-item Kessler Psychological Distress Scale (K10). We fitted unadjusted and adjusted logistic regression models to assess the association of ultra-processed food consumption (exposure) with significant psychological distress (outcome and defined as K10 ≥ 20). We fitted additional logistic regression models to determine whether these associations were modified by sex, age and body mass index.

RESULTS

After adjusting for sociodemographic characteristics and lifestyle and health-related behaviours, participants with the highest relative intake of ultra-processed food were at increased odds of significant psychological distress compared to participants with the lowest intake (aOR: 1.23; 95%CI: 1.10, 1.38, p for trend = 0.001). We found no evidence for an interaction of sex, age and body mass index with ultra-processed food intake.

CONCLUSION

Higher ultra-processed food intake at baseline was associated with subsequent elevated psychological distress as an indicator of depression at follow-up. Further prospective and intervention studies are necessary to identify possible underlying pathways, specify the precise attributes of ultra-processed food that confer harm, and optimise nutrition-related and public health strategies for common mental disorders.

Aspects Regarding the Consumption of Dietary Supplements among the Active Population in Romania

Food supplements contain a variety of combinations of vitamins, minerals, plant extracts, and other substances. Any physical effort requires energy from balanced and healthy nutrition. This research aimed to identify the categories of dietary supplements used by active and very active participants who attend the sports and leisure centers from Targu Mures city. The survey was developed in paper and online forms using the Internet and supported multimedia and self-administration. The sample consists of 517 subjects chosen randomly from the research population and divided into the active and highly active PAI subgroups based on age, education, and gender. IBM SPSS Statistics Version 20.0 was used to process the collected data. All data were analysed descriptively. Differences between independent groups were assessed using an Independent sample t-test and a Chi-square test. Statistical significance was accepted when p < 0.05. Additionally, a Pearson correlation was done. The most representative age category was between 18 and 22 years old (42.7%), the ones using dietary supplements most frequently. There were significant differences by group of age regarding the consumption of food supplements (p < 0.05) and also by gender (p < 0.05).

The Association between Dietary Inflammatory Index and Aging Biomarkers/Conditions: A Systematic Review and Dose-response Meta-analysis

OBJECTIVES

We performed a current study to examine the association between dietary inflammatory index (DII) score and older age-related muscle conditions, including sarcopenia, low muscle mass, low muscle strength, frailty, and/or disability.

DESIGN

Systematic review and dose-response meta-analysis.

SETTING

A systematic literature search was performed using Scopus, PubMed/MEDLINE, and ISI Web of Science without limitation until October 04, 2022. Relative risk (RR) and 95% confidence interval (CI) were pooled by applying a random-effects model, while validated methods examined assess quality and publication bias via Newcastle-Ottawa Scale, Egger's regression asymmetry, and Begg's rank correlation tests respectively. A dose-response meta-analysis was conducted to estimate the RRs per 1-unit increment in DII scores.

PARTICIPANTS

Adults (≥18 years).

MEASURES

The risk of older age-related muscle conditions (sarcopenia, low muscle mass, low muscle strength, frailty, and/or disability).

RESULTS

Data were available from 19 studies with 68079 participants. Results revealed that a higher DII score was significantly related to an increased risk of sarcopenia (RR=1.50; 95% CI: 1.26, 1.79; I2=53.3%; p<0.001; n=10; sample size =43097), low muscle strength (RR=1.47; 95% CI: 1.24, 1.74; I2=6.6%; p<0.001; n=4; sample size =9339), frailty (RR=1.61; 95% CI: 1.41, 1.84; I2=0.0%; p<0.001; study=5; participant=3882) and disability (RR=1.41; 95% CI: 1.16, 1.72; I2=58.4%; p=0.001; n=5; sample size =13760), but not low muscle mass (RR=1.24; 95% CI: 0.98, 1.56; I2=49.3%; p=0.069; n=4; sample size =11222). Additionally, results of the linear dose-response indicated that an increase of one point in the DII score was related to a 14% higher risk of sarcopenia, 6% higher risk of low muscle mass, 7% higher risk of low muscle strength, and a 7% higher risk of disability in adults. Non-linear dose-response relationships also revealed a positive linear association between the DII score and the risk of sarcopenia (Pnonlinearity = 0.097, Pdose-response<0.001), frailty (Pnonlinearity = 0.844, Pdose-response=0.010) and disability (Pnonlinearity = 0.596, Pdose-response=0.007).

CONCLUSION

Adherence to a pro-inflammatory diet was significantly associated with a higher risk of sarcopenia and other age-associated adverse effects such as low muscle strength, disability, and frailty. These results indicate a necessity to prioritize the reduction of pro-inflammatory diets to help promote overall older age-related muscle conditions.

Cognitive Impairment Mediates the Association between Dietary Inflammation and Depressive Symptoms in the Elderly

The underlying mechanism in both cognitive impairment and depression was chronic inflammation, which could be reflected by the dietary inflammatory index (DII). However, the effect of cognitive impairment on the association between DII and depression was not clear. Therefore, in this study, we hypothesized that cognitive impairment could mediate the association between dietary inflammation and depressive symptoms. A total of 2550 participants aged ≥60 from the National Health and Nutrition Examination Survey (NHANES) in 2011-2014 were involved in the serial, cross-sectional study. Proinflammatory and anti-inflammatory diets were measured by DII. Cognitive impairment was measured by four dimensions, CERAD-immediate, CERAN-delayed, animal fluency test, and DSST. Depressive symptoms were measured by PHQ-9 scores. We found that a proinflammatory diet and cognitive impairment were both risk factors for depressive symptoms. An interaction between an inflammatory diet and cognitive impairment was detected (P-interaction = 0.060). In addition, all four dimensions of cognition mediated the association between DII and depressive symptom scores. Part of the association between DII and depressive symptoms scores could be explained by different dimensions of cognitive function, and the proportion of mediation ranged from 10.0% to 36.7%. In conclusion, cognitive impairment levels partly mediated the association between DII and depressive symptoms.

The role of dietary plant and animal protein intakes on mitigating sarcopenia risk

PURPOSE OF REVIEW

To highlight contemporary findings comparing the digestibility of animal and plant proteins, their stimulatory effects on muscle protein synthesis, and associations with sarcopenia.

RECENT FINDINGS

Animal proteins are more digestible than plant proteins, resulting in greater amino acid availability and stimulation of muscle protein synthesis. However, isolated plant proteins, plant protein blends, and modified plant proteins enriched with indispensable amino acids can elicit comparable digestion and absorption kinetics to animal proteins. More research is needed to determine whether these modified plant protein sources can effectively mitigate sarcopenia risk.

SUMMARY

Both animal and plant protein foods can be incorporated into a healthful eating plan that limits risk of age-related diseases, such as sarcopenia. Humans eat food rather than isolated nutrients; as such, considering the context of the overall diet and its impact on health, instead of solely focusing on individual nutrients in isolation, is important.

Nonfermented Dairy Intake, but Not Fermented Dairy Intake, Associated with a Higher Risk of Depression in Middle-Age and Older Finnish Men

BACKGROUND

Despite the putative health benefits of fermented dairy products, evidence on the association between fermented dairy and nonfermented dairy intake, and depression incidence is limited.

OBJECTIVES

This study examined cross-sectional and prospective associations between total dairy, fermented dairy, and nonfermented dairy intake with 1) the presence of elevated depressive symptoms and 2) the risk of a future hospital discharge or outpatient diagnosis of depression.

METHODS

Data from 2603 Finnish men (aged 42-60 y), recruited as part of the Kuopio Ischaemic Heart Disease Risk Factor Study, were included. Multivariable logistic regression models were used to examine ORs and 95% CIs for elevated depressive symptoms (Human Population Laboratory scale ≥5 points) at baseline. Cox proportional hazards regression models were used to estimate HRs and 95% CIs between dairy categories and risk of depression diagnoses.

RESULTS

In cross-sectional analyses, fermented dairy intake in the highest (compared with lowest) tertile was associated with lower odds of having elevated depressive symptoms (adjusted OR: 0.70; 95% CI: 0.52, 0.96). Each 100-g increase in nonfermented dairy intake was associated with higher odds of having elevated depressive symptoms (adjusted OR: 1.06; 95% CI: 1.01, 1.10). During a mean follow-up time of 24 y, 113 males received a diagnosis of depression. After excluding cheese intake, higher fermented dairy intake was associated with a lower risk of depression diagnosis (adjusted HR: 0.62; 95% CI: 0.38, 1.03), which was strengthened after excluding those with elevated depressive symptoms at baseline (adjusted HR: 0.55; 95% CI: 0.31, 0.99), whereas nonfermented dairy intake in the highest tertile was associated with a 2-fold higher risk of depression (adjusted HR: 2.02; 95% CI: 1.20, 3.42).

CONCLUSIONS

Fermented dairy and nonfermented dairy intake were differentially associated with depression outcomes when examined cross-sectionally and over a mean period of 24 y. These findings suggest that dairy fermentation status may influence the association between dairy intake and depression in Finnish men. The KIHD study was registered at clinicaltrials.gov as NCT03221127.

Associations between Dietary Patterns and Malnutrition, Low Muscle Mass and Sarcopenia in Adults with Cancer: A Scoping Review

Dietary patterns examine the combinations, types and quantities of foods consumed in the diet. Compared to individual nutrients, dietary patterns may be better associated with cancer-related malnutrition, low muscle mass and sarcopenia. This scoping review identified associations between dietary patterns, assessed using data-driven methods (i.e., statistical methods used to derive existing dietary patterns) and hypothesis-orientated methods (i.e., adherence to diet quality indices), and malnutrition, low muscle (lean) mass and sarcopenia. MEDLINE, Embase and CINAHL databases were searched up to September 2021. Of the 3341 studies identified, seven studies were eligible for review. Study designs included experimental (n = 5) and observational (n = 2), and people with prostate, ovarian and endometrial, bladder, breast, and gastrointestinal cancers. One study used data-driven methods to derive dietary patterns, finding adherence to a 'fat and fish' diet was associated with lower odds of low muscle mass. Two studies examined adherence to hypothesis-orientated methods including the Mediterranean Diet Adherence Screener and Healthy Eating Index 2010 and four studies used 'non-traditional' approaches to analyse dietary patterns. Hypothesis-orientated dietary patterns, developed to improve general health and prevent chronic disease, and 'non-traditional' dietary patterns demonstrated inconsistent effects on muscle (lean) mass. All studies investigated muscle (lean) mass, omitting malnutrition and sarcopenia as cancer-related outcomes. This scoping review highlights the limited research examining the effect of dietary patterns on cancer-related outcomes.

Dietary Inflammatory Index and Cross-Sectional Associations with Inflammation, Muscle Mass and Function in Healthy Old Adults

IMPORTANCE

Inflammaging is considered a driver of age-related loss of muscle mass and function (sarcopenia). As nutrition might play a role in this process, the Dietary Inflammatory Index® (DII) has been developed to quantify the inflammatory potential of an individual diet.

OBJECTIVES

We aimed to examine associations between the DII, inflammation, oxidative stress and sarcopenia-related parameters in healthy old compared to young adults.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included data of 79 community-dwelling, healthy old adults (65-85 years) and 59 young adults (18-35 years) who participated in a randomized controlled trial from April to December 2019.

MEASUREMENTS

The DII was computed with dietary data collected from 24-h recall interviews. Associations between the DII, inflammatory and oxidative stress markers as well as bioimpedance-derived body composition, handgrip strength and gait speed were determined with multiple linear regression analyses adjusted for age, sex, physical activity and insulin resistance.

RESULTS

Regression analyses revealed significant relationships between a higher interleukin (IL) 6 and IL-6:IL-10-ratio and higher percentage fat mass (%FM), waist-to-height-ratio (WHtR) as well as lower percentage skeletal muscle mass (%SMM) and gait speed exclusively in old adults. Subsequent analyses showed that IL-6 was associated with a pro-inflammatory diet as indicated by a higher DII, again exclusively in old adults (beta coefficient (β)= 0.027, standard error (SE) 0.013, p=0.037). While the DII was not related with handgrip strength or oxidative stress in neither old nor young adults, linear models confirmed that a higher DII was inversely associated with gait speed in old participants (β= -0.022, SE 0.006, p<0.001). Finally, a pro-inflammatory diet was significantly associated with higher %FM, WHtR and lower %SMM in both age groups.

CONCLUSION AND RELEVANCE

A pro-inflammatory diet reflected by the DII is associated with higher systemic inflammation, slower gait speed as well as lower muscle mass in old adults. Intervention studies are needed to examine whether anti-inflammatory dietary approaches can help to improve muscle mass and function and thus minimize the risk for sarcopenia in the long-term.