Nutrition Transition in Europe: East-West Dimensions in the Last 30 Years—A Narrative Review

Global burden, trends and inequalities for ischaemic heart disease attributable to high fasting plasma glucose, high low-density lipoprotein cholesterol and high systolic blood pressure, 1990-2021: An analysis of the Global Burden of Disease Study 2021

AIMS

The three key and direct risk factors for the significant health issue prevalent worldwide, ischaemic heart disease(IHD), are high fasting plasma glucose (HFPG), high low-density lipoprotein (HLDL) and high systolic blood pressure (HSBP) in metabolic syndrome (MetS). A comprehensive study is essential to present the most recent global epidemiological trends.

METHODS

IHD data attributable to HFPG, HLDL and HSBP (3H) were obtained from the Global Burden of Disease Study (GBD) 2021. The absolute burden was manifested in the number of death cases and disability-adjusted life years (DALY). The relative burden was quantified through the age-standardized mortality rate (ASMR) and the age-standardized DALY rate (ASDR). Estimated annual percentage change (EAPC) was used to measure trends.

RESULTS

HSBP caused the greatest IHD burden, followed by HLDL, which was much higher than HFPG. The IHD burden associated with HLDL and HSBP were more alike and notably different from HFPG. From 1990 to 2021, ASDR for HSBP and HLDL-related IHD generally declined, with the EAPC of -1.28 (95% CI: -1.34, -1.23) and -1.38 (95% CI: -1.44, -1.33). But the trend was less pronounced for HFPG-related IHD, with the EAPC of -0.90 (95% CI: -2.25, 0.46). The absolute burden was higher in men under 80 and peaked 5-10 years earlier than women. Compared to HSBP and HLDL, HFPG caused a significant increase in burden in low-middle and low socio-demographic index (SDI) regions. The high-middle SDI region, which originally had the highest burden, showed a clear downward trend after 2005 and was gradually overtaken by the low-middle region. Eastern Europe, Central Asia, North Africa and the Middle East had the highest burden among the regions with the same SDI level in Europe, Asia and Africa.

CONCLUSION

The HFPG-related IHD burden should be managed differently from HSBP and HLDL. Particular attention should be paid to men, older age groups and regions with low-middle SDI.

Diversity of dietary protein patterns across Europe - Impact on nutritional quality and environmental sustainability

Transitioning from animal-based to plant-rich diets could potentially improve both human and planetary health, but a thorough understanding of the protein component in the diet is essential. This research aimed to identify dietary protein patterns in the European adult population and evaluate differences in nutritional quality and environmental sustainability. Individual-level food consumption data were obtained from 25 European countries (40,101 participants, 18-64 years), available from the EFSA Comprehensive European Food Consumption Database. We applied statistical clustering to classify individuals according to their consumption of 24 protein source food groups. The patterns were evaluated for nutrient requirements, the Nutrient Rich Diet (NRD) 15.3 score, greenhouse gas emissions (GHGE) and land use (LU). Six patterns emerged: Common (42.2%), Fast-food (19.5%), Traditional (14.8%), Health-conscious (12.0%), Milk-rich (9.8%) and Plant-forward (1.6%), with country-specific variations. Most patterns obtained 64-69% of their protein intake from animal products, except for the Plant-forward pattern (52%). The Plant-forward pattern achieved the highest NRD15.3 (+11%), and lowest GHGE (-20%) and LU (-25%) compared to the population average and was most commonly consumed in Austria, Finland, Spain, Portugal and Belgium (4.1-4.5%). The Health-conscious pattern also scored high in nutritional quality (NRD15.3: +9%), whereas the Traditional pattern showed higher environmental impacts (GHGE: +5%, LU: +7%). These findings highlight the diversity of dietary protein patterns across Europe, each with unique nutritional profiles and varying environmental impacts. The Plant-forward pattern provides a promising example for healthier, more sustainable diets, but tailored approaches that consider the cultural and demographic contexts of individual countries are needed to optimize health and environmental outcomes for all patterns.

The Evolution of Dietary Consumption in the Spanish Adult Population and Its Relationship with Environmental Sustainability

BACKGROUND/OBJECTIVE

The relationship between food consumption and environmental sustainability is becoming increasingly evident. The aim of this study was to estimate the evolution of the environmental impact of food consumption in the Spanish population, assessed in terms of greenhouse gas (GHG) emissions.

METHODS

Data collected from the Household Budget Survey were included, from approximately 24,000 households for the period of 2006-2023. The environmental impact of diet, in terms of GHG emissions, was estimated from the EAT-Lancet Commission tables, and the adherence to the Mediterranean Diet (MedDiet) was calculated using the Dietary Score index.

RESULTS

The environmental impact of the Spanish diet, in terms of GHG, followed a downward trend over the years analysed, from 3978.1 g CO2-eq in 2006 to 3281.4 g CO2-eq in 2023, a decrease of 17.5%. The food groups with the largest decrease in consumption during this period were red meat (from 39.9 kg/year to 35.5 kg/year), fish (from 24.3 kg/year to 19.0 kg/year), and dairy products (from 113.4 kg/year to 99.7 kg/year). The level of adherence to the MedDiet increased slightly from 34 points in 2006 to 35 points in 2023 due to an increase in the amount of vegetables (42.7 kg/year vs. 44.3 kg/year) and grains consumed (53.1 kg/year vs. 72.6 kg/year) and a decrease in fish consumption (24.3 kg/year vs. 19.0 kg/year).

CONCLUSIONS

In Spain, a reduction in GHG emissions associated with food consumption was observed due to a decrease in the consumption of red meat, fish, dairy products, and fats. National surveys are very useful tools to analyse the impact of food consumption on climate change and to assess the effect of the policies implemented to contain it.

Socio-demographic determinants of dietary choices and their impact on health in Spanish adults

Background

Although Spain has traditionally followed the Mediterranean diet, in recent years, changes have become noticeable in the food preferences of the population. These changes include adopting new diets and dietary trends, such as plant-based diets, intermittent fasting and raw food diets. These choices are influenced by cultural, social and socio-demographic factors, and their impact on health should be studied in detail.

Aim

The objectives of this research are: (1) to study the prevalence of different dietary patterns among the Spanish population, (2) to explore the dependence of dietary choice on socio-demographic factors, (3) to investigate the relationship between the social habits and lifestyle choices of the population and how it affects health.

Methods

A descriptive cross-sectional study was carried out on the Spanish population. Using a questionnaire constructed and validated by the research team, socio-demographic data were collected and different nutritional, social and lifestyle habits of the targeted population were explored.

Results

A valid sample of 22,181 people was collected among which 17,573 (79.2%) people claimed to follow a Mediterranean dietary pattern, 1,425 (6.4%) people followed a plant-based diet, 365 (1.6%) people are vegans, 1,018 people (4.6%) practiced intermittent fasting, 252 (1.1%) people followed a raw food diet and 1,548 people (7%) claimed to follow other types of diets. The data show that younger people (18-25 years old) tend to adopt more often a plant-based diet than older people and that women tend to follow this type of diet more often than men. On the other hand, men seem to practice intermittent fasting more frequently. A higher tendency to practice a raw food diet was found among people living in villages than those living in cities. Moreover, some trends were found in different regions of Spain, with greater adherence to a plant-based diet in Catalonia, while intermittent fasting is more common in the Region of Murcia. Finally, the results indicate that individuals who pay attention to their diet and experiment with various dietary patterns are generally more health-conscious. This is reflected in their adoption of healthier behaviors, such as exercising more and reducing their intake of alcohol and sugary drinks.

Changes over time of fruit, vegetable and sweets consumption among European adolescents and associations with sociodemographic characteristics: an HBSC study

BACKGROUND

European adolescents do not eat enough fruits and vegetables and have a high sweets consumption. This study aims to analyse the changes in time of dietary behaviours related to sociodemographic characteristics, among European adolescents.

METHODS

Health Behaviour in School Age Children data (2013/14 to 2017/18), of European adolescents, aged 11- to15-year-old, were used. Family Affluence Scale identified socioeconomic status (SES). Changes in time of dietary behaviours and associations with sociodemographic characteristics were estimated by binary and multilevel logistic regression.

RESULTS

182 719 adolescents were included, and 10/36 European countries showed a significant increase in daily fruit and vegetable consumption and 12/36 countries a significant decrease in sweets consumption over 4 years. The multilevel analysis showed that 13- and 15-year-old adolescents consumed fewer daily fruits and vegetables (P < 0.001) and more daily sweets (P < 0.001) than 11-year-old adolescents. Also, 15-year-old adolescents' sweets consumption change over time was less favourable (P = 0.006). Girls consumed more daily fruits, vegetables and sweets than boys (P < 0.001).Low SES adolescents consumed fewer daily fruits and vegetables than medium/high SES adolescents. Additionally, the low SES adolescents' vegetable consumption change over time was less favourable (P < 0.001).

CONCLUSIONS

Dietary behaviour policy recommendations should be adapted for the sex, age and SES of the population.

Urban environment exposures, energy balance-related behaviors and their combination in preschoolers from three European countries

BACKGROUND

Urban environments are characterized by many factors that may influence children's energy balance-related behaviors (EBRBs), but there is limited research on the impact of prospective exposure to multiple urban factors in preschoolers. We evaluated prospective associations between various urban exposures and EBRBs in preschoolers across Europe, with EBRBs considered both individually and combined into lifestyle patterns.

METHODS

We used data from 4,073 preschoolers (aged 3-4 years) participating in three European cohorts from the EU Child Cohort Network: BiB (United Kingdom), EDEN (France), and INMA (Spain). Eighteen built and food environment, green spaces, road traffic and ambient air pollution exposures were characterized at residential addresses. Various EBRBs were considered as the outcomes including screen time, sleep duration and diet (fruit, vegetables, discretionary sweet foods, sweet beverages) individually and combined into unhealthy lifestyle patterns, using principal components analysis. Associations between urban exposures and outcomes were estimated using a single-exposure analysis and the deletion-substitution-addition algorithm was used to construct multi-exposure models.

RESULTS

In multi-exposure models, greater walkability and smaller distance to the nearest road were associated with higher scores on the unhealthy lifestyle patterns. Likewise, greater walkability was associated with higher screen time and more frequent discretionary sweet food consumption. A smaller distance to the nearest road was also associated with lower sleep duration and more frequent sweet beverages consumption. On the other hand, higher levels of street connectivity showed an inverse association with the unhealthy lifestyle patterns. In the same vein, greater street connectivity was associated with decreased screen time.

CONCLUSION

This comprehensive examination of multiple urban exposures indicates that residing in walkable environments and in close proximity to roads in densely-populated areas may not be advantageous for children EBRBs, while residing in neighborhoods with higher street connectivity appears to supposedly be beneficial.

Underrated aspects of a true Mediterranean diet: understanding traditional features for worldwide application of a "Planeterranean" diet

Over the last decades, the Mediterranean diet gained enormous scientific, social, and commercial attention due to proven positive effects on health and undeniable taste that facilitated a widespread popularity. Researchers have investigated the role of Mediterranean-type dietary patterns on human health all around the world, reporting consistent findings concerning its benefits. However, what does truly define the Mediterranean diet? The myriad of dietary scores synthesizes the nutritional content of a Mediterranean-type diet, but a variety of aspects are generally unexplored when studying the adherence to this dietary pattern. Among dietary factors, the main characteristics of the Mediterranean diet, such as consumption of fruit and vegetables, olive oil, and cereals should be accompanied by other underrated features, such as the following: (i) specific reference to whole-grain consumption; (ii) considering the consumption of legumes, nuts, seeds, herbs and spices often untested when exploring the adherence to the Mediterranean diet; (iii) consumption of eggs and dairy products as common foods consumed in the Mediterranean region (irrespectively of the modern demonization of dietary fat intake). Another main feature of the Mediterranean diet includes (red) wine consumption, but more general patterns of alcohol intake are generally unmeasured, lacking specificity concerning the drinking occasion and intensity (i.e., alcohol drinking during meals). Among other underrated aspects, cooking methods are rather simple and yet extremely varied. Several underrated aspects are related to the quality of food consumed when the Mediterranean diet was first investigated: foods are locally produced, minimally processed, and preserved with more natural methods (i.e., fermentation), strongly connected with the territory with limited and controlled impact on the environment. Dietary habits are also associated with lifestyle behaviors, such as sleeping patterns, and social and cultural values, favoring commensality and frugality. In conclusion, it is rather reductive to consider the Mediterranean diet as just a pattern of food groups to be consumed decontextualized from the social and geographical background of Mediterranean culture. While the methodologies to study the Mediterranean diet have demonstrated to be useful up to date, a more holistic approach should be considered in future studies by considering the aforementioned underrated features and values to be potentially applied globally through the concept of a "Planeterranean" diet.

Nutrition, Physical Activity and Smoking Habit in the Italian General Adult Population: CUORE Project Health Examination Survey 2018-2019

BACKGROUND

Tobacco consumption, incorrect nutrition and insufficient physical activity/sedentariness represent modifiable NCDs risk factors in Western countries. To evaluate recent lifestyle indicators in Italy, data from the national Health Examination Survey (HES), implemented in 2018-2019 within the CUORE Project, were assessed.

METHODS

Age-sex standardized results from random samples of Italian general population (35-74 years) were reported by sex, age-class, educational level and geographical area. From 2106 participants, 2090 were considered for smoking habit, 2016 for physical activity and 1578 for nutrition. Standardized questionnaires were used for smoking habit and physical activity, and the EPIC questionnaire for nutrition.

RESULTS

Total cigarette current smokers were 23% in men and 19% in women; sedentariness during leisure time was 34% in men and 45% in women and at work 45% and 47% in men and women, respectively. Prevalence of balanced eating behaviours for vegetables was 28% in men and 39% in women; and for fruits 50% and 52%, respectively; prevalence of correct lifestyle (not smoker, regular physical activity and following at least five correct eating behaviours) was 7% and 12% for men and women, respectively.

CONCLUSIONS

In 2018-2019, levels of unhealthy lifestyles were found to be still epidemic and basically stable compared to 10 years earlier (slight smoking habit decrease, slight sedentariness increase and slight nutrition improvements); intersectoral strategies and monitoring need to be continued.

Adapting the Dietary Fat and Free Sugar Short Questionnaire: A Comprehensive Polish Modification for Enhanced Precision in Nutritional Assessments

BACKGROUND

This study aimed to investigate whether The Dietary Fat and Free Sugar-Short Questionnaire (DFS) is a reliable and valid measure that can be used in Polish conditions. It involved 291 participants, aged 14 to 70 (M = 25.9, SD = 10.1), the majority of whom were women (75%).

METHODS

The questionnaire consisted of, among others, Polish DFS version, FFQ-6, TFEQ, and SCOFF. Test-retest reliability was established on the group of 26 students with a 2-week interval. Participants' percentage of energy intake from both free sugars and saturated fats based on FFQ was correlated with DFS total and subscales scores. To investigate convergent and divergent validity, DFS scores with TFEQ correlations were performed. Diagnostic validity was established based on difference analysis between groups with the risk of eating disorders and those without the risk of those based on SCOFF.

RESULTS

Test-retest reliability (rtr = 0.856) and internal consistency (α = 0.797) indicated excellent reliability. DFS correlated significantly with FFQ for both total scores (r = 0.82) and each subscale: sugar (0.79), fat (0.75), and fat-sugar (0.59). The correlations of DFS and TFEQ were statistically significant for cognitive restraint (r = 0.32) and uncontrolled eating (r = 0.19). There also have been found significant differences based on SCOFF regarding DFS.

CONCLUSIONS

The results suggest good reliability and validity of the Polish version of DFS.

Association between dietary nutrient intake and prevalence of myopia in Korean adolescents: evidence from the 7th Korea National Health and Nutrition Examination Survey

Background

The rise in myopia prevalence, particularly among adolescents in East Asia, is a cause for concern. While a combination of environmental and genetic factors is understood to contribute to this trend, the role of dietary nutrients is not yet fully clarified.

Objective

To assess the potential association between the intake of specific nutrients and the prevalence of myopia in a large, population-based sample of Korean adolescents.

Methods

Data from 18,077 adolescents (average age: 15.05 ± 1.67 years; 51.7% male, 48.3% female) who participated in the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII, 2016) were analyzed. Refractive error was measured using an auto-refractor-keratometer (KR-8800) without cycloplegia. Dietary intake of 14 nutrients was assessed through a 24-h personalized dietary recall method.

Results

The study revealed a myopia prevalence of 87.6% among the adolescents. Multivariable models adjusted for age, gender, BMI, and other confounding factors indicated that higher intakes of carbohydrates, proteins, cholesterol, sodium, and vitamin B2 were associated with an increased risk of myopia. Conversely, higher intake of vitamin C was found to be associated with a decreased risk.

Conclusion

The findings suggested a potential association between dietary nutrient intake and myopia prevalence in Korean adolescents. While the study did not establish a causal link, the differences in nutrient intake between the myopic and non-myopic groups could indicate that diet plays a role in the development or progression of myopia. Further research is warranted to corroborate these findings and explore the underlying mechanisms.

Lifestyle patterns in European preschoolers: Associations with socio-demographic factors and body mass index

BACKGROUND

Energy balance-related behaviours (EBRBs), that is, dietary intake, screen, outdoor play and sleep, tend to combine into 'lifestyle patterns', with potential synergistic influences on health. To date, studies addressing this theme mainly focused on school children and rarely accounted for sleep, with a cross-country perspective.

OBJECTIVES

We aimed at comparing lifestyle patterns among preschool-aged children across Europe, their associations with socio-demographic factors and their links with body mass index (BMI).

METHODS

Harmonized data on 2-5-year-olds participating in nine European birth cohorts from the EU Child Cohort Network were used (EBRBs, socio-demographics and anthropometrics). Principal component analysis and multivariable linear and logistic regressions were performed.

RESULTS

The most consistent pattern identified across cohorts was defined by at least three of the following EBRBs: discretionary consumption, high screen time, low outdoor play time and low sleep duration. Consistently, children from low-income households and born to mothers with low education level had higher scores on this pattern compared to their socioeconomically advantaged counterparts. Furthermore, it was associated with higher BMI z-scores in the Spanish and Italian cohorts (β = 0.06, 95% CI = [0.02; 0.10], both studies).

CONCLUSION

These findings may be valuable in informing early multi-behavioural interventions aimed at reducing social inequalities in health at a European scale.

Dietary approaches for normalizing dysbiosis induced by high-fat, obesogenic diets

PURPOSE OF REVIEW

Given the world-wide problem of obesity, this review considers what types of dietary changes can be utilized to minimize the adverse effects of an obesogenic diet on the intestinal microbiota.

RECENT FINDINGS

In rodents fed high-fat diets containing lard or Western blend fats to induce obesity, switching to high-fat diets formulated to contain higher amounts of fiber or fiber-containing foods, plant extracts, omega-3 fatty acids or whole grains has beneficial effects on body weight, metabolic alterations, and the intestinal microbiota. Several studies show that the intestinal microbiota has a role in mediating the beneficial health effects of these dietary factors. Many aspects of the microbiota observed in animals when healthful dietary components were added to the feed have also been observed in humans who follow healthful dietary patterns.

SUMMARY

The data shows that specific foods and macronutrients can normalize the obesity-associated microbiota and improve metabolic health. These findings support the design of dietary interventions that would allow individuals to focus on diet quality independently of weight loss to mitigate the adverse sequelae of obesity.

Changes in food and nutrient intakes in Korean adults before and during the COVID-19 pandemic: data from the 2011-2020 Korea National Health and Nutrition Examination Survey

OBJECTIVES

This study was to examine the changes in dietary habits and food and nutrient intakes between before (2019) and during (2020) the coronavirus disease 2019 (COVID-19) pandemic from the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

A total of 54,995 participants aged ≥19 years who participated in the 2011-2020 KNHANES were included. The 10-year trend (2011-2020) and differences between 2019 and 2020 for dietary habits and food and nutrient intakes were estimated using SAS.

RESULTS

In the past 10 years (2011-2020), the dietary habits (increase in skipping meals and eating out), food intake (increase in meats and decrease in fruits and vegetables), and nutrient intake (increase in fat and decrease in sodium) in adults have changed. When comparing between 2019 and 2020, there were 4.6%p decrease in the eating out more than once a day. On the other hand, there were no significant differences in the intakes of food, energy and most of nutrients between 2019 and 2020, except for the proportion of energy intake from fat (1.0%p increase) and carbohydrate (1.0%p decrease).

CONCLUSIONS

Although a change in dietary habits from before to during the COVID-19 pandemic was observed, food and nutrient intakes have not deteriorated markedly and appear similar to the trends in the past 10 years. Throughout the COVID-19 pandemic, it is necessary to monitor the effects of changes in dietary habits on health as well as food and nutrient intakes.

Can Artificial Sweeteners Increase the Risk of Cancer Incidence and Mortality: Evidence from Prospective Studies

Cancer has become a major challenge in the global disease burden. Artificial sweeteners are a class of chemical compounds that are used as food and beverage addition agent to replace sugar. However, the health effects of consuming artificial sweeteners are still unclear. This meta-analysis was performed to evaluate the role of artificial sweeteners on cancer. The databases PubMed, Cochrane Library, MEDLINE, Web of Science and EMBASE were searched up until July 2022. A Newcastle−Ottawa scale (NOS) was used to estimate the study quality. A total of 25 observational studies were included with a total of 3,739,775 subjects. The intake of artificial sweeteners had no apparent association with overall cancer incidence and mortality. However, in Europe, artificial sweeteners’ intake could increase the risk of cancer incidence (HR/RR = 1.07, 95% CI = [1.02, 1.12], I2 = 25.8%, P = 0.223), which appears to be related to a shift in nutritional behaviors in the countries. Significant results were also observed in subgroups with aspartame and a mixed intake of artificial sweeteners. Moreover, higher risk was observed for artificial sweeteners intake in all-cause mortality (HR/RR =1.13, 95% CI = [1.03, 1.25], I2 = 79.7%, p < 0.001) and a J-shaped association between them was found. More data from well-conducted studies and clinical trials are required.