Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance

Degree of Food Processing Is Associated With Glycemic Control in African American Adults With Type 2 Diabetes: Findings From Texas Strength Through Resilience in Diabetes Education Clinical Trial

BACKGROUND

Type 2 diabetes mellitus (T2DM) disproportionately affects African American (AA) populations. Despite the importance of diet in diabetes management, the association of diet quality and/or the degree of food processing with glycemic control in AA adults with T2DM remains unclear.

OBJECTIVE

This study aimed to examine associations between diet quality scores and the degree of processing in the diet with glycosylated hemoglobin (HbA1c) level in AA adults with T2DM.

DESIGN

This cross-sectional study used baseline data from participants in Texas Strength Through Resilience in Diabetes Education, an ongoing clinical trial.

PARTICIPANTS/SETTING

Participants involved in this analysis (N = 273) were AA adults with T2DM recruited through local churches in Austin, TX, and the surrounding areas from August 2020 through April 2023.

MAIN OUTCOME MEASURES

Participants provided 2 24-hour dietary recalls (1 weekend and 1 weekday) and a blood sample to measure HbA1c level. Healthy Eating Index 2015, Alternative Healthy Eating Index 2010, and Alternate Mediterranean Diet scores were calculated. The NOVA method was used to calculate the percentage of grams and calories that came from ultraprocessed foods and unprocessed or minimally processed foods.

STATISTICAL ANALYSES PERFORMED

Linear regression and analysis of variance models tested associations between the diet quality scores and degree of food processing with HbA1c level, adjusting for demographic covariates. Models were stratified by insulin use after finding a significant interaction with ultraprocessed foods and unprocessed or minimally processed foods.

RESULTS

Regression analyses revealed that the percentage of grams in the total diet from ultraprocessed foods was positively associated with HbA1c level (βadj = .015; Padj = .032), whereas unprocessed or minimally processed foods were inversely associated with HbA1c level (βadj = -.014; Padj = .043). There was no significant association between any diet quality score and HbA1c level.

CONCLUSIONS

In AA adults with T2DM, only the degree of food processing was associated with HbA1c level. Future research should explore whether a causal relationship exists between food processing and HbA1c level and investigate mechanisms by which ultraprocessed foods may affect glycemic control.

Mediterranean diet, semen quality and medically assisted reproductive outcomes in the male population: a systematic review and meta-analysis

BACKGROUND

Environmental pollution, sedentary lifestyles and unhealthy dietary patterns have been hypothesized as the main modifiable factors of human semen quality decline.

OBJECTIVE

To assess associations between a-priori defined Mediterranean diet (MedDiet) adherence and semen quality parameters or medically assisted reproductive (MAR) outcomes in men.

METHODS

A systematic review was conducted with studies from PUBMED,EMBASE or SCOPUS databases until October 2024. A-priori defined MedDiet adherence was considered as exposure and conventional semen quality parameters as the primary outcomes. Secondary outcomes included MAR outcomes, reproductive hormone levels and sperm DNA fragmentation. A quality assessment was performed using the NHLBI tool. Meta-analysis was conducted following Cochrane guidelines. A subgroup analysis was done for healthy participants and those from fertility clinics separately. A sensitivity analysis was performed to check the influential studies.

RESULTS

A qualitative analysis was performed on 11 eligible articles (n=2,558 individuals). Data from 9 observational studies showed a positive association between the adherence to MedDiet and semen volume (1/9), sperm concentration (5/9 studies), count (5/9), total motility (5/9), progressive motility (4/9), vitality (1/9), normal morphology (2/9), or follicular stimulating hormone (1/9). Among these, the links between MedDiet adherence and MAR outcomes were prospectively explored only in one study, that reported no association. A total of 8 studies were eligible for meta-analysis (n=1,835 individuals). Total MedDiet adherence showed a significant positive association with sperm count (24.37 M spz.; 1.30 to 47.44, I2=89%), total motility (8.81%; 2.26 to 15.37, I2=88%), progressive motility (7.49%; 1.47 to 13.50, I2=86%) and normal morphology (1.02%, 0.21 to 1.82, I2=77%). Evidence from two randomized clinical trial evaluating the effect of MedDiet on semen parameters aligns with the primary results.

CONCLUSION

Evidence from observational studies and clinical trials show potential benefit of adhering to a MedDiet in terms of seminal quality parameters, but not with fertility outcomes.

REGISTRATION NUMBER

PROSPERO (ID: CRD42024584003) STATEMENT OF SIGNIFICANCE: This SRMA is the most updated and first article with the specific association of a-priori MedDiet on the male semen quality and medically assisted reproductive outcomes, including latest RCTs and also with meta-analysed data for observational studies.

Vitamin-mineral supplements and cognition among adults aged 65 and older: multiple cross-sectional population-based studies

PURPOSE

Many people consume vitamin-mineral supplements (VMS), to prevent cognitive decline or enhance cognition. We assessed the association between VMS intake and cognition.

METHODS

Data from three follow-ups of the population-based CoLaus|PsyColaus cohort. Participants aged ≥ 65 years were included and categorized as VMS consumers or non-consumers. Cognitive tests included the Mini-Mental State Examination (MMSE), Stroop colour test, the CERAD praxis items, lexical and semantic fluency tasks, and the Grober and Buschke episodic memory test.

RESULTS

There were 925 (64.5% women), 836 (41.1%), and 516 (29.4%) participants from the first (2009-2013), second (2014-2018) and third (2019-2021) follow-ups, respectively. After multivariable adjustment, no significant differences were found between VMS non-consumers and consumers regarding almost all cognitive tests. The multivariable-adjusted mean ± SEM of MMSE for VMS non-consumers vs. consumers were 29.27 ± 0.06 vs. 29.28 ± 0.09, 29.21 ± 0.06 vs. 29.28 ± 0.07 and 29.32 ± 0.08 vs. 29.21 ± 0.09 for the first, second, and third follow-ups, all p > 0.05. The exceptions were Stroop C, where non-consumers had a statistically better but clinically irrelevant performance than consumers at the third follow-up: effect size 0.30 (0.01; 0.58) p = 0.042 and the Grober and Buschke test in the first follow-up, where VMS consumers scored better than non-consumers in free recall: 9.11 ± 0.15 vs. 8.55 ± 0.10 (p = 0.003), with opposite findings in cued recall: 5.99 ± 0.14 vs. 6.48 ± 0.09 (p = 0.004).

CONCLUSION

We found no clinically significant association between VMS use and cognitive performance.

Endocrine-Disrupting Chemicals and Persistent Nausea among Pregnant Women Enrolled in the Illinois Kids Development Study (I-KIDS)

BACKGROUND

Pregnant women are exposed to numerous endocrine-disrupting chemicals (EDCs). Pregnancy-related nausea likely has hormonal etiology and may persist beyond the first trimester.

OBJECTIVES

Therefore, we aimed to determine the relationship between EDC biomarkers and pregnancy nausea characteristics.

METHODS

Illinois Kids Development Study (I-KIDS) pregnant women (n = 467 ) reported nausea symptoms monthly from conception to delivery. We categorized women as never having nausea (9%) or as having typical (ends by 17 wk gestation; 42%), persistent (ends after 17 wk gestation; 25%), or irregular (24%) nausea. Women provided five urine samples across pregnancy, which we pooled and analyzed for phthalate/replacement, phenol, and triclocarban biomarkers. Using covariate-adjusted logistic regression, we evaluated relationships of EDCs with nausea and used quantile-based g-computation (QGComp) and Bayesian kernel machine regression (BKMR) to evaluate joint associations of EDCs with nausea symptoms. We also considered differences in associations by fetal sex.

RESULTS

Only the sum of urinary biomarkers of di(isononyl) cyclohexane-1,2-dicarboxylate (Σ DiNCH ) was associated with higher risk of persistent nausea compared to typical nausea [odds ratio (OR) = 1.18 ; 95% CI: 1.01, 1.37] in all women. However, using QGComp, a 10% higher concentration of the EDC mixture was associated with 14% higher risk of persistent nausea [relative risk (RR) = 1.14 ; 95% CI: 1.01, 1.30], due to Σ DiNCH , ethylparaben, and the sum of di-2-ethylhexyl phthalate (Σ DEHP ) metabolites. Similarly, using BMKR, the EDC mixture was associated with greater odds of persistent nausea in all women. In women carrying male offspring, ethylparaben was associated with persistent nausea, and a 10% higher concentration of the QGComp mixture was associated with 26% higher risk of persistent nausea (RR = 1.26 ; 95% CI:1.13, 1.41), driven by ethylparaben and Σ DiNCH . Consistently, using BKMR, EDCs were positively associated with persistent nausea in women carrying males. We did not identify associations between EDC biomarkers and persistent nausea in women carrying females or between EDC biomarkers and other nausea patterns.

DISCUSSION

Nonpersistent EDCs, modeled as a mixture, are associated with persistent nausea in pregnancy, primarily in women carrying males. Future work should explore possible mechanisms, clinical implications, and interventions to reduce exposures and symptoms. https://doi.org/10.1289/EHP15547.

Circulating Levels of Branched-Chain Amino Acids Are Associated with Diet: A Cross-Sectional Analysis

Background: Higher circulating branched-chain amino acids (BCAAs) are linked to cardiometabolic and neurological diseases. While diet is the primary BCAA source, its impact on circulating levels remains unclear. This study examined the association between dietary intake and circulating BCAA concentrations in a large population-based sample. Methods: Data from 2159 participants (58.2% women, mean age 53.4 ± 8.6 years) were analyzed. Dietary intake was assessed using a questionnaire covering 91 individual food items, 9 nutrient categories, and 3 dietary patterns. BCAA concentrations were measured via LC-MS. All analyses were stratified by gender. Results: Circulating BCAA levels were higher in men than in women. BCAA levels were negatively associated with vegetables (standardized β = -0.029, p = 0.088; -0.051, p = 0.003; -0.038, p = 0.043 for leucine, isoleucine, and valine, respectively), dairy (-0.037, p = 0.029; -0.063, p < 0.001; -0.041, p = 0.028), and fruit (-0.031, p = 0.084; -0.039, p = 0.030; -0.041, p = 0.034), and a positive trend was observed for meat and meat-derived products, but the associations did not reach statistical significance. Vegetal protein, total carbohydrates, and monosaccharides showed a significant negative association with circulating BCAAs levels. Participants who complied with "dairy ≥ 3/day", "meat ≤ 5/week", or "at least three guidelines" had lower circulating BCAA levels. Conclusions: Circulating BCAA levels were negatively associated with dairy, vegetables, fruits, plant protein, carbohydrates, non-digestible fiber, calcium, and iron. While circulating BCAA levels were linked to meat consumption and adherence to dietary guidelines, the association was not linear. Differences were observed between men and women, which may be attributed to variations in dietary intake and preferences.

Transitioning to healthy and sustainable diets has higher environmental and affordability trade-offs for emerging and developing economies

Switching to alternative global diets offers established benefits, but the challenges and opportunities for individual countries during and after the transition remain unassessed. In this study, we project changes in water use, dietary quality, and food affordability under four dietary scenarios (including Mediterranean diet, the EAT-Lancet diet, the Healthy US-Style diet, and Vegetarian diet), assessing the potential implications at the country level from 2020 to 2070. Here, we show that by 2070, transitioning to healthy and sustainable diets can improve dietary quality by 30.29 - 45.43%, with all countries reducing water use (1.21 - 14.73%) and increasing food affordability (9.29 - 63.23%). However, in the initial phases, increased food demand escalated water use and worsened food affordability, especially in emerging and developing economies, with the maximum average deterioration being 2.62% and 13.06%, respectively. These highlight the need for long-term planning and financial support to ensure successful global transitions.

Multiomics Analysis of a Micronutrient-Rich Dietary Pattern and the Aging Genotype 9p21 on the Plasma Proteome of Young Adults

Background: Diet is one of the most significant modifiable lifestyle factors influencing human health, contributing to both morbidity and mortality. Genetic variations in the pleiotropic 9p21 risk locus further shape premature aging, disease susceptibility, and have been strongly linked to cardiovascular disease (CVD), metabolic disorders, certain cancers, and neurodegenerative conditions. However, given that this region was discovered based on Genome-Wide Association Studies, the mechanisms by which 9p21 exerts its effects remain poorly understood and its interactions with diet and biomarkers are insufficiently explored. Methods: This study investigated the association between the rs2383206 SNP in 9p21, dietary patterns, and plasma proteomic biomarkers in a multi-ethnic cohort of 1280 young adults from the Toronto Nutrigenomics and Health Study. Participants' dietary intake was assessed using a validated food frequency questionnaire, and dietary patterns were categorized using principal component analysis. Plasma proteomics analyses quantified 54 abundant proteins involved in the cardiometabolic and inflammatory pathways. Genotyping identified individuals who were homozygous for the 9p21 risk allele (GG), known to confer the highest susceptibility risk to premature aging and multiple chronic diseases. Results: A significant interaction was observed between the 9p21 genotype and adherence to a micronutrient-rich Prudent dietary pattern for eight plasma proteins (α1 Antichymotrypsin, Complement C4 β chain, Complement C4 γ chain, Complement C9, Fibrinogen α chain, Hemopexin, and Serum amyloid P-component). However, only Complement C4-γ showed a pattern consistent with the risks associated with the 9p21 genotype and adherence to a Prudent diet. Individuals with the high-risk GG genotype had significantly higher concentrations of Complement C4-γ, but only among those with a low adherence to a Prudent diet. Conclusions: These findings suggest that Prudent dietary patterns rich in micronutrients may counteract genetic-mediated proinflammatory susceptibility by modulating key proteomic biomarkers in young adults, highlighting the potential for tailored dietary interventions to mitigate disease risk. This study also introduces a novel framework for post hoc micronutrient resolution within dietary pattern analysis, offering a new lens to interpret nutrient synergies in gene-diet interaction research.

Prospective association of depression symptoms with exceptional longevity among older women

Older women may experience elevated depression symptoms, which have been associated with morbidity and mortality. Yet, few studies have examined associations of depression symptoms with longevity. We examined associations among older women of depression symptoms with survival to ages 90, 95, and 100, and survival to age 90 with intact mobility and cognitive functioning. Participants were 70,560 women enrolled in the Women's Health Initiative with potential, due to birth year, to reach age ≥ 90 as of February 2022. Depression symptoms were assessed at baseline (1993-1998) using the Burnam screen, which comprises the 6-item Center for Epidemiologic Studies Depression Scale and 2 items from the Diagnostic Interview Schedule. Depression symptoms were classified as elevated (vs. not) using an established cut point of ≥ 0.06 for detecting depressive disorders. Survival (vs. death) to ages 90, 95, and 100 years was assessed. Among women surviving to age ≥ 90, maintenance of mobility and cognitive function were assessed in relation to depression symptoms. A total of 37,460 women (53.1%) survived to age ≥ 90. Women with (vs. without) elevated depression symptoms had 15% lower odds of surviving to age 90, 18% lower odds of surviving to age 95, and 23% lower odds of surviving to age 100. Among women surviving to 90, those with (vs. without) elevated depression symptoms had 46% lower odds of surviving with intact mobility and cognition. Depression symptoms associated with lower odds of healthy longevity. Findings underscore importance of depression intervention to increase women's odds of healthy longevity.

Cancer Incidence in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)-The Onco-SOL Ancillary Study

BACKGROUND

Few studies have examined how cancer incidence varies by the country of origin among US Hispanic/Latino adults. In this study, we describe the incidence rates (IR) of cancer overall and for screen-detectable, tobacco-related, and obesity-related cancers among 16,415 participants in the Hispanic Community Health Study/Study of Latinos, an ongoing population-based cohort study of Hispanic/Latino adults from diverse backgrounds.

METHODS

Cohort participant records were linked to the state cancer registries in New York, Florida, California, and Illinois to ascertain cancer incidence from baseline (2008-2011) through 2021. We estimated weighted age-adjusted IRs and age- and sex-adjusted HRs.

RESULTS

Over a mean follow-up of 10.7 (SD = 2.0) years, 715 incident invasive cancers were diagnosed including 118 female breast, 102 prostate, and 79 bronchus and lung cancers. The IR of all cancers combined was 26.2 [95% confidence interval (CI), 22.6-30.2] per 10,000 (10K) person-years (py). The IRs were lowest among persons of Mexican descent [IR, 19.0 (95% CI, 15.0-24.1) per 10K py] and highest for those of Puerto Rican [IR, 36.6 (95% CI, 28.4-47.0) per 10K py] descent. Compared with those of Mexican descent, those of Puerto Rican, Cuban, and Dominican descent had higher hazards of cancer incidence; the incidence of obesity-related (HR, 2.37; 95% CI, 1.43-3.95) and tobacco-related (HR, 3.00; 95% CI, 1.58-5.71) cancers was also the highest among Puerto Ricans.

CONCLUSIONS

Cancer IRs varied by Hispanic/Latino heritage and were masked when Hispanics/Latinos were aggregated into a single group.

IMPACT

Understanding disparities in cancer risk by Hispanic/Latino heritage may help tailor cancer prevention and control strategies.

Food-based indexes and their association with dietary inflammation

Chronic inflammation is associated with an increased risk of noncommunicable diseases, prompting an intensified interest in the diet-disease relationship for modulating inflammation. Diet quality indexes are widely used to quantify dietary patterns. However, the optimal tool for assessing dietary quality in relation to chronic inflammation remains unclear. The objective of this study was to synthesize the literature on food-based diet quality indexes and their association with chronic inflammation. A systematic scoping review of scientific databases was conducted from inception to March 2024. Studies describing the development and validation of original dietary inflammatory indexes or assessed associations between established indexes and inflammatory biomarkers were included. Studies that predominantly focused on nutrient-based indexes were excluded. Forty-three food-based indexes, evaluated across 65 studies, were categorized into 4 distinct groups based on dietary patterns (n = 18), dietary guidelines (n = 14), dietary inflammatory potential (n = 6), and therapeutic diets (n = 5). Established indexes based on the Mediterranean diet and dietary guidelines were the most extensively utilized, demonstrating inverse associations with several inflammatory biomarkers across diverse populations. The Anti-Inflammatory Diet Index, Dietary Inflammation Score, and Empirical Dietary Inflammatory Index were identified as robust, empirically derived indexes to assess diet quality based on their inflammatory potential. The dietary composition of the evaluated indexes ranged from 4 to 28 dietary components, with fruits, vegetables, whole grains, and legumes consistently classified as favorable, whereas red/processed meats and added sugars were unfavorable. This scoping review identified several promising food-based indexes for assessing inflammation-related diet quality. Methodological variations and inconsistencies in algorithms underscore the need for further validation across diverse populations. Future research should consider the scoring methods, dietary composition, and validated inflammatory biomarkers when selecting indexes to evaluate diet-inflammation associations. Understanding the characteristics that underpin these indexes informs their application in nutrition research and clinical practice.

Plant-Based Culinary Medicine Intervention Improves Cooking Behaviors, Diet Quality, and Skin Carotenoid Status in Adults at Risk of Heart Disease Participating in a Randomized Crossover Trial

Background: Culinary medicine (CM) interventions in teaching kitchens have emerged as novel approaches for influencing dietary behaviors, but their efficacy, content, and delivery vary. Objective: The effects of a virtual vegan CM intervention on behavioral determinants, cooking competencies, diet quality, and skin carotenoid status were assessed. Methods: This analysis from a 9-week randomized crossover study evaluated behavioral survey assessments, Whole Plant Food Density (WPFD) as a diet quality indicator utilizing Automated Self-Administered 24 h Dietary Recall data, and skin carotenoid status (SCS) via pressure-mediated reflection spectroscopy at multiple timepoints. Adults at ≥5% atherosclerotic cardiovascular disease (ASCVD) risk followed a vegan diet pattern that was high or low in extra virgin olive oil (EVOO) for 4 weeks each with weekly virtual cooking classes, separated by a 1-week washout period. Qualitative feedback was collected for thematic analysis. Results: In 40 participants (75% female; body mass index, 32 ± 7 kg/m2; age, 64 ± 9 years mean ± SD), perceived control over trajectory of heart disease, knowledge of lifestyle behaviors for heart health, and confidence in cooking skills and preparing a variety of plant-based foods improved post intervention (all p ≤ 0.001). WPFD increased by 69-118% from baseline. Greater SCS changes occurred after high-EVOO (+51.4 ± 13.9 mean ± SEM, p < 0.001) compared to low-EVOO (+6.0 ± 16.4, p = 0.718) diets. Conclusions: A virtual vegan CM intervention improved dietary behaviors and quality, which was associated with reductions in CVD risk factors. SCS is influenced by EVOO intake, warranting consideration when used to estimate fruit and vegetable intake. The potential impacts of CM on behaviors and health outcomes warrant continued research efforts in medical and public health settings.

Combined healthy lifestyle behaviors and all-cause mortality risk in middle-aged and older US adults: A longitudinal cohort study

BACKGROUND

While various lifestyle behaviors separately or partly have been shown to be associated with health outcomes, including a multitude of diseases and death, none of the earlier research has comprehensively investigated the combined impact of modified lifestyle behaviors. This longitudinal study investigated the association between a composite of healthy lifestyle behaviors and all-cause mortality in middle-aged and older Americans.

METHODS

We utilized data from the National Health and Nutrition Examination Survey from 2007 to 2018, as well as relevant mortality data, applying the Healthy Lifestyle Score1 (HLS) index to assess healthy lifestyle behaviors, defined by no smoking, moderate alcohol, appropriate sleep, a balanced diet, adequate physical activity, and limited sedentary time. Weighted multivariate Cox proportional hazards analyses were applied to investigate the associations between these lifestyle practices and overall mortality, followed by stratified analyses to explore potential effect modifications by subgroups.

RESULTS

This study included 5448 participants, categorized into unfavorable (28%), intermediate (56%), and favorable (16%) HLS groups. During a median 103-month follow-up, 388 participants died. Cox regression revealed that individuals with favorable lifestyles had a reduced likelihood of death than those with unfavorable lifestyles (HR = 0.49, 95% CI: 0.34-0.70). There was a linear negative relationship established between HLS and the likelihood of all-cause death (p for non-linearity = 0.0512).

CONCLUSION

Adherence to a composite of healthy habits is linearly and substantially related to decreasing the likelihood of all-cause mortality among the elderly in the U.S., highlighting the substantial benefits of maintaining these behaviors for longevity and health.

Effectiveness of Health Action Interventions in Enhancing Diet Quality and Glycemic Control Among Individuals With Type 2 Diabetes Mellitus: A Systematic Review of Randomized Clinical Trials

CONTEXT

Diet quality is directly related to glycemic control in individuals with type 2 diabetes mellitus (T2DM). The use of dietary indices can provide a comprehensive understanding of the relationship between diet quality and clinical outcomes.

OBJECTIVE

The aim was to evaluate the relationship between diet quality, measured using dietary indices, and its impact on improving glycemic control in individuals with T2DM through health interventions.

DATA SOURCE

This study was conducted using 6 databases, including Web of Science, MEDLINE (via PubMed), Embase, Bireme, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), as well as the gray literature (Google Academic).

DATA EXTRACTION

Randomized clinical trials that evaluated the effectiveness of health interventions in adult and older adult individuals with T2DM and presented data on diet quality evaluated using dietary indices and the percentage of glycated hemoglobin (%HbA1c) were included.

DATA ANALYSIS

A total of 3735 articles were retrieved, 4 of which were included in the study selection stages. The quality indices assessed in the studies were the Alternate Healthy Eating Index (AHEI), Healthy Eating Index-2010 (HEI-2010), Diet Quality Index-International (DQI-I), and Diet Quality Index-Revised (DQI-R). A reduction in %HbA1c was observed in 2 studies, which correlated with the AHEI and DQI-I scores in the intervention groups. The approach of using food labels to improve diet quality reduced %HbA1c by 0.08% in the intervention group compared with the control group. Only 1 study found no significant association between the DQI-R index and %HbA1c. Additionally, negative correlations were observed between body weight and the AHEI and DQI-I scores.

CONCLUSION

Health interventions improved diet quality, glycemic control, and weight loss in individuals with T2DM.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO no. CRD42023430036.

Maternal dietary flavonoid intake and child wheeze and asthma in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) cohort

BACKGROUND

Higher intakes of flavonoids have been associated with better lung function in adults. The aim of this study was to examine the associations between maternal prenatal intake of flavonoids and offspring asthma and wheeze.

METHODS

We conducted a prospective study of Black (62.8%) and White (37.2%) mother-child dyads (N = 906) enrolled in the CANDLE study. We estimated prenatal dietary flavonoid intake using the Block Food Frequency Questionnaire administered during the second trimester and subsequently linked to the United States Department of Agriculture's Provisional Flavonoid Addendum and Proanthocyanidin database. Our primary outcomes included parent report of child current wheeze and asthma (based on diagnosis, symptoms, and/or medication use) at approximately age 4 years. We used multivariable logistic regression to investigate associations between prenatal flavonoid intake and child respiratory outcomes.

RESULTS

Overall, 19.4% and 15.8% of children had current wheeze and asthma, respectively. The highest quartile of prenatal dietary total flavonoid was associated with lower odds of childhood respiratory outcomes, relative to the lowest quartile, for current wheeze (adjusted odds ratios (aOR) [95% confidence intervals (CI)]: 0.58 [0.35, 0.96]) and current asthma (aOR [95% CI]: 0.53 [0.31, 0.91]), respectively, although there was not a clear dose-response. We observed an inverse association between the prenatal intake of proanthocyanidin and offspring current asthma, but no associations for other flavonoid subclasses.

CONCLUSIONS

We report a novel finding that children of women with the highest compared to the lowest prenatal intake of total dietary flavonoids had lower odds of current wheeze and asthma at age 4 years.

Unraveling the Extra Virgin Olive Oil Effect on Inflammation and on Gut and Saliva Microbiota

Extra virgin olive oil (EVOO) with a high content of polyphenols has attracted attention due to its proved beneficial effects in decreasing the risk of cardiovascular disease, modulating cholesterol levels (HDL and LDL), modulating inflammatory markers, and decreasing the levels of haemoglobin1Ac, suggesting that EVOO can have an impact in glycemia regulation. This study assessed the impact of the consumption of a northern Portuguese polyphenol-rich EVOO with a high profile of bioactive molecules on several parameters, such as saliva and serum inflammatory biomarkers, and explored EVOO impact on gut and oral microbiota regarding Bacillota and Bacteroidota content. Thus, the impact on glycated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), inflammatory biomarkers, and faecal and salivary microbiomes were evaluated before and after the exposure to EVOO. The results showed that EVOO promotes a decrease in the levels of HbA1C and in the pro-inflammatory interleukin IL-1β, associated with inflammatory processes. Moreover, EVOO intake modulated gut and oral microbiota, increasing Bacteroidota in both ecological niches and Bacillota in the oral microbiota, both phyla being associated with health, demonstrating a prebiotic effect.

Comparing the Association Between Depressive Symptoms and Cardiovascular Disease Among the Middle-Aged and Elderly Population: A National Survey of 9,049 Subjects Based on the Indonesian Family Life Survey-5

Introduction

The association between depressive symptoms and cardiovascular disease (CVD) is widely acknowledged. However, there is a lack of relevant evidence among the middle-aged population in developing countries where depressive symptoms often go undetected and untreated. The objectives of this study were to assess the association between depressive symptoms and CVD in Indonesia and to compare the association between the middle-aged and elderly population.

Methods

This national cross-sectional population-based survey used secondary data from the publicly available Indonesian Family Life Survey (IFLS-5). Depressive symptoms were assessed using a modified Center for Epidemiologic Studies Depression (CESD-R-10) scale, and data on CVD and sociodemographic variables were self-reported. Binary logistic regression was performed to determine the association between depressive symptom and self-reported CVD after adjusting for confounding factors, with an adjusted odds ratio (AOR) and 95% confidence interval (CI) reported. Subgroup analysis was performed based on the age group.

Results

The study included 9049 respondents, predominantly the middle-aged (71.1%), female (52.6%), elementary school graduates (50.7%), non-smokers (59.0%), non-obese (77.3%), without depressive symptoms (82.2%), and without self-reported CVD (96.7%). Respondents with depressive symptoms were more likely to experience self-reported CVD (AOR = 1.56; 95% CI = 1.18-2.05; p-value = 0.002), after adjusting for potential confounders. A significant association was observed between depressive symptoms and self-reported CVD in elderly respondents (AOR = 1.89; 95% CI = 1.22-2.94; p-value = 0.005), whereas no significant association was observed in the middle-aged group (AOR = 1.39; 95% CI = 0.98-1.98; p-value = 0.063) after adjusting for confounders.

Conclusion

Respondents with depressive symptoms were associated with an increased risk of self-reported CVD, highlighting the urgent need for targeted prevention strategies, especially for those struggling with depressive symptoms.

Vitamin and mineral supplements and fatigue: a prospective study

PURPOSE

The consumption of vitamin/mineral supplements (VMS) and vitamin/mineral and/or dietary supplements (VMDS) is popular among the general population. However, the association of VMS/VMDS with fatigue remains sparse and conclusions are mixed. We aimed to understand the association between VMS/VMDS and fatigue.

METHODS

Prospective study in the city of Lausanne, Switzerland, including 1361 participants (50.3% female, mean age 61.0 ± 9.4 years). Participants were divided into VMS/VMDS users and non-users. Fatigue levels were assessed using the Fatigue Severity Scale (FSS) and the 14-item version of the Chalder Fatigue Scale (CFS). Statistical analyses included multivariable logistic regression for categorical outcomes and analysis of variance for continuous outcomes, adjusting for relevant covariates.

RESULTS

No association was found between VMS consumption and changes in FSS (mean ± standard error 0.05 ± 0.03 vs. -0.06 ± 0.14 for non-consumers and consumers, respectively, p = 0.440) and CFS (-0.05 ± 0.06 vs. 0.22 ± 0.28, p = 0.388). Similarly, no effect of VMS consumption was found on incidence odds ratio and 95% confidence interval: 1.75 (0.82-3.74), p = 0.149 or remission 1.36 (0.49-3.74), p = 0.550 of clinical fatigue. Similar findings were obtained for VMDS: FSS 0.06 ± 0.04 vs. 0 ± 0.08, p = 0.577; CFS - 0.07 ± 0.08 vs. 0.04 ± 0.15, p = 0.545 for non-consumers and consumers, respectively. OR 1.96 (1.20-3.20), p = 0.008 and 1.14 (0.57-2.31), p = 0.712 for incidence and remission of fatigue. Alternate or persistent VMS/ VMDS consumers had a higher incidence of clinical fatigue and a higher increase in FSS compared with never consumers.

CONCLUSION

In this population-based sample, we found no consistent association between VMS or VMDS consumption and remission of fatigue. Conversely, VMDS users tended to develop greater fatigue.

Nutrition Knowledge, Food Insecurity, and Dietary Biomarkers: Examining Fruit and Vegetable Intake Among College Students

OBJECTIVES

Food insecurity among college students, combined with limited nutrition knowledge and barriers to healthy eating, significantly impacts diet quality and fruit and vegetable intake. Efforts to address these issues are further complicated by the challenges of accurately and efficiently collecting dietary data in research settings. This study aimed to explore the relationship between nutrition knowledge and fruit/vegetable intake using skin, plasma, and dietary carotenoid levels as biomarkers.

METHODS

Undergraduate and graduate students aged 18 years and older (n = 166) from a California public university were recruited. The sample was predominately female (n = 133, 80%), with 30 males (18%) and three individuals (2%) identifying as non-binary. Food security was assessed using the USDA's 10-item Adult Food Security Survey Module and nutrition knowledge through a validated questionnaire. Biological data included blood samples and skin carotenoid measurements (Veggie Meter®). Dietary quality (HEI-2015) and carotenoid intake were assessed through Diet ID™, a photo-based assessment tool.

RESULTS

The mean nutrition knowledge scores were 36.55 ± 8.83 out of 58 points, and the mean skin carotenoid score was 307.07 ± 110.22. Higher knowledge scores were associated with increased plasma carotenoids, HEI-score, and Diet ID™ total carotenoids. Food security classification did not significantly impact nutrition knowledge but did influence HEI scores and skin carotenoid levels, with very low food security linked to poorer diet quality and lower carotenoid levels.

CONCLUSIONS

Nutrition knowledge may serve as a significant predictor of fruit and vegetable intake in university students. Despite this correlation, the impact of overall diet quality is potentially hindered by an individual's food security status. Therefore, while knowledge is critical, addressing food insecurity is essential for enhancing diet quality among college students.

Fine particulate matter and nonaccidental and cause-specific mortality: Do associations vary by exposure assessment method?

Background

There is considerable heterogeneity in fine particulate matter (PM2.5)-mortality associations between studies, potentially due to differences in exposure assessment methods. Our aim was to evaluate associations of PM2.5 predicted from different models with nonaccidental and cause-specific mortality.

Methods

We followed 107,906 participants of the Nurses' Health Study cohort from 2001 to 2016. PM2.5 concentrations were estimated from spatiotemporal models developed by researchers at the University of Washington (UW), Pennsylvania State University (PSU), and Harvard TH Chan School of Public Health (HSPH). We calculated 12-month moving average concentrations and we used time-varying Cox proportional hazard ratios (HRs).

Results

There were 30,242 nonaccidental deaths in 1,435,098 person-years. We observed high correlations and similar temporal trends between the PM2.5 predictions. We found no associations of UW, PSU, or HSPH PM2.5 with nonaccidental mortality, but suggestive positive associations with cancer, cardiovascular, and respiratory disease mortality. There were small differences in HRs between the PM2.5 predictions. All three predictions showed the strongest associations with cancer mortality: HRs (95% confidence interval, expressed per 5 µg/m3 increase) were 1.06 (1.01, 1.12) for UW, 1.08 (1.03, 1.13) for PSU, and 1.05 (1.00, 1.10) for HSPH. In a subset restricted to participants who were always exposed to PM2.5 below 12 µg/m3, we observed positive associations with nonaccidental mortality.

Conclusion

We found that differences between PM2.5 exposure assessment methods could lead to minor differences in strengths of associations between PM2.5 and cause-specific mortality in a population of US female nurses.

Diet quality patterns and chronic kidney disease incidence: a UK Biobank cohort study

BACKGROUND

Only a few studies have investigated the role of diet on the risk of chronic kidney disease (CKD) in European populations and have mainly focused on the Mediterranean diet. This is the first study to evaluate the association between various diet quality indices and CKD incidence in British adults.

OBJECTIVE

To study the relationship between a set of 6 different diet quality indices and CKD incidence among British adults.

METHODS

A prospective cohort with 106,870 participants from the UK Biobank, followed from 2009 to 2012 through 2021. Food consumption was obtained from ≥2 24-h dietary assessments. Dietary patterns were assessed using previously established indices: Alternate Mediterranean Index (aMED), Alternative Healthy Eating Index 2010, dietary approaches to stop hypertension (DASH), healthful plant-based diet index (hPDI), unhealthful plant-based diet index (uPDI), and dietary inflammatory index (DII). Incident CKD was obtained from clinical records, death registries, and self-reports. Analyses were performed with Cox regression models and adjusted for the main confounders.

RESULTS

After a median follow-up of 9.27 y, 2934 cases of CKD were ascertained. Hazard ratios (95% confidence interval) of CKD for the highest compared with lowest tertile of adherence to each diet score were 0.84 (0.76, 0.93) for aMED, 0.94 (0.85, 1.03) for alternative healthy eating index 2010, 0.77 (0.70, 0.85) for DASH, 0.79 (0.72, 0.87) for hPDI, 1.27 (1.16, 1.40) for uPDI, and 1.20 (1.18, 1.33) for DII. The results were robust in sensitivity analyses.

CONCLUSIONS

In British adults, higher adherence to the aMED, DASH, and hPDI patterns was associated with lower risk of CKD, whereas greater adherence to the uPDI and DII patterns was associated with greater risk.

Dietary carotenoid intakes and biological aging among US adults, NHANES 1999-2018

BACKGROUND

Carotenoids have been shown to have multiple health benefits, including antioxidant and anti-inflammatory. The data for the effect of dietary specific carotenoids on biological aging is limited. Our study aims to examine the association between dietary carotenoid intake levels and biological aging.

METHODS

This cross-sectional study was performed among 27,338 adults from NHANES 1999-2018. Dietary intake was assessed through two 24-hour dietary recall interviews. Biological aging indices included allostatic load (AL), homeostatic dysregulation (HD), Klemera-Doubal method (KDM), and phenoAge (PA). Multiple linear regression, weighted quantile sum (WQS) regression and quantile g-computation (QG-comp) were used to explore the associations of single carotenoid and mixed carotenoids with biological aging.

RESULTS

Associations between dietary carotenoid intake levels and biological aging indices were significant among adults across the United States. Multiple linear regression showed that most carotenoids were significantly negatively correlated with AL (β = -0.017 - -0.011), HD (β = -0.045 - -0.032), KDM (β = -0.984 - -0.471), and PA (β = -0.975 - -0.539). Subgroup analysis indicated that male, older individuals, smokers, alcohol drinkers, and less physically active individuals are particularly sensitive populations. Meanwhile, WQS regression and QG-comp analyses consistently indicated a negative association between mixed carotenoids exposure and four biological aging indices, highlighting that lutein/zeaxanthin and β-carotene were responsible for the outcomes.

CONCLUSIONS

Increased dietary intakes of various carotenoids were associated with lower biological aging indices, which was possibly and mainly driven by lutein/zeaxanthin and β-carotene.

Are the ways women cope with stressors related to their health behaviors over time?

OBJECTIVE

Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (eg, anxiety) and states (eg, happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes, including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (eg, seeking emotional support) and maladaptive (eg, denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in the use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle.

METHODS

Women (N = 46 067) from the Nurses' Health Study II cohort reported their use of 8 coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (eg, physical activity, smoking, sleep), self-reported every 4 years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health-related factors, were performed.

RESULTS

Most adaptive strategies and greater variability levels were associated with a higher likelihood of sustaining a healthy lifestyle (eg, active coping, relative risk [RR] = 1.09, 95% confidence interval [CI], 1.08-1.11), with the reverse evident with maladaptive strategies (eg, behavioral disengagement, RR = 0.94, CI, 0.93-0.95), but some unexpected results also emerged.

CONCLUSIONS

Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.

Dietary quality and chemotherapy-induced peripheral neuropathy in colon cancer

BACKGROUND

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and dose-limiting chemotoxicity caused by oxaliplatin. This study investigated the relationship between dietary quality and the development of moderate and/or severe CIPN in colon cancer survivors using data from the Focus on Reducing Dose-Limiting Toxicities in Colon Cancer with Resistance Exercise trial (ClinicalTrials.gov identifier NCT03291951).

METHODS

Diet quality was collected using a 127-item food-frequency questionnaire and was scored using the Alternative Healthy Eating Index-2010 (AHEI-2010). CIPN was assessed with the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events at each chemotherapy cycle. The association of dietary quality with time to the first moderate-to-severe (moderate-severe) or severe event of CIPN was estimated using Cox proportional hazards models. Only participants who received oxaliplatin were included in this analysis (n = 132).

RESULTS

Seventy-four participants (56.1%) reported moderate-severe CIPN. Higher dietary quality was associated with a significantly decreased risk of moderate-severe CIPN (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.93-0.99) and severe CIPN (HR, 0.91; 95% CI, 0.85-0.98). Consumption of red and processed meat (HR, 1.78; 95% CI, 1.07-2.83) and sugar-sweetened beverages (HR, 1.33; 95% CI, 1.10-1.59) was associated with an increased risk of moderate-severe CIPN. Consumption of sugar-sweetened beverages also was associated with an increased risk of severe CIPN (HR, 1.57; 95% CI, 1.14-2.18), whereas vegetable consumption was associated with a reduced risk of severe CIPN (HR, 0.29; 95% CI, 0.09-0.73).

CONCLUSIONS

Among patients with colon cancer who received oxaliplatin-based chemotherapy, higher baseline dietary quality was associated with a reduced risk of moderate-severe CIPN.

Association Between Dietary Patterns and Subgingival Microbiota: Results From the Oral Infections, Glucose Intolerance, and Insulin Resistance Study (ORIGINS)

OBJECTIVE

To study the association between dietary patterns and subgingival microbiota.

METHODS

Participants (n = 651) who were enrolled in the Oral Infections, Glucose Intolerance, and Insulin Resistance Study (ORIGINS) with subgingival plaque sampling (n = 890 plaques) and a dietary assessment were included. 16S rRNA gene amplicon sequences of subgingival plaque from sites with either probing depth <4 or ≥4 mm were processed separately and used to obtain α-diversity metrics (Faith, Shannon, Simpson, Observed) and taxa ratios (Red Complex to Corynebacterium [RCLR], Treponema to Corynebacterium [TCLR], and Treponema to Neisseria [TNLR]). Food frequency questionnaires (FFQs) were processed to calculate Alternate Healthy Eating Index (AHEI) and A Priori Diet Quality Score (APDQS) scores. Mixed regression models examined the mean levels of microbial metrics across quartiles of diet quality. Means ± standard errors are reported along with p-values.

RESULTS

In multivariable models assessing the association between diet scores and α-diversity metrics, higher AHEI values were significantly associated with lower Faith (p-value = 0.01) and Observed (p-value = 0.04) diversity values; similar findings were observed for APDQS (p-value = 0.01, p-value = 0.04). In multivariable models assessing the association between diet scores (AHEI and APDQS) and taxa ratios (RCLR, TCLR and TNLR), as the AHEI quartile increased, all taxa ratios decreased significantly as follows: -1.06 ± 0.093 in Q1 to -1.34 ± 0.099 in Q4 (RCLR), -0.43 ± 0.077 in Q1 to -0.64 ± 0.083 in Q4 (TCLR) and -0.09 ± 0.083 in Q1 to -0.38 ± 0.089 in Q4 (TNLR), respectively. In contrast, as the APDQS quartiles increased, only TNLR decreased significantly from -0.08 ± 0.085 in Q1 to -0.34 ± 0.091 in Q4.

CONCLUSION

Diets rich in fruits, vegetables, whole grains and other nutritionally rich plant foods are associated with lower oral microbial diversity and favourable ratios of pathogenic to commensal microbiota.

Exploring diet as a source of plasticizers in pregnancy and implications for maternal second-trimester metabolic health

BACKGROUND AND OBJECTIVES

Diet plays critical roles in modulating maternal metabolic health in pregnancy, but is also a source of metabolic-disrupting phthalates and their replacements. We aimed to evaluate whether the effects of better diet quality on favorable maternal metabolic outcomes could be partially explained by lower exposure to phthalates/replacements.

METHODS

At 13 weeks gestation, 295 Illinois women (enrolled 2015-2018) completed a three-month food frequency questionnaire that we used to calculate the Alternative Healthy Eating Index (AHEI)-2010 to assess diet quality. We quantified 19 metabolites, reflecting exposure to 10 phthalates/replacements, in a pool of five first-morning urine samples collected monthly across pregnancy. We measured 15 metabolic biomarkers in fasting plasma samples collected at 17 weeks gestation, which we reduced to five uncorrelated principal components (PCs), representing adiposity, lipids, cholesterol, inflammation, and growth. We used linear regression to estimate associations of diet quality with [1] phthalates/replacements and [2] metabolic PCs, as well as [3] associations of phthalates/replacements with metabolic PCs. We estimated the proportion of associations between diet quality and metabolic outcomes explained by phthalates/replacements using a causal mediation framework.

RESULTS

Overall, every 10-point improvement in AHEI-2010 score was associated with -0.15 (95% CI: -0.27, -0.04) lower adiposity scores, reflecting lower glucose, insulin, C-peptide, leptin, C-reactive protein, but higher adiponectin biomarker levels. Every 10-point increase in diet quality was also associated with 18% (95%CI: 7%, 28%) lower sum of di-2-ethylhexyl terephthalate urinary metabolites (∑DEHTP). Correspondingly, each 18% increase in ∑DEHTP was associated with 0.03 point (95% CI: 0.01, 0.05) higher adiposity PC scores. In mediation analyses, 21% of the inverse relationship between diet quality and adiposity PC scores was explained by lower ∑DEHTP.

CONCLUSIONS

The favorable impact of diet quality on maternal adiposity biomarkers may be partially attributed to lower metabolite concentrations of DEHTP, a plasticizer allowed to be used in food packaging materials.

Environmental mixtures and body mass index in two prospective US-based cohorts of female nurses

We estimated the joint effect of particulate matter ≤ 2.5 µm in diameter (PM2.5), nitrogen dioxide (NO2), seasonal temperature, noise, greenness, light at night, and neighborhood socioeconomic status (NSES) on body mass index (BMI) in a mixture context among 194,966 participants from the Nurses' Health Study (NHS) and Nurses' Health Study II (NHSII) over 30 years. BMI was calculated from self-reported weight and height. Single- and multi-exposure generalized estimating equations models were used to estimate the difference in BMI per interquartile range (IQR) increase of environmental factors, and quantile g-computation methods were used to estimate joint associations. In both cohorts, we consistently observed positive associations of BMI with PM2.5 and NO2 concentrations as well as negative associations with light at night and NSES regardless modeling approach. A positive association with noise was only observed in NHS. Negative associations with greenness and winter temperature were only observed in NHSII. Overall, the changes in BMI per quintile increase in all eight exposures were -0.11 (-0.13, -0.08) in NHS and -0.39 (-0.41, -0.37) in NHSII, which were largely driven by air pollution and nighttime noise (18-45 %) in the positive direction and NSES (>70 %) in the negative direction. Future intervention on environmental factors, especially reducing PM2.5, NO2 and noise or improving the NSES, might be helpful to lower BMI.

Dietary trajectories over 21 years and frailty in Norwegian older adults: the Tromsø Study 1994-2016

PURPOSE

To investigate the association between five dietary trajectories over 21 years and frailty in Norwegian older adults.

METHODS

This study used data from three surveys of the Tromsø Study. Diet was measured using food frequency questionnaires at baseline (Tromsø4, 1994-95), after 7 years (Tromsø5, 2001) and at the end of follow-up (Tromsø7, 2015-16). Survey-specific diet scores were constructed based on the Nordic Nutrition Recommendations 2023 and group-based trajectory modelling was used to derive dietary trajectories. At follow-up, frailty was assessed with a 41-item frailty index. Linear regression analysis was performed to assess the associations between dietary trajectories and frailty, adjusted for baseline variables.

RESULTS

Among the 715 participants, 55% were women, with an average age of 54 years at baseline and 74 years at follow-up. The dietary trajectories 'moderately healthy' and 'healthy increase' were associated with a lower frailty index score at follow-up (β = -0.02, 95% confidence interval (CI) = -0.04, -0.002, β = -0.03, 95% CI = -0.06, -0.007), compared with the 'unhealthy' trajectory.

CONCLUSION

Our findings suggest that maintaining a moderately healthy to very healthy diet from mid-life into older age is associated with a lower risk of frailty and supports the promotion of a healthy diet from adulthood to facilitate healthy ageing.

Lipidomic Signature of Healthy Diet Adherence and Its Association with Cardiometabolic Risk in American Adults

BACKGROUND

The aim of this study was to identify the blood lipidomic profile associated with a healthy eating pattern in a middle-aged US population sample and to determine its relationship with metabolic disorders and cardiovascular risk (CVR).

METHODOLOGY

Self-reported information about diet and blood samples were obtained from 2114 adult participants in the Midlife in the United States study (MIDUS). Food intake data were used to design a Healthy Diet Index (MIDUS-HEI) and to evaluate the predictive value by examining its association with health variables. The associated lipid signature (HEI-LS) was constructed using Lasso regression, from lipidomic data (LC/MS). Associations between HEI-LS, cardiometabolic biomarkers, and estimated CVR were assessed using multiple linear regression.

RESULTS

MIDUS-HEI score was a robust indicator of dietary quality and inversely associated with body mass index (p < 0.001) and metabolic syndrome (p = 0.012). A lipidomic signature comprising 57 distinct lipid species was highly correlated with the MIDUS-HEI score (r = 0.39, p < 10⁻16). It was characterized by lower levels of saturated fatty acid and adrenic acid (n-6) and higher levels of docosahexaenoic acid (n-3). Healthier HEI-LS scores were strongly associated with better cardiometabolic indicators and lower estimated CVR (OR 0.89 CI 95% 0.87-0.91).

CONCLUSIONS

The MIDUS-HEI effectively assessed dietary quality, confirming the link between poor diet quality and metabolic disorders in American population. Lipidomic profiling offered an objective assessment of dietary patterns and provided insights into the relationship between diet quality, metabolic responses, and CVR. This approach supports precision nutrition strategies for at-risk populations.

Vitamin and mineral supplements: Are they associated with fatigue?

BACKGROUND AND AIMS

Vitamin/mineral supplements (VMS) and vitamin/mineral and/or dietary supplements (VMDS) are commonly consumed, based on the belief of their invigorating properties. Still, the association of VMS/VMDS with fatigue in the general population remains sparse and conclusions are mixed. This study aimed to understand the association between VMS/VMDS and fatigue.

METHODS

Two cross-sectional studies (2014-2017 and 2018-2021) conducted on a population-based cohort. Participants were divided into VMS/VMDS users and non-users. Fatigue levels were assessed using the Fatigue Severity Scale (FSS) and the 14-item version of the Chalder Fatigue Scale (CFS).

RESULTS

Overall, 2084 (50.8 % female, 61.7 ± 9.8 years) and 1728 (51.0 % female, 64.1 ± 9.3 years) were included in the first and second surveys, respectively. In the first survey, after multivariable analysis, no association was found between VMS use and FSS: adjusted mean ± sem 3.04 ± 0.13 vs. 2.82 ± 0.03 for users and non-users, respectively, p = 0.083, while users scored higher in the CFS: 6.17 ± 0.22 vs. 5.72 ± 0.06 for users and non-users, respectively, p = 0.048. In the second survey, no association was found between VMS use and FSS (2.83 ± 0.19 vs. 2.84 ± 0.03, p = 0.952) and CFS (5.38 ± 0.33 vs. 5.61 ± 0.06, p = 0.504). In the first survey, VMDS users scored higher in both FSS (3.03 ± 0.06 vs. 2.76 ± 0.04, p < 0.001) and CFS (6.19 ± 0.11 vs. 5.58 ± 0.06, p < 0.001) while no differences were found in the second survey in both FSS (2.93 ± 0.07 vs. 2.81 ± 0.04, p = 0.161) and CFS (5.78 ± 0.12 vs. 5.54 ± 0.07, p = 0.088).

CONCLUSION

In this population-based cross-sectional study, the authors found no consistent association between VMS consumption and fatigue. Participants taking VMDS tended to present with higher fatigue scores.

Maternal Dietary Patterns During Pregnancy and Child Autism-Related Traits in the Environmental Influences on Child Health Outcomes Consortium

We examined relationships between prenatal dietary patterns and child autism-related outcomes, including parent-reported clinician diagnoses of autism spectrum disorder (ASD) and Social Responsiveness Scale (SRS-2) scores, in up to 6084 participants (with analytic samples ranging from 1671 to 4128 participants) from 14 cohorts in the Environmental Influences on Child Health Outcomes (ECHO) consortium. Associations between quartiles of the Healthy Eating Index (HEI-2015), the Alternative Healthy Eating Index modified for Pregnancy (AHEI-P), and the Empirical Dietary Inflammatory Pattern (EDIP), calculated based on reported prenatal diet, and outcomes were examined using crude and multivariable regression (quantile for SRS scores and logistic for diagnosis). In adjusted models, the higher quartile of prenatal HEI score was associated with lower SRS scores (Q4 vs. Q1 β for median quantile = -3.41 95% CI = -5.15, -1.26). A similar association was observed for the AHEI-P score when adjusting for total calories (Q4 vs. Q1 β = -2.52 95% -4.59, -0.45). There were no significant associations of prenatal diet with ASD diagnosis. Findings from this large U.S.-based study do not suggest strong associations between prenatal dietary patterns and ASD-related outcomes, although subtle associations with broader traits suggest the need to further consider how prenatal diet may relate to ASD-related phenotypes.

Diet quality indexes for use during pregnancy: a scoping review

AIMS

High diet quality is related to better health outcomes in general. During pregnancy, a high-quality diet is of paramount importance to promote optimal maternal and neonatal outcomes. This is a scoping review of research available on diet quality indexes (DQIs) for use during pregnancy that summarizes the DQIs in terms of development, country of origin, population used, components, scoring and weighting of components, and evaluation. Furthermore, the DQIs are discussed narratively to inform and direct the development of improved and country-specific DQIs for pregnancy.

METHODS

The EBSCOhost database was used to identify English-language, peer-reviewed articles published between 2000 and 2023, from which 11 publications were identified that describe the development of pregnancy-specific DQIs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews model.

RESULTS

Almost all DQIs (n = 9 of 11) were developed in high-income countries, using dietary intake data from food frequency questionnaires. Several DQIs (n = 5 of 11) used the US Healthy Eating Index as basis and modified it in various ways. Almost all DQIs included both foods and nutrients as components (n = 9 of 11), with vegetables being the most commonly included component alone (n = 8 of 11) or combined with fruit (n = 2 of 11).

CONCLUSION

Because most DQIs were developed using dietary guidelines, recommendations, and dietary intake data from high-income countries, it is recommended that pregnancy-specific DQIs be developed and validated to reflect the nutrition guidelines for lower-income and culturally diverse countries.

Differential effects of low or high-fat dairy and fat derived from dairy products on MASLD

Background & Aims

Metabolic dysfunction-associated steatotic liver disease (MASLD) is strongly related to nutrition. However, only a few human and animal studies have tested the association between MASLD and dairy consumption and the effect of milk fat on liver damage. Therefore, we aimed at testing the association between consumption of dairy product and the incidence of MASLD and fibrosis markers in humans, and the effect of milk fat vs. other fats on MASLD in animal studies.

Methods

A prospective 7-year follow-up cohort study was performed including baseline and follow-up fasting blood tests, liver evaluation and a face-to-face interview on health status and behaviour using structured questionnaires. MASLD was determined by ultrasonography or by controlled attenuation parameter (CAP), and liver fibrosis by FibroTest™ or FibroScan®. An animal study was performed in which 6-week-old C57BL/6j male mice were fed a high-fat diet (HFD) consisting of lard, soybean oil, and milk fat for 12 weeks. Metabolic impairment was assessed during the animal experiment, and serum advanced glycation end-products (AGEs) and liver damage were evaluated.

Results

A total of 316 patients were included in the prospective cohort. In multivariable analysis, high consumption of low-medium fat low-sugar dairy products (g/day above the baseline sex-specific median) was associated with a lower risk for MASLD incidence (OR 0.42, 95% CI 0.18-0.95, p = 0.037) or incidence/persistence at follow-up (OR 0.58, 0.34-0.97, p = 0.039). Constantly high consumption of high-fat low-sugar dairy products was associated with greater odds for new onset/persistence of MASLD. Neither low-medium nor high-fat dairy consumption was related to fibrosis markers. In mice, all HFDs induced similar weight gain and steatosis and did not affect liver enzymes. Milk fat increases serum cholesterol and AGEs levels more than lard or soybean oil.

Conclusions

Low-medium fat low-sugar dairy products may be protective and should be preferred over high-fat dairy to prevent MASLD. HFDs from different fat sources with a wide spectrum of fatty acid saturation content are equally deleterious.

Impact and implications

MASLD is related to nutrition, but evidence of an association between high-fat and low-fat dairy products is lacking, therefore, we evaluated this association by performing experimental studies in mice and an observational human study. For MASLD prevention, a differential effect based on the type of dairy products should be considered: low-medium fat low-sugar dairy products were found to be protective, in contrast high-fat dairy and generally high-fat diets may be harmful. It would be advisable to prefer low-fat low-sugar dairy products and minimise intake of high-fat dairy products; however, additional evidence is needed to allow generalisability of our findings.

Dietary patterns during pregnancy in relation to maternal dietary intake: The Mutaba'ah Study

AIM

To relate adherence to healthy dietary patterns, evaluated by different dietary indices, to the intake of nutrients and food groups among pregnant women in the United Arab Emirates.

METHODS

The analyses included 1122 pregnant women from the Mutaba'ah Study. Dietary intake was assessed using a semi-quantitative Food Frequency Questionnaire. Adherence to three dietary pattern indices was assessed; Alternate Healthy Eating Index for Pregnancy (AHEI-P), Alternate Mediterranean Diet (aMED) and Dietary Approaches to Stop Hypertension (DASH). Associations between adherence (score >median) to the three dietary indices and intake of nutrients and food groups were analyzed using logistic regression analysis.

RESULTS

Women with higher intake of polyunsaturated fatty acids, fiber, vegetables, fruits, legumes, and nuts and lower intake of saturated fatty acids, red meat, and sweetened beverages had significantly higher odds of adherence to all three dietary patterns (p<0.05). Associations between intakes of nutrients and food groups with odds of adherence to the dietary patterns differed for total fat (only with AHEI-P, [odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.94-0.98]) and monounsaturated fatty acids (only with aMED, [OR: 1.06; 95% CI: 1.02-1.10]), dairy (with AHEI-P [OR: 0.89; 95% CI: 0.84-0.95] and aMED [OR: 0.86; 95% CI: 0.81-0.91], and with DASH [OR: 1.10; 95% CI: 1.04-1.17]), whole grain (only with aMED [OR: 2.19; 95% CI: 1.61-2.99] and DASH [OR: 4.27; 95% CI: 3.04-5.99]) and fish (with AHEI-P [OR: 1.36; 95% CI: 1.02-1.80] and aMED [OR: 1.79; 95% CI: 1.35-2.38], and with DASH [OR: 0.67; 95% CI: 0.52-0.86]).

CONCLUSION

Adherence to the three dietary pattern indices was generally associated with a favorable intake of nutrients and food groups. However, the indices captured slightly different aspects of dietary intake. These results show that dietary indices that assess adherence to healthy dietary patterns cannot be used interchangeably.

Development of a Diabetes Dietary Quality Index: Reproducibility and Associations with Measures of Insulin Resistance, Beta Cell Function, and Hyperglycemia

AIMS

Various dietary risk factors for type 2 diabetes have been identified. A short assessment of dietary patterns related to the risk for type 2 diabetes mellitus may be relevant in clinical practice given the largely preventable nature of the disease. The aim of this study was to investigate the reproducibility of a short food frequency questionnaire based on available knowledge of diabetes-related healthy diets. In addition, we aimed to investigate whether a Diabetes Dietary Quality Index based on this questionnaire was related to metabolic risk factors, including measures of beta cell function and insulin sensitivity.

METHODS

A short food frequency questionnaire was composed by selecting fourteen questions (representing eight dietary factors) from existing food frequency questionnaires on the basis of their reported relationship with diabetes risk. Healthy participants (N = 176) from a Dutch family study completed the questionnaire and a subgroup (N = 123) completed the questionnaire twice. Reproducible items from the short questionnaire were combined into an index. The association between the Diabetes Dietary Quality index and metabolic risk factors was investigated using multiple linear regression analysis. Measures of beta cell function and insulin sensitivity were derived from a mixed meal test and an euglycemic-hyperinsulinemic and modified hyperglycemic clamp test.

RESULTS

Our results show that this new short food frequency questionnaire is reliable (Intraclass Correlations ranged between 0.5 and 0.9). A higher Diabetes Dietary Quality index score was associated with lower 2 h post-meal glucose (β -0.02, SE 0.006, p < 0.05), HbA1c (β -0.07, SE 0.02, p < 0.05), total cholesterol, (β -0.02, SE 0.07, p < 0.05), LDL cholesterol, (β -0.19, SE 0.07, p < 0.05), fasting (β -0.4, SE 0.16, p < 0.05) and post-load insulin, (β -3.9, SE 1.40, p < 0.05) concentrations and the incremental AUC of glucose during MMT (β -1.9, SE 0.97, p < 0.05). The scores obtained for the oral glucose insulin sensitivity-derived mixed meal test were higher in subjects who scored higher on the Diabetes Dietary Quality index (β 0.89, 0.39, p < 0.05). In contrast, we found no significant associations between the Diabetes Dietary Quality index and clamp measures of beta cell function.

CONCLUSIONS

We identified a questionnaire-derived Diabetes Dietary Quality index that was reproducible and inversely associated with a number of type 2 diabetes mellitus and metabolic risk factors, like 2 h post-meal glucose, Hba1c and LDL, and total cholesterol. Once relative validity has been established, the Diabetes Dietary Quality index could be used by health care professionals to identify individuals with diets adversely related to development of type 2 diabetes.

Association of healthy eating index (HEI), alternative healthy eating index (AHEI) with antioxidant capacity of maternal breast milk and infant's urine: a cross-sectional study

Maternal dietary quality may alter the nutrient content of breast milk. In this study, we aimed to investigate the relationship between the healthy eating index (HEI) and alternative healthy eating index (AHEI) of a breastfeeding mother's diet with the antioxidant profile of her breast milk and her infant's urine. This study included 300 healthy mother-infant pairs. The participants' dietary intake was estimated using a validated semi-quantitative food frequency questionnaire. The diet quality of participants was assessed using the HEI and AHEI. The total antioxidant content of the breast milk and infant's urine was evaluated using ferric reducing antioxidant power (FRAP), 2, 2'-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Thiol quantification assays. After adjusting for confounding factors, the odds of a low malondialdehyde (MDA) content of breast milk were significantly higher in the highest quartile of HEI than in the lowest quartile. The odds of low DPPH and FRAP in infant urine decreased in the highest quartile of HEI compared to the lowest quartile. No significant relationship was found between AHEI and antioxidant levels of breast milk and the infant's urine. Our findings demonstrate that a high quality diet of breastfeeding mothers, identified by a higher HEI, can affect the oxidant-antioxidant balance of a mother's breast milk and her infant's urine.

Development of a Concise Healthy Diet Score for Cardiovascular Disease among Japanese; The Japan Collaborative Cohort Study

AIMS

Several diet quality indicators have been developed primarily for cardiovascular disease (CVD) prevention in Western countries. However, those previous indicators are complicated and less feasible in clinical and health-promoting settings. Therefore, we aimed to develop a concise dietary risk score for CVD prevention in Japanese.

METHODS

Using the self-administered food frequency questionnaire with 35 food items, we developed a concise healthy diet score (cHDS) ranging from 0 to 5 points. We examined the association of cHDS with risks of all-cause and cause-specific mortality among 23,115 men and 35,557 women who were free of CVD and cancer.

RESULTS

During 19.2 years of median follow-up, 6,291 men and 5,365 women died. In men, the multivariable hazard ratios (95% confidence intervals) for the highest cHDS (5 points) compared to the lowest (0-1 points) were 0.74 (0.60-0.91, P-trend=0.008) for CVD and 0.86 (0.77-0.95, P-trend=0.05) for all causes. No significant associations were found for stroke, coronary heart disease, and other causes in men. The corresponding hazard ratio in women was 0.65 (0.52-0.81, P-trend＜0.001) for CVD, 0.63 (0.45-0.88, P-trend＜0.001) for stroke, 0.48 (0.30-0.78, P-trend=0.008) for coronary heart disease, 0.67 (0.54-0.84, P-trend＜0.001) for other causes, and 0.75 (0.66-0.85, P-trend＜0.001) for all causes.

CONCLUSION

We developed a concise diet quality score named cHDS in the Japanese population and found the inverse association of cHDS with mortality from CVD and all causes for both men and women.

Dairy products and hypertension: Cross-sectional and prospective associations

BACKGROUND

The association between dairy intake and prevalence or incidence of hypertension remains controversial. We aimed to investigate the association between intake of different dairy products and prevalence and incidence of hypertension in a community-dwelling sample.

METHODS

Three cross-sectional studies (2009-12, 2014-17 and 2018-21) and one prospective study (2009-12 to 2018-21) were conducted in Lausanne, Switzerland. Dietary intake was assessed via a validated food frequency questionnaire. Dairy consumption was compared between participants with and without prevalent or incident hypertension.

RESULTS

For the cross-sectional analyses, data from 4437 (2009-12, 54.0% women, 57.7 ± 10.5 years), 2925 (2014-17, 53.4% women, 62.5 ± 10.0 years), and 2144 (2018-21; 53.3% women, 65.5 ± 9.6 years) participants were used. No consistent differences between participants with and without hypertension were found for all dairy products (total dairy, milk, yogurt, cheese, low-fat dairy, and full-fat dairy) although participants with hypertension tended to consume less cheese (51 ± 1 vs. 55 ± 1, p = 0.014, 52 ± 1 vs. 56 ± 1, p = 0.053, and 54 ± 1 vs. 56 ± 1 g/day for 2009-12, 2014-17 and 2018-21, respectively). For the prospective study, data from 2303 participants (60.8% women, 53.9 ± 9.0 years) were used. Irrespective of the dairy product considered, no association was found between quartiles of dairy consumption and development of hypertension. Similar findings were obtained after stratifying on dietary quality.

CONCLUSION

In this population-based study, no association was found between the consumption of different dairy products and the prevalence or incidence of hypertension.

Diet and Survival in Black Women With Epithelial Ovarian Cancer

Importance

Ovarian cancer survival among Black women is the lowest across all racial and ethnic groups. Poor dietary quality also disproportionately affects Black populations, but its association with ovarian cancer survival in this population remains largely unknown.

Objective

To examine associations between dietary patterns and survival among Black women diagnosed with epithelial ovarian cancer (EOC).

Design, Setting, and Participants

This prospective cohort study was conducted among self-identified Black women aged 20 to 79 years newly diagnosed with histologically confirmed EOC in the African American Cancer Epidemiology Study (AACES) between December 2010 and December 2015, with follow-up until October 2022. AACES is a population-based study of ovarian cancer risk and survival among Black women in 11 US regions. Data were analyzed from March 2023 to June 2024.

Exposures

Dietary patterns were assessed by the Healthy Eating Index-2020 (HEI-2020) and Alternative Healthy Eating Index-2010 (AHEI-2010), with scores calculated based on dietary intake in the year prior to diagnosis and collected via the validated Block 2005 Food Frequency Questionnaire. Higher scores indicate better dietary quality.

Main outcomes and measures

Hazard ratios (HRs) and 95% CIs were estimated from multivariable Cox models for the association between adherence to dietary recommendations and overall mortality among all participants and those with high-grade serous ovarian cancer (HGSOC).

Results

Among 483 Black women with EOC (mean [SD] age, 58.1 [10.5] years), 310 deaths were recorded during a median (IQR) follow-up of 4.3 (2.0-8.2) years. No association of dietary patterns with mortality was found among women with EOC overall. However, among 325 women with HGSOC, better adherence to HEI-2020 was associated with decreased mortality in later quartiles compared with the first quartile (HR, 0.63; 95% CI, 0.44-0.92 for quartile 2; HR, 0.67; 95% CI, 0.46-0.97 for quartile 3; HR, 0.63; 95% CI, 0.44-0.91 for quartile 4 ). Similar results were observed with AHEI-2010 among women with HGSOC for the second (HR, 0.62; 95% CI, 0.43-0.89) and fourth (HR, 0.67; 95% CI, 0.45-0.98) quartiles compared with quartile 1.

Conclusions and relevance

In this study, women with moderate and high prediagnosis dietary quality had significantly lower mortality rates from HGSOC compared with women with the lowest prediagnosis dietary quality. These findings suggest that even moderate adherence to dietary guidelines prior to diagnosis may be associated with improved survival among Black women with HGSOC, the most lethal form of ovarian cancer.

Assessing the Hypertension Risk: A Deep Dive into Cereal Consumption and Cooking Methods-Insights from China

BACKGROUND

Cereal grains are rich in carbohydrates and could trigger a hyperglycemic response which is closely linked to blood pressure status. We aim to examine the associations between the consumption of cereals with different cooking methods and hypertension risk.

METHODS

We conducted a prospective analysis utilizing the nationwide data of 11,080 adult participants who were free of hypertension at baseline. Cereal intake was assessed using 3-day 24 h dietary recalls with a weighing technique. Hypertension incidence was identified in adherence with the Seventh Joint National Commission guidelines during the follow-up. Cox proportional hazards regression models were used to extrapolate hazard ratios associated with hypertension risk.

RESULTS

Over an average follow-up span of 7 years (77,560 person-years), we identified 3643 new hypertension cases. The intake of total, fried, and baked cereals was associated with 15%, 20%, and 20% higher risk of hypertension, respectively. Whole grain consumers had an 8% lower risk of hypertension compared with non-consumers, while total refined grain consumers showed no significant association. Replacing one daily serving of fried or baked cereals with an equivalent serving of boiled cereals was related to a 28% or 14% lower risk, respectively.

CONCLUSIONS

Total, fried, and baked cereal consumption was positively associated with hypertension risk, while consuming whole grains was related to a lower risk. Modifying cooking methods from frying or baking to boiling for cereals may be beneficial to lower risk. The current study underscores the significance of considering both the degree of processing and cooking methods applied to cereals in addressing hypertension prevention and management.

An unfavorable dietary pattern is associated with symptomatic peripheral artery disease

BACKGROUND AND AIMS

Diet has an essential role in primary and secondary cardiovascular prevention by modulating various cardiovascular risk factors. The need to have easily useable tools seems essential to facilitate the daily practice of clinicians in order to propose the most optimal management of their patients' diet. The aim of this study was to compare the diet assessed with a simple food frequency questionnaire (FFQ) between patients with symptomatic peripheral artery disease (PAD) and healthy subjects.

MATERIALS AND RESULTS

In this ancillary study (ELECTRO-PAD study), we included symptomatic PAD patients and healthy participants. All participants filled a FFQ previously validated called Cardiovascular-Dietary-Questionnaire 2 (CDQ-2). CDQ-2 allows the calculation of different scores: global food score, saturated fatty acids score (SFA), unsaturated fatty acids score (UFA), fruit and vegetable score. The higher the score, the better the diet. We compared the different scores between PAD patients and healthy participants. We included 37 PAD patients and 40 healthy subjects. Mean global score was significantly lower in PAD patients compared to the healthy participants (5.35 ± 7.65 vs 10.60 ± 5.81; p = 0.0011). Similarly, the sub-scores concerning unsaturated fatty acids and fruits-vegetables were significantly lower in PAD patients (p < 0.010). Only the sub-score concerning saturated fatty acids was not significantly different (p = 0.8803) between PAD patients and healthy participants.

CONCLUSION

CDQ-2 highlights that PAD patients have an unfavorable diet compared with healthy participants. CDQ-2 is a tool of interest to help the clinicians for dietary advice of PAD patients.

Ultraprocessed food consumption and risk of gallstone disease: analysis of 3 prospective cohorts

BACKGROUND

Majority of dietary intake in United States adults comes from ultraprocessed foods (UPFs), which have been linked to several adverse health outcomes. Gallstone disease is highly prevalent and constitutes a significant burden to the United States health system but remains understudied.

OBJECTIVES

This study aimed to investigate the association between UPF consumption and incident gallstone disease risk.

METHODS

In this analysis, 44,149 males in the Health Professionals' Follow-up Study (HPFS: 1986-2022), 71,145 females in the Nurses' Health Study (NHS: 1986-2021), and 90,932 females in the NHS II (1991-2021) were prospectively followed. Dietary intake was quadrennially assessed with semiquantitative food frequency questionnaires and used to identify UPFs. The primary outcome was defined as cholecystectomy. Cox proportional hazards model was used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs).

RESULTS

Baseline median age was 54 y in HPFS, 53 y in NHS, and 36 y in NHS II. We identified 32,374 incident gallstone disease cases over 5,077,059 person-years. Participants in the highest UPF quintile had a higher incidence of gallstone disease than those in the lowest quintile (aHR: 1.29; 95% CI: 1.24, 1.36; P < 0.001). Incremental risk of incident gallstone disease was 2.8% per daily serving (95% CI: 2.4%, 3.2%; P < 0.001). This risk was driven by sugar-sweetened beverages and artificially sweetened beverages on UPF subgroup analyses. The proportion of risk mediated by obesity was 12.8% (95% CI: 7.7%, 20.5%; P < 0.001) in HPFS, 14.3% (95% CI: 10.4%, 19.4%; P < 0.001) in NHS, and 39.4% (95% CI: 31.2%, 48.1%; P < 0.001) in NHS II. The partial population attributable risk was estimated at 15.9% (95% CI: 13.4%, 18.3%).

CONCLUSIONS

UPF consumption is associated with a higher risk of gallstone disease, particularly consumption of sugar-sweetened beverages and artificially sweetened beverages. A substantial proportion of this risk is potentially mediated by obesity in younger females.

Co-Development of Three Dietary Indices to Facilitate Dietary Intake Assessment of Pediatric Crohn's Disease Patients

Literature on dietary behaviours of the pediatric Crohn's Disease (CD) population and the relationship between dietary intake and CD activity is limited. Three dietary indices were developed and tested to conduct dietary pattern analysis in pediatric patients with CD consuming a free diet following remission induction via exclusive enteral nutrition (n = 11). Index scores underwent descriptive and inferential analysis. The mean adjusted scores (out of 100) for the Pediatric Western Diet Index, Pediatric Prudent Diet Index, and Pediatric-Adapted 2010 Alternate Healthy Eating Index (PA2010-AHEI) were 29.82 ± 15.22, 34.25 ± 15.18, and 51.50 ± 11.69, respectively. The mean Western-to-Prudent ratio was 0.94 ± 0.55. A significant correlation (r = -0.71) and relationship (F[1, 9] = 9.04, P < 0.05, R2 = 0.501) between the Western-to-Prudent ratio and PA2010-AHEI was found. The results suggest participants were not following a Western or Prudent diet, and were consuming foods not captured by the indices. More research is needed to describe dietary intake of individuals with CD, validate dietary indices in diverse samples, and explore the utility of these indices in CD assessment and treatment. The co-authors hope this work will stimulate/inspire subsequent interprofessional, dietitian-led research on this topic.

Metabolomic profiles of incident gallstone disease

BACKGROUND AND AIMS

Gallstone disease affects ≥40 million people in the USA and accounts for health costs of ≥$4 billion a year. Risk factors such as obesity and metabolic syndrome are well established. However, data are limited on relevant metabolomic alterations that could offer mechanistic and predictive insights into gallstone disease. This study prospectively identifies and externally validates circulating prediagnostic metabolites associated with incident gallstone disease.

METHODS

Female participants in Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II) who were free of known gallstones (N=9960) were prospectively followed up after baseline metabolomic profiling with liquid chromatography-tandem mass spectrometry. Multivariable logistic regression and enrichment analysis were used to identify metabolites and metabolite groups associated with incident gallstone disease at PFDR<0.05. Findings were validated in 1866 female participants in the Women's Health Initiative and a comparative analysis was performed with 2178 male participants in the Health Professionals Follow-up Study.

RESULTS

After multivariate adjustment for lifestyle and putative risk factors, we identified and externally validated 17 metabolites associated with incident gallstone disease in women-nine triacylglycerols (TAGs) and diacylglycerols (DAGs) were positively associated, while eight plasmalogens and cholesterol ester (CE) were negatively associated. Enrichment analysis in male and female cohorts revealed positive class associations with DAGs, TAGs (≤56 carbon atoms and ≤3 double bonds) and de novo TAG biosynthesis pathways, as well as inverse associations with CEs.

CONCLUSIONS

This study highlights several metabolites (TAGs, DAGs, plasmalogens and CE) that could be implicated in the aetiopathogenesis of gallstone disease and serve as clinically relevant markers.

Association between dietary spermidine intake and depressive symptoms among US adults: National Health and Nutrition Examination Survey (NHANES) 2005-2014

BACKGROUND

Spermidine (SPD) has a number of advantageous effects, including life extension and neuroprotection. However, few observational studies have investigated the association of dietary SPD intake with depression.

METHODS

We used data from the 2005-2014 National Health and Nutrition Examination Survey (NHANES) and the corresponding Food Patterns Equivalents Database (FPED). SPD content of food groups from published data were merged with the appropriate FPED data to estimate the SPD intake for each subject. Patients with Patient Health Questionnaire-9 (PHQ-9) scores of 10 or above were thought to experience clinically relevant depression symptoms. Logistic regression, sensitivity analysis, and restricted cubic spline (RCS) were used.

RESULTS

Among the 19,306 participants, the overall prevalence of depression was 8.72 %. After controlling for relevant confounders, individuals in the highest tertile or quartile of total SPD and SPD derived from fruits, vegetables, cereals, nuts, eggs and seafood had a significantly lower prevalence of depression (OR total SPD = 0.77, 95 % CI: 0.63-0.93); OR fruit-sourced SPD = 0.81, 95 % CI: 0.68-0.95; OR vegetable-sourced SPD = 0.72, 95 % CI: 0.61-0.85; OR cereals-sourced SPD = 0.73,95 % CI:0.60-0.88; OR nuts- sourced SPD = 0.80, 95 % CI: 0.71-0.91; OR egg-sourced = 0.72, 95 % CI: 0.62-0.84 and OR seafood-sourced SPD = 0.65, 95 % CI: 0.55-0.77) comparing those in the lowest tertile or quartile.

CONCLOUSION

Our fndings reveal a negative association between dietary SPD intake and depression.

Long-term exposure to air pollution, greenness and temperature and survival after a nonfatal myocardial infarction

BACKGROUND

Little is known about the impact of environmental exposures on mortality risk after a myocardial infarction (MI).

OBJECTIVE

The goal of this study was to evaluate associations of long-term temperature, air pollution and greenness exposures with mortality among survivors of an MI.

METHODS

We used data from the US-based Nurses' Health Study to construct an open cohort of survivors of a nonfatal MI 1990-2017. Participants entered the cohort when they had a nonfatal MI, and were followed until death, loss to follow-up, end of follow-up, or they reached 80 years old, whichever came earliest. We assessed residential 12-month moving average fine particulate matter (PM2.5) and nitrogen dioxide (NO2), satellite-based annual average greenness (in a circular 1230 m buffer), summer average temperature and winter average temperature. We used Cox proportional hazard models adjusted for potential confounders to assess hazard ratios (HR and 95% confidence intervals). We also assessed potential effect modification.

RESULTS

Among 2262 survivors of a nonfatal MI, we observed 892 deaths during 19,216 person years of follow-up. In single-exposure models, we observed a HR (95%CI) of 1.20 (1.04, 1.37) per 10 ppb NO2 increase and suggestive positive associations were observed for PM2.5, lower greenness, warmer summer average temperature and colder winter average temperature. In multi-exposure models, associations of summer and winter average temperature remained stable, while associations of NO2, PM2.5 and greenness attenuated. The strength of some associations was modified by other exposures. For example, associations of greenness (HR = 0.88 (0.78, 0.98) per 0.1) were more pronounced for participants in areas with a lower winter average temperature.

CONCLUSION

We observed associations of air pollution, greenness and temperature with mortality among MI survivors. Some associations were confounded or modified by other exposures, indicating that it is important to explore the combined impact of environmental exposures.

Identification of interactions between genetic risk scores and dietary patterns for personalized prevention of kidney dysfunction in a population-based cohort

BACKGROUND & AIM

Chronic kidney disease (CKD) is a heterogeneous disorder that affects the kidney structure and function. This study investigated the effect of the interaction between genetic factors and dietary pattern on kidney dysfunction in Korean adults.

METHODS

Baseline data were obtained from the Ansan and Ansung Study of the Korean Genome and Epidemiology Study involving 8230 participants aged 40-69 years. Kidney dysfunction was defined as an estimated glomerular filtration rate < 90 mL/minute/1.73 m2. Genomic DNAs genotyped on the Affymetrix® Genome-Wide Human SNP array 5.0 were isolated from peripheral blood. A genome-wide association study using a generalized linear model was performed on 1,590,162 single-nucleotide polymorphisms (SNPs). To select significant SNPs, the threshold criterion was set at P-value < 5 × 10-8. Linkage disequilibrium clumping was performed based on the R2 value, and 94 SNPs had a significant effect. Participants were divided into two groups based on their generic risk score (GRS): the low-GR group had GRS > 0, while the high-GR group had GRS ≤ 0.

RESULTS

Three distinct dietary patterns were extracted, namely, the "prudent pattern," "flour-based and animal food pattern," and "white rice pattern," to analyze the effect of dietary pattern on kidney function. In the "flour-based and animal food pattern," higher pattern scores were associated with a higher prevalence of kidney dysfunction in both the low and high GR groups (P for trend < 0.0001 in the low-, high-GR groups of model 1; 0.0050 and 0.0065 in the low-, high-GR groups of model 2, respectively).

CONCLUSIONS

The results highlight a significant association between the 'flour-based and animal food pattern' and higher kidney dysfunction prevalence in individuals with both low and high GR. These findings suggest that personalized nutritional interventions based on GR profiles may become the basis for presenting GR-based individual dietary patterns for kidney dysfunction.

Adding more beans to the US typical dietary pattern can lead to greater intake of shortfall nutrients and a higher diet quality in younger and older adults

INTRODUCTION

Data on nutrient and diet quality outcomes when additional beans are consumed as part of the typical American dietary pattern are scarce. The purpose of this study was to assess the effect of increased bean consumption, in the typical American dietary pattern, on the intake of shortfall nutrients and overall diet quality.

METHODS

Using data from the US National Health and Nutrition Examination Survey, 2001-2018, the current analyses modeled the addition of one and two servings of canned and dried beans in all adults (N = 44,574; ≥19 y), younger adults (N = 23,554; 19-50 y) and older adults (N = 21,020; ≥51 y). The beans considered were kidney beans, black beans, chickpeas, and pinto beans.

RESULTS

The modeling of beans to the typical American dietary pattern resulted in significant increases in the intake of several shortfall nutrients, including dietary fiber, potassium, magnesium, iron, folate, and choline (p's < 0.0001). Modeling 1 and 2 servings of beans daily to the US typical dietary pattern significantly increased overall diet quality in all adult age groups considered. Total diet quality, as measured by Healthy Eating Index-2015 scores, was 15-16 % greater with an additional serving of beans and 19-20 % higher with 2 servings of beans relative to the US typical dietary pattern (p values<0.0001).

CONCLUSIONS

Dietary patterns that are rich in beans are associated with significantly higher diet quality scores and greater intake of shortfall nutrients, including nutrients of public health concern. Dietary guidance should consider the health benefits associated with the promotion of increased consumption of canned and dry beans in dietary patterns as benefits seen in younger adults continue to older adulthood.

Is there an "optimal" diet for prevention of inflammatory bowel disease?

Nutritional epidemiological studies have evolved from a focus of single nutrients to diet patterns to capture the protective role of healthy diets on chronic disease development. Similarly, in inflammatory bowel disease (IBD), a healthy diet may be protective against its development in individuals with genetic susceptibility, but the definitions of the optimal diet pattern deserve further exploration. Hence, this review article presents evidence, mainly from prospective cohort studies, for the role of diet quality based on adherence to dietary guidelines, traditional and modern diet patterns in the prevention of IBD. Findings from a limited number of studies on diet quality suggest that high diet quality scores are associated with lower risk of developing Crohn's disease, but the data are inconsistent for ulcerative colitis (UC). There are signals that a Mediterranean diet pattern reduces the risk of Crohn's disease but, again, the data are inconsistent and further studies are much needed. Finally, the evidence is conflicting regarding the role of food additives, with difficulties in the assessment of their intake, namely non-nutritive sweeteners and emulsifiers, precluding accurate assessment of a relationship with IBD risk. In contrast, emerging evidence for a role of ultra-processed food in the development of Crohn's disease but not UC is identified. Given the potential influence of diet quality, a Mediterranean diet and ultra-processed food intake on the risk of Crohn's disease, assessment and implementation of dietary advice for these patients need to be tailored. The search for an optimal diet for UC remains elusive and further research for increasing the evidence in the area is greatly needed.

Association between dietary patterns and periodontal disease: The OsteoPerio cohort study

AIM

To examine the association of dietary patterns with periodontal disease (PD) and its progression over 5 years.

MATERIALS AND METHODS

Analyses involved 1197 post-menopausal women from the OsteoPerio cohort. Dietary patterns assessed include Healthy Eating Index-2015 (HEI), Alternative HEI (AHEI), Dietary Approaches to Stop Hypertension (DASH) and alternate Mediterranean Diet (aMed) at baseline (the average of two food frequency questionnaires administered between 1993 and 2001). At baseline and the 5-year follow-up, periodontal assessments evaluated alveolar crestal height (ACH), probing pocket depth (PPD), clinical attachment loss (CAL), percentage of gingival sites bleeding on probing (%BOP) and missing teeth due to PD. Linear and logistic regression were used to examine the associations.

RESULTS

Cross-sectionally, HEI and aMed were associated with smaller CAL and %BOP; along with DASH, they were associated with a decreased odds of teeth missing due to PD. AHEI and aMed were associated with a decreased odds of severe PD. Prospectively, AHEI was associated with greater ACH progression. This association was attenuated to the null after loss of ACH was imputed for teeth lost due to PD over follow-up, or after excluding participants with diabetes, osteoporosis, hypertension or heart disease at baseline.

CONCLUSIONS

Better adherence to healthy dietary patterns was associated with better PD measures cross-sectionally but greater progression of ACH over 5 years. The latter might be explained by incident tooth loss due to PD and pre-existing comorbidities.