Association between dietary mineral nutrient intake, body mass index, and waist circumference in U.S. adults using quantile regression analysis NHANES 2007-2014

Deciphering the causality between micronutrients and esophageal cancer via Mendelian randomization

BACKGROUND

There is an ongoing debate about how micronutrients influence the risk of developing esophageal cancer (EC), requiring more definitive proof to ascertain their causal relationship.

OBJECTIVE

The current study seeks to identify the causal relationship between 14 micronutrients and EC through Mendelian randomization (MR) methods.

METHODS

We performed a two-sample MR analysis of micronutrients in relation to EC, using five different MR methodologies, chief among them the Inverse Variance Weighted method. To ascertain the direction of causal links, Steiger filtering was applied. The study culminated in a sensitivity analysis to test the robustness of the results.

RESULTS

In the European population, iron (OR = 0.231, 95% CI: 0.073-0.727, P = 0.012) and magnesium (OR = 0.357, 95% CI: 0.143-0.894, P = 0.028) were associated with a reduced risk of EC, both showing suggestive evidence of a causal relationship. In Asian populations, however, no significant causal effects were found between the 14 micronutrients and EC. The direction of causality was validated across all results.

CONCLUSION

Among European populations, iron and magnesium intake is associated with a reduced risk of EC, a benefit not seen in Asian populations. Personalized strategies and region-specific advice are necessary for EC prevention and control.

Metal mixtures and adiposity indicators in women from Northern Mexico

Exposure to individual metals has been inconsistently associated with adiposity. However, populations are exposed to more than one metal at a time, thus recent studies have been conducted to assess more comprehensively metal exposure through a mixture approach. To explore the association between Body Mass Index (BMI), Waist-Hip Ratio (WHIR) and Waist-Height Ratio (WHER) with urinary metal concentrations, using individual and mixture approaches, as well as identifying the most important metals within the mixtures, in women from Northern Mexico. This is a secondary cross-sectional analysis that included 439 women residents of five states in Northern Mexico. We weighed and measured participants to estimate BMI, WHIR, and WHER. We determined the concentrations of 19 urinary metals using inductively coupled plasma triple quadrupole. We used Weighted Quantile Sum regression to evaluate the association between adiposity indicators and metal mixtures, as well as to identify the metals of concern within the mixtures. We identified a mixture of metals that was negatively associated with BMI (ß:-0.96, 95% CI:-1.90,-0.01), where the most prominent were lead, molybdenum and magnesium. Furthermore, WHIR was negatively and suggestively associated with a mixture where the predominant metals were aluminum, cadmium, arsenic and nickel (ß:- 7.12, 95% CI: - 1.75,0.00), likewise WHER was associated with a mixture where the important metals were arsenic and nickel (ß: - 1.03, 95% CI: - 2.24,0.00). Our results provide evidence about the associations between metal mixtures and some anthropometric indicators of adiposity. Experimental studies are warranted to identify the underlying biological mechanisms.

Association of Higher Intakes of Dietary Zinc with Higher Ferritin or Hemoglobin: a Cross-sectional Study from NHANES (2017-2020)

Zinc is an essential trace element that plays a critical role in numerous physiological processes, including immune function, cell growth, and particularly iron metabolism. This study aimed to explore the association between dietary zinc intake and key biomarkers of iron status, specifically serum ferritin and hemoglobin levels, in a representative sample of the US population. A cross-sectional analysis was conducted using data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES), which included 15,560 participants. Dietary zinc intake was assessed through 24-h dietary recall, and serum ferritin and hemoglobin levels were measured through laboratory tests. Participants were grouped into quartiles based on their zinc intake. Multivariable linear regression models were applied to evaluate the relationship between dietary zinc intake and ferritin and hemoglobin levels, adjusting for potential confounders such as age, sex, body mass index (BMI), waist circumference, energy intake, macronutrients, and micronutrients. These adjustments ensured a more accurate analysis of the associations between zinc intake and iron markers. Our findings demonstrate that higher dietary zinc intake is significantly associated with elevated serum ferritin (B = 6.17, p = 0.027) and hemoglobin (B = 0.048, p = 0.019) levels, independent of other factors. Participants in the highest zinc intake quartile also showed higher hematocrit and mean corpuscular volume (MCV) levels compared to those in the lowest quartile. These results suggest that adequate dietary zinc intake may play a crucial role in improving iron status and reducing the risk of iron-deficiency anemia, particularly in populations at risk. Future research is necessary to further elucidate the mechanisms behind this relationship and to inform public health nutritional guidelines.

Copper biomarkers and their relationship with parameters of insulin resistance in obese women

Some studies have demonstrated the involvement of high concentrations of copper in the manifestation of insulin resistance in individuals with obesity. The objective of this study was to evaluate the copper nutritional status and its relationship with parameters of glycemic control in women with obesity. An observational case-control clinical study involving 203 women aged between 20 and 50 years, divided into two groups: obese (n = 84) and eutrophic (n = 119). Body weight, height and waist, hip and neck circumferences, dietary copper intake, copper biomarkers, determine ceruloplasmin activity and glycemic control parameters were measured. It was observed that women with obesity had higher copper concentrations in plasma and lower concentrations in erythrocytes when compared to the control group. Analysis of glycemic control parameters revealed a statistically significant difference in fasting blood glucose (p < 0.05) between groups. The study identified a significant positive correlation between plasma copper and fasting insulin values and the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) index (p < 0.05). The results of this study demonstrate that obese women have high copper concentrations in plasma and lower concentrations in erythrocytes. Furthermore, the significant positive correlation between plasma copper and fasting insulin and HOMA-IR index suggests the influence of this mineral on glycemic control parameters in obese women.

Thermogenic Adipocytes Promote M2 Macrophage Polarization through CNNM4-Mediated Mg Secretion

M2 macrophages promote adipose tissue thermogenesis which dissipates energy in the form of heat to combat obesity. However, the regulation of M2 macrophages by thermogenic adipocytes is unclear. Here, it is identified magnesium (Mg) as a thermogenic adipocyte-secreted factor to promote M2 macrophage polarization. Mg transporter Cyclin and CBS domain divalent metal cation transport mediator 4 (CNNM4) induced by ADRB3-PKA-CREB signaling in thermogenic adipocytes during cold exposure mediates Mg efflux and Mg in turn binds to the DFG motif in mTOR to facilitate mTORC2 activation and M2 polarization in macrophages. In obesity, downregulation of CNNM4 expression inhibits Mg secretion from thermogenic adipocytes, which leads to decreased M2 macrophage polarization and thermogenesis. As a result, CNNM4 overexpression in adipocytes or Mg supplementation in adipose tissue ameliorates obesity by promoting thermogenesis. Importantly, an Mg wire implantation (AMI) approach is introduced to achieve adipose tissue-specific long-term Mg supplement. AMI promotes M2 macrophage polarization and thermogenesis and ameliorates obesity in mice. Taken together, a reciprocal regulation of thermogenic adipocytes and M2 macrophages important for thermogenesis is identified, and AMI is offered as a promising strategy against obesity.

Serum total testosterone is associated with phosphate and calcium excretion in response to oral phosphate loading in healthy middle-aged males

Androgen receptors are expressed in the kidney and serum testosterone is negatively associated with serum phosphate in males, suggesting a role of testosterone in renal phosphate handling. In this cross-sectional study, we examined the association of serum total and free testosterone with acute phosphate and calcium excretion in males in response to an oral phosphate challenge. Thirty-five healthy adult males with normal baseline testosterone levels consumed a 500 mg phosphorus drink and the urinary excretion of minerals, as well as levels of relevant circulating parameters, were assessed at baseline and hourly for 4 h. Serum total testosterone was positively associated with overall phosphate excretion (r = 0.35, p = 0.04) and calcium excretion (r = 0.44, p = 0.00) in response to the challenge. Serum free testosterone was positively associated with post-challenge calcium excretion (r = 0.34, p = 0.048), but significance was not reached for phosphate excretion (r = 0.31, p = 0.07). Serum total and free testosterone were not associated with parathyroid hormone, fibroblast growth factor-23, or vitamin D-key factors implicated in phosphate and calcium regulation. Overall, higher serum total testosterone levels in healthy middle-aged males are associated with a greater capacity to acutely excrete phosphate and calcium after a single oral phosphate challenge, suggesting potential ramifications of testosterone deficiency related to mineral homeostasis.

Associations between nine dietary minerals intake and all-cause mortality in individuals with atherosclerotic cardiovascular disease

Background

Varied intake of dietary minerals critically affects cardiovascular health. This study examines the associations of nine dietary minerals intake with all-cause mortality in atherosclerotic cardiovascular diseases (ASCVDs).

Methods

This study analyzed 4,125 individuals with ASCVD from the National Health and Nutrition Examination Survey, employing Kaplan-Meier survival analyses, weighted Cox models, and restricted cubic splines to assess linear and nonlinear relationships between dietary minerals intake and all-cause mortality. Associations across different body mass index (BMI) categories were also evaluated separately.

Results

Over 6.25 years of median follow-up, 1,582 deaths were documented. Adjusted for potential covariates, results show a negative linear correlation between dietary magnesium intake and all-cause mortality (p for trend <0.001). Compared to the lowest quartile, all-cause mortality risk in the highest quartile was found to be 0.63 (95% CI 0.49-0.81). The associations between intake of the other eight dietary minerals and all-cause mortality were not robust. BMI significantly influenced the links between dietary minerals intake and all-cause mortality (p for interaction <0.05). Across BMI categories, significant negative associations were found between intake of magnesium, phosphorus, potassium, sodium, and copper and all-cause mortality in underweight or normal weight groups. In overweight individuals, intake of calcium, iron, magnesium, and potassium was negatively linked to all-cause mortality. For obese groups, sodium intake negatively affected all-cause mortality (p for trend <0.001).

Conclusion

Unlike other dietary minerals, increased magnesium intake significantly reduced all-cause mortality risk in ASCVD. BMI influenced the associations between dietary minerals intake and all-cause mortality.

Inquiry of the Metabolic Traits in Relationship with Daily Magnesium Intake: Focus on Type 2 Diabetic Population

Magnesium (Mg), an essential nutrient with a wide area of physiological roles, stands as a cofactor in over 600 enzymatic reactions involved in the synthesis of proteins and nucleic acids, DNA repair, neuromuscular functions, neuronal transmission, cardiac rhythm regulation, and the modulation of metabolic pathways, as well as acting as a natural blocker for the calcium channels. Our objective was to highlight the most recent clinical data with respect to daily Mg intake (DMI) and metabolic traits, particularly type 2 diabetes mellitus (DM). This was a PubMed-based review of the English-language medical papers across different key terms of search; the time frame was from January 2019 until April 2024. We included (clinically relevant) original studies and excluded cases reports, series, reviews, editorials, opinion, experimental studies, and non-human data as well as studies that did not specifically assessed DMI and only provided assays of serum Mg, studies on patients diagnosed with type 1 or secondary DM. A total of 30 studies were included and we organized the key findings into several sections as follows. Studies investigating DMI in relationship with the adherence to local recommendations in diabetic subjects (n = 2, one transversal and another retrospective cohort; N = 2823) found that most of them had lower DMI. Deficient DMI was correlated with the risk of developing/having DM across five studies (n = 5, one prospective and four of cross-sectional design; N = 47,166). An inverse correlation between DMI and DM prevalence was identified, but these data are presented amid a rather heterogeneous spectrum. Four novel studies (N = 7279) analysed the relationship between DMI and DM control according to various methods (HbA1c, fasting and postprandial glycaemia, and insulin); the association may be linear in diabetic subjects only at certain levels of DMI; additionally, the multifactorial influence on HBA1c should take into consideration this dietary determinant, as well, but there are no homogenous results. Three studies concerning DMI and diabetic complications (one cross-sectional, one prospective, and another case-control study) in terms of retinopathy (n = 1, N = 3794) and nephropathy (n = 2, N = 4805) suggested a lower DMI was associated with a higher risk of such complications. Additionally, two other studies (one prospective and one retrospective cohort) focused on mortality (N = 6744), which, taking only certain mortality indicators into consideration, might be decreased in the subgroups with a higher DMI. Seven studies (N = 30,610) analysed the perspective of DMI in the general population with the endpoint of different features amid glucose profile, particularly, insulin resistance. Concerning HOMA-IR, there were three confirmatory studies and one non-confirmatory, while fasting plasma glucose was highlighted as inversely correlated with a DMI (n = 1). The highest level of evidence regarding Mg supplementation effects on glucose metabolism stands on seven randomised controlled trials (N = 350). However, the sample size was reduced (from 14 to 86 individuals per study, either diabetic or pre-diabetic) and outcomes were rather discordant. These clinical aspects are essential from a multidisciplinary perspective and further trials are mandatory to address the current areas of discordant results.

Association Between Dietary Intake of Phosphorus and Measures of Obesity in the Jackson Heart Study

BACKGROUND

The relation between phosphorus (P) intake and obesity is equivocal, with hypotheses in both directions.

OBJECTIVES

We investigated the relationship between P intake, assessed from a current database, and calculated bioavailable P intake and obesity among African-American adults.

METHODS

We examined associations between original and bioavailable P (total, added, and natural) and BMI and waist circumference (WC) in a cross-sectional study of 5306 African-American adults (21-84 y) from the Jackson Heart Study. A total of 3300 participants had complete interviews, valid dietary data, and normal kidney function. Diet was assessed by food frequency questionnaire. A novel algorithm was used to estimate P bioavailability. BMI or WC was regressed on each P variable, adjusting for total energy intake and potential confounders.

RESULTS

After adjusting for covariates, original P (total and added) and bioavailable P (total and added) intakes (expressed/100 mg) were associated with BMI (β: 0.11, 0.67, 0.31, and 0.71, respectively; all P < 0.0001). Neither original nor bioavailable natural P was significantly associated (β: -0.03 and 0.09, respectively; both P > 0.05). When added and natural P were included in the same model, added P (original and bioavailable) intakes remained strongly associated with BMI (0.70 and 0.73, respectively; both P < 0.0001). Similar results were seen for WC. Intake of original added P tended to be more strongly associated with BMI, in females (β: 0.72; P < 0.0001) than in males (β: 0.56; P = 0.003) (P-interaction = 0.06).

CONCLUSIONS

We found that greater intake of added, not natural, which may be a proxy for intake of processed foods was associated with higher BMI and WC. These were somewhat stronger when bioavailability was considered and for women than for men. Further investigation is needed to fully understand the mechanisms driving these associations.

Circulating Selenium Level Was Positively Related to Visceral Adiposity Index with a Non-linear Trend: a Nationwide Study of the General Population

Selenium plays a role in obesity. However, whether circulating selenium levels are related to the visceral adiposity index (VAI), an indicator of obesity, is still unknown. Based on the National Health and Nutrition Examination Survey (NHANES) 2011-2018, data from 12,777 individuals aged ≥ 20 years were analyzed to clarify this question. In fully adjusted models of multivariate regression analysis, natural logarithm (Ln) selenium was positively related to Ln VAI (β = 0.41; 95% confidence interval [CI], 0.27, 0.55; P < 0.001). Compared with the lowest quartile of Ln selenium, the highest quartile was also positively associated with Ln VAI (β = 0.16; 95% CI, 0.11, 0.21; P < 0.001). Moreover, we found that this positive connection was non-linear. When Ln selenium was less than the inflection point, Ln selenium was positively related to Ln VAI (β = 0.41; 95% CI, 0.31, 0.52; P < 0.001). However, when Ln selenium was greater than or equal to the inflection point, Ln selenium was not significantly related to Ln VAI (β = -0.15; 95% CI, -0.56, 0.25; P = 0.455). In subgroup analysis, significant interactions were observed with age and sex (P for interaction < 0.05). Stronger interactions were observed among middle-aged participants (β = 0.65; 95% CI, 0.31, 0.98; P = 0.002) and males (β = 0.61; 95% CI, 0.43, 0.79; P < 0.001). Overall, circulating selenium levels were positively related to VAI, with a non-linear trend. Prospective studies and interventional experiments are necessary to verify the possible mechanisms.

A case-control study on asthma and obese patients: Influence of lifestyle patterns, serum trace elements, heavy metals, and total antioxidants

Background and aim

Asthma is a chronic airway hyperresponsiveness disorder and Obese people have greater rates of asthma incidence and prevalence. Obesity, a complex condition, can cause nutritional metabolic problems that change trace elements and minerals. Trace element and antioxidant levels affect asthma aetiology. In this study, we aim to determine the serum levels of trace elements Zn, Fe, Cu, Mg, Co, Ni, Pb, Cd, and Cr, total antioxidants (TAS), and lifestyle that determine specific clinical conditions in asthma and obesity patients from Vellore City (Tamil Nadu, India).

Methods

A case-control study to determine the level of the serum trace elements with 838 subjects (n = 242 asthma patients, n = 140 asthmatic obese, n = 185 obese patients, and n = 271 controls) between the ages of 20 and 60 years was carried out. Asthma was diagnosed based on the clinical examination and pulmonary function tests. Trace element levels were determined by atomic absorption spectrophotometry (AAS) in serum, and a DPPH-free radical scavenging assay was used to determine the total antioxidant capacity level in serum.

Result

In asthma male patients, serum levels of Zn, Fe, Cu, Mg, and TAS were significantly lower and Pb, Cd, and Cr significantly higher, whereas in female asthma patients, serum levels of Zn, Fe, Mg, and TAS were significantly lower and Pb significantly higher. In asthmatic obese male patients, Fe, Cu, and TAS were significantly lower, and Pb, Cd, and Co were significantly higher; in asthmatic obese female patients, Zn, Fe, Cu, Mg, and TAS were significantly lower, and Ni was significantly higher. In obese male patients, Zn, Fe, Cu, and TAS were significantly lower and Cd was significantly higher, and in obese female patients, Zn, Fe, Cu, Mg, and TAS were significantly lower.

Conclusion

The influence of the level of trace elements, heavy metal, total antioxidant, and the lifestyle patterns, may increase the risk of asthma and obesity.

A cross-sectional analysis of the PURE study on minerals intake among Malaysian adult population with hypertension

Hypertension (HPT) is the leading modifiable risk factor for cardiovascular diseases and premature death worldwide. Currently, attention is given to various dietary approaches with a special focus on the role of micronutrient intake in the regulation of blood pressure. This study aims to measure the dietary intake of selected minerals among Malaysian adults and its association with HPT. This cross-sectional study involved 10,031 participants from the Prospective Urban and Rural Epidemiological study conducted in Malaysia. Participants were grouped into HPT if they reported having been diagnosed with high blood pressure [average systolic blood pressure (SBP)/average diastolic blood pressure (DBP) ≥ 140/90 mm Hg]. A validated food frequency questionnaire (FFQ) was used to measure participants' habitual dietary intake. The dietary mineral intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, sodium, and zinc was measured. The chi-square test was used to assess differences in socio-demographic factors between HPT and non-HPT groups, while the Mann-Whitney U test was used to assess differences in dietary mineral intake between the groups. The participants' average dietary intake of calcium, copper, iron, magnesium, manganese, phosphorus, potassium, selenium, sodium, and zinc was 591.0 mg/day, 3.8 mg/day, 27.1 mg/day, 32.4 mg/day, 0.4 mg/day, 1431.1 mg/day, 2.3 g/day, 27.1 µg/day, 4526.7 mg/day and 1.5 mg/day, respectively. The intake was significantly lower among those with HPT than those without HPT except for calcium and manganese. Continuous education and intervention should be focused on decreasing sodium intake and increasing potassium, magnesium, manganese, zinc, and calcium intake for the general Malaysian population, particularly for the HPT patients.

The Circulating Selenium Concentration Is Positively Related to the Lipid Accumulation Product: A Population-Based Cross-Sectional Study

The lipid accumulation product (LAP) is a reliable marker of metabolic syndrome, which includes conditions like obesity. However, the correlation between the circulating selenium (CSe) concentration and the LAP is currently unclear. This study aimed to ascertain this correlation. Overall, 12,815 adults aged ≥20 years were enrolled in this study. After adjusting for all the confounding variables, CSe was positively correlated to the LAP (β = 0.41; 95% confidence interval [CI]: 0.28, 0.54; p < 0.001). Compared with the lowest quartile of CSe, the highest quartile of CSe was positively related to the LAP (β = 0.16; 95% CI: 0.12, 0.21; p < 0.001). Moreover, the correlation between CSe and the LAP revealed a positive non-linear trend. In the subgroup analysis, interaction effects were observed for age, sex, smoking, and stroke (p for interaction < 0.05). The effects were stronger for males (β = 0.64, 95% CI: 0.47, 0.80; p < 0.001) and individuals who smoke at the time of the trial (β = 0.64, 95% CI: 0.37, 0.91; p < 0.001). In conclusion, our results indicated that CSe was positively correlated with the LAP in a non-linear manner. Future research is warranted to explore their relationship and better understand the mechanisms underlying this association.

Association between plasma and dietary trace elements and obesity in a rural Chinese population

Trace elements may play an important role in obesity. This study aimed to assess the plasma and dietary intake levels of four trace elements, Mn, Cu, Zn and Se in a rural Chinese population, and analyse the relationship between trace elements and obesity. A cross-sectional study involving 2587 participants was conducted. Logistic regression models were used to analyse the association between trace elements and obesity; restricted cubic spline (RCS) models were used to assess the dose-response relationship between trace elements and obesity; the weighted quantile sum (WQS) model was used to examine the potential interaction of four plasma trace elements on obesity. Logistic regression analysis showed that plasma Se concentrations in the fourth quartile (Q4) exhibited a lower risk of developing obesity than the first quartile (Q1) (central obesity: OR = 0·634, P = 0·002; general obesity: OR = 0·525, P = 0·005). Plasma Zn concentration in the third quartile (Q3) showed a lower risk of developing obesity in general obesity compared with the first quartile (Q1) (OR = 0·625, P = 0·036). In general obesity, the risk of morbidity was 1·727 and 1·923 times higher for the second and third (Q2, Q3) quartiles of dietary Mn intake than for Q1, respectively. RCS indicated an inverse U-shaped correlation between plasma Se and obesity. WQS revealed the combined effects of four trace elements were negatively associated with central obesity. Plasma Zn and Se were negatively associated with obesity, and dietary Mn was positively associated with obesity. The combined action of the four plasma trace elements had a negative effect on obesity.

Association of Plasma Zinc and Copper with Body Composition, Lipids and Inflammation in a Cross-Sectional General Population Sample from Germany

We aimed to relate circulating plasma zinc and copper to a broad spectrum of adiposity-related traits in a cross-sectional Northern German study (n = 841, 42% female, age: 61 ± 12 years). Zinc and copper were measured by inductively coupled plasma-mass spectrometry. Subcutaneous (SAT) and visceral (VAT) adipose tissue and liver fat were derived from 534 and 538 participants, respectively, via magnet resonance imaging. Associations were assessed using multivariable-adjusted linear regression analysis. An increase per one standard deviation (SD) in zinc was associated with direct linear increases in body mass index (BMI) (1.17%; 95% confidence interval (95%CI) 0.15-2.20%), waist circumference (0.85%; 95%CI 0.04-1.67%) and waist-to-hip ratio (0.64%; 95%CI 0.18-1.09%). A 1-SD increment in copper was directly associated with BMI (1.64%; 0.41-2.88%) and waist circumference (1.22%; 95%CI 0.25-2.20%) but not waist-to-hip ratio. Independent of fat intake, zinc displayed associations with VAT (5.73%; 95%CI 2.04-9.56%) and with liver fat (3.84%; 95%CI 1.49-6.25%), the latter association being also independent of BMI. Copper was directly associated with SAT (4.64%; 95%CI 0.31-9.15%) before accounting for BMI, but showed no association with VAT or liver fat. Observed associations suggest a possible relevance of zinc and copper to adiposity. Particularly zinc displayed associations with traits of abdominal adiposity and liver fat.

Dietary Patterns in 1125 Iranian Women: Adequacy of Energy and Micronutrient Intakes and Weight Statuses

Background

Women's nutrition status includes significant effects on their children and household health. The purpose of this study was to assess energy and micronutrient intake adequacy in Iranian women.

Methods

This study was a part of the Urban HEART Study, which has jointly been developed by the World Health Organization (WHO) Centre for Health Development, Kobe, Japan. In total, anthropometric and dietary intake data were collected from 1125 women in southern Tehran municipality districts. A 24-h recall questionnaire was completed by the expert nutritionists and the participants' anthropometric statuses were assessed. Food intakes were calculated in grams per capita per day. Micronutrients and energy requirements were adapted from WHO/Food and Agriculture Organization (FAO) tables and Iran National Food Consumption Survey, respectively.

Results

Nearly 71.5% of the women were overweight or obese [body mass index (BMI) ≥25 kg/m2]. Furthermore, 1.2% of the women were underweight (BMI <18.5 kg/m2), while 27.3% had normal weight (BMI = 18.5--24.9 kg/m2). The mean bread/cereal and vegetable intakes were significantly higher in obese group, compared to that in normal/under/overweight group (375.6 g/day ± 151.4, P = 0.05; and 331.4 g/day ± 227.5, P = 0.02), respectively]. Women in the lean group significantly consumed higher quantities of cakes/pastries and had the lowest calcium and iron adequacy ratios, compared to other groups (p = 0.001, P = 0.03, and P = 0.05, respectively).

Conclusions

These findings suggest that Iranian women, especially those who reside in the southern areas of Tehran, need to change their dietary habits to maintain their health. Moreover, being under/normal weight does not necessarily mean following healthy diets.

Effect of imbalance in dietary macronutrients on blood hemoglobin levels: a cross-sectional study in young underweight Japanese women

Background

Iron deficiency and underweight are common nutritional problems among young Japanese women, many of whom show unhealthy dietary patterns owing to a desire for thinness. We conducted a cross-sectional analysis of the relationship between iron status, nutritional status, and dietary intake among young Japanese women with underweight to identify dietary risk factors for iron deficiency.

Methods

Of the 159 young women (18-29 years of age) enrolled, 77 underweight and 37 normal-weight women were included in the study. They were further categorized into four groups based on quartiles of hemoglobin levels among all participants. Dietary nutrient intake was ascertained using a brief self-administered diet history questionnaire. Blood level of hemoglobin and nutritional biomarkers such as total protein, albumin, insulin-like growth factor-1 (IGF-1), and essential amino acids were measured.

Results

In underweight, the multiple comparison test showed that dietary intakes of fat, saturated fatty acid, and monosaturated fatty acid were significantly higher and carbohydrate intake was significantly lower in the group with the lowest hemoglobin level, whereas intakes of iron were the same across groups. Multivariate regression coefficients suggested that replacing fat with protein or carbohydrates increased hemoglobin levels under isocaloric conditions. Additionally, significant positive correlations were observed between hemoglobin levels and nutritional biomarkers.

Conclusion

Dietary iron intake did not change across different hemoglobin groups among Japanese underweight women. However, our results suggested that an imbalanced dietary macronutrient induces anabolic status and hemoglobin synthesis deterioration among them. Especially, a higher fat intake may be a risk factor for lower hemoglobin.

Determinants of continuum of care for maternal, newborn, and child health services in Ethiopia: Analysis of the modified composite coverage index using a quantile regression approach

Maternal and child mortality remain unacceptably high in the Sustainable Development Goals era. Continuum of care has become a key strategy for improving the health of mothers and newborns. Previous research on the continuum of care in Ethiopia is often limited to maternal health services. Maternal and child health services are inseparably linked, and an integrated approach to care is essential. This study assessed the continuum of maternal, newborn, and child health care and associated factors in Ethiopia. The analysis was based on the 2016 Ethiopian Demographic and Health Survey data. We restricted our analysis to women with their most recent children-alive and living with their mother- aged 12-23 months at the time of the survey (n  =  1891). The modified composite coverage index, constructed from twelve maternal and child health services, was calculated as an indicator of the continuum of care. Bivariable and multivariable quantile regression were used to analyse the relationship between the predictors and specific quantiles of the composite coverage index. The effect of each variable was examined at the 10th, 25th, 50th, 75th, and 95th quantiles. The results showed that the average composite coverage index value was 39%. The overall completion rate of the continuum of care was low (2%). Four % of the women did not receive any of the services along the continuum of care. Postnatal care for newborns had the lowest coverage (12%). This study provides evidence that factors such as the educational status of women, region, residence, socio-economic status, perceived distance to a health facility, pregnancy intention, mode of delivery, parity, and early antenatal care initiation influence the continuum of care differently across levels of the composite coverage index. The findings call for integrated and targeted strategies that aim to improve the continuum of care considering the determinants.

Nutritional intake of sport undergraduates in Sabaragamuwa University of Sri Lanka

BACKGROUND

Nutritional intake plays an important role in determining energy availability which is vital to health, wellbeing, and sports performance in an active population. This research assessed the sports undergraduates' nutritional intake compared to the Dietary Guidelines for Americans and nutrition goals provided by WHO.

METHODS

This study is a quantitative, cross-sectional descriptive study. One hundred and one (n = 101) sports undergraduates aged between 20 to 23 years were recruited and the nutrient intake was assessed using the three-day food diary method and quantified the macro and micronutrients by the food composition database. One sample t-test was performed to compare the mean nutrient intakes with the lowest recommendation values.

RESULTS

Though most undergraduates were able to meet the dietary requirements in carbohydrates, they were deficient in their protein intake and exceeded in fats intake. Further, both male and female students were deficient in their daily energy intake (1723 kcal, 1607 kcal) and dietary fiber intake (8 g, 11 g). The saturated fat intake was met by all students while 20% of males and 21% of females exceeded the recommendations (< 10%). The micronutrient intake of vitamins such as C, B1, B2, B9, and B12 and minerals such as Calcium, Magnesium, and Potassium, were significantly below the recommendations (p < 0.05) except for vitamin B3 niacin.

CONCLUSIONS

Providing a nutritionally valuable meal is essentially required to maintain both physical and mental fitness. Our results revealed that the Sri Lankan sport science undergraduates do not have an adequate daily dietary intake of energy, proteins, calcium, magnesium, potassium, and vitamins such as C, B1, B2, B9, and B12.

Relationship between overweight and obesity and insufficient micronutrient intake: a nationwide study in Taiwan

The aim of the present study is to examine whether overweight or obese people in Taiwan have an inadequate intake of selected micronutrients. A population-based study was conducted using data from the Nutrition and Health Survey in Taiwan (NAHSIT) 2013-2016. We evaluated fourteen nutrient intakes using the 24 h dietary recall method. The dietary reference intake (DRI) adherence was estimated by the prevalence of participants whose intake was lower than the recommended dietary allowance (RDA) or adequate intakes (AIs) for selected micronutrients. Body mass index (BMI) ≥ 27 kg/m² and waist circumference (WC), with men having WC ≥ 90 cm or women having WC ≥ 80 cm, were defined as obesity. A total of 3075 participants aged 19 years and above were included. After adjusting for confounders, we found that obese women have a lower DRI adherence of vitamin C (odds ratio (OR) 0⋅73, 95 % confidence interval (CI) 0⋅56, 0⋅95) and magnesium (OR 0⋅72, 95 % CI 0⋅54, 0⋅95), compared with normal-weight women. Obese men have a higher DRI adherence of vitamin B3 (OR 1⋅70, 95 % CI 1⋅29, 2⋅23), iron (OR 1⋅46, 95 % CI 1⋅06, 2⋅00) and zinc (OR 1⋅41, 95 % CI 1⋅07, 1⋅85), compared with normal-weight men. Similar findings were found using WC to define obesity. We conclude that obese women may have insufficient intakes of vitamin A, vitamin C and magnesium.

Phosphate Dysregulation and Metabolic Syndrome

Phosphorus is one of the most abundant minerals in the human body. It is essential for almost all biochemical activities through ATP formation, intracellular signal transduction, cell membrane formation, bone mineralization, DNA and RNA synthesis, and inflammation modulation through various inflammatory cytokines. Phosphorus levels must be optimally regulated, as any deviations may lead to substantial derangements in glucose homeostasis. Clinical studies have reported that hyperphosphatemia can increase an individual's risk of developing metabolic syndrome. High phosphate burden has been shown to impair glucose metabolism by impairing pancreatic insulin secretion and increasing the risk of cardiometabolic disorders. Phosphate toxicity deserves more attention as metabolic syndrome is being seen more frequently worldwide and should be investigated further to determine the underlying mechanism of how phosphate burden may increase the cardiometabolic risk in the general population.

The Levels of Bioelements in Postmenopausal Women with Metabolic Syndrome

(1) Metabolic syndrome is a set of factors that considerably increase the risk of developing atherosclerosis, type 2 diabetes, and their cardiovascular complications. Studies show that menopause and the levels of elements may be significantly associated with increased risk of MetS. The present study evaluated the relationship between element levels (Ca, P, Na, K, Fe, Mg, Cu, Zn, Sr) and the incidence of MetS and concomitant metabolic disorders in peri-menopausal women. (2) The study involved 170 perimenopausal women. The methods used were: survey, anthropometric measurement (WC, height, BMI, WHtR), blood pressure measurement, and biochemical analysis of venous blood (lipid profile, glucose, insulin, HbA1C). (3) The study demonstrated statistically significantly higher WC, WHtR, SBP, and DBP values in women with pre-Mets than in those with Mets and the control group. Significantly higher FPG, TG, LDL, HbA1C, insulin, TG/HDL ratio, and TC/HDL ratio were recorded in the MetS group compared to the rest of respondents. In addition, post hoc analysis revealed statistically significant differences in mean K concentrations between pre-MetS and MetS women. (4) Low blood K levels in perimenopausal women are associated with an increased risk of MetS. Significantly higher Cu levels were observed in overweight women. The concentration of Cu negatively correlates with the values of TC, LDL, and SBP.

Dietary Micronutrient Status and Relation between Micronutrient Intakes and Overweight and Obesity among Non-Pregnant and Non-Lactating Women Aged 18 to 49 in China

Women between the ages of 18 and 49 are women of reproductive age, for whom physical health and nutritional status are closely related to successful pregnancy, good pregnancy outcomes and the nurturing of the next generation. Overweight and obesity have become important nutrition and health problems of women aged 18−49 years in China. In social life, non-pregnant and non-lactating Chinese women aged 18−49 are the most vulnerable and neglected group. At present, there are no research data on their dietary micronutrient intake, and the relationship between dietary micronutrient intake and overweight and obesity in China. However, non-pregnant and non-lactating women aged 18−49 are the best window of opportunity to implement strategies, correct nutrition and improve physical health. It remains to be explored whether their overweight and obesity are related to inadequate dietary micronutrient intake. The aim of this study was to evaluate dietary micronutrient intake in non-pregnant and non-lactating Chinese women aged 18−49 years, and to analyze the relationship between dietary micronutrient intake and overweight and obesity. Data were obtained from 2015 China Adult Chronic Disease and Nutrition Surveillance (CACDNS 2015). In CACDNS 2015, 12,872 women aged 18 to 49 years (excluding pregnant women and lactating mothers) were surveyed for a three-day 24 h dietary recall and a three-day household weighing of edible oil and condiments. The average daily dietary intake of micronutrients was calculated according to the Chinese food composition table. In 2015, the median intake of vitamin A, vitamin B1, vitamin B2, vitamin C and folate in non-pregnant and non-lactating women aged 18−49 years in China was 267.0 μg RE/day, 0.7 mg/day, 0.6 mg/day, 63.5 mg/day and 121.0 μg/day, respectively. The median mean intake of vitamin A, niacin, calcium and zinc in overweight/obese group was lower than that in non-overweight/obese group, and the difference was statistically significant (p < 0.05). Multivariate Logistic regression analysis showed that vitamin A intake (Q3 vs. Q1: OR = 0.785, 95% CI: 0.702~0.878; Q4 vs. Q1: OR = 0.766, 95% CI: 0.679~0.865), niacin intake (Q2 vs. Q1: OR = 0.801, 95% CI: 0.715−0.898; Q3 vs. Q1: OR = 0.632, 95% CI: 0.554~0.721; Q4 vs. Q1: OR = 0.662, 95% CI: 0.568~0.772), Zinc intake (Q4 vs. Q1: OR = 0.786, 95% CI: 0.662~0.932) were a protective factor for overweight/obesity in women, while vitamin B2 intake (Q2 vs. Q1: OR = 1.256, 95% CI: 1.120~1.408; Q3 vs. Q1: OR = 1.416, 95% CI: 1.240~1.617; Q4 vs. Q1: OR = 1.515, 95% CI: 1.293−1.776), vitamin E intake (Q2 vs. Q1: OR = 1.114, 95% CI: 1.006−0.235; Q3 vs. Q1: OR = 1.162, 95% CI: 1.048~0.288; Q4 vs. Q1: OR = 1.234, 95% CI: 1.112−1.371) was a risk factor for overweight/obesity in females. The intakes of most dietary micronutrients in non-pregnant and non-lactating women aged 18−49 in China were low. The intakes of dietary vitamin A, niacin and zinc were negatively correlated with the risk of overweight/obesity, while the intakes of vitamin B2 and vitamin E were positively correlated with the risk of overweight/obesity.

No association between dietary magnesium intake and body composition among Iranian adults: a cross-sectional study

PURPOSE

Obesity is becoming more prevalent worldwide. Magnesium (Mg) intake may play a role in the regulation of energy metabolism and body weight. Therefore, in this cross-sectional study, we aimed to investigate the association between dietary Mg intake and body composition among healthy adults.

METHODS

A total of 778 adult men and women aged 18-59 years who attended health care centers in Tehran, Iran, entered the final analysis. Dietary intake was assessed with a validated and reliable food frequency questionnaire with 168 items and the dietary Mg intake was estimated using Nutritionist IV software. Anthropometric measurements and blood samples were collected and body composition was evaluated employing the Body Mass Index (BMI), A Body Shape Index (ABSI), Body Adiposity Index (BAI), Body Roundness Index (BRI), Visceral Adiposity Index (VAI), Lipid Accumulation Index (LAP), and Triglyceride-Glucose index (TyG). Multiple linear regression analysis was used to determine the association of the dietary Mg intake with body composition indices.

RESULTS

The mean daily dietary Mg intake was 294 ± 140 mg in men and 262 ± 112 mg in women. Unadjusted linear regression showed that dietary magnesium intake is significantly associated with a waist to hip ratio (WHR) and total cholesterol (TC) in men, and hip circumference (HC) in women. After adjusting for potential confounders including age, education, marriage, occupation and smoking, total energy intake, and activity score, there remained no significant association between dietary Mg intake and any of the body composition indices including BMI, ABSI, BAI, BRI, VAI, LAP, and TyG neither in men nor women.

CONCLUSION

Higher Mg intake was not associated with anthropometric indices in Iranian adults, according to our findings. Additional observational studies would be beneficial in clarifying the existing findings.

Healthy Eating Index Scores, Body Mass Index and Abdominal Obesity Among Asian Americans: NHANES 2011-2018

Objective

Obesity rates are increasing among Asian Americans so, the objective of this study was to examine associations between Healthy Eating Index scores (a measure of adherence to the Dietary Guidelines for Americans (DGAs)) and body mass index (BMI) and waist circumference (measure of abdominal obesity) among Asian American adults.

Methods

Included in these analyses were Asian Americans ≥20 years from the National Health and Nutrition Examination Survey (2011-18) who had: (1) two 24 h diet recalls to calculate HEI and HEI subcomponent scores, (2) height and weight data to calculate BMI overweight ≥25 kg/m2 and obese ≥ 30kg/m (2), and (3) waist circumference data (high risk ≥ 80 cm for women and ≥ 90 cm for men; n = 1024 women and n = 904 men). Multinomial logistic regression models were run with BMI as the outcome and logistic regression models were run with waist circumference as the outcome, controlling for age, income, marital status, education, and physical activity.

Results

Among women, a diet with greater adherence to the DGAs for total fruit, fatty acids and total protein was associated with lower likelihood of developing obesity, but a diet with greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a higher likelihood of obesity. Among men, greater adherence to the DGAs for fatty acids was associated with a lower likelihood of obesity but greater adherence to the DGAs in terms of whole grains and sodium (i.e., lower sodium intake) was associated with a greater likelihood of obesity.

Conclusions

Future research is needed to examine associations between consumption of specific foods and beverages and how they are associated with BMI and waist circumference among Asian American adults. Furthermore, there is a need culturally relevant obesity prevention interventions for Asian American adults, especially interventions that take into consideration cultural food norms of specific Asian American subgroups.

The Role of Magnesium in the Pathogenesis of Metabolic Disorders

Magnesium (Mg) is an essential nutrient for maintaining vital physiological functions. It is involved in many fundamental processes, and Mg deficiency is often correlated with negative health outcomes. On the one hand, most western civilizations consume less than the recommended daily allowance of Mg. On the other hand, a growing body of evidence has indicated that chronic hypomagnesemia may be implicated in the pathogenesis of various metabolic disorders such as overweight and obesity, insulin resistance (IR) and type 2 diabetes mellitus (T2DM), hypertension (HTN), changes in lipid metabolism, and low-grade inflammation. High Mg intake with diet and/or supplementation seems to prevent chronic metabolic complications. The protective action of Mg may include limiting the adipose tissue accumulation, improving glucose and insulin metabolism, enhancing endothelium-dependent vasodilation, normalizing lipid profile, and attenuating inflammatory processes. Thus, it currently seems that Mg plays an important role in developing metabolic disorders associated with obesity, although more randomized controlled trials (RCTs) evaluating Mg supplementation strategies are needed. This work represents a review and synthesis of recent data on the role of Mg in the pathogenesis of metabolic disorders.

Higher Iron Intake Is Independently Associated with Obesity in Younger Japanese Type-2 Diabetes Mellitus Patients

We aimed to analyze the association between dietary iron intake and obesity assessed by BMI after adjustment for nutrient intake (macronutrients and fiber) and food groups. The study design was cross-sectional. Patients with type-2 diabetes (n = 1567; 63.1% males; mean age 62.3 ± 11.6 years) were included in the study. To assess diet, consumption of typical food groups was determined by a food frequency questionnaire. Obesity was defined as BMI ≥ 25 kg/m². We performed a binary regression analysis between quartiles of iron intake and obesity by quartiles of age group. A direct linear association was found for the highest quartile of iron intake and obesity in the younger age group of 30 to 54 years (OR = 3.641, 95% CI = 1.020–12.990; p trend = 0.011). Multivariate analysis using food groups as opposed to nutrients revealed a positive trend for obesity in the younger age group after adjusting for lifestyle factors, energy intake and bean and vegetable intake (p trend = 0.023). In all participants, an inverse association was observed before adjustment by vegetable intake (OR = 0.453, 95% CI = 0.300–0.684; p trend = 0.001). Higher iron intake was associated with obesity independent of macronutrient and fiber intake but only in the youngest quartile of age group examined.

Analysis of spot urine biomarkers and association with body weight in Japanese elementary schoolchildren

Childhood obesity is rapidly increasing worldwide and is largely the consequence of adoption of unhealthy diets excessive in calories and salt (NaCl) as well as devoid in pivotal micronutrients such as potassium (K) and magnesium (Mg). Education-based programs aiming to encourage healthy food knowledge and behaviors are crucial at a young age, and for this purpose, convenient ways to assess daily dietary intake are warranted. We therefore attempted to evaluate the dietary intake of Okinawan schoolchildren in Japan by analyzing a series of biomarkers in morning spot urine samples and explore whether these biomarkers correlate with body weight and a series of metabolic parameters. We enrolled 98 third-grade elementary schoolchildren in Okinawa, Japan. Morning spot urine samples were collected and analyzed using high-performance liquid chromatography (HPLC) to assess dietary intake. We found that estimated daily NaCl intake was higher in obese/overweight children as compared to healthy-weight children (p = 0.0001). There was also a significant positive correlation between body mass index (BMI) and NaCl intake (Spearman) (ρ = 0.45, p < 0.0001) and a negative correlation between BMI and Mg/Cr (ρ =  -0.27, p = 0.01). Furthermore, Na/K ratio was higher in samples collected on Monday (weekend) as compared to samples collected on Thursday or Friday (weekday) (p < 0.0001).

CONCLUSION

Via the use of morning spot urine analyses, our results show that NaCl intake was associated with obesity, and Mg excretion negatively correlated with BMI in Japanese schoolchildren, highlighting the potential role of these micronutrients in maintaining a healthy body weight.

WHAT IS KNOWN

•Overweight and obesity are largely due to excessive consumption of calories and positively correlated with salt (NaCl) intake. •Spot urine methods are convenient for assessing the nutritional needs and targeting prevention programs in children.

WHAT IS NEW

•Utilizing morning spot urine analyses, estimated NaCl intake is positively correlated and Mg/Cr negatively correlated with BMI in Okinawan schoolchildren. •As estimated via morning spot urine samples, a greater proportion of children likely exceeds the recommended NaCl intake on the weekend as compared to weekday.

Osteosarcopenic adiposity syndrome update and the role of associated minerals and vitamins

The objectives are to present an updated synopsis on osteosarcopenic adiposity (OSA) syndrome and evaluate the roles of selected micronutrients in its prevention and management. OSA refers to the concurrent deterioration of bone (osteopenia/osteoporosis), muscle (sarcopenia) and adipose tissue expansion. It portrays the most advanced stage in a continuum of body composition disorders. Although OSA has been widely studied involving the populations of different backgrounds, its prevalence is hard to collate because different methodologies and criteria were used for its diagnosis. Another critical health aspect is the presence of low-grade chronic inflammation (LGCI) which contributes to OSA and vice versa. Nutrition is important in the prevention and management of both OSA and LGCI. Although micronutrients act in numerous metabolic and physiological processes, their roles here are presented in relation to OSA (and its components) and LGCI in general and relevant to the COVID-19 pandemic. These include calcium, magnesium, phosphorus, potassium, sodium and vitamins D and K; their interactions, physiological ratios and synergism/antagonism are discussed as well. In conclusion, calcium, magnesium and vitamin D have a profound impact on OSA and its components, and the latter two also on LGCI. Potassium and vitamin K are vital in bone, muscle functioning and possibly adipose tissue modification. Both, but particularly vitamin D, surfaced as important modulators of immune system with application in COVID-19 infections. While both phosphorus and sodium have important roles in bone, muscle and can impact adiposity, due to their abundance in food, their intake should be curbed to prevent possible damaging effects.

Magnesium in Obesity, Metabolic Syndrome, and Type 2 Diabetes

Magnesium (Mg²⁺) deficiency is probably the most underestimated electrolyte imbalance in Western countries. It is frequent in obese patients, subjects with type-2 diabetes and metabolic syndrome, both in adulthood and in childhood. This narrative review aims to offer insights into the pathophysiological mechanisms linking Mg²⁺ deficiency with obesity and the risk of developing metabolic syndrome and type 2 diabetes. Literature highlights critical issues about the treatment of Mg²⁺ deficiency, such as the lack of a clear definition of Mg²⁺ nutritional status, the use of different Mg²⁺ salts and dosage and the different duration of the Mg²⁺ supplementation. Despite the lack of agreement, an appropriate dietary pattern, including the right intake of Mg²⁺, improves metabolic syndrome by reducing blood pressure, hyperglycemia, and hypertriglyceridemia. This occurs through the modulation of gene expression and proteomic profile as well as through a positive influence on the composition of the intestinal microbiota and the metabolism of vitamins B1 and D.