Healthy and unhealthy dietary patterns and the risk of chronic disease: an umbrella review of meta-analyses of prospective cohort studies

The dose-response relationships between all-cause and cardiovascular mortality and the accrual of various dietary habits

Objective

To evaluate the potential dose-response relationships of all-cause and cardiovascular death with the accumulation of various dietary habits.

Setting

A prospective cohort study.

Methods

Twenty-three dietary habits were assessed through face-to-face interviews with 57,737 participants in health check-up programs from 2015 to 2021. The total score of various dietary habits was calculated as the sum of each dietary habit multiplied by its own full-adjusted coefficient (β) for all-cause mortality in Cox proportional hazard models. Cox proportional hazard models were fitted for the associations of total and cause-specific mortality with the scores of various dietary habits.

Results

1,692 deaths occurred after the earliest check-ups in our center, followed up for a median time of 2.14 years (range: 1.01-7.71 years). Total mortality was 11.23/1,000 person-years, and the mean scores of dietary habits were 2.83±2.14. All-cause mortality increased significantly with the cumulative score of dietary habits (the highest quartile vs. lowest quartile: adjusted hazard ratio [AHR], 1.72; 95 % confidence interval [CI], 1.49-1.99; Plinear <0.01). Significance was also found for cardiovascular disease (CVD) mortality (HR, 1.82; 95 % CI, 1.47-2.27; Plinear <0.01), cancer mortality (AHR, 1.59; 95 % CI, 1.23-2.04; Plinear <0.01), and other-cause mortality (AHR, 2.00; 95 % CI, 1.46-2.73; Plinear <0.01). These dose-response trends were more significant in total mortality and CVD mortality among middle-aged adults, and non-obese population.

Conclusions

The greater the accumulation of diverse dietary habits, the higher the total mortality, CVD mortality, cancer mortality, and other mortality. This additive effect was particularly pronounced in the risk of death among middle-aged individuals and those with average body statures.

Disparities in neighborhood food environment and cognitive decline among US older adults: a cohort study

BACKGROUND

Disparities in neighborhood food environments in the United States, attributed to numerous complex economic, social, and political factors, likely to contribute to disparities in access to healthy food and cognitive function in older adults. However, the role of food environment in cognitive function is not well understood. Accordingly, this study examined the association of residing a low food access and low-income neighborhood with changes in cognitive function among older adults in urban areas.

METHODS

This is a cohort study leveraging existing datasets. The 2010 Food Access Research Atlas data was linked to the 2011-2021 National Health and Aging Trends Study (NHATS). A total of 4768 urban-dwelling older adults aged 65 years and older were included in this analysis. Total cognitive function (range: 0-33) was assessed through tests of orientation, executive function, immediate memory, and delayed memory. An unhealthy food environment was defined as residing in census tracts with both low access to healthy food stores and low income. Survey-weighted mixed-effects models were fitted, adjusting for individual- and area-level covariates.

RESULTS

The mean age of participants was 77.1 years (SD = 7.6), and 2779 were women (weighted % = 56.7). A total of 1238 participants (weighted % = 9.9%) were racialized as Black, 365 (weighted % = 9.1%) racialized as Latinx, and 3165 (weighted % = 81.1%) racialized as White. In adjusted models, older urban- and community-dwelling adults living in neighborhoods with low access and low income had faster annual cognitive decline than their peers (β = - 0.19; 95% CI = - 0.32, - 0.05).

CONCLUSIONS

Living in neighborhoods with both low food access and low income may be a risk factor for accelerated cognitive decline among urban-dwelling older adults and contribute to widening disparities in healthy food access and cognitive decline.

Hospital-Based Food Environment Interventions to Improve Workforce Dietary Behaviour: A Systematic Literature Review

The aim of this study was to determine the effectiveness of hospital-based interventions in improving eating patterns and food purchasing behaviours of hospital staff. Four electronic databases were searched from inception to November 2021 for intervention studies conducted within hospital retail food environments. Studies assessing outcomes pertaining to changes in eating patterns and/or food purchasing behaviour were included. Intervention effectiveness was defined as a statistically significant change in primary outcomes. Study quality was assessed independently by two researchers using the Mixed-Methods Appraisal Tool. In total, 20 studies were included in the review. 10 studies were moderate to low quality and almost half of the included studies (n = 9) utilised a quantitative descriptive design. Intervention modes included signage and health labels (n = 17), price modifications (n = 9), recipe modifications (n = 7), choice architecture (n = 5), altering healthy food availability (n = 5) and cooking processes (n = 1). Most studies (n = 15) contained more than one intervention type within their intervention design. Significant improvements in all primary outcomes were identified within eight studies, in which all had included a point-of-purchase prompt. Multicomponent interventions that incorporate point-of-purchase prompts may be useful in improving eating patterns and/or food purchasing behaviour of hospital staff. Further rigorous research identifying the long-term effectiveness of these interventions on improving health outcomes is warranted.

Avoidable Mortality Across US States and High-Income Countries

Importance

Although there are increasing differences in health policy and population health across US states over the past decade, little is known about how US states compare with other countries on avoidable mortality.

Objective

To compare trends in avoidable mortality across US states and countries in the European Union (EU) and the Organisation for Economic Co-operation and Development (OECD).

Design, Setting, and Participants

Retrospective, population-based, repeated cross-sectional study comparing changes in avoidable mortality among decedents aged 0 to 74 years in 50 US states (and Washington, DC) and 40 high-income countries between 2009 and 2021. Data analysis was conducted from May to July 2024.

Main Outcomes and Measures

Avoidable mortality comprising both preventable deaths related to prevention and public health and treatable deaths related to timely and effective health care treatment.

Results

Between 2009 and 2019, total avoidable mortality increased in all US states (median [IQR], 29.0 [20.1 to 44.2] deaths per 100 000 people), while it decreased in most comparator countries (-14.4 [-28.4 to -8.0]). During this period, variation in avoidable mortality widened across US states (2009: median [IQR], 251.1 [228.4 to 280.4]; 2019: 282.8 [249.1 to 329.5]), but narrowed in comparator countries (2009: 201.5 [166.2 to 320.8]; 2019: 187.1 [152.0 to 298.2]). During the COVID-19 pandemic (2019-2021), avoidable mortality increased for all US states (median [IQR], 101.5 [64.7 to 143.1]) and comparator countries (25.8 [9.1 to 117.7]). The states and countries that experienced the greatest increase in avoidable deaths during the COVID-19 period were those with the highest baseline avoidable mortality (Pearson ρ = 0.86; P < .001). Health spending and avoidable mortality have a consistent, negative, and significant association among comparator countries (2019: Pearson ρ = -0.7; P < .001) but no statistically significant association within US states (2019: Pearson ρ = -0.12; P = .41).

Conclusions and Relevance

This cross-sectional study found that the stark contrast in avoidable mortality trends between all US states compared with EU and OECD countries suggests that broad, systemic factors play a role in worsening US population health. While other countries appear to make gains in health with increases in health care spending, such an association does not exist across US states, raising questions regarding US health spending efficiency.

Improved stability and biocompatibility of lycopene liposomes with sodium caseinate and PEG coating

In this study, novel surface-modified lycopene liposomes were prepared for functional food applications, with systematic comparison of their physicochemical characteristics and biological evaluation. In contrast to whey protein isolate/polyethylene glycol layer-by-layer assembled lycopene liposomes (Lips-LYC/WPI) and PEGylated lycopene liposomes (LYC Lips), sodium caseinate/polyethylene glycol layer-by-layer assembled lycopene liposomes (Lips-LYC/SC) exhibited significantly reduced particle size and improved stability. Besides, Lips-LYC/SC highlighted enhanced encapsulation efficiency and minimized lycopene leakage attributed to sodium caseinate modification. DSC and PXRD confirmed effective reduction of lycopene crystallinity through excipient interaction, which was conducive to its water solubility improvement. FT-IR and fluorescence analysis revealed intermolecular hydrogen bonding between lycopene and the excipients. Furthermore, DPPH antioxidant and ROS scavenging experiments showed that the encapsulation of lycopene effectively improved its antioxidant activity. Cytotoxicity test revealed that Lips-LYC/SC had minimal cytotoxicity towards LO2 cells and Caco-2 cells, achieving cell survival rates >90 %, while the cell scratch results confirmed that LYC Lips induced significantly slower migration rates towards these cells. Moreover, Lips-LYC/SC significantly ameliorated metabolic disorders, oxidative stress, and hepatotoxicity in HFD-induced liver injury model. The above results highlighted the strategic advantage of sodium caseinate and PEG co-decorated liposomes, establishing Lips-LYC/SC as a promising delivery platform for the hydrophobic bioactive ingredient.

Quantifying the effect of afternoon moderate-intensity exercise on sleep quality and quantity in healthy adult males using polysomnography

OBJECTIVES

To investigate the effect of afternoon moderate-intensity cycling exercise on objective and subjective sleep in healthy adult males.

DESIGN

Repeated-measures, counter-balanced, crossover study design.

METHODS

To assess the effect of moderate-intensity afternoon exercise on sleep quality and quantity, 12 healthy adult males who were identified as good sleepers (<5 on Pittsburgh Sleep Quality Index) completed either moderate-intensity cycling exercise for 40 min at 70 % HRmax at ~15:30 h or sedentary activities. Polysomnography was used to measure sleep during a 9-hour sleep opportunity (23:00 h to 08:00 h). Sleep was subjectively assessed using questionnaires 30 min after waking.

RESULTS

There were no statistically significant changes in objective or subjective sleep quality or quantity between conditions. The inter-quartile range for total sleep time (exercise: 51.5 min vs no exercise: 13.4 min) and sleep efficiency (exercise: 9.5 % vs no exercise: 2.5 %) suggests that there was more individual variability in subsequent sleep after afternoon exercise compared to no exercise. Exercise appeared to have a moderate effect on reducing total sleep time (mean ± SD; control 493.7 ± 12.6 min vs exercise: 471.5 ± 55.2 min; Cohen's d: -0.56), sleep efficiency (control 91.4 ± 2.3 % vs exercise: 87.3 ± 10.2 %; Cohen's d: -0.56), and delaying REM onset latency (control: 76.1 ± 45.1 min vs exercise: 102.8 ± 46.9 min; r: 0.33), although the results did not reach statistical significance (p > 0.05).

CONCLUSIONS

Healthy adult males can complete moderate-intensity exercise in the afternoon without compromising subsequent sleep. Individual responses in objective sleep outcomes may vary after exercise.

Reduced Predicted Glycaemic Response and Inhibitory Effects on Lipid-Digesting Enzymes of Pasta Enriched With Flour of Malus domestica "Annurca cv." Pulp or Peel

Pasta is widely consumed, and incorporating certain components can transform it into a functional food with health advantages. These components include antioxidants, dietary fiber, and enzyme inhibitors associated with a decreased risk of various health issues. The Malus domestica variety Annurca is abundant in bioactive compounds, making it a suitable candidate for producing functional foods. We developed durum wheat tagliatelle enriched with dried and powdered Annurca pulp or peels at two distinct supplementation levels (3% and 6%) on a laboratory scale. The in vitro ability to inhibit digestive enzymes and the predicted glycaemic value of the enriched pasta were evaluated. Every formulation demonstrated inhibition of α-amylase, α-glucosidase, cholesterol esterase, and lipase in vitro. All the samples exhibited a low predicted glycaemic index (pGI), ranging from 41.25 to 45.76. These low pGI values indicate that fortified pasta has a lower impact on blood sugar levels and a slower digestion rate. The predicted glycaemic indices for pasta enriched with 3% or 6% pulp flour were 18.7% and 26.7% lower, respectively, than those for control pasta with durum wheat semolina alone. The reductions were similar for peel-enriched pasta at 3% and 6% (24.4% and 24.7%, respectively). Our in vitro results indicate that Annurca apple-fortified pasta has lipid- and glucose-lowering effects. Adding Annurca fruit flour with valuable and functional compounds could be relevant for obtaining pasta with potential health benefits.

Exploring patients' understanding of behavioral risk factors for non-communicable diseases: a study on diabetes and hypertension in Bushbuckridge, South Africa

BACKGROUND

Non-communicable diseases (NCDs) account for 41 million annual deaths worldwide, or 74% of all deaths. Notably, 86% of the 17 million premature deaths attributed to NCDs occur in low- and middle-income countries. Despite the burden of these diseases, many patients lack sufficient knowledge of behavioral risk factors that contribute to NCDs. The study aimed to explore the knowledge of patients diagnosed with diabetes and hypertension about behavioral risk factors contributing to non-communicable diseases.

METHOD

The study employed a qualitative, explorative, and descriptive design. Data was collected through semi-structured interviews, and participants were selected purposively. The data analysis followed Tesch's open thematic approach, applied at various levels and based on patient-provided text data, with the thematic analysis, the researcher was able to organize and interpret the data presented in the themes systematically.

RESULTS

Four major themes emerged regarding the understanding of behavioral risk factors for non-communicable diseases among patients diagnosed with diabetes and hypertension. These include unhealthy eating habits and poor lifestyle choices, mental health issues and stress, challenges patients face in adhering to medications, and optimal management of their conditions, cultural practices, and beliefs.

CONCLUSION

The study shed some insights into the knowledge of patients diagnosed with diabetes and hypertension about behavioral risk factors contributing to NCD. They indicated that witchcraft, cultural beliefs, and inadequate health education could have resulted in NCDs, which influenced them to consult traditional healers before coming to the health facility. The observations of participants underscore the urgent need for targeted interventions to improve the knowledge of patients regarding behavioral risk factors for NCDs.

Association of lifestyle components with prevalence of chronic obstructive pulmonary disease (COPD): Findings of a cohort study

BACKGROUND

Chronic Obstructive Pulmonary Disease (COPD) is a complex condition influenced by various lifestyle factors. Dietary patterns, physical activity, and sleep quality play a crucial role in the prevalence and management of COPD.

OBJECTIVES

We aimed to evaluate the relationship between dietary patterns, physical activity, and sleep quality with the prevalence of COPD in the PERSIAN Organizational Cohort study at Mashhad University of Medical Sciences (POCM).

METHODS

This cohort study utilized data from 12,000 participants in POCM. Dietary intake was assessed using a food frequency questionnaire, physical activity was measured using the International Physical Activity Questionnaire, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index. Spirometry was performed to diagnose and categorize COPD severity.

RESULTS

Out of the eligible 4269 participants, 3768 (91 %) were healthy and 373 (9 %) had COPD. Compared to the highest quartile, the second quartiles and third quartiles of the healthy dietary pattern were inversely associated with COPD prevalence, even after adjusting for confounders for the second and third quarters respectively. The second quartile of the fast-food dietary pattern was positively associated with COPD. Older age and poorer sleep quality were also significantly associated with higher COPD prevalence. Physical activity levels did not differ between healthy and COPD individuals.

CONCLUSIONS

Findings of this study indicate that healthy diet with more fruits, vegetables, and whole grains was related to reduced incidence of COPD, while the incidence of COPD was related to poor sleep quality. These findings highlight the possible interplay of lifestyle factors and respiratory health.

Dietary patterns and risk of all-cause mortality in individuals with dyslipidemia based on a prospective cohort in Guizhou China

BACKGROUND

Death in dyslipidemia is a significant health problem, dietary intervention plays an important role in this context.

OBJECTIVE

Our study investigated the association between dietary patterns and all-cause mortality in individuals with dyslipidemia. This will lay a foundation for the relevant departments to develop more precise and targeted dietary strategies and help high-risk people with early prevention by adjusting their dietary patterns, which may reduce their mortality and reduce the medical burden.

METHODS

This study included 5369 participants. Factor analysis identified distinct dietary patterns, each categorized into tertiles based on factor scores: low, medium, and high. Cox proportional hazards regression models were estimated the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the association between dietary patterns and all-cause mortality in individuals with dyslipidemia.

RESULTS

Over a median follow-up of 12.61 years, 365 deaths occurred among the 5369 participants. Four primary dietary patterns were identified. We found that compared to the lowest tertile, the highest tertile of the equilibrium pattern (HR=0.740, 95%CI: 0.565~0.969) and the aquatic products and poultry high loadings pattern (HR=0.757, 95%CI: 0.575~0.997) were negatively correlated with all-cause mortality. Conversely, the grain-tuber and vegetables high loadings pattern (HR=1.338, 95%CI: 1.031~1.737) was positively correlated with all-cause mortality. The oil and salt high loadings pattern (HR=0.973, 95%CI: 0.747~1.268) was not statistically significant.

CONCLUSIONS

The equilibrium pattern and the aquatic products and poultry high loadings pattern were linked to a lower risk of all-cause mortality among individuals with dyslipidemia, whereas the grain-tuber and vegetables high loadings pattern was linked to a higher risk. The results implying that adopting appropriate dietary pattern could provide survival benefit for individuals with dyslipidemia. However, this study has only considered dietary intake at baseline, and future research should consider the dynamic changes in dietary habits over time.

Effect of a controlled lifestyle intervention on medication use and costs: The Healthy Lifestyle Community Program (cohort 2)

Background: Establishing a healthy lifestyle has a great potential to reduce the prevalence of non-communicable diseases (NCDs) and their risk factors. NCDs contribute immensely to the economic costs of the health care system arising from therapy, medication use, and productivity loss. Aim: The aim of this study was to evaluate the effect of the Healthy Lifestyle Community Program (cohort 2; HLCP-2) on medication use and consequently on medication costs for selected NCDs (diabetes, hypertension, and dyslipidemia). Methods: Data stem from a 24-month non-randomised, controlled intervention trial aiming to improve risk factors for NCDs. Participants completed questionnaires at six measurement time points assessing medication use, from which costs were calculated. The following medication groups were included in the analysis as NCD medication: glucose-lowering medications (GLM), antihypertensive drugs (AHD) and lipid-lowering drugs (LLD). Statistical tests for inter- and intra-group comparison and multiple regression analysis were performed. Results: In total, 118 participants (intervention group [IG]: n = 79; control group [CG]: n = 39) were considered. Compared to baseline medication use decreased slightly in the IG and increased in the CG. Costs for NCD medication were significantly lower in the IG than in the CG after 6 (p = 0.004), 12 (p = 0.040), 18 (p = 0.003) and 24 months (p = 0.008). After multiple regression analysis and adjusting for confounders, change of costs differed significantly between the groups in all final models. Conclusion: The HLCP-2 was able to moderately prevent an increase of medication use and thus reduce costs for medication to treat NCDs with the greatest impact on AHD.Trial registrationGerman Clinical Trials Register DRKS (www.drks.de; reference: DRKS00018775).

Dr. Ruth Lawrence, An Exemplar of Successful Aging (AKA Ruthie Turns 100: What is Her Secret?)

Successful aging is a dynamic process shaped by genetic, environmental, and lifestyle factors that influence health and well-being across the lifespan. Pioneering researchers such as Dr. Ruth Lawrence have demonstrated how intentional choices in diet, physical activity, social engagement, and mental resilience contribute to longevity and quality of life. This review explores the concept of successful aging, tracing its origins in the groundbreaking work of Havighurst, Rowe, and Kahn, and incorporating insights from Dr. George Vaillant's longitudinal studies, including the Harvard Study of Adult Development and the Grant Study. These works highlight the profound impact of psychosocial factors, adaptability, and meaningful relationships in fostering vitality and emotional fulfillment throughout life. Drawing on evidence from meta-analyses, centenarian studies, and landmark intervention trials such as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, this review examines how modifiable lifestyle factors influence aging trajectories. It also discusses emerging research linking maternal behaviors-such as breastfeeding-to long-term health benefits, including reduced risks of chronic diseases and cognitive decline. Dr. Lawrence's extraordinary century-long life exemplifies these principles, showcasing the interplay of genetics, lifestyle, and purpose in achieving successful aging. By synthesizing existing research and honoring Dr. Lawrence's legacy, this article highlights the importance of integrative approaches to aging well. It advocates for holistic strategies that combine individual health behaviors, community support, and systemic policy changes to promote longevity and health span. Dr. Lawrence's contributions to breastfeeding medicine and her embodiment of the six pillars of lifestyle medicine-nutrition, physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connections-serve as a testament to the power of lifestyle in shaping vibrant, fulfilling lives. Her example inspires a vision of aging as an opportunity for growth, connection, and continued impact.

Exploring Healthcare Workers' Knowledge and Perspectives on Behavioral Risk Factors Contributing to Non-Communicable Diseases: A Qualitative Study in Bushbuckridge, Ehlanzeni District, Mpumalanga Province, South Africa

Healthcare workers have been the backbone of information regarding behavioral risk factors and non-communicable diseases that have caused morbidity and mortality globally over the past decades. The study explores the knowledge of healthcare workers about behavioral risk factors contributing to non-communicable diseases. The study utilized a qualitative, explorative, and descriptive design. Data were collected through a semi-structured interview guide, involving eight healthcare workers from Bushbuckridge. Purposive sampling was used to select the participants. Healthcare workers were interviewed at their convenience, such as at lunch or as per their appointment time. Using thematic analysis, the researchers were able to systematically organize and interpret the data presented in the themes. Two themes and seven subthemes emerged regarding the knowledge of healthcare workers about behavioral risk factors contributing to non-communicable diseases. These themes, identified through deductive analysis, include behavioral risk factors and health system factors. The study found that a lack of seminars or training in the management of chronic disorders has left healthcare providers in Bushbuckridge with less information about behavioral risk factors related to non-communicable diseases. However, these findings reflect the perspectives of a small sample and require further investigation through broader qualitative and quantitative research to determine their generalizability and potential systemic implications.

2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

BACKGROUND

The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).

METHODS

The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2025 AHA Statistical Update is the product of a full year's worth of effort in 2024 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. This year's edition includes a continued focus on health equity across several key domains and enhanced global data that reflect improved methods and incorporation of ≈3000 new data sources since last year's Statistical Update.

RESULTS

Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.

CONCLUSIONS

The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

The relationship between physical activity level, dietary patterns, and metabolic syndrome: An empirical study in Saudi Arabia

BACKGROUND

Metabolic syndrome, a cluster of conditions increasing the risk of heart disease, stroke, and diabetes, is a growing concern globally. In Saudi Arabia, lifestyle factors such as physical activity and dietary patterns play a significant role in the prevalence of metabolic syndrome.

STUDY PURPOSE

This study aims to explore the relationship between physical activity levels, dietary patterns, and the prevalence of metabolic syndrome among adults in Saudi Arabia.

METHODS

A cross-sectional study was conducted using purposive and convenience sampling techniques. A total of 468 participants completed questionnaires assessing their physical activity levels and dietary patterns. Metabolic syndrome was determined based on clinical measurements of waist circumference, blood pressure, fasting glucose, and lipid levels.

RESULTS

The analysis revealed a significant association between lower physical activity levels and poor dietary patterns with higher prevalence rates of metabolic syndrome. The analysis revealed that participants with low physical activity levels had a higher prevalence of metabolic syndrome (p < 0.01). Similarly, those with unhealthy dietary patterns (high in saturated fats and sugars) showed a metabolic syndrome risk (p < 0.01), compared to those with healthy dietary patterns.

CONCLUSION

The findings underscore the critical role of physical activity and dietary patterns in the development of metabolic syndrome in Saudi Arabia. Public health interventions targeting lifestyle modifications could be essential in mitigating metabolic syndrome and improving overall health.

Associations of Global Burden of Diseases study-derived dietary scores with mortality and chronic disease risk: a comprehensive analysis from the prospective NutriNet-Santé study

The Global Burden of Diseases (GBD) network has proposed theoretical minimum risk exposure level (TMREL) for leading risk factors associated with diet that minimize the risk of morbimortality from chronic diseases. TMREL can be applied to develop follow-up or evaluation indicators in individual studies. The validity of these scores can be tested by assessing associations with health outcomes in prospective cohorts. In this study conducted within the NutriNet-Santé cohort, four dietary scores (TMREL-Risk Score, TMREL-Probability of adequacy, TMREL-standardized distance, and TMREL dietary score) using different scoring methods were developed, with higher scores reflecting less healthy diets. Associations of these scores with the risk of type 2 diabetes, cancer, cardiovascular diseases (CVD) and mortality were estimated using multivariable Cox proportional hazards models, adjusted for a wide range of covariates. Counterfactual and marginal structural models were used to infer causality. Analyses were conducted in a sample of up to103,324 participants ((78.3% women, mean age of 43.6 years old (y) (SD = 14.6)), followed for a median of 8.47 (IQR = 14.7) years (2009-2024). The association with dietary scores (for 1SD-increase) varied in magnitude for each health outcome. For mortality, HR varied from 1.12 (95%CI = 1.07-1.18, ) to 1.18 (95%CI = 1.12-1.24) for TMREL-Stdis and TMREL-DI, for overall cancer from 1.07 (95%CI = 1.03-1.12) to 1.09 (1.04-1.13) for TMREL-RS and TMREL-PA, for CVD from 1.07 (95%CI = 1.00-1.16) to 1.12 (95%CI = 1.04-1.20) for TMREL-PA and TMREL-RS, and for type 2 diabetes from 1.33 (95%CI = 1.23-1.43) to 1.47 (95%CI = 1.36-1.59) for TMREL-DI and TMREL-PA. Marginal structural Cox models strengthened all associations compared to classical analyses. Standardized survival curves showed clear associations, especially for the risk of cancer and type 2 diabetes. Dietary scores based on GBD TMREL can serve as key indicators for characterizing diet quality in relation to long-term health, and using different scoring systems helped evaluate the robustness of these associations.

Context effects on healthy food choice under situational modes of consumer thinking: A case study with poke bowls

In the context of healthy food consumption, this research aims to explore the moderating role of situational modes of thinking for both 1) the attraction effect (individuals tend to choose options that are similar to others but dominate inferior alternatives) and 2) the compromise effect (individuals prefer intermediate options over those with high- and low-end extremes). With the experimental priming of thinking style (analytic vs. holistic), these context effects were investigated by measuring French participants' purchase intention and willingness to pay for poke bowls-a lower-calorie, nutrient-dense food. The results demonstrate that situational induction of thinking style has a differential impact on the relative increase in consumers' purchase preferences for options offering either a dominant value in a specific attribute or an intermediate value throughout the available attributes. The attraction (compromise) effect was amplified with analytic (holistic) thinking style, leading consumers to have a higher purchase intention and willingness to pay for the dominating (intermediate) option of poke bowls. This research highlights the shifts in purchase preferences depending on consumer thinking in either the analytic or holistic mode and suggests effective global strategies to facilitate target consumers' purchase orientation toward a specific option of lower-calorie packaged foods.

Suboptimal dietary patterns are associated with accelerated biological aging in young adulthood: A study with twins

BACKGROUND & AIMS

Suboptimal diets increase morbidity and mortality risk. Epigenetic clocks are algorithms that can assess health and lifespan, even at a young age, before clinical manifestations of diseases. We investigated the association between dietary patterns and biological aging in young adult twins.

METHODS

The data were drawn from the population-based FinnTwin12 study and consisted of twins aged 21-25 years (n = 826). Food and beverage intakes were assessed using a food frequency questionnaire. Biological aging was estimated using the epigenetic clocks GrimAge and DunedinPACE. Latent class analysis was used to identify dietary patterns. The association between dietary patterns and biological aging was assessed using linear regression modeling at the individual level, followed by within-twin pair analyses to account for genetic liabilities and shared familial confounders.

RESULTS

Six dietary patterns were identified: 1) High fast food, low fruits and vegetables (F&V), 2) Plant-based, 3) Health-conscious, 4) Western with infrequent fish, 5) Western with regular fish, and 6) Balanced average. At the individual level, GrimAge acceleration was slower in the Plant-based, Health-conscious, and Balanced-average patterns compared to the High fast food, low F&V, and faster in the Western with infrequent fish pattern compared to the Balanced average, regardless of sex, nonalcoholic energy intake, smoking, and alcohol consumption. After further adjustment for BMI and sports participation, the strengths of the associations modestly decreased; however, the difference between the Balanced-average and High fast food, low F&V patterns remained significant. The pace of aging (DunedinPACE) was slower in the Plant-based pattern compared to the High fast food, low F&V and the Western with infrequent fish patterns after adjustment for sex, nonalcoholic energy intake, smoking, and alcohol. The effect sizes were attenuated and reached a non-significant level when BMI and sports participation were added to the model. Most of the associations were replicated in the within-pair analyses among all twin pairs and among dizygotic twin pairs, but the effect sizes tended to be smaller among monozygotic twin pairs. This suggests that genetics, but not a shared environment, may partially explain the observed associations between diet and biological aging.

CONCLUSION

Diets high in fast food, processed red meat, and sugar-sweetened beverages and low in fruits and vegetables are associated with accelerated biological aging in young adulthood. The clustering effect of lifestyle factors and genetic confounders should be considered when interpreting the findings.

Which factors influence the transition towards a healthy and sustainable food environment in Dutch hospitals? A qualitative view from stakeholders

BACKGROUND

Hospitals fulfill an important exemplary role in promoting health and well-being. It is therefore crucial to have a supportive food environment that stimulates healthy and sustainable food choices of patients, staff, and visitors. This qualitative study aimed to identify factors influencing the implementation of long-lasting actions to enhance the healthiness and sustainability of the food environment in the hospital setting in the Netherlands, from the perspective of different stakeholders.

METHODS

Semi-structured interviews were conducted in hospitals realizing a healthy and sustainable food environment. Verbatim transcripts were thematically analyzed, guided by the Consolidated Framework for Implementation Research. Data were organized and interpreted per theme as well as stakeholder group.

RESULTS

In three hospitals, 29 semi-structured interviews were conducted with 30 stakeholders from a wide spectrum of stakeholder groups (i.e., facility professionals, healthcare professionals, project coordinators, and board of directors). Identified themes and subthemes were: 1 the outer setting, with momentum for change, government-established policies and guidelines, collaboration and networks outside the hospital, and caterers' and suppliers' food offerings, interests, and contracts; 2 the innovation domain, with familiarity and compliance with the TEH program; 3 support at all levels, achieving organizational buy-in with communication as a strategy, and end user interests; 4 the inner setting, with key priority in policy and having a vision, available resources, infrastructure within the hospital, ambassadors, and gradual process with continuous effort; and 5 the individual domain with personal drive.

CONCLUSIONS

The results revealed an interplay of perceived factors that influence the enhancement of a healthy and sustainable food environment and underscored the importance of addressing various facilitators and barriers across multiple domains within and outside the hospital setting. To ensure successful integration of a healthy and sustainable food environment in hospitals, throughout the entire organization it is crucial to engage diverse stakeholders at all levels and address their barriers with tailored implementation strategies. We suggest verification of our findings in more hospitals.

Association of Dietary Intake with Chronic Disease and Human Health

Eating habits are among the major determinants of health, and in most countries in the world part of the population suffers from one or more problems related to malnutrition, by default (due to an acute or chronic lack of micronutrients) or by excess (energy, sugars, and fats, and deficiencies in important micronutrients) [...].

Burden of diet-related chronic diseases in Chinese and Japanese adults attributable to dietary risk factors from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

Chronic diseases are a major cause of death, contributing significantly to the global disease burden. The growing aging population and chronic disease burden in China and Japan have a substantial impact on health outcomes. Dietary factors, as key modifiable elements, are particularly important. Therefore, we aimed to analyze and compare the impact of dietary factors on the burden of chronic diseases in China and Japan and to develop measures to reduce this burden.

Methods

According to the WHO classification of chronic diseases, we selected cardiovascular diseases, neoplasms, and diabetes for analysis. We collected relevant data from the GBD database, described and analyzed the disease burden by age, gender, and year, and created bar and trend charts. We conducted a comparative analysis of the dietary factors influencing these three chronic diseases by generating heatmaps. The joinpoint model was used to analyze the time trends of these three diseases from 1990 to 2021.

Results

From 1990 to 2021, the burden of neoplasms and cardiovascular diseases in China and Japan declined to varying degrees, while the burden of diabetes continued to increase. The main dietary risk factor for neoplasms is a high red meat diet, while for cardiovascular diseases, a high-sodium diet, especially in China. In addition, high meat consumption appears to serve as a protective factor for both Chinese and Japanese populations. Regarding dietary risk factors for diabetes, China is associated with a high red meat diet, whereas Japan is characterized by a high-processed meat diet.

Conclusion

By comparing the burden of chronic diseases related to dietary factors in China and Japan, this study proposes strategies for national healthy diets, such as reducing sodium, processed meat, and red meat intake and increasing whole grains, vegetables, and fruit intake. In addition, attention should be given to the dietary status of the elderly, along with targeted health education initiatives.

Plant-Based Burgers in the Spotlight: A Detailed Composition Evaluation and Comprehensive Discussion on Nutrient Adequacy

This study aimed to evaluate the nutritional profile of commercial plant-based burgers (PBBs) available in Brazil and to assess their suitability for fulfilling nutritional requirements. Seven PBBs were selected, based on the different protein sources used in the formulations. The proximate and mineral compositions were evaluated, and the fatty acid and amino acid profiles were determined. The protein contents ranged from 5.25 ± 0.37 to 13.55 ± 1.16 g/100 g in the PBBs made from quinoa and a mix of proteins, respectively. The studied PBBs can offer between 46 and 71% of the essential amino acid (EAA) requirements. In addition, the total amount of EAAs provided the nutritional requirements established by the FAO/UN for all of the PBBs, considering the 100 g portion intake. The total fat content in the PBBs ranged from 3.51 ± 0.11 to 12.74 ± 1.93 g/100 g. Linoleic acid and oleic acid were the major fatty acids in the three PBBs, while myristic acid was the major fatty acid in one PBB studied. This study revealed significant differences in the nutritional composition between PBBs marketed in Brazil. Additionally, the lack of regulation allows for considerable variation in their nutritional profiles, making it difficult to compare them with those of meat burgers.

Assessing and Enhancing Nutrition and Physical Activity Environments in Early Childhood Education and Care Centers: Scoping Review of eHealth Tools

BACKGROUND

Early childhood is a critical period for shaping lifelong health behaviors, making early childhood education and care (ECEC) environments ideal for implementing nutrition and physical activity interventions. eHealth tools are increasingly utilized in ECEC settings due to their accessibility, scalability, and cost-effectiveness, demonstrating promise in enhancing educators' practices. Despite the potential effectiveness of these eHealth approaches, a comprehensive collection of available evidence on eHealth tools designed to assess or support best practices for nutrition or physical activity in ECECs is currently lacking.

OBJECTIVE

The primary objective of this scoping review is to map the range of available eHealth tools designed to assess or deliver interventions aimed at improving nutrition or physical activity in ECEC settings, while evaluating their components, theoretical foundations, and effectiveness.

METHODS

This scoping review adhered to the Joanna Briggs Institute methodology, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The objectives, inclusion criteria, and methods for this review were predefined and specified. Eligibility criteria were (1) early childhood educators (population); (2) eHealth (digital) technologies, such as websites, smartphone apps, emails, and social media; and (3) tools designed to assess or deliver interventions aimed at improving best practices for nutrition, physical activity, or both within ECEC settings (context). A search was conducted across 5 electronic databases (PubMed, Scopus, CINAHL Plus, ERIC, and Embase) to identify white literature, and 3 electronic databases (ProQuest, Google Scholar, and targeted Google search), along with hand-searching of reference lists, were used to identify gray literature. All literature was reported in English or French, with the search extending until May 2024. Separate data charting tools were used for white and gray literature.

RESULTS

The search strategy identified 3064 results for white literature, yielding 2653 unique citations after duplicates were removed. Full texts for 65 citations were retrieved and screened for inclusion, resulting in 30 studies eligible for data extraction and analysis. The most common study design was a randomized controlled trial, comprising 16 studies (53%). The largest proportion of studies were conducted in the United States (11 studies, 37%). In total, 19 eHealth tools were identified, targeting nutrition (8 tools, 42%), physical activity (5 tools, 26%), or both nutrition and physical activity (6 tools, 32%). All tools were web based (19 tools, 100%). The gray literature search yielded 1054 results, of which 17 were moved to full-text screening, and 7 met the eligibility criteria for data extraction and analysis. The tools identified in the gray literature originated in Canada (4 tools, 57%) and the United States (3 tools, 43%). The majority targeted nutrition (4 tools, 57%) and were primarily web based (6 tools, 86%), with 1 mobile app (1 tool, 14%).

CONCLUSIONS

This scoping review mapped the available eHealth tools designed to improve nutrition or physical activity environments in ECEC settings, highlighting the growing emphasis on web-based tools and the need for psychometric testing. Future research should systematically evaluate the effectiveness of these tools, particularly those addressing both nutrition and physical activity, to identify the key factors that contribute to long-term behavior change.

TRIAL REGISTRATION

Open Science Framework XTRNZ; https://osf.io/xtrnz.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/52252.

Evaluating agreement between individual nutrition randomised controlled trials and cohort studies - a meta-epidemiological study

BACKGROUND

In nutrition research, randomised controlled trials (RCTs) and cohort studies provide complementary evidence. This meta-epidemiological study aims to evaluate the agreement of effect estimates from individual nutrition RCTs and cohort studies investigating a highly similar research question and to investigate determinants of disagreement.

METHODS

MEDLINE, Epistemonikos, and the Cochrane Database of Systematic Reviews were searched from January 2010 to September 2021. We matched individual RCTs to cohort studies based on population, intervention/exposure, comparator, and outcome (PI/ECO) characteristics. Two reviewers independently extracted study characteristics and effect estimates and rated the risk of bias using RoB2 and ROBINS-E. Agreement of matched RCTs/cohort studies was analysed by pooling ratio of risk ratios (RRR) and difference of (standardised) mean differences (DSMD).

RESULTS

We included 64 RCT/cohort study pairs with 4,136,837 participants. Regarding PI/ECO similarity, 20.3% pairs were "more or less identical", 71.9% "similar but not identical" and 7.8% "broadly similar". Most RCTs were classified as "low risk of bias" (26.6%) or with "some concerns" (65.6%); cohort studies were mostly rated with "some concerns" (46.6%) or "high risk of bias" (47.9%), driven by inadequate control of important confounding factors. Effect estimates across RCTs and cohort studies were in high agreement (RRR 1.00 (95% CI 0.91-1.10, n = 54); and DSMD - 0.26 (95% CI - 0.87-0.35, n = 7)). In meta-regression analyses exploring determinants of disagreements, risk-of-bias judgements tend to have had more influence on the effect estimate than "PI/ECO similarity" degree.

CONCLUSIONS

Effect estimates of nutrition RCTs and cohort studies were generally similar. Careful consideration and evaluation of PI/ECO characteristics and risk of bias is crucial for a trustworthy utilisation of evidence from RCTs and cohort studies.

Associations between the Global Diet Quality Score and risk of type 2 diabetes: Tehran lipid and glucose study

BACKGROUND

Previous studies reported that focusing on healthy lifestyle, especially high diet quality is necessary for preventing type 2 diabetes (T2D). This study investigated the association between the innovative index, the Global Diet Quality Score (GDQS), and the risk of Type 2 Diabetes incidence.

METHODS

In this secondary analysis, we included elective adult participants (n = 5948) from the third and fourth survey of the Tehran Lipid and Glucose Study. Participants checked out until the sixth phase with an average follow-up of 6.65 years. Expert nutritionists collected dietary data using a valid and reliable semi-quantitative food frequency questionnaire. The GDQS were calculated, including healthy and unhealthy food group scores. Biochemical and anthropometric characteristics were assessed during the first and follow-up surveys. Multivariable Cox proportional hazards regression models were used to estimate the progression of T2D in association with the GDQS.

RESULTS

This study was implemented on 2,688 men and 3,260 women, respectively with the mean (SD) age of 41.5(14.1) and 39.3(13.02) years. A total of 524 subjects were found to have had T2D incidence. The healthy component of GDQS was conversely associated with T2D incidence [HR: 1, 0.91 (0.84-0.98), 0.91 (0.84-0.98), 0.84 (0.77-0.92) P trend = <0.001] in an adjusted model. The unhealthy component of GDQS was conversely associated with T2D incidence in an adjusted model [HR: 1, 0.86 (0.80-0.92), 0.93 (0.86-1.01), 0.89 (0.81-0.98) P trend = 0.009].

CONCLUSION

The results of this study suggested that higher adherence to the healthy component of GDQS and lower intake of the unhealthy component decreased the risk of T2D incidence.

Bread Consumption and Cancer Risk: Systematic Review and Meta-Analysis of Prospective Cohort Studies

Because bread can contain potential carcinogens such as acrylamide, and is widely consumed, we conducted a systematic review and meta-analysis to determine whether bread consumption is associated with increased cancer risk. PubMed and Medline databases were searched up to 1 March 2024, for studies that provided hazard ratios (HRs) (or similar) for bread consumption and cancer incidence or mortality. Only prospective cohort studies were included. We used the Preferred Reporting Items of Systematic reviews and Meta-Analyses checklist. Meta-analysis was performed with Cochrane's RevMan 5.4.1 software using a DerSimonian-Laird random-effects model. Heterogeneity was assessed with Cochrane's Q (χ2) and I 2 statistics, and publication bias was assessed with Egger's test. Twenty-four publications met inclusion criteria, including 1,887,074 adults, and were included in the systematic review. Ten publications that provided HRs were included in the meta-analysis for highest compared with lowest intakes, and an additional 7 publications that provided mortality or incident rate ratios or relative risks were included in supplemental meta-analyses. Of 108 reported HRs (or similar), 97 (79%) were either not statistically significant (n = 86) or indicated lower cancer risk (n = 11) associated with the highest intakes of bread. The meta-analysis indicated that bread intake was not associated with site-specific cancer risk [HR: 1.01; 95% confidence interval (CI): 0.89, 1.14; P = 0.92; 8 publications] or total cancer mortality (HR: 0.90; 95% CI: 0.73, 1.11; P = 0.32; 2 publications). Supplemental meta-analyses using all risk estimates in addition to HRs confirmed these findings. Whole-grain bread was associated with a lower site-specific cancer risk, mainly because of reduced colorectal cancer risk. Results of the systematic review and meta-analysis indicate that bread consumption is not associated with increased site-specific cancer risk, whereas high whole-grain/nonwhite bread consumption is associated with lower total cancer mortality and colorectal cancer risk. This study was registered at Clinical Trials Registry of PROSPERO as registration number CRD42023414156.

Chronic Obstructive Pulmonary Disease: The Role of Healthy and Unhealthy Dietary Patterns-A Comprehensive Review

Chronic obstructive pulmonary disease (COPD) is a progressive and irreversible disease affecting many people worldwide. Recent evidence suggests that diet and lifestyle play a vital role in COPD progression. We aimed to provide a comprehensive review of the effect of healthy and unhealthy dietary patterns on preventing and treating COPD. For this reason, Scopus, EMBASE, Web of Science, and PubMed were searched. Based on our findings, it appears that adhering to a healthy dietary pattern rich in vegetables, legumes, fruit, nuts, and whole grains may have advantageous impacts on preventing and treating COPD while following an unhealthy dietary pattern rich in red and processed meat, saturated fats, sweets, and sugary drinks affect COPD negatively. Adhering to Mediterranean, dietary approaches to stop hypertension (DASH), Prudent, Ketogenic, and High-protein diet may be related to a lower risk of COPD and improved pulmonary function. Conversely, Western and Ramadan Intermittent Fasting diets may elevate the prevalence of COPD. Proposing a nutritious diet that enhances pulmonary function could potentially be an effective approach to preventing and managing COPD. A comprehensive knowledge of the relationship between dietary factors and COPD can provide healthcare professionals with properly supported approaches to advise patients and empower individuals to make informed lifestyle decisions that are beneficial to improve their pulmonary health.

The Effectiveness of the Low-Glycemic and Insulinemic (LOGI) Regimen in Maintaining the Benefits of the VLCKD in Fibromyalgia Patients

Background: Fibromyalgia (FM) is a chronic disorder that causes damage to the neuro-muscular system and alterations in the intestinal microbiota and affects the psychological state of the patient. In our previous study, we showed that 22 women patients subjected to a specific very low-carbohydrate ketogenic therapy (VLCKD) showed an improvement in clinical scores as well as neurotransmission-related and psychological dysfunctions and intestinal dysbiosis. Furthermore, NMR metabolomic data showed that changes induced by VLCKD treatment were evident in all metabolic pathways related to fibromyalgia biomarkers. Methods: Based on this evidence, we extend our investigation into dietary interventions for fibromyalgia by evaluating the impact of transitioning from a VLCKD to a low-glycemic insulinemic (LOGI) diet over an additional 45-day period. Therefore, participants initially following a VLCKD were transitioned to the LOGI diet after 45 days to determine whether the improvements in FM symptoms and metabolic dysfunctions achieved through VLCKD could be sustained with LOGI. Results: Our findings suggested that while VLCKD serves as an effective initial intervention for correcting metabolic imbalances and alleviating FM symptoms, transitioning to a LOGI diet offers a practical and sustainable dietary strategy. This transition preserves clinical improvements and supports long-term adherence and quality of life, underscoring the importance of adaptable nutritional therapies in chronic disease management. Control patients who adhered only to the LOGI diet for 90 days showed only modest improvement in clinical and psychological conditions, but not elimination of fibromyalgia symptoms. Conclusions: In conclusion the LOGI diet is an excellent alternative to maintain the results obtained from the regime VLCKD.

Associations Among Reduced Income, Unhealthy Habits, the Prevalence of Non-Communicable Diseases, and Multimorbidity in Middle-Aged and Older US Adults: A Cross-Sectional Study

INTRODUCTION

Evidence supports the relationships between socioeconomic status and access to health care, incidence of pathologies, and lifestyle.

OBJECTIVE

The aim of this research was to investigate whether there are associations between having a household income below the poverty line, and participation in unhealthy lifestyle habits, the prevalence of non-communicable diseases, and the number of comorbidities in US middle-aged and older adults.

METHODS

This cross-sectional study is based on the NHANES 2011-2020. A total of 10,788 US middle-aged and older adults (5653 males and 5135 females) participated in this research. Associations were studied through the Chi-squared test, and odds ratios were calculated using a binary logistic regression model.

RESULTS

There were associations between a household income below the poverty line and physical inactivity, unhealthy diet, and being or having been an alcoholic. Associations were found between this adverse economic situation and having hypertension, diabetes, liver disease, kidney problems, arthritis, congestive heart failure, angina pectoris, heart attack, stroke, and also with having two or more, three or more, four or more, and five or more comorbidities. Increased odds of being involved in these unhealthy habits and of suffering these diseases and multimorbidity were found for those with a family income below the poverty threshold.

CONCLUSIONS

The existence of associations between having a family income under the poverty threshold and having unhealthy habits, suffering non-communicable diseases, and having multimorbidity is confirmed in US middle-aged and older adults. Increased odds for various non-communicable diseases, multimorbidity, and for being involved in these unhealthy habits were found for this low-income group. These findings should serve to draw the attention of policy makers to the increased health vulnerability of the adult population below the poverty line in the US.

The Effects of Smoking, Alcohol, and Dietary Habits on the Progression and Management of Spondyloarthritis

Spondyloarthritis (SpA) is a group of chronic inflammatory diseases affecting the spine and peripheral joints, causing pain, stiffness, and reduced mobility. This narrative review examines how lifestyle factors-specifically smoking, alcohol consumption, and unhealthy diet-contribute to the onset and progression of SpA. It highlights their impact on disease activity, comorbidities, radiographic damage, and treatment response. Therefore, healthcare providers are encouraged to support patients in making personalized lifestyle changes. These findings underscore the importance of a comprehensive approach to SpA management, integrating lifestyle modifications with conventional therapies for optimal disease control and improved outcomes.

Relationships of dietary habits with prostate cancer risk: results from Mendelian randomization analyses and the National Health and Nutrition Examination Survey

Background: Prior investigations identified correlations between dietary habits and the risk of prostate cancer (PCa); however, the causative dynamics are unclear. Methods: Utilizing the Mendelian randomization (MR) framework, we investigated the causal links between dietary habits, daily nutrient intakes, and risk of PCa (79 148 cases and 61 106 controls). Exposure and outcome data were obtained from the UK Biobank and the Prostate Cancer Association Group to Investigate Cancer-Associated Alterations in the Genome (PRACTICAL) consortium, respectively. Univariable and multivariable MR analyses were employed. Sensitivity analyses were performed to detect outliers, evaluate heterogeneity, and discern potential pleiotropic effects. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) database (2009-2010), we selected 1294 and 1778 men aged ≥40 years from a pool of 10 537 participants, ensuring no missing information. Regression analyses examined the associations between leafy/lettuce salad intake, daily nutrient intake, and the odds of PCa. Results: Univariable MR (UVMR) analysis reveals that the intake of pork and salad/raw vegetable correlated with an elevated PCa risk. Subsequent to confounder adjustment via multivariable MR (MVMR) analysis, a causal link was established between salad/raw vegetable intake and an increased risk of PCa (odds ratio [OR]: 1.658, 95% confidence interval [95% CI]: 1.037-2.644, P = 0.046). The analysis based on NHANES datasets demonstrated a link between leafy/lettuce salad intake and heightened odds of PCa (OR: 1.025, 95% CI: 1.003-1.049, P = 0.038). Increased daily intakes of β-carotene (original OR: 1.00006, 95% CI: 1.00001-1.00011, P = 0.024) and vitamin B1 (OR: 1.474, 95% CI: 1.104-1.967, P = 0.014) were associated with a higher likelihood of PCa. Conclusions: These MR analyses substantiate the causal nexus between salad/raw vegetable intake and PCa risk. Similarly, leafy/lettuce salad intake and the odds of PCa were significantly correlated in the cross-sectional observational study. Moreover, higher daily intakes of β-carotene and vitamin B1 were linked to an increased likelihood of PCa. These findings provide practical dietary recommendations for PCa prevention and enhance early identification and diagnosis.

Are Maternal Dietary Patterns During Pregnancy Associated with the Risk of Gestational Diabetes Mellitus? A Systematic Review of Observational Studies

BACKGROUND/OBJECTIVES

Maternal nutritional status is a "key" contributor to Gestational Diabetes Mellitus (GDM). However, the role of maternal dietary patterns (DPs) during pregnancy remains poorly understood. Thus, we conducted a systematic review to assess associations between "a posteriori-derived" DPs and GDM.

METHODS

A systematic search was conducted in PubMed, ScienceDirect, Web of Science, and Scopus for cohort, cross-sectional, and case-control studies published until June 2024. A total of twenty-eight studies involving 39,735 pregnant women were included, and their quality was evaluated by the Newcastle-Ottawa Scale. The 91 identified DPs were classified into four categories: "Westernized", "Nutritious", "Plant-based", and "Miscellaneous".

RESULTS

Our findings do not reveal definitive associations between maternal DPs during pregnancy and GDM risk. Notably, "Westernized" DPs tended to be associated with an increased risk. However, a very small portion of patterns within this category exhibited protective associations. Conversely, "Nutritious" and "Plant-based" appear beneficial for GDM prevention in specific populations. The "Miscellaneous" category presented an almost equal distribution of DPs with both detrimental and protective associations, pinpointing the absence of a clear directional trend regarding GDM risk.

CONCLUSIONS

The heterogeneity in findings can be attributed to geographic and sociocultural variations and methodological differences across studies. Thus, there is a need for more standardized research methodologies to provide more precise insights that will ultimately help develop effective and tailored dietary guidelines for GDM prevention.

Measuring Environmental and Behavioral Drivers of Chronic Diseases Using Smartphone-Based Digital Phenotyping: Intensive Longitudinal Observational mHealth Substudy Embedded in 2 Prospective Cohorts of Adults

BACKGROUND

Previous studies investigating environmental and behavioral drivers of chronic disease have often had limited temporal and spatial data coverage. Smartphone-based digital phenotyping mitigates the limitations of these studies by using intensive data collection schemes that take advantage of the widespread use of smartphones while allowing for less burdensome data collection and longer follow-up periods. In addition, smartphone apps can be programmed to conduct daily or intraday surveys on health behaviors and psychological well-being.

OBJECTIVE

The aim of this study was to investigate the feasibility and scalability of embedding smartphone-based digital phenotyping in large epidemiological cohorts by examining participant adherence to a smartphone-based data collection protocol in 2 ongoing nationwide prospective cohort studies.

METHODS

Participants (N=2394) of the Beiwe Substudy of the Nurses' Health Study 3 and Growing Up Today Study were followed over 1 year. During this time, they completed questionnaires every 10 days delivered via the Beiwe smartphone app covering topics such as emotions, stress and enjoyment, physical activity, access to green spaces, pets, diet (vegetables, meats, beverages, nuts and dairy, and fruits), sleep, and sitting. These questionnaires aimed to measure participants' key health behaviors to combine them with objectively assessed high-resolution GPS and accelerometer data provided by participants during the same period.

RESULTS

Between July 2021 and June 2023, we received 11.1 TB of GPS and accelerometer data from 2394 participants and 23,682 survey responses. The average follow-up time for each participant was 214 (SD 148) days. During this period, participants provided an average of 14.8 (SD 5.9) valid hours of GPS data and 13.2 (SD 4.8) valid hours of accelerometer data. Using a 10-hour cutoff, we found that 51.46% (1232/2394) and 53.23% (1274/2394) of participants had >50% of valid data collection days for GPS and accelerometer data, respectively. In addition, each participant submitted an average of 10 (SD 11) surveys during the same period, with a mean response rate of 36% across all surveys (SD 17%; median 41%). After initial processing of GPS and accelerometer data, we also found that participants spent an average of 14.6 (SD 7.5) hours per day at home and 1.6 (SD 1.6) hours per day on trips. We also recorded an average of 1046 (SD 1029) steps per day.

CONCLUSIONS

In this study, smartphone-based digital phenotyping was used to collect intensive longitudinal data on lifestyle and behavioral factors in 2 well-established prospective cohorts. Our assessment of adherence to smartphone-based data collection protocols over 1 year suggests that adherence in our study was either higher or similar to most previous studies with shorter follow-up periods and smaller sample sizes. Our efforts resulted in a large dataset on health behaviors that can be linked to spatial datasets to examine environmental and behavioral drivers of chronic disease.

Nutrition-Related Mobile Apps in the Spanish App Stores: Quality and Content Analysis

Background

Mobile apps represent accessible and cost-effective tools to improve nutrition and prevent chronic diseases. However, most of these apps have been characterized as having limited functionality, raising concerns about their effectiveness, acceptability, and efficacy.

Objective

The aims of the study were to assess the quality of popular nutrition-related app platforms in Spain and to describe their characteristics and functionalities.

Methods

We screened apps providing information on dietary advice, food advice, and nutritional content in the Apple App Store and Google Play Store in Spain from March 2 to March 16, 2024. Apps with a star rating of ≥4 (of 5 stars), those available in Spanish, those that were free of charge, those last updated after January 2022, those with >500 reviews, and those with >500,000 downloads were included. The quality of apps was assessed using the user version of the Mobile App Rating Scale (uMARS). General characteristics and nutritional, health, and market-related functionalities of the nutrition-related apps were described. Correlations among total and uMARS sections, star ratings, and number of reviews and downloads were evaluated.

Results

Among the 1460 apps identified in the search, 42 apps met the criteria. The majority of these (n=20, 48%) aimed at recording and analyzing food intake, followed by those providing nutritional plans or diets (n=9, 21%), advising on healthy habits (n=7, 17%), and offering recipes (n=6, 14%). The most prevalent nutritional functionalities offered were recording and monitoring body measurements (n=30, 71%), food tracking (n=26, 62%), and dietary analysis (n=25, 60%), whereas nutrition education was less common (n=16, 38%). Among market-related functionalities, advertisements were the most common among the study apps (n=30, 71%), followed by the option of sharing on social media (n=29, 69%) and customizable reminders (n=26, 62%). Sharing the recorded information in the app with health professionals was infrequent (n=1, 2%). The mean (SD) total uMARS score (maximum 5 points) was 3.78 (0.35), while the mean (SD) uMARS scores for functionality, aesthetics, engagement, and information were 4.21 (0.38), 3.94 (0.54), 3.51 (0.46), and 3.48 (0.44), respectively. Lower mean scores were observed for the subjective quality (mean 2.65, SD 0.56) and perceived impact (mean 3.06, SD 0.67). Moderate to strong positive significant correlations were mostly observed between total uMARS and section-specific uMARS scores, while the correlations between the uMARS section scores were mostly moderate positive. Total uMARS scores were very weakly correlated with user rating, number of reviews, and number of downloads.

Conclusions

The quality of popular nutrition-related app platforms in Spain was acceptable, with observed remarkable differences between sections. The majority of the apps were appealing due to their user-friendly interfaces. Only a few apps, however, provided dietary structure analysis or nutritional education. Further research is needed to assess the long-term impact of these apps on users.

Identifying influencing factors of metabolic syndrome in patients with major depressive disorder: A real-world study with Bayesian network modeling

BACKGROUND

The bidirectional relationships between metabolic syndrome (MetS) and major depressive disorder (MDD) were discovered, but the influencing factors of the comorbidity were barely investigated. We aimed to fully explore the factors and their associations with MetS in MDD patients.

METHODS

The data were retrieved from the electronic medical records of a tertiary psychiatric hospital in Beijing from 2016 to 2021. The influencing factors were firstly explored by univariate analysis and multivariate logistic regressions. The propensity score matching was used to reduce the selection bias of participants. Then, the Bayesian networks (BNs) with hill-climbing algorithm and maximum likelihood estimation were preformed to explore the relationships between influencing factors with MetS in MDD patients.

RESULTS

Totally, 4126 eligible subjects were included in the data analysis. The proportion rate of MetS was 32.6 % (95 % CI: 31.2 %-34.1 %). The multivariate logistic regression suggested that recurrent depression, uric acid, duration of depression, marriage, education, number of hospitalizations were significantly associated with MetS. In the BNs, number of hospitalizations and uric acid were directly connected with MetS. Recurrent depression and family history psychiatric diseases were indirectly connected with MetS. The conditional probability of MetS in MDD patients with family history of psychiatric diseases, recurrent depression and two or more times of hospitalizations was 37.6 %.

CONCLUSION

Using the BNs, we found that number of hospitalizations, recurrent depression and family history of psychiatric diseases contributed to the probability of MetS, which could help to make health strategies for specific MDD patients.

Gut microbiota metabolites: potential therapeutic targets for Alzheimer's disease?

Background

Alzheimer's disease (AD) is a neurodegenerative disease characterized by progressive decline in cognitive function, which significantly increases pain and social burden. However, few therapeutic interventions are effective in preventing or mitigating the progression of AD. An increasing number of recent studies support the hypothesis that the gut microbiome and its metabolites may be associated with upstream regulators of AD pathology.

Methods

In this review, we comprehensively explore the potential mechanisms and currently available interventions targeting the microbiome for the improvement of AD. Our discussion is structured around modern research advancements in AD, the bidirectional communication between the gut and brain, the multi-target regulatory effects of microbial metabolites on AD, and therapeutic strategies aimed at modulating gut microbiota to manage AD.

Results

The gut microbiota plays a crucial role in the pathogenesis of AD through continuous bidirectional communication via the microbiota-gut-brain axis. Among these, microbial metabolites such as lipids, amino acids, bile acids and neurotransmitters, especially sphingolipids and phospholipids, may serve as central components of the gut-brain axis, regulating AD-related pathogenic mechanisms including β-amyloid metabolism, Tau protein phosphorylation, and neuroinflammation. Additionally, interventions such as probiotic administration, fecal microbiota transplantation, and antibiotic use have also provided evidence supporting the association between gut microbiota and AD. At the same time, we propose an innovative strategy for treating AD: a healthy lifestyle combined with targeted probiotics and other potential therapeutic interventions, aiming to restore intestinal ecology and microbiota balance.

Conclusion

Despite previous efforts, the molecular mechanisms by which gut microbes act on AD have yet to be fully described. However, intestinal microorganisms may become an essential target for connecting the gut-brain axis and improving the symptoms of AD. At the same time, it requires joint exploration by multiple centers and multiple disciplines.

Sex-specific dietary patterns and their association with metabolic syndrome: Insights from a cross-sectional analysis

AIMS

This study aims to identify a posteriori dietary patterns with a sex approach and to evaluate their association with metabolic syndrome criteria.

METHODS

Cross-sectional study conducted in 6821 men and women between 55 and 75 years of age. Forty-two food groups were analyzed from dietary information collected with food frequency questionnaires, using principal component analysis and cluster analysis and then information from both statistical methods was compared. Prevalences were calculated foreach cluster group, based on the number and types of metabolic syndrome criteria they met.

RESULTS

Following principal component analysis, two dietary patterns labeled "healthy" and "unhealthy" were identified in both men and women, due to the presence of foods that are considered more or less healthy. These same dietary patterns were found in cluster analysis plus an "intermediate" cluster consisting of both healthy and unhealthy foods. The presence of metabolic syndrome is related to the "healthy" dietary pattern in women and to the "unhealthy" dietary pattern in men. Comparison of the two statistical approaches showed a high level of correlation between them (weighted Kappa = 0.703 in women and weighted Kappa = 0.691 in men).

CONCLUSIONS

Adherence to both healthy and unhealthy dietary pattern appears to be related to the development of MS. The differences found by sex make it necessary to develop interventions with a sex-specific approach.

Association between processed red meat intake and cardiovascular risk factors in patients with type 2 diabetes: a cross-sectional study from China

Aim

To explore the association between Processed red meat (PRM) consumption and cardiovascular risk factors in Chinese adults with type 2 diabetes mellitus (T2DM).

Methods

Dietary survey, physical measurement, and blood biochemical examination were conducted on 316 patients with type 2 diabetes in Bengbu, China from May to July 2019. Possible confounding factors were identified by comparing between-group variability in the baseline table. To eliminate the effect of confounding factors, subgroup analysis was used to explore whether there were differences in the correlation between PRM intake status and the indicators in cardiovascular disease risk factors. A logistic regression model was used to analyze the association between PRM and the risk of abnormal levels of cardiovascular risk factors in T2DM patients. Restricted cubic spline plots were used to analyze the dose-response relationship between PRM intake and the indicators of cardiovascular disease risk factors.

Results

A total of 316 subjects were included in the study, of whom 139 (44.0%) were male and 177 (56.0%) were female. In the multiplicative interaction, there was an effect modifier for smoking (Pinteraction = 0.033) on the association between PRM intake and the risk of substandard FPG level control; sex (Pinteraction = 0.035), smoking status (Pinteraction = 0.017), and alcohol consumption (Pinteraction = 0.046) had effect modifying effects on the association between PRM intake and risk of abnormal systolic blood pressure. Sex (Pinteraction = 0.045) had an effect modifier on the association of PRM intake status with the risk of diastolic blood pressure abnormality. In addition, age had an effect modifier on the association of PRM intake status with risk of abnormal triglyceride index (Pinteraction = 0.004) and risk of abnormal HDL index (Pinteraction = 0.018). After adjusting for potential confounding variables, logistic regression showed that the OR for substandard HbA1c control in patients in the highest PRM intake group, T3 (3.4 ~ 57.2 g/d), was 1.620-fold higher than in the lowest intake, i.e., the no-intake group, T1 (0.0 ~ 0.0 g/d; OR = 2.620; 95% CI 1.198 ~ 5.732; p = 0.016). Whereas the OR for abnormal control of systolic blood pressure levels was 1.025 times higher (OR = 2.025; 95% CI 1.033 ~ 3.968; p = 0.040) in patients in the PRM low intake group T2 (0.1 ~ 3.3 g/d) than in the non-intake group T1 (0.0 ~ 0.0 g/d), the OR for substandard control of systolic blood pressure in patients in the highest group T3 (3.4 ~ 57.2 g/d) was 1.166 times higher than in the no-intake group T1 (OR = 2.166; 95% CI 1.007 ~ 4.660; p = 0.048). The OR for abnormal TG levels in patients in the highest PRM intake group T3 (3.4 ~ 57.2 g/d) was 1.095 times higher than in the no-intake group T1 (OR = 2.095; 95% CI 1.076 ~ 4.078; p = 0.030). Restricted cubic spline plots presented a nonlinear dose-response relationship between PRM intake and risk of substandard HbA1c and SBP control (P nonlinear <0.05), and an atypical inverted U-shaped association between PRM intake and TC and LDL-C levels (P nonlinear <0.05). The strength of the associations between PRM intake and the control levels of FPG, DBP, HDL-C, and TG were not statistically significant (p > 0.05).

Conclusion

PRM intake was generally low in patients with T2DM, but a nonlinear dose-response relationship between PRM intake and the risk of suboptimal control of HbA1c and SBP, with an atypical inverted U-shaped association with TC and LDL-C levels, was observed. Appropriate control of PRM intake may be important for tertiary prevention of T2DM and cardiovascular disease prevention. We need to better understand these relationships to promote improved cardiometabolism and global health.

Reduced Income and Its Associations with Physical Inactivity, Unhealthy Habits, and Cardiac Complications in the Hypertensive Population

(1) Background: A low socioeconomic status significantly increases the risk of hypertension and its associated cardiovascular diseases due to limited access to healthcare and may be even more accentuated by the presence of unhealthy lifestyle habits. The aim of the present research was to study if associations exist between having a family income under the poverty threshold and having an unhealthy diet, being physically inactive, being an alcohol drinker, perceiving one's own health as bad, and suffering from congestive heart failure, coronary heart disease, angina pectoris, heart attack, or stroke. Additionally, the odds ratios of having these unhealthy habits and of suffering from the abovementioned cardiac complications of participants under the poverty threshold were calculated. (2) Methods: This cross-sectional study was based on the National Health and Nutrition Examination Survey (NHANES) 2011-2020. The sample comprised 6120 adults with hypertension (3188 males and 2932 females). A descriptive analysis and non-parametric chi-squared tests were used to study the associations. A binary logistic regression model and backward LR method were used to calculate the odds ratios, normalized by age and sex. (3) Results: The chi-squared test showed associations between having a family income under the poverty threshold and being physically inactive (p < 0.001), having an unhealthy diet (p < 0.001), being an alcohol drinker (p < 0.001), perceiving one's own health as bad (p < 0.001), and suffering from congestive heart failure (p = 0.002), heart attack (p = 0.001), or stroke (p = 0.02). A significantly increased odds ratio for these unhealthy habits and cardiac complications, and also for having coronary heart disease and angina pectoris, were found for hypertension sufferers under the poverty threshold. (4) Conclusions: It was confirmed that having a family income under the poverty threshold is associated with perceiving one's own health as bad, having a series of negative habits in terms of physical activity, diet, and alcohol consumption, and with suffering from congestive heart failure, heart attack, or stroke. Increased odds ratios for these unhealthy habits and these conditions, plus coronary heart disease and angina pectoris, were found for hypertension sufferers under the poverty threshold.

Exploring the associations between chronotype, meal frequency, and physical activity: A population-based study in adults

Chronotype is an established concept designed to capture the internal clock's phase in real-life conditions. It is vital in many aspects of daily life and can interfere considerably with numerous factors in a given population. Recognizing nonmodifiable and modifiable factors is crucial for identifying covariates of interest when studying the link between chronotype and health status. To date, chronotype and its related factors have not been extensively investigated. The present study aimed to explore the association of chronotypes with meal frequency, physical activity, and demographic factors among the Saudi population. This cross-sectional web-based questionnaire involved 1369 adults (aged 18 years and above) from the general public in Saudi Arabia and was conducted between March and May 2019. Chronotype was assessed using the reduced version of the original Horne and Ostberg morningness-eveningness questionnaire (MEQ). Meal frequencies and demographics data (age, gender, marital status, place of residence, educational level, employment status, income) were obtained. Physical activity level was also obtained using the international physical activity questionnaire. The MEQ scores group individuals into three categories: morning-type, neither-type, and evening-type. The neither-type individuals represented 41.6% (95% confidence interval [CI], 37.5% - 45.6%) of the study population, followed by the morning-type (34.1%; 95% [CI], 29.8% - 38.4%), then the evening-type (24.3%, 95% [CI], 19.6% - 28.9%). Chronotype was significantly associated with age, marital status, employment status and monthly income (All p < 0.05). Significant associations between chronotype with meal frequencies (number of meals per day, breakfast frequency, lunch frequency, and dinner frequency) and physical activity were also observed (All p < 0.05). This study highlights that meal frequencies and physical activity levels are associated with chronotype distribution. Furthermore, demographics, including age, marital status, employment status, and income, were associated with chronotype distribution.

Dietary Intake of (Poly)phenols and Risk of All-Cause and Cause-Specific Mortality in the Mexican Teachers' Cohort Study

BACKGROUND

Observational studies have reported that total (poly)phenol intake is associated with a reduction in all-cause and cardiovascular mortality, but mainly from high-income countries, where (poly)phenol intake may differ from that of low- and middle-income countries.

OBJECTIVES

Our objective was to evaluate the association between the intake of total, all classes, and subclasses of (poly)phenols and risk of all-cause and cause-specific mortality in a Mexican cohort.

METHODS

We used data from the Mexican Teachers' Cohort, which included 95,313 adult females. After a median follow-up of 11.2 y, 1725 deaths were reported, including 674 from cancer and 282 from cardiovascular diseases. (Poly)phenol intake was estimated using a validated food frequency questionnaire and the Phenol-Explorer database. Multivariable Cox models were applied to estimate the association between (poly)phenol intake and all-cause mortality and competitive risk models for cause-specific mortality.

RESULTS

Comparing extreme quartiles, total (poly)phenol intake was associated with lower risk of all-cause [hazard ratio (HR)Q4vs.Q1: 0.88; 95% CI: 0.76, 0.99; P-trend = 0.01] and cancer mortality (HRQ4vs.Q1: 0.81; 95% CI: 0.64, 0.99; P-trend = 0.02). Among (poly)phenol classes, phenolic acids, particularly hydroxycinnamic acids from coffee, showed an inverse association with all-cause (HRQ4vs.Q1: 0.79; 95% CI: 0.69, 0.91; P-trend = 0.002) and cancer mortality (HRQ4vs.Q1: 0.75; 95% CI: 0.61, 0.94; P-trend = 0.03). No associations were observed with flavonoids or with cardiovascular mortality.

CONCLUSION

Our study suggests that high (poly)phenol intake, primarily consisting of phenolic acids such as hydroxycinnamic acids, may have a protective effect on overall and cancer mortality. Null associations for flavonoid intake might be due to the potential underestimation of their intake in this population.

Nutritional quality and level of processing of food items broadcasted on Italian television in advertisements targeted to children

This study evaluates the nutritional quality and level of processing of food and beverage products advertised on television channels most watched by children, in Italy. Data were collected over 20 non-consecutive days from the five top channels in Italy. A total of 209 food items were analysed using the Nutri-Score and the NOVA classification. Additionally, compliance with nutritional criteria established by the World Health Organisation (WHO) and the EU-PLEDGE was assessed. Results indicate a high proportion of energy-dense and low nutritional quality foods, with 68% falling into less favourable Nutri-Score categories (C, D, and E), and 61% classified as ultra-processed by NOVA classification. When applying WHO and PLEDGE criteria, 71% and 56% of products, respectively, did not meet nutritional standards. This study underscores the low prevalence of nutritionally adequate products in food advertisements targeting children on Italian television, despite differences found based on methodological variations.

Diet Quality of Community Café Meals Among Guests With Food Insecurity

OBJECTIVE

Compare the diet quality of a meal consumed at a community café (café meals), a pay-what-you-can restaurant, to a meal consumed for an equivalent eating occasion on the day before (comparison meal) by guests with food insecurity.

METHODS

Dietary recalls were collected from café guests with food insecurity to determine the Healthy Eating Index-2020 (HEI-2020) total and component scores. Healthy Eating Index-2020 scores were compared between meals using paired-sample t tests and Wilcoxon signed-rank tests.

RESULTS

Most participants (n = 40; 80% male; 42.5% Black) had very low food security (70.0%). Café meal had a higher HEI-2020 total score (46.7 ± 10.5 vs 34.4 ± 11.6; P < 0.001) and total vegetables (2.6 ± 2.0 vs 1.2 ± 1.7; P = 0.004), total fruits (2.1 ± 2.2 vs 0.6 ± 1.5; P < 0.001), whole fruits (1.6 ± 2.0 vs 0.3 ± 0.9; P < 0.001), and refined grains (7.8 ± 3.5 vs 3.9 ± 3.9; P < 0.001) scores than comparison meals.

CONCLUSIONS AND IMPLICATIONS

The café meal had better diet quality than the comparison meal, suggesting its potential for improving diet quality among guests with food insecurity.

Unfavorable food consumption in children up to school entry age: results from the nationwide German KiESEL study

Introduction

Evidence points toward the early life being crucial for preventing nutrition-related diseases. As promotion of healthier food preferences in toddlerhood and preschool age might still modulate the trajectories of disease risk, understanding diet in these age groups is necessary. The objective was to analyze food consumption and diet quality of 1-5-year-old children living in Germany in relation to age and sex.

Methods

Data from 890 children, a subsample of the representative, cross-sectional Children's Nutrition Survey to Record Food Consumption (KiESEL) conducted by the German Federal Institute for Risk Assessment in 2014-2017, were analyzed. Dietary data were collected using food records (3 consecutive plus 1 independent day). Diet quality was evaluated against the German food-based dietary guidelines (FBDG).

Results

Consumption of unfavorable foods (e.g., sweets, soft drinks) exceeded the recommended maximum of 10% of energy intake (E%) by a multiple in all age and sex groups (medians: 24.8-35.8 E%). Preschoolers consumed more unfavorable foods than toddlers and boys more than girls. More than half of the children exceeded the recommendation for meat intake (medians: 2.3-3.2% of the total food consumption (%TFC) vs. 2 %TFC), especially preschoolers. In nearly all children, vegetable consumption was too low (medians: 4.2-4.5 %TFC vs. 12 %TFC). Also, milk/milk product consumption was below recommendations, more so in preschoolers (median: 12.0 %TFC ♂, 11.9 %TFC ♀ vs. 18 %TFC) than in toddlers (median: 16.1 %TFC ♂, 19.6 %TFC ♀). In toddlers and preschoolers with overweight or obesity, adherence to dietary recommendations of these food groups was largely similar to that of the total sample. Overall, 5-year-olds showed an unhealthier dietary pattern than 1-year-olds, which already emerged at age 2 years and became more evident at age 3 years.

Discussion

An adverse dietary pattern arises and even deteriorates at a very young age, showing sex-specific aspects. High attention from public health and research needs to be given to toddlerhood and even earlier life phases, e.g., to develop more age-specific FBDGs, aiming at reducing unhealthy food consumption.

Ultraprocessed foods, unprocessed or minimally processed foods, and risk of frailty in a cohort of United States females

BACKGROUND

Ultraprocessed foods (UPFs) and poor diet quality have been associated with frailty but existing studies had relatively short follow-up time. It is also unclear whether the association of UPF was primarily due to its correlation with poorer diet quality.

OBJECTIVES

We examined the association between unprocessed or minimally processed foods (UMFs) and UPF and risk of frailty and explored whether the association with UPF was mainly driven by poor diet quality.

METHODS

In total, 63,743 nonfrail females aged 60+ y from the Nurses' Health Study (cohort study) were followed up for ≥26 y. Diet was assessed every 4 y by food frequency questionnaires. UPF and UMF intakes were calculated using the Nova classification. Diet quality was estimated using the Alternate Healthy Eating Index (AHEI) 2010. The association of UMF and UPF with risk of frailty was examined using multivariable adjusted Cox proportional hazard model.

RESULTS

During the follow-up period, we recorded 15,187 incident cases of frailty. The hazard ratio (HR) of frailty for the highest compared with the lowest quintile of UMFs (servings per day) was 0.86 (95% CI: 0.83, 0.95; P-trend < 0.001). However, this was no longer statistically significant after adjustment for AHEI-2010. UPFs (servings per day) was directly associated with risk of frailty, even after adjustment for AHEI-2010 (1.31; 95% CI: 1.23, 1.39; P-trend < 0.001). Among those at the highest category of the AHEI-2010, UPFs remained directly associated with frailty (HR comparing top with bottom quintile: 1.40; 95% CI:1.24, 1.57; P-trend < 0.001). For UPF components, we found a higher frailty risk with each serving per day of artificial and sugar-sweetened beverages; fat, spreads, and condiments; yogurt and dairy-based desserts; and other UPFs. However, processed whole grains were not associated with frailty.

CONCLUSIONS

Higher intake of UPF is associated with a higher risk of frailty in older females. This is not explained by a lower diet quality contributed by UPFs.

The impact of cannabis use on erectile dysfunction and sex hormones: a Mendelian randomization analysis

Previous study has highlighted an association between cannabis use (CU) and an increased risk of erectile dysfunction (ED), potentially due to indirect effects on sex hormonal balance. However, the evidence remains controversial, and the causal relationship is unclear. This study utilized genome-wide association study (GWAS) data to investigate the causal relationships between cannabis use disorder (CUD), lifetime cannabis use (LCU), and ED, as well as levels of sex hormones including estradiol (E2), bioavailable testosterone (BT), follicle-stimulating hormone (FSH), and luteinizing hormone (LH) through Mendelian randomization (MR) analysis. The primary method of analysis was the inverse variance weighted (IVW) method. Data from the FinnGen and UK Biobank were used for replication and meta-analysis. The results indicated no causal relationship between genetically predicted CUD (OR = 0.97, 95% CI 0.87-1.10, P = 0.66) and LCU (OR = 1.13, 95% CI 0.84-1.50, P = 0.42) with the risk of ED. The meta-analysis provided consistent evidence (P > 0.05). No causal relationships were found between CUD and LCU with E2(CUD: β = 0.00, 95% CI 0.00-0.01, P = 0.37; LCU: β = 0.00, 95% CI -0.02-0.01, P = 0.62), BT (CUD: β = 0.00, 95% CI -0.03-0.02, P = 0.90; LCU: β = 0.02, 95% CI -0.04-0.09, P = 0.46), FSH (CUD: β = 0.01, 95% CI -0.18-0.20, P = 0.92; LCU: β = 0.01, 95% CI -0.44-0.47, P = 0.95), and LH (CUD: β = 0.01, 95% CI -0.18-0.21, P = 0.90; LCU: β = 0.13, 95% CI -0.22-0.49, P = 0.46). Sensitivity analyses detected no evidence of horizontal pleiotropy or heterogeneity, ensuring the robustness of the results. In conclusion, this MR analysis did not provide evidence supporting a causal relationship between CU and ED or sex hormone levels.

The association between adherence to the EAT-Lancet diet and cognitive ageing

BACKGROUND

The EAT-Lancet commission has proposed a dietary pattern that is both sustainable and healthy. However, the impact of this diet on cognition in older adults remains unexplored. Therefore, we examined the association between adherence to the EAT-Lancet diet and cognitive ageing.

METHODS

We used data from a previous intervention study involving cognitively healthy community-dwelling adults aged ≥65 years. Adherence to the EAT-Lancet diet was calculated using a recently published index and a 190-item food frequency questionnaire. Global and domain-specific cognitive functioning were assessed at baseline and after 2 years using a neuropsychological test battery. Multivariate-adjusted linear regression was conducted to examine associations between EAT-Lancet diet adherence and cognitive functioning (n = 630) and 2-year change (n = 302).

RESULTS

Greater adherence to the EAT-Lancet diet was associated with better global cognitive functioning (β per SD = 3.7 points [95% CI]: 0.04 [0.00, 0.08]) and slower rate of decline (β per SD [95% CI]: 0.05 [0.02, 0.08]). With respect to domain-specific functioning, beneficial associations were observed cross-sectionally for executive functioning (P < 0.01), and longitudinally for change in executive functioning (P < 0.01) and attention and working memory (P < 0.01). The degree of adherence to the EAT-Lancet was not associated with (changes in) information processing speed or episodic memory.

CONCLUSION

We demonstrated that greater adherence to the EAT-Lancet diet is associated with better global cognitive functioning and slower cognitive decline among cognitively healthy older adults. Further research is needed to confirm these findings and assess the potential benefits of the EAT-Lancet diet for the ageing population in a broader context.

Diabetes Risk Reduction Diet and Colorectal Cancer Risk

BACKGROUND

Diabetes has been associated with colorectal cancer. We evaluated whether adherence to a diabetes risk reduction diet (DRRD) can favorably influence the risk of colorectal cancer.

METHODS

Data came from a multicentric Italian case-control study including 1,953 histologically confirmed colorectal cancer cases and 4,154 hospital controls admitted for acute nonneoplastic diseases. Diet was assessed through a validated and reproducible food frequency questionnaire. The DRRD score was computed assigning higher values for higher consumption of cereal fiber, fruit, coffee, nuts and a higher polyunsaturated/saturated fats ratio and for lower glycemic index and lower consumption of red/processed meat and sweetened beverages and fruit juices. The ORs and the corresponding 95% confidence intervals (CI) of colorectal cancer according to the DRRD score were obtained using logistic regression models adjusting for total energy intake and other major confounders.

RESULTS

The DRRD was inversely related to colorectal cancer risk. The ORs of colorectal cancer were 0.77 (95% CI, 0.67-0.89) for the third versus first score tertile (Ptrend < 0.001) and 0.92 (95% CI, 0.87-0.96) for a 3-point increment in the score. Inverse associations were observed for colon and rectal cancers and were consistent in strata of sex, age, and other major covariates.

CONCLUSIONS

A higher adherence to a DRRD was inversely associated with colorectal cancer risk.

IMPACT

Given the high incidence and mortality rates of colorectal cancer, adherence to a DRRD can have relevant prevention and public health implications.

The impact of social media interventions on eating behaviours and diet in adolescents and young adults: a mixed methods systematic review protocol

INTRODUCTION

Adolescents and young adults are susceptible population when it comes to healthy eating and dietary behaviours. The increasing use of social media by this age group presents a unique opportunity to promote healthy eating habits. Social media has become a popular platform for promoting health interventions, particularly among young people. However, there is a lack of consensus on the effectiveness of social media interventions in this population. This mixed-method systematic review aims to synthesise the available evidence on the impact of social media interventions on healthy eating behaviours among young people, their qualitative views and user experiences, and the intervention characteristics, behaviour change theories and techniques used to promote healthy eating.

METHODS AND ANALYSIS

We will conduct a comprehensive search of seven electronic databases, including ASSIA, Cochrane Library, Embase, MEDLINE, PsycINFO, Scopus and Web of Science. The search strategy will use a combination of Medical Subject Headings terms and keywords covering three domains: social media, eating behaviours and young people. The search will be limited to peer-reviewed published papers in any language, published from 2000. Three independent reviewers will screen studies based on predetermined eligibility criteria. Data will be extracted and analysed using a convergent segregated mixed-method approach. We will use random-effect meta-analysis or Synthesis Without Meta-analysis for quantitative data and thematic synthesis for qualitative data. Finally, narrative synthesis using concurrent triangulation will be used to bring together the results of the mixed-method data analysis to provide a comprehensive and integrated understanding of the impact and other features of social media interventions. This systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

ETHICS AND DISSEMINATION

Ethical approval is not required since this systematic review will not collect original data. The outcomes of this review will be shared through peer-reviewed publications and conference presentations and will contribute to the PhD thesis of the primary author.

PROSPERO REGISTRATION NUMBER

CRD42023414476.

Spatial Barriers to Transforming toward a Healthy Food System in the Noreste of Mexico

In the past five decades, global food systems have undergone a notable transition, moving from predominantly rural settings to increasingly urban and industrialized environments, largely driven by processes of globalization and supply chain integration. However, this evolution has not adequately addressed equitable access to nutritious diets and food environments, resulting in adverse health outcomes. This study delves into the spatial and non-spatial barriers that impede the adoption of healthy diets in the Noreste of Mexico, particularly focusing on the challenges associated with accessing and cultivating plant-based foods. Through an examination of suitable areas for urban agriculture and an exploration of the socio-cultural factors influencing the adoption of plant-based diets, the research focuses on interventions aimed at promoting healthier and more sustainable eating practices in Monterrey. The findings of the study reveal significant disparities in food access across the Monterrey metropolitan area, with central urban zones exhibiting superior access to fresh foods compared to suburban and peripheral regions. This inequality disproportionately affects marginalized areas characterized by higher poverty rates, exacerbating issues of food insecurity. Nevertheless, traditional dietary practices could offer promising avenues for creating culturally significant and healthier dietary transitions, even amidst the ongoing process of urbanization.