Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review

Loneliness and social isolation, mediating lifestyle factors, and incidence of COPD: A prospective cohort study

BACKGROUND

Limited information exists regarding the associations and pathways of loneliness and social isolation with chronic obstructive pulmonary disease (COPD). Our goal was to investigate the associations of loneliness and social isolation with COPD, as well as to analyze how lifestyle factors may play a role in mediating these effects.

METHODS

In the UK Biobank, 293,864 participants were included in this study. The study assessed five lifestyle factors: physical activity, eating habits, smoking, alcohol consumption, and body mass index (BMI). Incident COPD was detected through algorithms based on electronic health records. We used Cox proportional models to explore the association. Cause mediation analyses were applied to estimate the effect of various lifestyle factors.

RESULTS

In the fully adjusted model, the lonely participants had a greater risk of developing COPD (HR: 1.31; 95 % CI: 1.20-1.43) compared with those participants without loneliness. Similarly, the HR of social isolation on incident COPD was 1.39 (95 % CI: 1.30-1.48) after adjusting for potential confounders. Current smokers (21.9 %), unhealthy dietary characteristics (4.8 %), BMI (4.0 %), unhealthy drinking habits (1.4 %), and physical activity (0.7 %) explained 32.8 % of the association between loneliness and COPD. Likewise, current smokers, physical activity, and unhealthy drinking habit mediated 46.1 %, 4.7 %, and 4.2 % of the effect of social isolation on incident COPD.

LIMITATIONS

Despite extensive adjustment for potential confounders and several sensitivity analyses, residual confounding and reverse causality could not be ruled out.

CONCLUSION

Individuals with loneliness or social isolation have a higher risk of COPD, partly mediated through lifestyle factors.

Association between a healthy lifestyle and dementia in older adults with obesity: A prospective study in the UK biobank

BACKGROUND

The impact of adherence to low-risk lifestyle factors on dementia risk in individuals with obesity remains unclear. We aimed to explore the association between healthy lifestyles with dementia in obese participants.

METHODS

Dementia-free participants from the UK Biobank, aged 50 years or older with obesity (BMI ≥30 kg/m2) at baseline were included. A weighted healthy lifestyle score was calculated incorporating both traditional and emerging lifestyle factors. The primary outcome was all-cause dementia and its subtypes (Alzheimer's disease and Vascular dementia). Cox regression models analyzed the association between healthy lifestyle scores and dementia risk. Restricted cubic splines tested the dose-response. We also examined the effect of lifestyle scores on dementia risk in individuals with normal weight and overweight.

RESULTS

A total of 54,365 participants were included at baseline. During a median follow-up of 14.4 years, 1271 participants developed all-cause dementia, including 537 cases of Alzheimer's disease and 343 cases of vascular dementia. A 20 % increase in the lifestyle score was associated with a 7 % reduction in dementia risk (HR: 0.93; 95 % CI: 0.91,0.96) and a 4 % reduction in Alzheimer's disease risk (HR: 0.96; 95 % CI: 0.92,1.00). The association was stronger in overweight and obese participants. No significant link was found for vascular dementia.

LIMITATIONS

Information on lifestyle behaviors was self-reported and might be prone to measurement error.

CONCLUSIONS

Adherence to a healthy lifestyle may reduce the risk of dementia and Alzheimer's disease in older obese individuals, with a stronger effect observed in those with higher lifestyle scores.

Mitigating air pollution's impact on lung cancer in a large-scale longitudinal study: The unexplored potential of dietary interventions

BACKGROUND

Lung cancer remains a leading cause of cancer-related deaths globally, influenced by environmental and lifestyle factors. However, evidence on the impact of multiple air pollutants is limited. Moreover, their combined effect of air pollutants and dietary patterns on lung cancer remains unclear.

METHODS

This study used UK Biobank data to assess the impact of mixed air pollutants (PM10, PM2.5, NO2, NOx, and SO2) on lung cancer risk, with pollution scores based on weighted regression coefficients. Diet quality was measured using the Mediterranean Diet-based Healthy Diet Score. Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95 % confidence intervals (CIs).

RESULTS

Our analysis included 327,147 participants with 3705 incident lung cancer cases. Higher exposure to air pollutants significantly increased lung cancer risk (HR: 1.41, 95 % CI: 1.34-1.48 per interquartile range (IQR) increase in air pollution score). Per IQR increase, HRs (95 % Cis) for individual pollutants were as follows: PM10,1.25(1.19-1.32), PM2.5, 1.50(1.41-1.59), NO2, 1.35(1.29-1.42), NOx, 1.29(1.24-1.34), and SO2, 1.20(1.15-1.26). Conversely, a higher healthy diet score was associated with lower lung cancer risk, with each IQR increase corresponding to an HR of 0.88 (95 % CI: 0.85-0.90). The combination of high air pollution and an unhealthy diet showed synergistic effects (synergy index: 1.40, 95 % CI: 1.11-1.76), further elevating lung cancer risk.

CONCLUSIONS

Poor dietary habits exacerbate the adverse effects of long-term air pollution exposure on lung cancer risk. Public health interventions promoting dietary improvements and reducing air pollution are critical for lung cancer prevention.

Experiences of healthcare practitioners providing nutrition care to people with cancer in New Zealand: A qualitative study

Aim: To explore the perspectives and experiences of healthcare practitioners in providing nutrition care to people with cancer in New Zealand. Methods: Semi-structured interviews were conducted with 16 New Zealand healthcare professionals (HCPs) practicing in specialist secondary and tertiary cancer care (both public and private) who had previously completed an online survey about nutrition in cancer care. Interviews were recorded and transcribed verbatim, and thematic analysis was undertaken. Results: Participants identified nutrition as important in cancer care, from diagnosis to survivorship, in order to maximise recovery and ongoing health. While participants reported that the best person to provide high-quality individualised nutrition care is a dietitian, other HCPs also have a role in nutrition care. Limited nutrition care is currently available, especially for those in rural areas, which impacts health and equity in cancer care. Participants identified a need for increased dietitian capacity in the workforce as well as a need for nutrition resources that were accessible and appropriate. Conclusion: The perspective of participants was that more must be done to provide nutrition care as part of cancer care in New Zealand to improve health and wellbeing among people with cancer.

Food Rx: Integrating horticulture research to improve nutrition and health

It is clear that the escalating epidemic of insulin resistance and type 2 diabetes has reached a crisis level in the United States, that overweight and obesity are drivers, and that diets and the food system have major roles. It is also clear that nutrition and medical research point to increased healthful fruit and vegetable intake as a key part of any strategy to manage the crisis. But although increasing healthful intake entails both expanding production of fruits and vegetables and improving their healthful characteristics, horticulture has generally been sidelined or taken for granted when strategies are envisioned. This article makes the case that horticulture research and practice can and should be equal partners with nutrition and medicine in the pressing search for effective crisis-management strategies. To do so, it first "runs the numbers" for the scale of the crisis, for trends in fruit and vegetable intake and production, for the scant federal support for horticultural crop production and research, and for horticulture research's high return on investment. The article then sketches a roadmap to integrate horticulture research and community outreach with nutrition and healthcare, stressing new opportunities. The goal is a US food system that i) makes healthful fruits and vegetables accessible, affordable, and appealing for all and ii) complements a healthcare system spanning patient-based to population-based nutrition.

Fish oil reduces intestinal fat absorption by promoting lacteal junction zippering via GPR120-VEGFR3-MLCK pathway

INTRODUCTION

Diet-induced obesity can be improved by reducing intestinal fat absorption. Fish oil, enriched in n-3 PUFAs such as DHA and EPA, has shown promise in weight reduction. However, the role of fish oil in regulating intestinal fat absorption and the possible underlying mechanism remains largely unknown.

OBJECTIVES

The aim of this study was to understand the mechanism underlying the fish oil elicited anti-obesity effects.

METHODS

HFD-fed mice were subjected to fish oil and lymphatic endothelial cells (LECs) were treated with DHA or EPA. The intestinal fat absorption, the lacteal zipper-like junctions, and the involvement of GPR120-VEGFR3-MLCK pathway were assessed.

RESULTS

We found that fish oil gavage suppressed intestinal fat absorption associated with elevated proportion of lacteal zipper-like junctions and decreased expression of VEGFR3 in mice jejunum. Meanwhile, inhibition of VEGFR3 signaling in HFD-fed mice enhanced zipper-like junctions in jejunal lacteal to reduce fat absorption and combat obesity. In addition, DHA and EPA increased the proportion of zipper-like junctions via downregulation of VEGFR3 signaling in PA-treated LECs. However, activation of VEGFR3 signaling with VEGFC or inhibition of GPR120 with AH-7614 totally blocked the elevation of zipper-like junctions induced by DHA and EPA. Furthermore, DHA and EPA inhibited MLCK signaling in a GPR120-VEGFR3 dependent manner and inhibition of MLCK mimicked the promotive effects of DHA and EPA on zipper-like junctions. These in vitro results suggested that DHA and EPA increased the proportion of zipper-like junctions in PA-treated LECs through the GPR120-VEGFR3-MLCK signaling pathway. Finally, fish oil supplementation reduced intestinal fat absorption, promoted lacteal zipper-like junctions, enhanced GPR120 expression, inhibited VEGFR3 expression and MLCK signaling.

CONCLUSION

Overall, these findings showed for the first time that fish oil reduced intestinal fat absorption by promoting lacteal junctions zippering via GPR120-VEGFR3-MLCK pathway.

Association of healthy lifestyle with excess risk of dementia in individuals with hypertension

BackgroundThe extent to which hypertension-related excess risk of dementia can be mitigated or eradicated through lifestyle factor modification remains unclear.ObjectiveTo explore the association between lifestyle behaviors and hypertension-related excess risk of dementia.MethodsIn this prospective cohort study using data from the UK Biobank, participants were enrolled from 2006 to 2010 and followed up until December 2022. A healthy lifestyle score was constructed by assigning one point for each of the seven selected healthy lifestyle factors. The association of dementia risk in individuals with hypertension according to the healthy lifestyle score was compared to individuals without hypertension.ResultsThis study included 337,378 individuals. During a median follow-up of 13.6 years, 5390 participants developed dementia. A higher healthy lifestyle score was associated with a gradual decrease in the excess risk of dementia for individuals with hypertension compared to individuals without hypertension. Excess dementia risk was not detected among individuals with hypertension who adopted at least six healthy lifestyle factors (hazard ratio (HR) = 1.05 (95% confidence interval (CI): 0.96-1.14)) for six scores; HR = 0.93 (95% CI: 0.82-1.06 for seven scores). The protective association between adhering to all seven healthy lifestyle factors and dementia was significantly stronger for individuals <60 years old than for individuals ≥60 years old.ConclusionsFor individuals with hypertension who adopted at least six healthy lifestyle factors had no hypertension-related excess risk of dementia.

Comorbid cardiovascular diseases and predictors among adults with type 2 diabetes in Bahir Dar city, Ethiopia: a multicentre hospital-based cross-sectional study

OBJECTIVE

The burden of comorbid cardiovascular disease (CVD) and its preventable factors in type 2 diabetes is not well acknowledged in Ethiopia. Therefore, this study aimed to identify the magnitude of comorbidity of CVD and predictors among individuals with type 2 diabetes.

DESIGN

A multicentre hospital-based cross-sectional study.

SETTING

Bahir Dar city Administration Public Hospitals, Ethiopia.

METHODS

Data on comorbid CVDs among individuals with type 2 diabetes were collected through patient chart reviews. To identify predictors of CVDs in type 2 diabetes, information on lifestyle and psychosocial characteristics, medication and dietary adherence, and disease management status was collected using standardised questionnaires. Statistical analyses were performed using SPSS V.26. The level of statistical significance was set at p<0.05, with ORs and 95% CIs.

RESULTS

The participants' mean age (±SD) was 51.5±10.9 years. The overall prevalence of comorbid CVDs among type 2 diabetes was 27.9% (95% CI 23.6% to 32.3%). Factors that statistically predicted the occurrence of comorbid CVDs in type 2 diabetes were: age >60 years (adjusted ORs (AORs)=2.6, 95% CI 1.1 to 6.6), non-adherence to diabetes-friendly diet (AOR=4.0, 95% CI 1.9 to 8.2), low medication adherence (AOR=2.8, 95% CI 1.5 to 5.3), being overweight (AOR=5.3, 95% CI 2.9 to 9.8), and diabetes duration >10 years (AOR=3.7, 95% CI 1.7 to 8.1).

CONCLUSION

Comorbid cardiovascular disease is a significant issue among type 2 diabetic patients. Its prevalence is higher in patients over 60 years of age, with modifiable factors identified as key contributors. Appropriate interventions are recommended, including educating type 2 diabetic patients on dietary regimens, medication adherence, weight management, and the benefits of timely healthcare for effective disease management.

The portfolio dietary pattern and risk of cardiovascular disease mortality during 1988-2019 in US adults: a prospective cohort study

BACKGROUND

The Portfolio Diet, a dietary pattern of cholesterol-lowering foods, has been shown to reduce cardiovascular disease (CVD) risk factors in clinical trials and lower CVD risk in observational cohorts of mainly white men and women. However, evidence on mortality outcomes in diverse populations is limited.

OBJECTIVE

To examine the association of the Portfolio dietary pattern with CVD mortality in a racially diverse cohort.

METHODS

A total of 14,835 US adults from the National Health and Nutrition Examination Survey, NHANES (1988-1994), were included. Diet was assessed by a 24-h dietary recall which was supplemented with a food frequency questionnaire at baseline using the Portfolio Diet Score (PDS), with positive points for nuts, plant protein, viscous fiber, phytosterols, and plant monounsaturated fatty acid sources, and negative points for foods high in saturated fat and cholesterol (range, 6-30 points). The primary outcome was CVD mortality. Other mortality outcomes included coronary heart disease (CHD), stroke, and all-cause mortality.

RESULTS

During 22 years of follow-up, 2300 CVD deaths, including 1887 CHD deaths, 413 stroke deaths, and 6238 all-cause deaths were documented. Greater adherence was inversely associated with risk factors including blood lipids, glycemia, and inflammation. Treated as a continuous variable, an increase in PDS by 8 points was associated with a 12% (hazard ratio 0.88 [95% confidence intervals:0.78, 0.99]), 14% (0.86 [0.78, 0.96]), and 12% (0.88 [0.82, 0.95]) lower risk of CVD, CHD, and all-cause mortality after adjustments for known CVD risk factors. Comparing the highest to lowest tertiles of the PDS, higher PDS was associated with 16% (0.84 [0.73, 0.98]), 18% (0.82 [0.72, 0.95]) and 14% (0.86 [0.78, 0.96]) lower risk of CVD, CHD, and all-cause mortality, respectively. As part of exploratory analyses, an interaction between PDS and race/ethnicity was observed, emphasizing the necessity of future research involving underserved groups.

CONCLUSIONS

Among a national cohort of racially diverse adults in the US, greater adherence to the Portfolio dietary pattern was inversely and prospectively associated with CVD, CHD, and all-cause mortality.

Chemical discovery of a novel MD2/ADAM17 dual-target inhibitor as a potential therapeutic candidate for saturated fatty acid-induced myocardial inflammatory injury

BACKGROUND AND AIMS

While the therapeutic promise of anti-inflammatory interventions for obesity-associated cardiomyopathy is well recognized, clinically effective targeted therapies remain to be developed. Here, through systematic anti-inflammatory screening, we elucidated both the therapeutic efficacy and mechanistic basis of a novel indole-substituted acetamide derivative (compound #3) in mitigating obesity-induced cardiomyopathy.

METHODS

A high-fat diet (HFD)-induced obese mouse model was used to evaluate the cardioprotective efficacy of compound #3. Integrated in vivo and in vitro studies, including transcriptomics, reverse molecular docking, proteomics, surface plasmon resonance, and kinase activity assays, were conducted to systematically identify molecular targets and elucidate the underlying mechanisms.

RESULTS

Compound #3 attenuated hypertension in HFD-induced obese mice without altering metabolic parameters (body weight, blood glucose, and lipid levels). This cardioprotective effect was attributed to improved cardiac function and anti-inflammatory mechanisms, including the suppression of NF-κB-driven inflammatory injury. Mechanistic studies revealed that compound #3 targeted the L348 residue of ADAM17, disrupting ADAM17-dependent inflammatory signal amplification. This cascade was primarily initiated by the MD2-P38MAPK/JNK-iRhom2 axis. In addition, compound #3 directly bound to MD2, inhibiting palmitic acid (PA)-induced activation of P38MAPK and JNK. This mechanism blocked the initiation of inflammatory responses and further suppressed ADAM17 and cytokine transcription through the P38MAPK-AP1 axis.

CONCLUSION

Compound #3 exhibits a dual-targeting mechanism by simultaneously inhibiting MD2 and ADAM17, which effectively suppresses both the initiation (via the MD2-P38MAPK/JNK) and amplification (via the P38MAPK/JNK-iRhom2-ADAM17 axis) of inflammatory cascades, highlighting its strong therapeutic promise for treating saturated fatty acid-induced myocardial pathologies.

Associations of Alcohol Consumption and Genetic Predisposition to Hepatic Steatosis With Liver-Related Events: Results From Large Population-Based Cohort Studies

BACKGROUND & AIMS

The new classification for steatotic liver disease identifies 3 phenotypes based on alcohol consumption. The aim of this study was to evaluate the associations between alcohol intake and liver-related events (LREs) across different drinking categories and whether genetic predisposition influences these associations.

METHODS

Data from 301,673 UK Biobank participants were analyzed. Alcohol consumption was self-reported and categorized by weekly intake as mild (< 140 g for females and < 210 g for males), moderate (140-350 g for females and 210-420 g for males), and heavy (> 350 g in females and > 420 g for males). A polygenic risk score based on 5 well-known single nucleotide polymorphisms associated with hepatic steatosis was calculated. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazard models. The analysis was validated in 47,252 participants from China Kadoorie Biobank.

RESULTS

During a median follow-up of 12.8 years, 1742 incident cases of LREs were documented. The multivariable-adjusted HRs per SD increment in alcohol intake for LREs were 0.95 (95% CI, 0.89-1.02) among mild drinkers, 1.23 (95% CI, 1.10-1.37) among moderate drinkers, and 1.18 (95% CI, 1.14-1.22) among heavy drinkers. The associations appeared stronger in those with high genetic risk. Compared with adults with low genetic risk and mild alcohol consumption, those with high genetic risk and heavy alcohol consumption had higher risks of LREs (HR, 6.50; 95% CI, 5.26-8.04; P for interaction < .001). Similar findings were observed in China Kadoorie Biobank.

CONCLUSIONS

Associations between alcohol intake and LREs vary across different drinking categories. Individuals with a higher genetic risk for steatotic liver disease appear more susceptible to alcohol.

Ten-year trajectories of ultra-processed food intake and prospective associations with cardiovascular diseases and all-cause mortality: findings from the Whitehall II cohort study

BACKGROUND

Ultra-processed food (UPF) intake has been associated with adverse health outcomes; however, research on UPF intake and cardiovascular disease (CVD) prognosis has largely neglected its longitudinal pattern over time. This study investigated trajectories of UPF intake over a decade and their prospective associations with the risk of fatal and non-fatal CVD, as well as all-cause mortality, using data spanning from 16 to 19 years.

METHODS

This study utilized data from the British Whitehall II cohort study, including 7,138 participants (68.3% male; median baseline age 60.4 years), all free of CVD at baseline. Dietary intake was assessed using a validated 127-item food frequency questionnaire at three time points: phase 3 (1991-1994), phase 5 (1997-1999), and phase 7 (2002-2004). UPF intake was estimated using the Nova classification, and group-based trajectory modelling identified different longitudinal consumption patterns. Phase 7 (2002-2004) was the baseline for subsequent monitoring of cardiovascular events and mortality outcomes until 2019/2021. Multivariate Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for socio-demographics, lifestyle, diet quality, energy intake, and clinical factors.

RESULTS

Three distinct UPF trajectory groups were identified: high (26.2% of participants), moderate (52.9%) and low UPF intake (20.9%). All groups showed a slight increase in UPF intake over time. Over the median follow-up of 16 years for incident cases and 19 years for mortality, we observed 1,128 incident CVD events, 859 CHD cases and 1,314 deaths. The highest vs. lowest UPF intake group had a 23% higher risk of CVD (HR 1.23, 95% CI 1.01 to 1.40), and a 32% higher risk of CHD (HR 1.32, 95% CI 1.06 to 1.65). No significant associations were observed between UPF trajectory groups and CVD mortality, CHD mortality, or all-cause mortality.

CONCLUSIONS

Sustained high UPF intake over 10 years was associated with increased risks of non-fatal CVD and CHD but not with CVD-specific, CHD-specific, or all-cause mortality. These findings suggest that sustained high intake of UPF may be a modifiable risk factor for preventing non-fatal cardiovascular risks.

Association between saturated and polyunsaturated fatty acid proportions in total fat intake and mortality risk: mediation by the neutrophil percentage-to-albumin ratio

BACKGROUND

For over half a century, dietary guidelines have consistently advocated for the substitution of saturated fatty acids (SFA) with monounsaturated (MUFA) and polyunsaturated fatty acids (PUFA) as a cornerstone strategy for health life, but evidence on independent associations between specific fatty acids and mortality remains inconsistent.

METHODS

This prospective cohort study from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 analyzed 21,823 participants aged 20-80 years. Survey-weighted Cox regression assessed associations between SFA, MUFA, PUFA intake, and their ratios to the total fat (TFAT) intake quantity, and all-cause mortality. Mediation analyses examined whether the neutrophil percentage-to-albumin ratio (NPAR) mediated the effects of fatty acid-related parameters on mortality risk.

RESULTS

In multivariable-adjusted models, no significant trends were observed for all-cause mortality across tertiles of SFA, MUFA, or PUFA intake. In multivariable-adjusted Cox models, the highest tertile of SFA/TFAT ratio was significantly associated with elevated mortality risk (HR = 1.23, p for trend < 0.01). Conversely, the highest PUFA/TFAT tertile demonstrated a protective association (HR = 0.86, p for trend < 0.01). However, the MUFA/TFAT ratio showed no significant mortality association across tertiles (p for trend = 0.137). Mediation analysis revealed that NPAR mediated 9.8% and 11.8% of SFA/TFAT and PUFA/TFAT effects on mortality risk, suggesting partial mediation through a shared inflammatory pathway.

CONCLUSION

This study provides the novel evidence that the proportional composition of dietary fatty acids within total fat intake-rather than their absolute intake levels-is a critical determinant of longevity. By demonstrating that replacing SFA with PUFA reduces mortality risk through NPAR-mediated inflammatory pathways, our findings inform the World Health Organization's 2023 guidelines on dietary fat modification. These results shift the paradigm from isolated nutrient restrictions to balanced fatty acid ratios, offering a novel mechanistic basis for public health strategies aimed at extending healthy lifespan.

Risk factors for cardiovascular disease among Saudi students: Association with BMI, current smoking, level of physical activity, and dietary habits

Cardiovascular disease (CVD) risk factors, including poor diet, lack of physical activity (PA), smoking, and obesity, are associated with unhealthy lifestyle choices and contribute significantly to the global disease burden. This study aims to investigate the prevalence of behavioral risk factors associated with overweight/obesity, PA, smoking, and eating habits among Saudi students and explores how these vary by region, age, gender, relationship status, and income. A total of 968 participants (285 males and 681 females), aged 18-50, were recruited from bachelor's, master's, doctoral, and other university programs across the Eastern, Riyadh, and Western provinces. Each participant completed the Saudi Food Frequency Questionnaire (SFFQ). The risk of CVD was assessed by summing individual risk factors related to BMI, tobacco use, PA level, glycemic load (GL) of ingested foods, and consumption of saturated fats (SF), processed meats, oily fish, nuts, and cereal fiber (CF). Participants were classified into minimal, medium, or high-risk categories based on their total scores. A high prevalence of CVD risk factors was observed, with 93.6% of participants having three or more risk factors. After adjusting for demographic variables, living in Riyadh was associated with a 12% lower probability of CVD risk. Conversely, students aged 46-50 showed a five- to nine-fold increase in CVD risk. Significant factors influencing CVD risk included BMI (Exp(β) = 11.70), smoking status (Exp(β) = 6.54), PA (Exp(β) = 7.61), SF intake (Exp(β) = 4.79), GL (Exp(β) = 7.00), CF intake (Exp(β) = 24.58), and oily fish consumption (Exp(β) = 2.99). Low CF intake and high BMI were the most prominent risk factors. Lifestyle interventions targeting overweight/obesity, physical inactivity, smoking, high GL and SF intake, and promoting CF and oily fish consumption could improve CV health among participants. Addressing these modifiable risk factors is essential for effective prevention.

Association of phenotypic aging, lifestyle, and genetic risk with incidence of atrial fibrillation: A large prospective cohort study in the UK Biobank

OBJECTIVES

Our study aimed to investigate the association of phenotypic aging, lifestyle, and genetic risk with the risk of incident atrial fibrillation (AF).

DESIGN

A large prospective cohort study.

SETTING AND PARTICIPANTS

This study included 327,122 participants from the UK Biobank.

METHODS

PhenoAge acceleration (PhenoAgeAccel) was calculated by regressing phenotypic age (PhenoAge) on chronological age. Two key stratification tools were derived from previous research: the Healthy Lifestyle Score (HLS) based on smoking, body mass index (BMI), physical activity, and diet, to assess participants' lifestyles; and the polygenic risk score (PRS) based on 104 AF-associated SNPs and their effect sizes identified in a GWAS to evaluate genetic risk. Cox proportional hazards models were employed to assess both independent and combined effects of PhenoAgeAccel, HLS, and PRS with AF risk.

RESULTS

At a median follow-up of 10.84 (10.08-11.56) years, 15,997 cases of AF were identified. Each standard deviation (SD) increase in PhenoAgeAccel was associated with a 30% higher AF risk (HR 1.30, 95% CI 1.28-1.31). Participants biologically older (PhenoAgeAccel>0) had a significantly higher risk of AF (HR 1.47, 95% CI 1.42-1.51) compared to those biologically younger (PhenoAgeAccel≤0), whereas ideal HLS was significantly associated with a lower risk of AF (HR 0.52, 95% CI 0.49-0.56 vs. poor HLS), and high genetic risk was significantly associated with a higher risk of AF (HR 2.30, 95% CI 2.21-2.39 vs. low genetic risk). Joint effects and multiplicative/additive interactions were noted between PhenoAgeAccel and HLS (or genetic risk). When combined PhenoAgeAccel and genetic risk, participants biologically older and in high genetic risk had the highest AF risk (HR 3.52, 95% CI 3.31-3.74). When combined PhenoAgeAccel and HLS, participants who were biologically older and had a poor lifestyle had the highest AF risk (HR 2.42, 95% CI 2.23-2.62). Further analysis categorized PhenoAgeAccel into quartiles based on its population distribution, and the associations remained consistent.

CONCLUSIONS

Increased PhenoAgeAccel is significantly associated with increased risk of AF. When combined with a poor lifestyle or high genetic risk, the risk is further increased. These findings highlight the importance of integrating phenotypic aging, genetic risk, and lifestyle factors into AF prevention strategies.

Dietary Approaches to Stop Hypertension (DASH) for the primary and secondary prevention of cardiovascular diseases

BACKGROUND

The Dietary Approaches to Stop Hypertension (DASH) diet is designed to lower blood pressure and improve cardiovascular health by reducing sodium and unhealthy fats while increasing nutrients, including potassium, calcium, magnesium, and fibre. While evidence supports its benefits for managing cardiovascular risk factors, gaps remain in understanding its long-term impact on preventing cardiovascular disease (CVD), particularly in terms of hard clinical outcomes such as myocardial infarction and stroke.

OBJECTIVES

To assess the effects of the DASH diet for the primary and secondary prevention of cardiovascular diseases.

SEARCH METHODS

We used standard extensive Cochrane search methods. The latest search date was in May 2024.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing a DASH diet intervention to no intervention (including usual care), minimal intervention, or other dietary interventions. In the context of this review, 'minimal intervention' includes brief dietary advice or informational leaflets provided during a medical consultation, without a structured dietary intervention. 'Other dietary interventions' include any other dietary programme besides the DASH diet. Participants were adults with or without CVD. The minimum duration of eligible interventions was eight weeks and the minimum follow-up was three months.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Primary outcomes were myocardial infarction, heart failure, and stroke. Secondary outcomes were the need for coronary revascularisation, carotid revascularisation, peripheral revascularisation, all-cause mortality, cardiovascular mortality, changes in blood pressure, blood lipids, the occurrence of type 2 diabetes, health-related quality of life, and adverse effects. We used GRADE to assess the certainty of evidence for each outcome.

MAIN RESULTS

Five RCTs involving 1397 participants met our inclusion criteria and were included in this review. All five trials contributed at least one intervention arm to one or more of the three prespecified comparisons. In total, 1075 participants across eligible arms were included in the meta-analyses. The difference reflects trial arms that did not meet our prespecified intervention and comparison definitions, and were therefore not analysed, though all participants were randomised within eligible trials and are accounted for in the review total. The trials assessed the DASH diet in a primary prevention setting; none evaluated its effects in secondary prevention. Participants were generally healthy adults aged 18 years or older, without diagnosed cardiovascular disease. The intervention duration ranged from 16 weeks to 12 months, with follow-up periods between 16 weeks and 18 months (medium- and long-term). The trials were conducted in the USA and Poland, with funding from public institutions, including the National Institutes of Health, the National Heart, Lung, and Blood Institute, and the Institute of Cardiology in Poland. DASH diet versus no intervention (including usual care) Myocardial infarction: one trial (144 participants) reported no myocardial infarctions in either group over a one-year follow-up. The GRADE certainty rating was low due to the high risk of performance bias and imprecision. Stroke: one trial (144 participants) reported no strokes in either group over the same follow-up period. The GRADE rating was low for similar reasons. All-cause mortality: one trial (90 participants) reported no deaths over a six-month follow-up. The GRADE rating was very low due to unclear risk of selection bias, high risk of performance bias, and imprecision. No data were available for heart failure or revascularisation needs (coronary, carotid, or peripheral) in this comparison. DASH diet versus minimal intervention Myocardial infarction: two trials (902 participants in total; 629 participants were in trial arms eligible for this comparison, based on our prespecified intervention and comparison definitions) reported limited events, with no clear differences between groups over one year (risk ratio (RR) 2.99, 95% confidence interval (CI) 0.12 to 73.04). The GRADE rating was low due to high risk of performance bias and imprecision. Stroke: two trials (reporting on the same 629 participants) reported no strokes in either group over follow-up periods ranging from six months to one year. The GRADE rating was low due to similar concerns. No data were available for heart failure, revascularisation needs (coronary, carotid, or peripheral), or all-cause mortality in this comparison. DASH diet versus another dietary intervention All-cause mortality: one trial (261 participants) reported no clear difference between the groups over one year (RR 2.98, 95% CI 0.12 to 72.42). The GRADE rating was very low due to multiple risks of bias and imprecision. No data were available for myocardial infarction, stroke, heart failure, or revascularisation needs in this comparison.

AUTHORS' CONCLUSIONS

The effect of the DASH diet on major cardiovascular outcomes - including myocardial infarction, stroke, cardiovascular mortality, and all-cause mortality - remains inconclusive due to a lack of robust long-term evidence. Additionally, no trials have assessed its impact on heart failure or the need for revascularisation procedures, such as coronary, carotid, or peripheral interventions. While the DASH diet may reduce blood pressure, total cholesterol, and triglyceride levels while increasing high-density lipoprotein (HDL) cholesterol compared to no intervention or usual care, it appears to have little to no effect on low-density lipoprotein (LDL) cholesterol. Evidence comparing the DASH diet to a minimal intervention or alternative dietary approaches remains limited. Although the DASH diet has minimal reported adverse effects, the absence of long-term safety data prevents definitive conclusions on its use in individuals with or without cardiovascular disease. The certainty of evidence is low to very low, primarily due to design limitations such as high risk of bias, small sample sizes, and short follow-up periods in the included trials. Most studies focused on cardiovascular risk factors rather than long-term clinical outcomes, and all eligible trials assessed primary prevention, with no data on secondary prevention. Given these uncertainties, well-designed, long-term randomised controlled trials are needed to evaluate the DASH diet's impact on major cardiovascular events, its effectiveness in secondary prevention, and its long-term safety.

Accelerometer-Measured Physical Activity and Neuroimaging-Driven Brain Age

Background: A neuroimaging-derived biomarker termed the brain age is considered to capture the degree and diversity in the aging process of the brain, serving as a robust indicator of overall brain health. The impact of different levels of physical activity (PA) intensities on brain age is still not fully understood. This study aimed to investigate the associations between accelerometer-measured PA and brain age. Methods: A total of 16,972 eligible participants with both valid T 1-weighted neuroimaging and accelerometer data from the UK Biobank was included. Brain age was estimated using an ensemble learning approach called Light Gradient-Boosting Machine (LightGBM). Over 1,400 image-derived phenotypes (IDPs) were initially chosen to undergo data-driven feature selection for brain age prediction. A measure of accelerated brain aging, the brain age gap (BAG) can be derived by subtracting the chronological age from the estimated brain age. A positive BAG indicates accelerated brain aging. PA was measured over a 7-day period using wrist-worn accelerometers, and time spent on light-intensity PA (LPA), moderate-intensity PA (MPA), vigorous-intensity PA (VPA), and moderate- to vigorous-intensity PA (MVPA) was extracted. The generalized additive model was applied to examine the nonlinear association between PA and BAG after adjusting for potential confounders. Results: The brain age estimated by LightGBM achieved an appreciable performance (r = 0.81, mean absolute error [MAE] = 3.65), which was further improved by age bias correction (r = 0.90, MAE = 3.03). We found that LPA (F = 2.47, P = 0.04), MPA (F = 6.49, P < 1 × 10-300), VPA (F = 4.92, P = 2.58 × 10-5), and MVPA (F = 6.45, P < 1 × 10-300) exhibited an approximate U-shaped relationship with BAG, demonstrating that both insufficient and excessive PA levels adversely impact brain aging. Furthermore, mediation analysis suggested that BAG partially mediated the associations between PA and cognitive functions as well as brain-related disorders. Conclusions: Our study revealed a U-shaped association between accelerometer-measured PA and BAG, highlighting that advanced brain health may be attainable through engaging in moderate amounts of objectively measured PA irrespectively of intensities.

Peumus boldus Extract Inhibits Lipid Accumulation in 3T3-L1 Adipocytes

Obesity is a metabolic condition of epidemic scale. Previously, we showed that antioxidant extracts from Ribes nigrum had antioxidant and anti-adipogenic effects in mature adipocytes (AD). Here, we evaluated an aqueous extract from Peumus boldus (Boldo) in AD and studied its effect on reactive oxygen species (ROS) and lipid production. We analyzed the antioxidant activity (AA) of the Boldo extract using the DPPH technique and polyphenol (Pph) content via Folin's reagent. In AD, we evaluated ROS production, catalase (CAT) activity, intracellular triglyceride (Tg) and cholesterol (Chol) contents, nitric oxide (NO) production via Griess reagent, and the levels of glycerol (Gly) and TNF-α released in the culture medium. We showed that the Boldo extract has high AA. In vitro, Boldo treatment decreased ROS intracellular production and CAT activity. In addition, the Boldo extract was effective in reducing Tg and Chol levels and NO production. We did not identify significant differences in Gly released or TNF-α secreted. We suggest that the Boldo extract has antioxidant and anti-adipogenic effects, but we did not observe lipolytic effects. Boldo did not modify inflammatory markers.

Estimates and projections in the economic impacts of fifteen dietary risk factors for two hundred four countries and territories from 2020 to 2050: A health-augmented macroeconomic modeling study

BACKGROUND

Suboptimal diet results in significant health and economic burdens. However, the global economic costs of dietary risks remain unclear.

OBJECTIVES

This study aimed to estimate the macroeconomic burden of 15 dietary risk factors in 204 countries and territories from 2020 to 2050.

METHODS

This health-augmented macroeconomic modeling study assessed the macroeconomic burden that accounted for the decrease in labor supply across different education levels due to mortality and morbidity, as well as the impact of healthcare expenses on investment and savings. Country-specific data were drawn from publicly accessible databases. The cumulative difference in the aggregate output between a realistic scenario without intervention and a counterfactual scenario assuming complete disease elimination was quantified as the macroeconomic burden attributable to diseases. The proportion of disease burden attributed to dietary risk factors was quantified using population-attributable fractions derived from the global burden of disease study 2019, which was integrated into the health-augmented macroeconomic model. Estimates were converted to 2017 international dollars (INT $).

RESULTS

The estimated global macroeconomic burden attributable to dietary risks from 2020 to 2050 was INT $15,491 [uncertainty interval 13078, 18742] billion, representing 0.34% (uncertainty interval 0.29%, 0.41%) of the total gross domestic product. The macroeconomic burden was unevenly distributed across countries, regions, income groups, disease types, and dietary risk factors. The United States (INT $3972 billion), China (INT $2764 billion), and India (INT $1300 billion) had the largest macroeconomic burden. Ischemic heart disease (INT $9384 billion), diabetes (INT $2392 billion), and stroke (INT $1954 billion) accounted for ∼90% of the overall macroeconomic burden. A diet low in whole grains (INT $3808 billion) incurred the highest cost, followed by a diet high in sodium (INT $2812 billion) and red meat (INT $2337 billion).

CONCLUSIONS

The global macroeconomic burden attributable to dietary risks was substantial and varied across countries, regions, income groups, disease types, and individual dietary risk factors.

Food literacy and eating motivation in relation to diet quality and general and abdominal obesity: A cross-sectional study

This cross-sectional study aimed to investigate the associations of food literacy and eating motivation with diet quality and obesity. Participants were 1055 Japanese adults aged 20-69 years. The self-perceived food literacy scale was used to assess food literacy (food preparation skills, resilience and resistance, healthy snack styles, social and conscious eating, examining food labels, daily food planning, healthy budgeting, and healthy food stockpiling). The Eating Motivation Survey was used to assess eating motives (liking, habits, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image). Diet quality (Healthy Eating Index-2020) was assessed based on 4-day weighed dietary records. After adjustment for potential confounders, higher scores for food preparation skills (β 0.64), healthy snack styles (β 1.62), examining food labels (β 0.72), healthy budgeting (β 0.71), and natural concerns motive (β 0.75) and lower scores for convenience (β -0.45) and pleasure (β -0.62) motives were significantly associated with a higher diet quality. In contrast, higher scores for liking (odds ratio (OR) 1.32) and weight control (OR 1.19) motives and lower scores for resilience and resistance (OR 0.76), daily food planning (OR 0.84), and health motive (OR 0.67) were significantly associated with a higher prevalence of abdominal obesity (waist circumference ≥90 cm for males; ≥80 cm for females); all of these variables (except for daily food planning) were also associated with general obesity (body mass index ≥25 kg/m2). In conclusion, the food literacy domains and eating motives associated with diet quality differed from those associated with obesity. The findings have important implications for effective strategies to improve diet quality and combat the obesity epidemic.

Exploring Environmental and Cardiometabolic Impacts Associated with Adherence to the Sustainable EAT-Lancet Reference Diet: Findings from the China Health and Nutrition Survey

BACKGROUND

To contribute to the growing evidence on the potential co-benefits of the EAT-Lancet reference diet for cardiometabolic health and sustainability, we investigated this topic in a nationwide prospective cohort of Chinese adults. Adherence to this diet has been measured using several indices, including the World Index for Sustainability and Health (WISH) and the Planetary Health Diet Index (PHDI).

OBJECTIVES

We aimed to investigate the associations between adherence to the EAT-Lancet reference diet, as evaluated by WISH and PHDI, with risk of new-onset cardiometabolic diseases (CMDs), risk of all-cause mortality, and greenhouse gas (GHG) emissions.

METHODS

We included adults (n = 14,652 for CMDs and 15,318 for all-cause mortality) from the China Health and Nutrition Survey (1997-2015) in the analysis. Dietary intake data were collected, and WISH and PHDI scores were computed with established methods. CMDs included myocardial infarction (MI), type 2 diabetes mellitus (T2DM), and stroke. We used Cox proportional hazard regression models to analyze data with a mean of 10 years of follow-up from the date of baseline to the end of study or until the occurrence of the event of interest, whichever came first. We adjusted for sociodemographic, anthropometric, lifestyle, and dietary characteristics of participants as confounders.

RESULTS

Greater adherence to the EAT-Lancet reference diet, as reflected by higher WISH or PHDI scores, was inversely associated with risk of MI {Q4 vs. Q1: hazard ratio  ( HR ) = 0.68 [95% confidence interval (CI): 0.48, 0.96] for WISH and 0.14 (95% CI: 0.07, 0.29) for PHDI}, T2DM [Q4 vs. Q1: HR = 0.81 (95% CI: 0.67, 0.96) for WISH and 0.68 (95% CI: 0.57, 0.82) for PHDI], and all-cause mortality [Q4 vs. Q1: HR = 0.80 (95% CI: 0.68, 0.95) for WISH and 0.60 (95% CI: 0.46, 0.80) for PHDI] in fully adjusted models (all p -trend < 0.05 ). Both WISH and PHDI were inversely associated with GHG emissions in fully adjusted models (all p -trend < 0.05 ). WISH and PHDI were not significantly associated with risk of stroke.

CONCLUSIONS

Our findings supported the co-benefits of the EAT-Lancet reference diet for both cardiometabolic health and environmental sustainability. Long-term adherence to this reference diet as effectively indicated by either higher WISH or PHDI scores may reduce the risk and burden of CMDs and all-cause mortality in Chinese adults. https://doi.org/10.1289/EHP15006.

The Food Environment Toolbox: Developing and Piloting a Suite of Tools to Measure Food Environments in Low- and Middle-Income Countries

Background

Measuring food environments in low- and middle-income countries (LMICs) can inform and support the design of interventions aimed at improving diets and reducing malnutrition in all its forms. Most food environment measurement tools have been developed for high-income countries, however, and do not sufficiently capture the diverse and dynamic food environments in LMICs.

Objectives

The objective of this study was to develop, modify, implement, and refine a suite of tools to measure the different dimensions of diverse food environments in LMICs.

Methods

Through an iterative process, we: 1) identified the food environment dimensions to be measured; 2) identified existing tools using literature searches; 3) modified and developed tools based on feedback from team members of study settings, an expert advisory board, and workshops with key food environment experts in India and Cambodia; 4) implemented the tools by piloting the suite in rural, peri-urban, and urban settings in India and Cambodia; and 5) finalized tools based on feedback from experts and our tool piloting implementation and analysis experience.

Results

Overall, we included 7 tools in the finalized Toolbox (Participatory Mapping, Seasonal Food Availability Calendar, Food Environment Perceptions Survey, Community Food Environment Mapping, Market Mapping, In-depth Vendor Assessment, and a Cost of a Healthy Diet data collection protocol), all of which were rated positively by workshop participants. On the basis of piloting experiences, the tools were relatively easy to implement in the field. Apart from the Seasonal Food Availability Calendar being better suited to rural or peri-urban settings and the In-depth Vendor Assessment being less suitable for large formal supermarkets, we found that the tools were feasible and useful across pilot settings in India and Cambodia.

Conclusions

The suite of tools included in the Food Environment Toolbox can be used to measure diverse food environments in LMICs, with minimal anticipated adaptations across contexts.

The NEW Soul Study: Implementation and Evaluation Impact From the Secular Trend of the COVID-19 Pandemic

CONTEXT

In process evaluation research, secular trends refer to external factors unrelated to an intervention that impact implementation. The COVID-19 pandemic was a secular trend that affected the implementation of the Nutritious Eating with Soul (NEW Soul) study.

OBJECTIVE

This paper describes steps taken in modifying intervention delivery due to the secular trend of the pandemic. This paper also addresses process evaluation measures of dose delivered, dose received, and satisfaction.

DESIGN

This study is a longitudinal study.

SETTING

The study took place in Columbia, SC, from 2018 to 2021.

PARTICIPANTS

African American adults between 18 and 65 years old.

INTERVENTION

The NEW Soul study, a dietary lifestyle intervention, lasted 24 months.

MAIN OUTCOME MEASURES

Process evaluation variables of dose delivered, dose received, and satisfaction.

RESULTS

The study team shifted intervention delivery and maintained the timeline of classes for participants and intervention activities. Dose delivered was higher in-person (7.0 out of 8) compared to online (6.4 out of 8; t = -3.92, P = .002). Attendance was higher in-person compared to online ( t = 2.80, P = .006). Overall, satisfaction of the intervention was favorable in-person and online. Helpfulness of nutrition information in the class was rated lower online compared to in-person ( t = 2.05, P = .04).

CONCLUSIONS

Even though the study team successfully shifted intervention delivery online, dose delivered was higher in-person. Evaluations of classes remained high across cohorts and for in-person and online classes. Future lifestyle interventions working with African American adults requires consistent flexibility in intervention delivery.

Risk Factors and Prevention of Cancer and CVDs: A Chicken and Egg Situation

Cardiovascular diseases and cancer are the two primary causes of mortality worldwide. Although traditionally regarded as distinct pathologies, they share numerous pathophysiological mechanisms and risk factors, including chronic inflammation, insulin resistance, obesity, and metabolic dysregulation. Notably, several cancers have been identified as closely linked to cardiovascular diseases, including lung, breast, prostate, and colorectal cancers, as well as hematological malignancies, such as leukemia and lymphoma. Additionally, renal and pancreatic cancers exhibit a significant association with cardiovascular complications, partly due to shared risk factors and the cardiotoxic effects of cancer therapies. Addressing the overlapping risk factors through lifestyle modifications-such as regular physical activity, a balanced diet, and cessation of smoking and alcohol-has proven effective in reducing both CV and oncological morbidity and mortality. Furthermore, even in patients with established cancer, structured interventions targeting physical activity, nutritional optimization, and smoking cessation have been associated with improved outcomes. Beyond lifestyle modifications, pharmacological strategies play a crucial role in the prevention of both diseases. Several cardiovascular medications, including statins, aspirin, beta-blockers, and metformin, exhibit pleiotropic effects that extend beyond their primary indications, demonstrating potential anti-neoplastic properties in preclinical and observational studies. Recently, novel therapeutic agents have garnered attention for their possible cardioprotective and metabolic benefits. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is), initially developed for managing type 2 diabetes, have shown CV and renal protective effects, alongside emerging evidence of their role in modulating cancer-related metabolic pathways. Inclisiran, a small interfering RNA targeting PCSK9, effectively lowers LDL cholesterol and may contribute to reducing CV risk, with potential implications for tumor biology. Additionally, sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor, has revolutionized heart failure management by improving hemodynamic parameters and exerting anti-inflammatory effects that may have broader implications for chronic disease prevention. Given the intricate interplay between CVD and cancer, further research is essential to clarify the exact mechanisms linking these conditions and assessing the potential of CV therapies in cancer prevention. This review aims to examine shared risk factors, consider the role of pharmacological and lifestyle interventions, and emphasize crucial epidemiological and mechanistic insights into the intersection of CV and oncological health.

Application of system dynamics approach in developing health interventions to strengthen health systems to combat obesity: a systematic literature review and critical analysis

BACKGROUND

Obesity is an escalating global public health challenge that is expected to impact a significant portion of the world's population in the coming decades. It leads to severe health conditions such as diabetes, cardiovascular diseases, and cancer, imposing significant economic burdens on health systems. Traditional intervention strategies, which emphasize individual lifestyle changes, fail to address the complex, systemic nature of obesity. This study aims to systematically review the application of system dynamics modelling (SDM) in obesity control, focusing on analyzing modelling methodologies and conducting a quality assessment of the included studies.

METHODS

Employing a comprehensive systematic literature retrieval, we explored terms pertinent to overweight/obesity and system dynamics across three databases, including PubMed, Web of Science, and Scopus. This search culminated in identifying peer-reviewed studies published from the inception of these databases until July 2024. Quality assessment was used to evaluate the SDM for obesity control. The protocol of this systematic review has been registered on PROSPERO (CRD42024554520).

RESULTS

Thirty studies were identified through a systematic review. These studies primarily focus on the effects of SD approaches, such as individual lifestyle changes, policy interventions within populations, and socio-economic and environmental improvements on obesity control. Among them, eleven studies completed the entire SDM process. Twenty-seven studies presented conceptual models, of which twenty-five developed casual loop diagrams (CLD). Seventeen studies conducted computational system dynamics modelling, with thirteen constructing stock-flow diagrams (SFD). Additionally, fourteen studies performed simulation analyses. These models facilitated multi-level strategies to reduce obesity prevalence.

CONCLUSIONS

Using SDM approaches has significant potential to enhance the effectiveness of obesity interventions and optimize resource allocation. Our study into the application of SDM in the design of obesity health interventions revealed its ability to promote multi-level, cross-sectoral cooperation and coordination, thereby enhancing the effectiveness of interventions. Further exploration and optimization of obesity health interventions can significantly advance health systems and welfare.

Hypocaloric low-carbohydrate versus low-fat diets on flow-mediated dilation, blood pressure, cardiovascular biomarkers, and body composition in individuals with overweight or obesity: a systematic review and meta-analysis of randomized clinical trials

Obesity can impair cardiometabolism, but low-carbohydrate diets (LCDs) may be beneficial for mitigating risk. We aimed to investigate the effects of LCDs versus low-fat diets (LFDs), under hypocaloric conditions, on flow-mediated dilation (FMD) in individuals with overweight/obesity. Secondarily, we assessed other cardiovascular markers (systolic blood pressure, diastolic blood pressure, C-reactive protein [CRP], high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides [TG], total cholesterol [TC]), and anthropometric and body composition measurements. PubMed, Scopus, and Web of Science were searched through May 2023 for studies involving hypocaloric LCDs versus LFDs on FMD. Meta-analyses were conducted for LCDs vs. LFDs to calculate weighted mean differences (WMD), including 10 studies reporting FMD (n = 475). Overall, hypocaloric LCDs resulted in a non-significant decrease in FMD compared with hypocaloric LFDs [WMD = -1.04% (95% CI -2.28 to 0.20), p = 0.10], while very-low-carbohydrate diets (VLCDs) significantly reduced FMD when compared with LFDs [WMD = -2.12% (95% CI: -3.35 to -0.9) p = 0.001]. LCDs did not change anthropometric and body composition measurements, nor CRP, blood pressure, HDL, or TC when compared with LFDs. However, LCDs significantly decreased TG [WMD = -19.94 mg/dL (95% CI -31.83 to -8.06), p = 0.001] and increased LDL [WMD = 20.00 mg/dL (95% CI 14.09 to 25.90), p = 0.001] when compared with LFDs. In conclusion, LCDs did not exert superior effects on cardiovascular markers or body composition when compared with LFDs in individuals with overweight or obesity, but LCDs reduced TG and increased LDL levels more than LFDs. Yet, vascular function (FMD) was reduced primarily for VLCDs.

Nutritional Value and Health Implications of Meat from Monogastric Animals Exposed to Heat Stress

Heat stress (HS), driven by rising global temperatures, significantly impairs the nutritional composition and sensory quality of meat from monogastric animals, particularly swine and poultry. HS induces physiological disturbances, including reduced feed intake, oxidative stress, and endocrine disruption, which together reduce muscle protein content by 10-15% and essential amino acid levels (e.g., lysine, methionine, threonine) by 15-25%. Lipid profiles are also altered, with up to 30% reductions in polyunsaturated fatty acids (PUFAs), especially omega-3s, and an increased saturated fat content. Additionally, HS reduces the retention of vitamins E, A, D, and C by 20-50% and critical minerals such as selenium, zinc, and iron, compromising antioxidant capacity, immune function, and oxygen transport. These changes diminish meat tenderness, juiciness, flavour, and colour stability, leading to reduced consumer appeal and dietary quality. The consumption of heat-stressed meat may elevate risks for cardiovascular disease, oxidative stress, and micronutrient deficiencies. Mitigation strategies, including dietary antioxidant and osmolyte supplementation, genetic selection for thermotolerance, and optimised feeding practices, can reduce oxidative damage by up to 40% and improve nutrient retention. This review synthesises the current evidence on HS-induced meat quality deterioration and explores nutritional and management strategies to protect animal productivity and human health.

Micronutrients adequacy according to six diet quality indices in the "Seguimiento Universidad de Navarra" cohort

Introduction

Objectives: diet quality indices (DQI) tend to relate positively to micronutrient intake. Our aim was to investigate the association between six DQIs and inadequate intake for 19 micronutrients in the SUN ("Seguimiento Universidad de Navarra") cohort. Methods: we assessed 16,768 participants (59.3 % women, 37.8 years for mean age). Diet quality was evaluated using Dietary Approaches to Stop Hypertension (DASH); Mediterranean Diet Adherence Screener (MEDAS); Alternate Healthy Eating Index (AHEI-2010); Food-Based Global Diet Quality Score (GDQS); Alternative Mediterranean Diet Score (aMED) and Mediterranean Diet Score (MDS). Logistic regression analyses were conducted to estimate the probability of failing to meet Estimate Average Requirement (EAR) for either ≥ 3 or ≥ 6 micronutrients. Results: overall, the lower and higher prevalence of inadequacy in fifth quintiles was for vitamins A, C, B1, B2, B3, B6, for Fe, P and Cr, and for vitamins E and D, respectively. In the multivariable adjusted model, the OR for failing to meet ≥ 3 DRI for the highest versus the lowest quintiles of DASH, MEDAS, AHEI-2010, GDQS, aMED and MDS were: 0.03 (95 % CI, 0.02 to 0.03), 0.06 (95 % CI, 0.05 to 0.07), 0.10 (95 % CI, 0.09 to 0.12), 0.05 (95 % CI, 0.04 to 0.06), 0.03 (95 % CI, 0.03 to 0.04), and 0.07 (95 % CI, 0.06 to 0.09), respectively. Conclusions: adherence to six DQIs showed inverse associations with micronutrient inadequacy. Food-based DQIs could be a useful prevention tool. GDQS and MEDAS do not require deriving nutrient intake data, particularly MEDAS, which is even easier and quicker to fill out.

Frailty and social contact with dementia risk: A prospective cohort study

BACKGROUND

Frailty and social contact are significant factors influencing dementia risk. While previous studies have separately examined these factors, their combined impact on dementia remains underexplored.

METHODS

This study included 338,567 UK biobank participants from 2006 to 2010, with follow-up until December 2022. Additionally, 30,408 participants with brain magnetic resonance imaging data were analyzed for hippocampal volume. Cox proportional hazards regression and linear regression models were used to assess associations.

RESULTS

The study followed 338,567 participants (mean [SD] age, 60.4 [5.2] years; 54.1 % men) for a median of 13.7 years, documenting 7362 cases of all-cause dementia. Both frailty and lower social contact independently increased the risk of all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VaD). Compared to individuals with non-frailty and high social contact, those with lower social contact and higher frailty had a significantly increased risk of all-cause dementia, with the highest risk observed in individuals with frailty and low social contact (HR = 2.65, 95 % CI: 2.27-3.11). Similar patterns were found for AD and VaD. Furthermore, hippocampal volume was significantly reduced in individuals with frailty and low social contact (β = -0.24, 95 % CI: -0.43 to -0.06) compared to those with non-frailty and high social contact.

LIMITATIONS

The study predominantly included European descent individuals, with most frailty and social contact data based on baseline self-reports.

CONCLUSIONS

The combination of frailty and low social contact is associated with the highest risk of dementia. These findings suggest that both physiological and social factors should be simultaneously considered in dementia prevention strategies.

Dietary patterns and physical activity in young South Asians and white Europeans and their potential implications for cardiovascular risk

Individuals of South Asian (SA) ethnicity have greater risk of developing cardiovascular disease (CVD) relative to white Europeans (WEs). Factors which generally contribute to increased CVD risk include physical inactivity and poor dietary habits, including high intake of salt and saturated fat. Contrastingly, diets rich in fibre, antioxidants and polyphenols are considered cardioprotective. The current questionnaire-based study aimed to examine whether the dietary habits and physical activity levels of young adult SAs living in the UK may contribute to their increased CVD risk in comparison to age-matched WEs. All participants (80 healthy individuals, 40 SA/ 40 WE (gender-balanced, aged 18-26 years) completed questionnaires to assess: general health; habitual physical activity levels, assessed by the International Physical Activity Questionnaire; and dietary patterns, assessed by EPIC-food frequency questionnaire and three-day food diaries. SAs had higher sitting times (SA: 469 ± 19.4, WE: 387 ± 21.5 min/day, p = 0.0107) and were less physically active (SA: 2050 ± 1110, WE: 4850 ± 2810 MET mins/day, p < 0.0001) than WEs. Further, SAs had lower consumption of cardioprotective nutrients, such as fibre (p = 0.0183), folate (p = 0.0242), vitamin C (p = 0.0105) and phytochemicals, such as flavonoids (p = 0.0644). SAs also consumed less alcohol (p < 0.0001), fat (p = 0.0066), sugar (p = 0.0218) and sodium (p = 0.0011) compared to WEs. These findings suggest that lower consumption of nutrients and phytochemicals that are cardioprotective, rather than excess consumption of fat, sugar and sodium, amongst young SAs may contribute to their increased CVD risk. Young SA individuals may also reduce their future CVD risk by increasing their physical activity.

A nutrient wide association study of cardiovascular disease prevalence in older adults from NHANES 2007 to 2018

Cardiovascular disease (CVD) remains the leading cause of mortality worldwide, particularly among older adults. Identifying modifiable dietary factors associated with CVD prevalence is essential for prevention. This cross-sectional study analyzed 7,341 adults aged ≥ 65 years from NHANES 2007-2018. CVD was defined based on self-reported physician-diagnosed conditions, including coronary heart disease, heart failure, angina, heart attack, or stroke. A nutrient-wide association study (NWAS) evaluated associations between 56 dietary nutrients and CVD prevalence using multivariable logistic regression. Dose-response relationships were assessed using restricted cubic spline (RCS) models. Model discrimination was evaluated using receiver operating characteristic (ROC) analysis. Eight nutrients were significantly associated with CVD prevalence after adjusting for confounders and correcting for multiple comparisons: PUFAs 20:4 (OR 0.88, 95% CI 0.80-0.97, P = 0.024), 22:5 (OR 0.72, 95% CI 0.56-0.92, P = 0.019), and 22:6 (OR 0.92, 95% CI 0.87-0.99, P = 0.032); total choline (OR 0.96, 95% CI 0.93-0.99, P = 0.024); cholesterol (OR 0.89, 95% CI 0.82-0.96, P = 0.037); protein (OR 0.82, 95% CI 0.76-0.89, P = 0.040); vitamin A (OR 0.95, 95% CI 0.91-0.99, P = 0.045); and total sugars (OR 0.97, 95% CI 0.96-0.98, P = 0.049). Clustering analysis identified protective effects of fat-soluble vitamins and unsaturated fatty acids. The inclusion of these nutrients significantly improved model discrimination (P < 0.05). This study identified key dietary nutrients and clusters associated with CVD prevalence and characterized their dose-response relationships. Integrating these nutrients into predictive models enhances CVD risk discrimination, providing actionable dietary targets for prevention strategies in older adults.

Exploring clinical parameters and salivary microbiome profiles associated with metabolic syndrome in a population of Rio de Janeiro, Brazil

OBJECTIVES

This study investigates for the first time the association between metabolic syndrome and oral microbial profiles in a population-based sample from Rio de Janeiro, Brazil.

DESIGN

We assessed 66 volunteers, collecting detailed sociodemographic, anthropometric, and clinical data alongside salivary samples for metagenomic analysis.

RESULTS

Our findings reveal significant differences in anthropometric parameters, including waist circumference, glycemia, High-Density Lipoprotein (HDL), and triglycerides between the metabolic syndrome and control groups. Increased abundance of Bacteroidetes and Bacteroidia was observed in the metabolic syndrome group, suggesting a potential link between these phyla and metabolic dysregulation. While no significant differences in alpha diversity were found between the overall groups, stratification by body mass index (BMI) indicated that the normal weight subgroup without Metabolic Syndrome exhibited notable variations compared to overweight and obese individuals.

CONCLUSIONS

This study identifies specific shifts in oral microbiota composition that are associated with metabolic syndrome, highlighting their potential as microbial biomarkers for this condition. These findings suggest a link between oral dysbiosis and metabolic dysregulation, providing new insights into the pathophysiology of metabolic syndrome. Additionally, the results pave the way for the development of non-invasive diagnostics tools and targeted therapies that leverage the oral microbiome's role in systemic health.

Diet and multiple sclerosis - development and mixed methods feasibility testing of a comprehensive nutritional information resource (NUTRIMS)

PURPOSE

Persons with multiple sclerosis (pwMS) are often confused by contradictory dietary advice. The purpose of this research was to explore the information needs and design a comprehensive, evidence-based nutritional information resource on diet and MS (NUTRIMS).

METHODS

A mixed-methods design with three sequential phases was adopted: (1) Needs assessment and development: Two focus groups with pwMS to explore experiences, information needs and preferred support around diet. Development of a draft NUTRIMS, (2) Feasibility Step 1: Feedback on the draft NUTRIMS from stakeholders and (3) Feasibility Step 2: Online survey among pwMS to explore content quality and acceptability.

RESULTS

Two focus groups with a total of 12 pwMS showed that MS-specific evidence on food groups/ingredients, nutrients and special diets were of most interest. The draft NUTRIMS was refined through feedback from 13 stakeholders. The pre-final NUTRIMS consisted of 81 pages including scientific references on each topic, 16 illustrations and a glossary of terms. 85 pwMS participated in the online survey and reported an intensive use and high satisfaction with the information resource, which was perceived as comprehensible, highly credible and useful for making decisions on dietary change.

CONCLUSIONS

A collaborative research approach led to a well-accepted nutrition information resource.

Environmental Hypertensionology and the Mosaic Theory of Hypertension

Hypertension is a multifactorial condition influenced by the intricate interplay of biological and genetic determinants. The growing field of Environmental Hypertensionology endorses the outsized role of environmental factors in the pathogenesis and exacerbation of hypertension. It provides a clinical approach to address these factors at the individual and societal levels. Environmental stressors contributing to blood pressure levels can be viewed within the mosaic model of hypertension, which offers a comprehensive framework for understanding blood pressure regulation through its connection with multiple other nodes causally related to the pathogenesis of hypertension. This review synthesizes growing evidence supporting the impact of several factors in the physical environment and adverse stressors embedded in key provisioning systems, including air, noise, and chemical pollution, along with aspects of the built environment, green spaces, food systems, on the global burden of hypertension. Although many factors may not be directly in the causal cascade of hypertension, the web of connections between many behooves an understanding of the important nodes for intervention. Public health strategies emphasizing the redesign of environments present an unprecedented opportunity to enhance global hypertension control rates. Future research should thus focus on integrating environmental risk assessment and interventions into clinical practice, optimizing urban planning, and public policy to achieve meaningful reductions in the global burden of hypertension. By understanding hypertension as a mosaic of interconnected causes, healthcare professionals are better equipped to individualize treatment, combining lifestyle interventions and multiple drug classes to target environmental and genetic factors driving high blood pressure.

Monounsaturated fatty acids from plant or animal sources and risk of type 2 diabetes in three large prospective cohorts of men and women

AIMS/HYPOTHESIS

Existing evidence on the relationship between intake of monounsaturated fatty acids (MUFAs) and type 2 diabetes is conflicting. Few studies have examined whether MUFAs from plant or animal sources (MUFA-Ps and MUFA-As, respectively) exhibit differential associations with type 2 diabetes. We examined associations of intakes of total MUFAs, MUFA-Ps and MUFA-As with type 2 diabetes risk.

METHODS

We used data from 51,290 women in the Nurses' Health Study (1990-2016), 61,703 women in the Nurses' Health Study II (1991-2017) and 29,497 men in the Health Professionals Follow-up Study (1990-2016). Using food frequency questionnaires and food composition tables, we calculated MUFA-P and MUFA-A intakes every 4 years and modelled their associations with type 2 diabetes using Cox regression models.

RESULTS

During 3,268,512 person-years of follow-up, we documented 13,211 incident type 2 diabetes cases. After multivariate adjustment, total MUFA intake was associated with higher type 2 diabetes risk, with HR for Q5 vs Q1 of 1.10 (95% CI 1.01, 1.22). MUFA-Ps and MUFA-As demonstrated divergent associations, with HRs of 0.87 (95% CI 0.81, 0.94) and 1.34 (1.23, 1.45), respectively. In substitution analyses, HRs were 0.92 (95% CI 0.86, 0.99) for replacing 2% of energy from trans fatty acids or 0.72 (0.66, 0.78) and 0.82 (0.77, 0.88) for replacing 5% from MUFA-As and 5% from the sum of saturated fatty acids and MUFA-As with MUFA-Ps, respectively. Substituting MUFA-As for saturated fatty acids and refined carbohydrates was associated with a 43% and 33% higher risk, respectively.

CONCLUSIONS/INTERPRETATION

Higher intake of MUFA-Ps was associated with lower type 2 diabetes risk, whereas increased intake of MUFA-As was associated with higher risk. Replacing saturated fatty acids, trans fatty acids and MUFA-As with MUFA-Ps may be beneficial for type 2 diabetes prevention.

Associations of Blood Lipid-Related Polygenic Scores, Lifestyle Factors and Their Combined Effects with Risk of Coronary Artery Disease in the UK Biobank Cohort

Circulating lipids play a crucial role in the development of coronary artery disease (CAD). However, it is unclear whether the genetic susceptibility to hyperlipidemia may interact with lifestyle factors in CAD risk. Using UK Biobank data from 328,606 participants, we evaluated combined effects of genetic susceptibility to hyperlipidemia and lifestyle factors with risk of CAD. We found that both blood lipid-related polygenic score (PGS) and healthy lifestyle score (HLS) are independently associated with CAD risk, and individuals with the highest-risk lipid-related PGS and the least healthy HLS had the highest CAD risk. This association was stronger in younger (< 60 years, hazard ratio: 4.46, 95% confidence interval: 3.44-5.78) than older adults (2.54, 2.13-3.03). Our study suggests that individuals, particularly younger adults, with higher-risk PGSs of blood lipid traits would benefit more substantially by adherence to a healthy lifestyle than those with lower PGSs.

Treatment options for heart failure in individuals with overweight or obesity: a review

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity and mortality. Obesity is not only a risk-factor for heart failure, but also complicates its management, by distinctive pathophysiological mechanisms and cumulative comorbidities, requiring tailored treatment plan. To present current treatment options for heart failure in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, and the management of related comorbidities. We conducted a comprehensive literature review regarding the results of heart failure treatments in individuals with overweight/obesity, including cornerstone interventions as well as emerging therapeutic options. Specific drug classes, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, have demonstrated consistent efficacy in heart failure irrespective of body mass index, while diuretics remain a key for fluid management. Glucagon-like peptide-1 receptor agonists have shown promising results in improving relevant outcomes and warrant further research. Non-pharmacological approaches, including weight-loss strategies and lifestyle modifications, have shown to improve symptoms, exercise tolerance and quality of life. Managing heart failure in individuals with overweight/obesity requires a multidisciplinary, individualized approach integrating pharmacological and non-pharmacological options. Emerging therapies and preventive strategies arise to address the unique challenges in this population and provide improved outcomes.

Ultra-processed food intake is associated with a displacement of the traditional diet of Costa Rican adolescents

Ultra-processed food (UPF) intake is high among adolescent populations worldwide. This study aimed to characterize the UPF intake and assess its contribution to the traditional diet of Costa Rican adolescents. Using cross-sectional data from 3-day food records obtained from 818 adolescents (13-18 years) from San José, Costa Rica, we calculated the daily % of total energy intake (TEI) from Nova-defined UPF, the Traditional Costa Rica Adolescents Diet Score (TCRAD; higher score reflecting higher traditional adherence), other nutrients, and fiber. The multivariable-adjusted mean UPF intakes were compared across participants' characteristics, mealtime, and days of the week, and assessed for association with TCRAD (continuous score and by adherence categories) and dietary components. UPF intake represented 35.9% of the TEI and was higher on weekdays (vs. weekends), among female adolescents (vs males), urban areas (vs. rural), and higher socioeconomic status. UPF were consumed mostly as snacks (43.5%), in the morning: (58.5%) and afternoon (41.5%). Each 10-percentage-point increase in the total UPF energy contribution was associated with -0.44 (SE = 0.04; P < .0001) lower TCRAD score. UPF was inversely associated with fiber and beneficial micronutrients, and directly associated with added sugars and trans fats. The multivariable-adjusted UPF intake was lower at moderate (38.5%, P < .0001) and high (29.9%, P < .0001) adherence to the TCRAD, compared with low adherence (43.9%). Our results support widespread trends of UPF displacing healthy diets. Strategies to reduce UPF consumption, especially during school hours, and encourage healthy traditional diets, are needed for Costa Rican adolescents.

Advancing The FDA's Human Foods Program Through Additional Authorities And User Fees

The Food and Drug Administration (FDA) lacks certain authorities and is persistently underresourced to fulfill its mission of protecting the public by ensuring that foods are safe, wholesome, sanitary, and properly labeled. Particularly concerning gaps exist in pre- and postmarket oversight of food ingredients that are often found in ultraprocessed foods. Numerous substances either have evidence of harm or are unknown to the FDA and the public. Additional authorities and resources are necessary. User fees have been successfully implemented to provide resources to the FDA for other programs under its purview. This legal and policy analysis evaluates the FDA's food-related authorities that would be amenable to a new user fee program. It reviews policy domains where new or enhanced user fees may be warranted. We find that a new comprehensive FDA user fee program for food may benefit industry and generate targeted new resources to strengthen the agency's oversight.

Accelerometer-derived "weekend warrior" physical activity pattern and incident type 2 diabetes

BACKGROUND

The guidelines provided by the World Health Organization (WHO) recommend a minimum of 150 min/week of moderate-to-vigorous physical activity (MVPA) for optimal overall health benefits. However, it remains unclear whether there are differential effects on the risk of incident type 2 diabetes (T2D) between concentrated and evenly distributed physical activity (PA) patterns. We aimed to investigate the associations of accelerometer-derived weekend warrior and regularly active pattern with risk of T2D.

METHODS

A total of 84,656 general participants from the UK Biobank with validated accelerometry data and free of T2D was included. Data on PA was collected using the Axivity AX3 wrist-based triaxial accelerometer worn for one week. Participants were categorized into three PA patterns: inactive (< 150 min/week of MVPA), weekend warrior (≥ 150 min/week with ≥ 50% of total MVPA occurring within 1-2 days), and regularly active (≥ 150 min/week but not meeting weekend warrior criteria).

RESULTS

During a median follow-up of 8.4 years, 2464 cases of T2D were documented. In multivariable-adjusted models, the weekend warrior pattern (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.67-0.84) and the regularly active pattern (HR 0.80, 95% CI 0.69-0.94) exhibited a comparable lower risk of T2D compared to physically inactive participants. When stratified by genetic risk score (PRS) of T2D, the weekend warrior pattern was associated with T2D in the higher PRS group (HR 0.78, 95% CI 0.67-0.91), intermediate PRS group (HR 0.78, 95% CI 0.62-0.97) and lowest PRS group (HR 0.59, 95% CI 0.43-0.80).

CONCLUSIONS

Engaging in the weekend warrior pattern is associated with a similarly lower risk of T2D to the regularly active pattern, even among individuals with high genetic risk. These findings highlight the weekend warrior pattern as a significant and flexible alternative in preventive intervention strategies for T2D, particularly for those unable to maintain daily activity routines.

Metabolic Syndrome and the Risk of Kidney Stones: Evidence from 487 860 UK Biobank Participants

CONTEXT

While some studies have suggested an association between metabolic syndrome and kidney stones, the quality and level of evidence in these studies vary.

OBJECTIVE

Whether some individual characteristics and clustering of metabolic syndrome traits increase the risk of kidney stones has not been examined in a large-scale prospective cohort.

MATERIALS

We conducted a retrospective analysis of data from a prospective cohort of 487 860 UK Biobank participants who were free from kidney stones at baseline. The presence of metabolic syndrome was based on 5 criteria: abdominal obesity, high triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, high blood pressure (HBP), and type 2 diabetes mellitus (T2DM). Cox proportional hazards regression models were used to evaluate the association between metabolic syndrome and risk of kidney stones.

RESULTS

After an average follow-up period of 12.6 years, a total of 5213 of the 487 860 participants included in the UK Biobank study developed kidney stones. The partial traits of metabolic syndrome, including waist circumference (hazard ratio [HR]: 1.15; 95% CI, 1.10-1.20), HDL cholesterol (0.66; 95% CI, 0.55-0.79), HBP (1.11; 95% CI, 1.03-1.19), and T2DM (1.14; 95% CI, 1.04-1.21), were independently associated with the occurrence of kidney stones. The clustering of metabolic syndrome is significantly associated with kidney stone formation, and as the number of metabolic syndrome traits increases, the risk of kidney stones gradually increases.

CONCLUSION

Metabolic syndrome is a significant and independent risk factor for the development of kidney stones. This association suggests that kidney stones may represent a systemic disorder influenced by the interplay of various metabolic risk factors.

The relationship between remnant cholesterol and young-onset myocardial infarction in patients with type 2 diabetes: a retrospective study

Background

Remnant cholesterol (RC) has emerged as a novel therapeutic target beyond low-destiny-lipoproteins cholesterol (LDL-c). While elevated RC levels are strongly associated with cardiovascular disease risk in the general population, their specific role in young-onset acute myocardial infarction (AMI) among patients with type 2 diabetes mellitus (T2DM) remains insufficiently explored and warrants further investigation.

Methods

This retrospective study included AMI patients with T2DM admitted to the First Affiliated Hospital of Xi'an Jiaotong University from 2018 to 2022. Patients were stratified into tertiles according to RC levels and compared using thresholds derived the commanded values from the PREDIMED cohort study. The primary outcome was young-onset AMI. Group differences were analyzed using the chi-square test and the Kruskal-Wallis H test, while Spearman correlation analyses assessed relationships between variables. Univariate and multivariate logistic regression analyses were employed to evaluate the association between RC and young-onset AMI.

Results

Among the 2,514 participants (mean age 61.58 ± 11.15 years), 802 (31.9%) had young-onset AMI. The increase of young-onset AMI increased significantly with rising RC levels (27.0% vs 29.7% vs 39.1%, P < 0.001). RC showed significant positive correlation with total cholesterol (TC, r = 0.497, P < 0.001), triglycerides (TG, r = 0.411, P < 0.001), and LDL-c (r = 0.166, P < 0.001). RC was independently associated with a higher risk of young-onset AMI (OR: 1.579; 95% CI: 1.354-1.842; P < 0.001), even after adjusting for other traditional risk factors of cardiovascular disease (OR: 1.415; 95% CI 1.189-1.684; P < 0.001). Notably, RC levels remained strongly linked to young-onset AMI regardless of whether LDL-c levels were within the desired range.

Conclusion

RC is a significant and independent risk factor for young-onset AMI in T2DM patients, irrespective of LDL-c level. These findings underscore the importance of monitoring and managing RC levels in clinical practice to mitigate cardiovascular risk in this population.

Associations between intuitive eating, overall diet quality, and physical health indicators: Results of the PREDISE study

Intuitive eating is a positive approach to eating involving high responsiveness to hunger and satiety cues. Although the association between intuitive eating and many psychological health indicators is well-documented, its associations with overall diet quality and physical health indicators are less explored. This study aimed to assess whether intuitive eating is associated with adherence to Canada's Food Guide recommendations and with physical health indicators. In the context of the PREDISE study, 1088 French-speaking Canadian adults from the Province of Québec completed a web-based survey including the Intuitive Eating Scale-2. Three web-based 24-h dietary recalls were completed and used to calculate the Canadian Healthy Eating Index (C-HEI) score, an indicator of adherence to Canada's Food Guide. Participants visited the research center to assess physical health indicators (body mass index, waist circumference, blood pressure, cholesterol, and blood glucose). Multiple linear regression analyses were performed to assess how intuitive eating is associated with diet quality and physical health indicators. The total intuitive eating score was not associated with C-HEI (B = 1.47, 95% CI: -0.10, 3.04). However, the "Body-Food Choice Congruence" subscale was positively associated with C-HEI (B = 5.60, 95% CI: 4.44, 6.76), while the "Unconditional Permission to Eat" subscale was negatively associated with C-HEI (B = -4.04, 95% CI: -5.28, -2.80). The total intuitive eating score was negatively associated with BMI in men (B = -4.83, 95% CI: -5.75, -3.91, p < 0.0001) and women (B = -5.01, 95% CI: -6.00, -4.02, p < 0.0001), with waist circumference in men (B = -3.60, 95% CI: -5.33, -1.87) and women (B = -2.20, 95% CI: -3.71, -0.70), and with HDL cholesterol only in women (B = -0.10, 95% CI: -0.17, -0.02). The associations of intuitive eating with diet quality are inconsistent, and only a few associations with physical health indicators were observed.

Recent advances in precision nutrition and cardiometabolic diseases

A growing body of research on nutrition omics has led to recent advances in cardiovascular disease epidemiology and prevention. Within the PREDIMED trial, significant associations between diet-related metabolites and cardiovascular disease were identified, which were subsequently replicated in independent cohorts. Some notable metabolites identified include plasma levels of ceramides, acyl-carnitines, branched-chain amino acids, tryptophan, urea cycle pathways, and the lipidome. These metabolites and their related pathways have been associated with incidence of both cardiovascular disease and type 2 diabetes. Future directions in precision nutrition research include: a) developing more robust multimetabolomic scores to predict long-term risk of cardiovascular disease and mortality; b) incorporating more diverse populations and a broader range of dietary patterns; and c) conducting more translational research to bridge the gap between precision nutrition studies and clinical applications.

Application of personalized nutrition counseling according to glycemic response in obese adults: A randomized dietary intervention study

This randomized clinical trial was conducted to investigate the effects of personalized nutrition counseling according to blood glucose response and dietary intake, which can be measured using a flash continuous glucose monitoring (CGM) device, on weight changes and eating habits in obese adults. The participants of this study comprised obese adults over 30 years of age, which were randomly assigned to either the (1) personalized nutrition group (PN) or (2) control group (CON) with a study period of up to 12 weeks. Body weight, body mass index, body fat mass, body fat percentage, and waist-to-hip ratio significantly decreased in the PN group when compared with the CON group (P < 0.05; P < 0.01). Based on the findings of the flash CGM, the PN group showed a significant decrease in both blood glucose levels, hemoglobin A1c (HbA1c), and time above range (P < 0.05). The levels of blood HbA1c and insulin were significantly decreased in both groups, but the PN group showed a greater decrease (HbA1c, P = 0.000; insulin, P = 0.000) than the CON group did (HbA1c, P = 0.001; insulin, P = 0.001). The blood triglyceride levels were significantly lowered only in the PN group (P = 0.026). It was confirmed that personalized nutrition counseling using a flash CGM device was effective in reducing body weight, abdominal fat, and blood HbA1c, insulin, and triglyceride levels and improving meal quantity and eating habits in obese adults.

Sugar-Sweetened Beverages, Artificially Sweetened Beverages and Sugar Forms With Long-Term Risk of Irritable Bowel Syndrome: A Large-Scale Prospective Cohort Study

We aimed to examine the prospective association of sugar-sweetened beverages (SSB), artificially sweetened beverages (ASB), natural juice, and sugar forms with irritable bowel syndrome (IBS). Participants free of IBS, celiac disease, inflammatory bowel disease, and any cancer at recruitment were included (N = 178,711, 53.1% female). SSB, ASB, natural juice, and different sugar forms' consumption were measured via a 24-h dietary recall questionnaire. The primary outcome was incident IBS. A Cox proportional hazard model adjusting for age, sex, BMI, Townsend deprivation index, education, ethnicity, smoking, alcohol drinking, physical activity, total energy intake, type 2 diabetes, depression, and anxiety was conducted to assess the relationship. Mean consumption of SSB, ASB, and natural juice was 90.0, 72.4, and 105.7 g/day, respectively. During a median of 11.3-year follow-up, 2690 participants developed IBS. Every 100 g/day SSB increment was associated with a 3% higher IBS risk (HR = 1.03, 95% CI: 1.01-1.05). Compared with no SSB intake, the highest quartile was associated with an increased risk of IBS (HR = 1.19, 1.03-1.37; p trend = 0.017). Regarding ASB and natural juice, no significant association was detected in those who consumed the highest quartile versus no intake (ASB: HRQ4 VS no intake = 1.12, 0.95-1.31, p trend = 0.062; Natural juice: HRQ4 VS no intake = 1.01, 0.87-1.18, p trend = 0.363). Considering different sugar forms, increased IBS risk was detected in added sugar (HRQ4 VS Q1 = 1.20, 1.05-1.36, p trend = 0.001), instead of naturally occurring sugar (HRQ4 VS Q1 = 0.99, 0.88-1.11, p trend = 0.869). Higher intake of SSB, rather than ASB and natural juice, is associated with increased IBS risk. Higher consumption of added sugar, instead of naturally occurring sugar, is associated with higher IBS risk. These findings highlight the importance of limiting SSB consumption in diets to reduce the modifiable burden of IBS.

Recent advances in precision nutrition and cardiometabolic diseases

A growing body of research on nutrition omics has led to recent advances in cardiovascular disease epidemiology and prevention. Within the PREDIMED trial, significant associations between diet-related metabolites and cardiovascular disease were identified, which were subsequently replicated in independent cohorts. Some notable metabolites identified include plasma levels of ceramides, acyl-carnitines, branched-chain amino acids, tryptophan, urea cycle pathways, and the lipidome. These metabolites and their related pathways have been associated with incidence of both cardiovascular disease and type 2 diabetes. Future directions in precision nutrition research include: a) developing more robust multimetabolomic scores to predict long-term risk of cardiovascular disease and mortality; b) incorporating more diverse populations and a broader range of dietary patterns; and c) conducting more translational research to bridge the gap between precision nutrition studies and clinical applications.

Dietary patterns modify the association between body mass index and mortality in older adults

BACKGROUND

The potential modifying roles of dietary patterns in the association between body mass index (BMI) and mortality in older adults remain unclear. This study aimed to examine the stratified and combined associations of dietary patterns and BMI with all-cause, cancer and cardiovascular disease (CVD) mortality.

METHODS

This prospective cohort study included 3982 Chinese community-dwelling older adults between 2001 and 2003. A 280-item validated food frequency questionnaire was used to calculate five dietary indies: Diet Quality Index-International (DQI-I), Dietary Inflammatory Index (DII), Mediterranean Diet Score (MDS), Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet. Higher DQI-I scores indicate better overall diet quality, while higher DII scores represent a pro-inflammatory diet. Higher MDS, DASH, and MIND scores indicate greater adherence to these healthy dietary patterns. Mortality data were obtained from official records. Hazard ratios (HRs) and 95 % confidence intervals (CIs) were estimated using Cox proportional hazards models.

RESULTS

Over a median follow-up of 16.8 years, there were 1879 all-cause deaths, 561 cancer deaths, and 386 CVD deaths. The J-shaped associations between BMI with all-cause and cancer mortality were weaker in healthier dietary patterns (DQI-I, MDS, DASH, MIND ≥median or DII

CONCLUSIONS

Higher diet quality attenuated the increased risks of all-cause and cancer mortality associated with underweight or obesity in older adults. Anti-inflammatory and antioxidative diets may protect against CVD mortality associated with obesity.

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Key Words

• Body mass index
• Diet quality
• Dietary pattern
• Mortality
• Obesity
• Older adults

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MESH Headings

• Humans
• Aged
• Female
• Male
• Body Mass Index
• Cardiovascular Diseases/mortality
• Neoplasms/mortality
• Prospective Studies
• Diet/mortality
• China/epidemiology
• Diet, Mediterranean/statistics & numerical data
• Proportional Hazards Models
• Risk Factors
• Aged, 80 and over
• Feeding Behavior
• Diet, Healthy/statistics & numerical data
• Middle Aged
• Cause of Death
• Dietary Approaches To Stop Hypertension

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Affiliation(s)

Shu-Yi Li Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Zhi-Hui Lu Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
Jason Leung Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
Yi Su Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
Blanche Yu Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
Timothy Kwok Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China.

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Multimorbidity patterns and influencing factors in older Chinese adults: a national population-based cross-sectional survey

Background

This study aims to develop specific multimorbidity relationships among the elderly and to explore the association of multidimensional factors with these relationships, thereby facilitating the formulation of personalised strategies for multimorbidity management.

Methods

Cluster analysis identified chronic conditions that tend to cluster together, and then association rule mining was used to investigate relationships within these identified clusters more closely. Stepwise logistic regression analysis was conducted to explore the relationship between influencing factors and different health statuses in older adults. The results of this study were presented by network graph visualisation.

Results

A total of 15 045 individuals were included in this study. The average age was 73.0 ± 6.8 years. The number of patients with multimorbidity was 7426 (49.4%). The most common binary disease combination was hypertension and depression. The four major multimorbidity clusters identified were the tumour-digestive disease cluster, the metabolic-circulatory disease cluster, the metal-psychological disease cluster, and the age-related degenerative disease cluster. Cluster analysis by sex and region revealed similar numbers and types of conditions in each cluster, with some variations. Gender and number of medications had a consistent effect across all disease clusters, while aging, body mass index (BMI), waist-to-hip ratio (WHR), cognitive impairment, plant-based foods, animal-based foods, highly processed foods and marital status had varying effects across different disease clusters.

Conclusions

Multimorbidity is highly prevalent in the older population. The impact of lifestyle varies between different clusters of multimorbidity, and there is a need to implement different strategies according to different clusters of multimorbidity rather than an integrated approach to multimorbidity management.