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Pouzou JG, Zagmutt FJ. Guidelines to restrict consumption of red meat to under 350 g/wk based on colorectal cancer risk are not consistent with health evidence. Nutrition 2024; 122:112395. [PMID: 38492553 DOI: 10.1016/j.nut.2024.112395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/25/2024] [Accepted: 02/10/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The Nordic Nutrition Recommendations of 2023 (NNR2023) incorporate sustainability, health, and nutrition in their food-based dietary guidelines (FBDGs). NNR2023 recommends a consumption of ≤350 g/wk of unprocessed red meat (RM) based on association with colorectal cancer (CRC). This recommendation is lower than other FBDGs such as the World Cancer Research Fund (WCRF) recommendation it is based on (350-500 g/wk). OBJECTIVE To evaluate the empirical evidence and models cited by the NNR2023 to support the RM guidance. METHODS We fitted least-assumption (LA) dose-response (DR) models to the studies included in two systematic reviews (SRs) selected by NNR2023 on the RM and CRC association. We compared them against six parametric models reported in the two SRs. We evaluated the statistical significance of modeled relative risks (RR) at different consumption levels. RESULTS Twenty-one studies (20,604,188 patient-years) were analyzed. We found no significant association (RR = 1.04, 0.99-1.09) between 350g/wk of RM and CRC using the LA models, in agreement with the least restrictive models reported by Lescinsky et al., 2022 (RR = 1.11[0.89-1.38]) and WCRF (RR= 1.01[0.96-1.07]). The association was significant at 350 g/wk only under restricting assumptions such as monotonicity RR=1.3[1.01-1.64], and linearity RR = 1.06 [1.00-1.12]. No significant empirical association is observed under 567 g/wk based on evidence used by NNR2023. CONCLUSIONS The sources cited by NNR2023 do not support a consumption restriction of ≤350 g/wk of RM due to CRC, and other studies omitted by NNR2023 do not support association between RM and CRC. We show that model assumptions rather than empirical evidence drive this recommendation. Model uncertainty should be explicitly incorporated in FBDGs.
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Byron C, Kissock KR, Barrett EM, Beck EJ. Aligning front-of-pack labelling with dietary guidelines: including whole grains in the health star rating. Eur J Nutr 2024:10.1007/s00394-024-03404-z. [PMID: 38653809 DOI: 10.1007/s00394-024-03404-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Front-of-pack labelling systems, such as the Health Star Rating (HSR), aim to aid healthy consumer dietary choices and complement national dietary guidelines. Dietary guidelines aim to be holistic by extending beyond the individual nutrients of food, including other food components that indicate diet quality, including whole grains. We aimed to test the feasibility of including whole grains in the HSR algorithm, to better inform dietary guidance in Australia coherent with existing dietary guidelines. METHODS We assigned whole-grain points as a favourable component of the HSR based on the whole-grain content of foods. We compared the original, and three modified HSR algorithms (including altered thresholds for star ratings) using independent-samples median tests. Finally, we used Spearman's correlation to measure the strength of association between an item's nutritional composition (all components of the HSR algorithm including all favourable and unfavourable components) and their HSR using each algorithm. RESULTS Up to 10 points were added for products with ≥ 50% whole-grain content, with no points for products with < 25%. Adjusting the HSR score cut-off by 3 points for grain products created the greatest difference in median HSR between refined and whole-grain items (up to 2 stars difference), compared to the original algorithm (a maximum of 1 star). CONCLUSIONS The addition of whole grains to the HSR algorithm improved the differentiation of refined and whole-grain items, and therefore better aligned with dietary guidelines. Holistic approaches to food guidance systems are required to provide consistent messaging and inform positive food choices.
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Affiliation(s)
- Caitlin Byron
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Katrina R Kissock
- The George Institute for Global Health, Sydney, NSW, 2000, Australia
- School of Health Sciences, University of New South Wales, Sydney, 2052, Australia
| | - Eden M Barrett
- The George Institute for Global Health, Sydney, NSW, 2000, Australia
- School of Health Sciences, University of New South Wales, Sydney, 2052, Australia
| | - Eleanor J Beck
- School of Health Sciences, University of New South Wales, Sydney, 2052, Australia.
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Bestle SMS, Lassen AD, Biltoft-Jensen AP, Matthiessen J, Gibbons SJ, Christensen BJ, Ersbøll BK, Trolle E. Reduction in intake of discretionary foods and drinks among Danish schoolchildren: dietary results from the real-life cluster-randomised controlled trial 'Are You Too Sweet?'. Public Health Nutr 2024; 27:e111. [PMID: 38528814 PMCID: PMC11036427 DOI: 10.1017/s1368980024000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 01/15/2024] [Accepted: 03/12/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of the multicomponent intervention trial 'Are You Too Sweet?' in reducing discretionary foods and drinks intake among young schoolchildren. DESIGN The study was a 3·5-month two-arm cluster-randomised controlled trial among primary schoolchildren and their families. School health nurses provided guidance to families regarding discretionary foods and drinks for the children. Moreover, families were given a variety of knowledge- and capability-building materials to utilise at home. Dietary intake was assessed using a web-based 7-d dietary record. Linear mixed regression models were used to estimate intervention effects as changes in child intake of discretionary foods and drinks and sugar between groups. SETTING Six schools from a Danish municipality were randomised to the intervention group (n 4) or the control group (n 2). PARTICIPANTS A total of 153 children aged 5-7 years. RESULTS No significant reduction in the children's intake of total discretionary foods and drinks or discretionary foods alone was observed between the intervention and control group, while a decreased intake of discretionary drinks of 40·9 % (P = 0·045) was observed compared with control. Secondary subgroup analysis showed that children of parents with shorter educational level significantly reduced their intake of added sugar by 2·9 E% (P = 0·002). CONCLUSION The results of this study indicate that multicomponent interventions involving school health nurses may have some effects in reducing, especially, discretionary drinks.
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Affiliation(s)
- Sidse Marie Sidenius Bestle
- Division of Food Technology, National Food Institute,
Technical University of Denmark, Henrik Dams Allé, Building
202, Lyngby, Denmark
| | - Anne Dahl Lassen
- Division of Food Technology, National Food Institute,
Technical University of Denmark, Henrik Dams Allé, Building
202, Lyngby, Denmark
| | - Anja Pia Biltoft-Jensen
- Division of Food Technology, National Food Institute,
Technical University of Denmark, Henrik Dams Allé, Building
202, Lyngby, Denmark
| | - Jeppe Matthiessen
- Division of Food Technology, National Food Institute,
Technical University of Denmark, Henrik Dams Allé, Building
202, Lyngby, Denmark
| | - Sarah Jegsmark Gibbons
- Division of Food Technology, National Food Institute,
Technical University of Denmark, Henrik Dams Allé, Building
202, Lyngby, Denmark
| | | | - Bjarne Kjær Ersbøll
- Department of Applied Mathematics and Computer Science,
Technical University of Denmark, Lyngby,
Denmark
| | - Ellen Trolle
- Division of Food Technology, National Food Institute,
Technical University of Denmark, Henrik Dams Allé, Building
202, Lyngby, Denmark
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Tran NR, Leech RM, Livingstone KM, McNaughton SA. Achieving high diet quality at eating occasions: findings from a nationally representative study of Australian adults. Br J Nutr 2024; 131:868-879. [PMID: 37855251 PMCID: PMC10864991 DOI: 10.1017/s0007114523002325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/28/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
This study examined differences in food groups consumed at eating occasions by the level of adherence to dietary guidelines in Australian adults (≤19 years) and whether consumption differed with respect to age, sex and education levels. Secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey (n 9054) was performed, using one 24-h dietary recall with self-reported eating occasions. Dietary Guideline Index scores were used to assess adherence to the 2013 Australian Dietary Guidelines. Mean differences (95 % CI) in servings of the five food groups and discretionary foods at eating occasions were estimated for adults with higher and lower diet quality, stratified by sex, age group and education. Using survey-based t-tests, differences of at least half a serving with P values < 0·05 were considered meaningful. Compared with adults with lower diet quality, women and men aged 19-50 years with higher diet quality consumed more serves of vegetables at dinner (mean difference (95 % CI), women; 1·0; 95 % CI (0·7, 1·2); men: 0·9; 95 % CI (0·6, 1·3)) and fewer serves of discretionary foods at snacks (women: -0·7; 95 % CI (-0·9, -0·5); men: -1·0; 95 % CI (-1·4, -0·7). Other food groups, such as grains, dairy products and alternatives, meats and alternatives, were not significantly different between adults with lower and higher diet quality, across any eating occasions and age groups. Discretionary food intake at lunch, dinner and snacks was consistently greater among adults with lower diet quality, regardless of education level. Our findings identify dinner and snacks as opportunities to increase vegetable intake and reduce discretionary food intake, respectively.
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Affiliation(s)
- Nancy R. Tran
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Rebecca M. Leech
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Katherine M. Livingstone
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
| | - Sarah A. McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
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Dicken SJ, Batterham RL. Ultra-processed Food and Obesity: What Is the Evidence? Curr Nutr Rep 2024; 13:23-38. [PMID: 38294671 PMCID: PMC10924027 DOI: 10.1007/s13668-024-00517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Obesity is a growing global healthcare concern. A proposed driver is the recent increase in ultra-processed food (UPF) intake. However, disagreement surrounds the concept of UPF, the strength of evidence, and suggested mechanisms. Therefore, this review aimed to critically appraise the evidence on UPF and obesity. RECENT FINDINGS Observational studies demonstrate positive associations between UPF intake, weight gain, and overweight/obesity, more clearly in adults than children/adolescents. This is supported by high-quality clinical data. Several mechanisms are proposed, but current understanding is inconclusive. Greater UPF consumption has been a key driver of obesity. There is a need to change the obesogenic environment to support individuals to reduce their UPF intake. The UPF concept is a novel approach that is not explained with existing nutrient- and food-based frameworks. Critical analysis of methodologies provides confidence, but future observational and experimental research outputs with greater methodological rigor will strengthen findings, which are outlined.
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Affiliation(s)
- Samuel J Dicken
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London, WC1E 6JF, UK
| | - Rachel L Batterham
- Centre for Obesity Research, Department of Medicine, University College London (UCL), London, WC1E 6JF, UK.
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital (UCLH), London, NW1 2BU, UK.
- National Institute for Health Research, Biomedical Research Centre, University College London Hospital (UCLH), London, W1T 7DN, UK.
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Charles JA, Habibullah NK, Bautista S, Davis B, Joshi S, Hull SC. Planting the Seed for Blood Pressure Control: The Role of Plant-Based Nutrition in the Management of Hypertension. Curr Cardiol Rep 2024; 26:121-134. [PMID: 38526748 PMCID: PMC10990999 DOI: 10.1007/s11886-023-02008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Hypertension results in significant morbidity, mortality, and healthcare expenditures. Fortunately, it is largely preventable and treatable by implementing dietary interventions, though these remain underutilized. Here, we aim to explore the role of healthy dietary patterns in hypertension management and describe approaches for busy clinicians to address nutrition effectively and efficiently with patients. RECENT FINDINGS DASH, Mediterranean, vegetarian, and vegan diets that include minimally processed, plant-based foods as core elements have consistently shown positive effects on hypertension. Recommendations that distill the most healthful components of these diets can significantly impact patient outcomes. Clinicians can harness evidence-based dietary assessment and counseling tools to implement and support behavioral changes, even during brief office visits. Healthful plant-based dietary patterns can often effectively prevent and treat hypertension. Clinicians may help improve patient outcomes by discussing evidence-based nutrition with their patients. Future work to promote infrastructural change that supports incorporating evidence-based nutrition into medical education, clinical care, and society at large can support these efforts.
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Affiliation(s)
- Justin A Charles
- Department of Family Medicine and Public Health, UC San Diego Health, San Diego, CA, USA.
| | | | - Saul Bautista
- Ethos Farm to Health/Ethos Primary Care, Long Valley, NJ, USA
| | - Brenda Davis
- Brenda Davis, Nutrition Consultations, Calgary, AB, Canada
| | - Shivam Joshi
- Department of Veterans Affairs, Orlando, FL, USA
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Sarah C Hull
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA
- Program for Biomedical Ethics, Yale School of Medicine, New Haven, CT, USA
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Xu Z, Chen S, Guo M, Zhang T, Niu X, Zhou Y, Tan J, Wang J. The impact of diet quality on cognitive ability of Chinese older adults: evidence from the China Health and Nutrition Survey (CHNS). BMC Geriatr 2024; 24:55. [PMID: 38216896 PMCID: PMC10785393 DOI: 10.1186/s12877-023-04630-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Numerous studies have demonstrated a positive correlation between diet quality and cognitive performance, indicating that improving diet quality may be beneficial in preventing cognitive decline in older adults. However, few study has investigated the causal relationship between diet quality and cognitive performance. The purpose of this study is to evaluate the causal effects of diet quality on cognitive performance in Chinese adults aged 55 years and older. Particularly, we utilize the Chinese Diet Quality Index (CHEI), a dietary assessment tool tailored for Chinese populations, as a proxy for older adults' diet quality. METHODS Data were obtained from the China Health and Nutrition Survey (CHNS) ([Formula: see text], [Formula: see text]55 years old) conducted in 2004 and 2006. Cognitive function was tested by a subset of items from the Telephone Interview for Cognitive Status-Modified (TICS-m). Data on dietary intake was retrieved from three consecutive 24 hour recalls by participants and its quality was assessed by the 17-items Chinese Healthy Eating Index (CHEI). An Instrumental Variable technique was used to deal with the potential endogeneity of dietary quality. The instrumental variable used in our study is the community mean of CHEI. RESULTS After adjusting for socio-demographic factors (age, gender, education, per capita household income), lifestyle habits (smoking, alcohol consumption, physical activity, BMI), and chronic diseases (hypertension, diabetes), our findings revealed that improving diet quality had a significant positive effect on cognitive performance ([Formula: see text]), particularly in females aged 55-65 years ([Formula: see text]) and females with primary education and below ([Formula: see text]). CONCLUSION Our study suggests that improving diet quality and adhering to the Dietary Guidelines for Chinese may enhance cognitive performance in Chinese adults aged 55 years and older.
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Affiliation(s)
- Ziwei Xu
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China
| | - Shuaizhen Chen
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China
| | - Min Guo
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China
| | - Tianlei Zhang
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China
| | - Xiaoxuan Niu
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China
| | - Yuxin Zhou
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China
| | - Jialong Tan
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China.
| | - Jian Wang
- Dong Fureng Institute of Economics and Social Development, Wuhan University, Bayi Road, Wuhan, 430072, Hubei, China.
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Yoong SL, Turon H, Wong CK, Bayles L, Finch M, Barnes C, Doherty E, Wolfenden L. An audit of the dissemination strategies and plan included in international food-based dietary guidelines. Public Health Nutr 2023; 26:2586-2594. [PMID: 37565494 DOI: 10.1017/s1368980023001714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Food-based dietary guidelines (FBDG) are an important resource to improve population health; however, little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDG. DESIGN A cross-sectional audit of FBDG with a published English-language version sourced from the United Nations FAO repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel and message). For guidelines with a dissemination plan, we described goals, audience, strategies and expertise and resources according to the Canadian Institute for Health Research guidance. SETTING FBDG from fifty-three countries mostly from high-income (n 28, 52·8 %), and upper-middle income (n 18, 34 %) areas were included. PARTICIPANTS n/a. RESULTS The source of guidelines was most frequently health departments (79·2 %). The message included quantities and types of foods, physical activity recommendations and 88·7 % included summarised versions of main messages. The most common channels were infographics and information booklets, and the main end-users were the public. For twelve countries (22·6 %), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the Canadian Institute for Health Research. CONCLUSIONS The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDG had formal dissemination plans and of those there was limited detailed provided.
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Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Heidi Turon
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Carrie K Wong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Lyndal Bayles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Meghan Finch
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Courtney Barnes
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Emma Doherty
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Luke Wolfenden
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
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Anastasiou K, Ribeiro De Melo P, Slater S, Hendrie GA, Hadjikakou M, Baker PK, Lawrence MA. From harmful nutrients to ultra-processed foods: exploring shifts in 'foods to limit' terminology used in national food-based dietary guidelines. Public Health Nutr 2023; 26:2539-2550. [PMID: 36458692 DOI: 10.1017/s1368980022002580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The choice of terms used to describe 'foods to limit' (FTL) in food-based dietary guidelines (FBDG) can impact public understanding, policy translation and research applicability. The choice of terms in FBDG has been influenced by available science, values, beliefs and historical events. This study aimed to analyse the terms used and definitions given to FTL in FBDG around the world, including changes over time and regional differences. DESIGN A review of terms used to describe FTL and their definitions in all current and past FBDG for adults was conducted, using a search strategy informed by the FAO FBDG website. Data from 148 guidelines (96 countries) were extracted into a pre-defined table and terms were organised by the categories 'nutrient-based', 'food examples' or 'processing-related'. SETTING National FBDG from all world regions. PARTICIPANTS None. RESULTS Nutrient-based terms (e.g. high-fat foods) were the most frequently used type of term in both current and past dietary guidelines (91 %, 85 %, respectively). However, food examples (e.g. cakes) and processing-related terms (e.g. ultra-processed foods) have increased in use over the past 20 years and are now often used in conjunction with nutrient-based terms. Regional differences were only observed for processing-related terms. CONCLUSION Diverse, and often poorly defined, terms are used to describe FTL in FBDG. Policymakers should ensure that FTL terms have clear definitions and can be integrated with other disciplines and understood by consumers. This may facilitate the inclusion of the most contemporary and potentially impactful terminology in nutrition research and policies.
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Affiliation(s)
- Kim Anastasiou
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | - Patricia Ribeiro De Melo
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | - Scott Slater
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
| | | | - Michalis Hadjikakou
- Centre for Integrative Ecology, School of Life and Environmental Sciences, Deakin University, Melbourne, VIC, Australia
| | - Phillip K Baker
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Mark Andrew Lawrence
- School of Exercise and Nutrition Sciences, Deakin University, Building J, Holland Ave, Burwood, VIC3125, Australia
- Institute of Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Gabe KT, Costa CDS, Dos Santos FS, Souza TN, Jaime PC. Is the adherence to the food practices recommended by the dietary guidelines for the Brazilian population associated with diet quality? Appetite 2023; 190:107011. [PMID: 37634827 DOI: 10.1016/j.appet.2023.107011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE The Brazilian Food Guide (BFG)'s messages are mostly qualitative and focused on food practices, such as meal planning, cooking, and eating modes. This study sough to investigate whether the adherence to these food practices is aligned with diet quality. METHODS A quota-based subsample of the NutriNet-Brasil Cohort (n = 2052) completed the Food Practices Brazil Scale (FPBr), a 24-item scale assessing the adherence to healthy eating practices recommended by the BFG. Four possible frequency-based answers are given and a score ranging from 0 to 72 is calculated by summing them (FPBr-score). Data from web-based 24-h recalls were used for calculating the usual percentage of energy intake (%energy) of ten food groups based on the level of food processing: plant-based unprocessed or minimally processed foods; processed foods; ultra-processed foods; fruits; vegetables; whole grains; beans and other legumes; nuts; red meat; and table sugar. The association between quartiles of the FPBr-score and food groups' %energy was analysed through crude and adjusted linear regression models. RESULTS Except for red meat, all the other food groups were linearly associated with the FPBr-score in the expected direction. For example, adjusted means for the %energy of plant-based unprocessed or minimally processed foods were 26.7% (CI95% 25.9-27.5) and 36.8% (CI95% 36.0-37.6) among those classified in the first and fourth quartiles of the FPBr-score, respectively. For ultra-processed foods, these percentages were 27.0 (CI95% 26.3-27.8) against 17.5 (CI95% 16.7-18.3). CONCLUSIONS These results support the use of messages based on practices and behaviors in Food-Based Dietary Guidelines. At the same time, they call attention to the importance of policies that enable people to adopt healthier food practices.
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Affiliation(s)
- Kamila Tiemann Gabe
- Graduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil; Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil.
| | - Caroline Dos Santos Costa
- Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil; Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | - Francine Silva Dos Santos
- Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil; Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | - Thays Nascimento Souza
- Graduate Program in Nutrition in Public Health, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil; Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
| | - Patricia Constante Jaime
- Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil; Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, University of São Paulo. Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, SP, 01246-904, Brazil
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11
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Alnasser A. The palm or the plate? An assessment of dietary guideline promotion, awareness, and preferences among Saudis: cross-sectional survey. BMC Public Health 2023; 23:1984. [PMID: 37828489 PMCID: PMC10568850 DOI: 10.1186/s12889-023-16435-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/01/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Dietary Guidelines for Saudis are offered and promoted in two forms: the Healthy Food Palm and the Saudi Healthy Plate. However, public awareness, recognition, and engagement with these guidelines is not well studied. Understanding the factors behind dietary guideline promotion, awareness, recognition, and use may lead to greater optimization of and engagement with the guidelines. This study aims to assess recognition of and public engagement with the My Palm and My Plate dietary guidelines as well as dietary guideline awareness, perceptions, and preferences among Saudis. METHODS To compare awareness, knowledge, and usability between the Healthy Food Palm and the Saudi Healthy Plate dietary guidelines, a cross-sectional survey-based study was conducted among Saudi adult males and females above 18 (n = 674) between October 2021 and January 2022. Participants were split into groups based on age and gender. T-test and χ2 tests were used to determine differences between groups for continuous and categorical variables, respectively. RESULTS Most participants were unaware of the Healthy Food Palm and the Saudi Healthy Plate guidelines, with only 11.1% and 30.3% able to recognize guideline-associated visual illustrations, respectively. However, nearly half of the participants correctly identified the number of food groups in the Healthy Food Palm and Saudi Healthy Plate. As well, more than half of the sample preferred the Saudi Healthy Plate, while one-quarter of the sample preferred neither guideline. In terms of future public health promotion, participants identified that "convenience and availability" (29.6%) and "my own health" (28.6%) were the most influential dietary choice factors with "social media campaigns" (2.4%) and the involvement of "an influencer" (3.1%) being the least influential dietary choice factors. CONCLUSIONS Implementation of and public awareness of dietary guidelines is less than optimal, and opportunities exist for greater information dissemination and public engagement. Measurement and ongoing evaluation of public dietary guideline awareness and use and a more in-depth understanding of dietary choice influences and behaviors are important considerations for dietary guideline development and promotion.
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Affiliation(s)
- Aroub Alnasser
- Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, P.O. Box 22452, 11495, Riyadh, Saudi Arabia.
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12
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Mozaffarian RS, Carter S, Bovenzi MC, Kenney EL. Comparison of foods and beverages served and consumed in Child and Adult Care Food Program-participating childcare centres to national guidelines. Public Health Nutr 2023; 26:1862-1870. [PMID: 37288521 PMCID: PMC10478045 DOI: 10.1017/s136898002300109x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 02/02/2023] [Accepted: 05/22/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The federal Child and Adult Care Food Program (CACFP) sets minimum nutrition and portion size standards for meals served in participating childcare programs. CACFP has been associated with more nutritious meals served. It is unclear, however, whether CACFP results in children's dietary intake being aligned with national recommendations. We assess whether children's dietary intake in CACFP-participating childcare centres meets benchmarks set by the Dietary Guidelines for Americans (DGA). DESIGN This is a cross-sectional study. We used direct observation to estimate quantities of foods/beverages served and consumed per child. Mean amounts served per child per day were compared with CACFP portion size requirements for each component (fruits, vegetables, milk and meat/meat alternate). Mean amounts of foods/beverages consumed were compared with DGA recommendations (energy content, fruits, vegetables, whole/refined grains, dairy, protein and added sugars). One sample t-tests evaluated if quantities served and consumed were different from CACFP and DGA standards, respectively. SETTING Six CACFP-participating childcare centres. PARTICIPANTS 2-5 year-old children attending childcare. RESULTS We observed forty-six children across 166 child meals. Most meals served met CACFP nutrition standards. Compared with CACFP portion size standards, children were served more grains at breakfast and lunch; more fruits/vegetables at lunch but less at breakfast and snack and less dairy at all eating occasions. Compared with DGA recommendations, children under-consumed every food/beverage category except grains during at least one eating occasion. CONCLUSIONS Children were served quantities of foods/beverages mostly consistent with CACFP portion size requirements, but had sub-optimal intake relative to DGA. More research is needed to help children consume healthy diets in childcare.
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Affiliation(s)
- Rebecca S Mozaffarian
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, USA
| | - Sonia Carter
- Boston Public Health Commission, Boston, MA02118, USA
| | | | - Erica L Kenney
- Department of Nutrition, Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, USA
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA02115, USA
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13
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Han SN. Vegetarian Diet for Cardiovascular Disease Risk Reduction: Cons. J Lipid Atheroscler 2023; 12:323-328. [PMID: 37800105 PMCID: PMC10548188 DOI: 10.12997/jla.2023.12.3.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
Numerous studies have reported that adopting a plant-based diet can significantly reduce the risk of cardiovascular diseases (CVDs). Not only does a vegetarian diet help mitigate the risk of these diseases, but it also contributes to enhancing environmental sustainability. However, it is not necessary to universally recommend a vegetarian diet as a preventive measure against CVDs. More research is needed to determine whether completely excluding animal products is necessary, or if adhering to a predominantly plant-based diet is sufficient. In this opinion paper, the potential adverse health effects of a vegetarian diet and the barriers associated with adopting it will be discussed, in order to provide a rationale for the disadvantages of using a vegetarian diet for CVD risk reduction.
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Affiliation(s)
- Sung Nim Han
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Korea
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14
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Zimmer M, Obbagy J, Scanlon KS, Gibbs K, Lerman JL, Hamner HC, Pannucci T, Sharfman A, Reedy J, Herrick KA. Count Every Bite to Make "Every Bite Count": Measurement Gaps and Future Directions for Assessing Diet From Birth to 24 Months. J Acad Nutr Diet 2023; 123:1269-1279.e1. [PMID: 37196980 PMCID: PMC10809843 DOI: 10.1016/j.jand.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 04/01/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Meghan Zimmer
- Harvard University, Cambridge, Massachusetts; U.S. Department of Health and Human Services, National Cancer Institute, Bethesda, MD
| | - Julie Obbagy
- Food and Nutrition Service, USDA, Alexandria, Virginia
| | - Kelley S Scanlon
- Supplemental Nutrition and Safety Research and Analysis Division, Office of Policy Support, USDA Food and Nutrition Service, Alexandria, Virginia
| | - Kimberlea Gibbs
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Jennifer L Lerman
- U.S. Department of Health and Human Services, National Cancer Institute, Bethesda, MD
| | | | | | | | - Jill Reedy
- U.S. Department of Health and Human Services, National Cancer Institute, Bethesda, MD
| | - Kirsten A Herrick
- U.S. Department of Health and Human Services, National Cancer Institute, Bethesda, MD.
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Buckland G, Northstone K, Emmett PM, Taylor CM. Adherence to UK dietary guidelines in school-aged children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Br J Nutr 2023; 130:454-466. [PMID: 36305030 PMCID: PMC10331434 DOI: 10.1017/s0007114522003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
Compliance to UK dietary recommendations was assessed in school-aged children from a population-based cohort: the Avon Longitudinal Study of Parents and Children (ALSPAC). A Children's Eatwell Guide (C-EWG) score was developed to assess socio-demographic predictors of meeting dietary recommendations. ALSPAC children with plausible diet diary data at 7 years (n 5373), 10 years (n 4450) and 13 years (n 2223) were included in the study. Their dietary intakes (recorded between 1998 and 2006) were compared with dietary guidelines for total and saturated fats, free sugars, salt, fibre, protein, carbohydrates, fruit and vegetables, non-oily and oily fish and red/processed meat. The C-EWG score (0-9 points) indicated the number of recommendations met at each age. Cross-sectional associations between socio-demographic characteristics and C-EWG scores were assessed using multivariable regression. The lowest adherence to guidelines at 7 years was for sugar (0·1 % meeting recommendations), followed by fibre (7·7 %), oily fish (9·5 %), saturated fat (9·7 %) and fruit and vegetables (15·2 %). Highest adherence was for limiting red/processed meat (67·3 %) and meeting carbohydrate recommendations (77·3 %). At 7 years, 12·1 % of participants failed to meet any of the nine recommendations, 26·9 % met one and 28·2 % met two. Similar patterns were seen at 10 and 13 years. A lower social class and maternal educational attainment and higher maternal BMI were associated with meeting fewer recommendations. Most school-aged children in this cohort did not meet UK dietary recommendations, particularly children from lower socio-economic backgrounds. Additional public health initiatives are needed to improve the quality of UK children's diets, particularly targeting lower socio-economic groups.
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Affiliation(s)
- Genevieve Buckland
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Northstone
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Pauline M. Emmett
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline M. Taylor
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
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Bercaw H, Reid LA, Mendoza JA, Frongillo EA, Sauder KA, Reboussin BA, Mayer-Davis EJ, Dabelea D, Marcovina SM, Mercado C, Liese AD. Food Insecurity and Adequacy of Dietary Intake in Youth and Young Adults With Youth-Onset Type 1 and Type 2 Diabetes. J Acad Nutr Diet 2023; 123:1162-1172.e1. [PMID: 36990427 PMCID: PMC10522799 DOI: 10.1016/j.jand.2023.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Household food insecurity is associated with poor dietary intake in the general population, but little is known about this association in persons with diabetes. OBJECTIVE We examined the degree of adherence to the dietary reference intakes and 2020-2025 Dietary Guidelines for Americans overall and according to food security status and diabetes type among youth and young adults (YYA) with youth-onset diabetes. DESIGN, PARTICIPANTS, AND SETTING The SEARCH for Diabetes in Youth study includes 1,197 YYA with type 1 diabetes (mean age = 21 ± 5 years) and 319 YYA with type 2 diabetes (25 ± 4 years). Participants (or parents if younger than age 18 years) completed the US Department of Agriculture Household Food Security Survey Module, wherein ≥3 affirmations indicate food insecurity. MAIN OUTCOME MEASURES Diet was assessed via food frequency questionnaire and compared with age- and sex-specific dietary reference intakes for 10 nutrients and dietary components (calcium; fiber; magnesium; potassium; sodium; vitamins C, D, and E; added sugar; and saturated fat). STATISTICAL ANALYSES PERFORMED Median regression models controlled for sex- and type-specific means for age, diabetes duration, and daily energy intake. RESULTS Prevalence of guideline adherence was overarchingly poor, with <40% of participants meeting recommendations for eight of 10 nutrients and dietary components; however, higher adherence (>47%) was observed for vitamin C and added sugars. YYA with type 1 diabetes who were food insecure were more likely to meet recommendations for calcium, magnesium, and vitamin E (P < 0.05), and less likely for sodium (P < 0.05) than those with food security. In adjusted models, YYA with type 1 diabetes who were food secure had closer median adherence to sodium (P = 0.002) and fiber (P = 0.042) guidelines than those food insecure. No associations were observed in YYA with type 2 diabetes. CONCLUSIONS Food insecurity is associated with lesser adherence to fiber and sodium guidelines in YYA with type 1 diabetes, which may lead to diabetes complications and other chronic diseases.
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Affiliation(s)
- Hope Bercaw
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Lauren A Reid
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jason A Mendoza
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Edward A Frongillo
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elizabeth J Mayer-Davis
- Department of Nutrition University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Carla Mercado
- Office of Minority Health and Health Equity, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
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Shankar V, Thompson KH, Wylie-Rosett J, Segal-Isaacson CJ. Validation and reliability for the updated REAP-S dietary screener, (Rapid Eating Assessment of Participants, Short Version, v.2). BMC Nutr 2023; 9:88. [PMID: 37468939 PMCID: PMC10357781 DOI: 10.1186/s40795-023-00747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND The American Heart Association (AHA) chose the REAP-S dietary screener in 2020 as one of three US dietary screeners recommended for integrating dietary assessment into clinical care. The REAP-S v.2 is an updated version that is aligned with the 2020-2025 US Dietary Guidelines and is easily incorporated into electronic medical records and taught to medical students. METHODS The University of New England, Institutional Review Board, approved the study protocol. We evaluated the reliability and validity of the REAP-S v.2 scale by having first-year medical students (n = 167) complete both the REAP-S v.2 and a three-day food record and then analyzing their data with the following statistical techniques: Internal consistency was measured using Cronbach's alpha. Construct validity was assessed with exploratory factor analysis. Criterion validity was evaluated using analysis of variance (ANOVA) that explored the associations between REAP-S v.2 scale item responses and selected nutrient estimates from the food record analyses. The hierarchical cluster analysis classified healthy and unhealthy diet grouping under each subscale. Further using these groupings, cut points for "good" and "bad" diets for each of the three main REAP-S v.2 subscales (Food Sufficiency/Food Insufficiency; Healthy Eating Pattern and Low Nutrient Density Foods) were calculated using receiver operating characteristics (ROC) analysis. Students analyzed their three-day food intake records using an online USDA application called SuperTracker. RESULTS The Cronbach's alpha measuring internal consistency was acceptable for the overall scale at 0.71. The exploratory factor analysis extracted three factors that roughly paralleled the three main subscales, suggesting construct validity. Most selected food record-derived nutrient values were significantly associated with scale items confirming criterion validity. The score cut points suggest that dietary counseling might be needed at ≤ 8, ≤ 10, and ≤ 16 for the above subscales. CONCLUSION The REAP-S v.2 is intended for clinicians to use as a brief dietary screener with their patients. Tested in a population of first-year medical students, the REAP-S v.2 brief dietary screener showed acceptable internal consistency, criterion, and construct validity. It is easily scored and incorporated into the electronic medical record.
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Affiliation(s)
- Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn H. Thompson
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | - C. J. Segal-Isaacson
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY USA
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Liyanapathirana NN, Grech A, Li M, Malik A, Lenzen M, Raubenheimer D. Nutrient-sensitive approach for sustainability assessment of Australian macronutrient dietary recommendations. Am J Clin Nutr 2023; 117:298-307. [PMID: 36863826 DOI: 10.1016/j.ajcnut.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Dietary guidelines that form the basis for food and nutrition policies in most countries are focused mainly on the social dimensions of health. Efforts are needed to incorporate environmental and economic sustainability. As the dietary guidelines are formulated based on nutrition principles, understanding the sustainability of dietary guidelines in relation to nutrients could support the better incorporation of environmental and economic sustainability aspects into dietary guidelines. OBJECTIVES This study examines and demonstrates the potential of integrating an input-output analysis with nutritional geometry to assess the sustainability of the Australian macronutrient dietary guidelines (AMDR) relating to macronutrients. METHODS We used daily dietary intake data of 5345 Australian adults from the most recent Australian Nutrient and Physical Activity Survey 2011-2012 and an input-output database for the Australian economy to quantify the environmental and economic impacts associated with dietary intake. Then, we examined the associations between environmental and economic impacts and dietary macronutrient composition using a multidimensional nutritional geometry representation. Thereafter, we assessed the sustainability of the AMDR regarding its alignment with key environmental and economic outcomes. RESULTS We found that diets adhering to the AMDR were associated with moderately high greenhouse gas emissions, water use, cost of dietary energy, and the contribution to wages and salaries of Australians. However, only about 20.42% of respondents adhered to the AMDR. Furthermore, high-plant protein diets adhering to the lower limit of recommended protein intake in the AMDR were associated with low environmental impacts and high incomes. CONCLUSIONS We conclude that encouraging consumers to adhere to the lower limit of the recommended intake of proteins and meeting the protein requirement through protein-dense plant sources could improve dietary environmental and economic sustainability in Australia. Our findings provide a means of understanding the sustainability of dietary recommendations concerning macronutrients for any country where input-output databases are available.
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Bekele TH, Covic N, Alemayehu D, Trijsburg LE, Brouwer ID, Feskens EJM, de Vries JHM. The feasibility of implementing food-based dietary guidelines and food graphics in Ethiopia. Food Secur 2023; 15:805-822. [PMID: 36691456 PMCID: PMC9850324 DOI: 10.1007/s12571-022-01335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/15/2022] [Indexed: 01/20/2023]
Abstract
This study aimed to test the acceptability, cultural appropriateness, consumers' understanding, and practicality of the Ethiopian food-based dietary guideline's messages, tips, and food graphics. A qualitative study design was applied with focus group discussions and key informant interviews. Four different participant groups were included: 40 consumers, 15 high-level nutrition experts, 30 frontline community health extension workers (HEWs), and 15 agriculture extension workers (AEWs) to incorporate different stakeholder perspectives. Data collection was conducted using 7 focus group discussions (FGDs) and 30 key informant interviews (KIIs). Collected data were coded and analyzed using QSR International NVivo V.11 software. Most of the study participants were highly interested in implementing the dietary guidelines once these guidelines are officially released. Based on the participants' views, most of the messages align with the current nutrition education materials implemented in the country except the messages about physical activity and alcohol intake. However, participants suggested defining technical terms such as ultra-processing, whole grain, safe and balanced diet in simpler terms for a better understanding. Practicality, affordability, availability, and access to the market were the major barriers reported for adherence to the guidelines. To be more inclusive of cultural and religious beliefs, findings show that the guideline should address fasting and traditional cooking methods. In conclusion, the dietary guidelines were well received by most stakeholders. They are thought to be feasible once feedback on wording, affordability, availability, and access is considered in the messages, tips, and graphic designs.
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Affiliation(s)
- Tesfaye Hailu Bekele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Namukolo Covic
- International Food Policy Research Institute, Addis Ababa, Ethiopia
| | | | - Laura E. Trijsburg
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Jeanne H. M. de Vries
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
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Lee A, Matthews R, Laws RA. Pregnancy nutrition knowledge of antenatal care providers: An evaluation of an online training module. Midwifery 2023; 116:103543. [PMID: 36403508 DOI: 10.1016/j.midw.2022.103543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Nutrition education for clinicians providing pregnancy care has the potential to enhance pregnant women's diet quality, leading to healthier outcomes for mother and baby. Following a study demonstrating nutrition knowledge gaps, an online training module was developed, implemented, and evaluated. METHODS Antenatal care providers completed a pregnancy nutrition knowledge questionnaire to assess knowledge levels at baseline (n = 97) and nine months after the introduction of online training (n = 64). FINDINGS Knowledge scores at baseline and post-training implementation were not significantly different. Sub-group post-training knowledge scores between clinicians who completed the training module was higher than for those that did not complete the training module. User experience of the training module was positive and they felt it was useful in enhancing nutrition knowledge. Just under half of clinicians felt more confident in providing nutrition advice as part of their pregnancy care. Clinicians reported that time constraints prevented them from completing the nutrition training and/or providing nutrition education. Despite the positive experience of completing the online training module, a majority of clinicians surveyed indicated they preferred face-to-face training. CONCLUSION Further research exploring how nutrition is prioritised in antenatal appointments and how knowledge levels influence nutrition education practices is needed.
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de Lacerda AT, do Carmo AS, Maia de Sousa T, Dos Santos LC. NOVA food groups' consumption associated with nutrient intake profile of school children aged 8-12 years. Public Health Nutr 2023; 26:56-62. [PMID: 35188094 DOI: 10.1017/S1368980022000441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the association between the consumption of NOVA food groups (classification based on the nature, extent and purpose of food processing) and the intake of energy, macro and micronutrients among school children. DESIGN Cross-sectional study. Food consumption was assessed by two 24-h dietary recalls on non-consecutive days. Energy from each NOVA food groups - ultra-processed foods, unprocessed or minimally processed foods, processed culinary ingredients and processed foods - was estimated. For analysis, the percentage of energy from ultra-processed foods and unprocessed or minimally processed foods were categorised into tertiles and associated with intake of energy, macro and micronutrients using analysis of covariance and linear regression. SETTING Public schools in Belo Horizonte, Minas Gerais, Brazil. PARTICIPANTS School children aged 8-12 years (n 797; 406 girls; 391 boys). RESULTS Mean energy intake was 2050·18 ± 966·83 kcal/d, 25·8 % was from ultra-processed foods, 56·7 % from unprocessed or minimally processed foods, 8·9 % from processed culinary ingredients and 8·6 % from processed foods. A higher energy contribution from ultra-processed foods was negatively associated with the intake of protein, fibre, vitamin A, Fe and Zn (P < 0·001) and positively associated with total energy, lipid and Na intake (P < 0·001). Concurrently, a higher energy contribution from unprocessed or minimally processed foods was positively associated with the consumption of protein, fibre, Fe and Zn (P < 0·001) and negatively associated with total energy (P = 0·002), lipid and Na intake (P < 0·001). CONCLUSIONS In conclusion, higher ultra-processed food consumption presented a negative association with the nutrient intake profile of school children.
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Bekele TH, de Vries JHM, Feskens EJM, de Weijer A, Brouwer ID, Covic N, Trijsburg L. Development of the Ethiopian Healthy Eating Index (Et-HEI) and evaluation in women of reproductive age. J Nutr Sci 2023; 12:e9. [PMID: 36721718 DOI: 10.1017/jns.2022.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023] Open
Abstract
Ethiopia announced its first food-based dietary guidelines (FBDGs) on 15 March 2022. The present study aims to develop and evaluate the Ethiopian Healthy Eating Index (Et-HEI) based on the FBDG. Data were collected from 494 Ethiopian women of reproductive age sampled from households in five different regions. The Et-HEI consists of eleven components, and each component was scored between 0 and 10 points, the total score ranging from 0 to 110, with maximum adherence to the FBDG. The Et-HEI score was evaluated against the Minimum Dietary Diversity for Women (MDD-W) and the probability of nutrient adequacy. The average Et-HEI score for women of reproductive age was 49 out of 110. Adherence to the recommendations for grains, vegetables, legumes, fat and oils, salt, sugar and alcohol contributed the most to this score. Most women had low scores for fruits, nuts and seeds, and animal-sourced foods, indicating low intake. The Cronbach's alpha coefficient, indicating the reliability of the Et-HEI to assess its diet quality, was 0⋅53. The low mean Et-HEI score agreed with a low mean score of the MDD-W (3⋅5 out of 10). Also, low nutrient adequacies confirmed poor adherence to nutrient-dense components of the FBDG. The Et-HEI was not associated with the intake of vitamin B12, vitamin C and calcium in this study population. Women who completed secondary school and above had relatively lower Et-HEI scores. The newly developed Et-HEI is able to estimate nutrient adequacy while also assessing adherence to the Ethiopian FBDG though there is room for improvement.
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Bailey RL, Stang JS, Davis TA, Naimi TS, Schneeman BO, Dewey KG, Donovan SM, Novotny R, Kleinman RE, Taveras EM, Bazzano L, Snetselaar LG, de Jesus J, Casavale KO, Stoody EE, Goldman JD, Moshfegh AJ, Rhodes DG, Herrick KA, Koegel K, Perrine CG, Pannucci T. Dietary and Complementary Feeding Practices of US Infants, 6 to 12 Months: A Narrative Review of the Federal Nutrition Monitoring Data. J Acad Nutr Diet 2022; 122:2337-2345.e1. [PMID: 34688966 PMCID: PMC10851078 DOI: 10.1016/j.jand.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 10/20/2022]
Abstract
Complementary foods and beverages (CFBs) are key components of an infant's diet in the second 6 months of life. This article summarizes nutrition and feeding practices examined by the 2020 Dietary Guidelines Advisory Committees during the CFB life stage. Breastfeeding initiation is high (84%), but exclusive breastfeeding at 6 months (26%) is below the Healthy People 2030 goal (42%). Most infants (51%) are introduced to CFBs sometime before 6 months. The primary mode of feeding (ie, human milk fed [HMF]; infant formula or mixed formula and human milk fed [FMF]) at the initiation of CFBs is associated with the timing of introduction and types of CFBs reported. FMF infants (42%) are more likely to be introduced to CFBs before 4 months compared with HMF infants (19%). Different dietary patterns, such as higher prevalence of consumption and mean amounts, were observed, including fruit, grains, dairy, proteins, and solid fats. Compared with HMF infants of the same age, FMF infants consume more total energy (845 vs 631 kcal) and protein (22 vs 12 g) from all sources, and more energy (345 vs 204 kcal) and protein (11 vs 6 g) from CFBs alone. HMF infants have a higher prevalence of risk of inadequate intakes of iron (77% vs 7%), zinc (54% vs <3%), and protein (27% vs <3%). FMF infants are more likely to have an early introduction (<12 months) to fruit juice (45% vs 20%) and cow's milk (36% vs 24%). Registered dietitian nutritionists and nutritional professionals should consider tailoring their advice to caregivers on dietary and complementary feeding practices, taking into account the primary mode of milk feeding during this life stage to support infants' nutrient adequacy. National studies that address the limitations of this analysis, including small sample sizes and imputed breast milk volume, could refine findings from this analysis.
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Affiliation(s)
- Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN.
| | - Jaime S Stang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota - Twin Cities, MN
| | - Teresa A Davis
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Timothy S Naimi
- Section of General Internal Medicine, Boston University Medical Center, Boston, MA
| | | | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, CA
| | - Sharon M Donovan
- Department of Food Science and Human Nutrition, Endowed Chair in Nutrition and Health, University of Illinois, Urbana-Champaign, IL
| | - Rachel Novotny
- Department Human Nutrition Food and Animal Science, University of Hawai'i at Mānoa, Honolulu, HI
| | - Ronald E Kleinman
- Harvard Medical School, Boston, MA; Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Elsie M Taveras
- Department of Pediatrics, Harvard Medical School, Boston, MA; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Lydia Bazzano
- Tulane Center for Lifespan Epidemiology Research, New Orleans, LA
| | - Linda G Snetselaar
- Department of Epidemiology, Endowed Chair in Preventive Nutrition Education, University of Iowa, Iowa City, IA
| | - Janet de Jesus
- Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD
| | - Kellie O Casavale
- Office of Nutrition and Food Labeling, Center for Food Safety and Applied Nutrition, Food and Drug Administration, US Department of Health and Human Services, College Park, MD
| | - Eve E Stoody
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Joseph D Goldman
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
| | - Alanna J Moshfegh
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
| | - Donna G Rhodes
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
| | - Kirsten A Herrick
- Risk Factor Assessment Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Kristin Koegel
- Center for Nutrition Policy and Promotion, Food and Nutrition Service, US Department of Agriculture, Alexandria, VA
| | - Cria G Perrine
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention, Atlanta, GA
| | - TusaRebecca Pannucci
- Food Surveys Research Group, Agricultural Research Service, US Department of Agriculture, Beltsville, MD
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Abstract
Diet plays a fundamental role in maintaining long-term health, with healthful diets being endorsed by current dietary guidelines for the prevention and management of type 2 diabetes. However, the response to dietary interventions varies widely, highlighting the need for refinement and personalisation beyond population-based 'one size fits all'. This article reviews the clinical evidence supporting precision nutrition as a fundamental approach for dietary advice in diabetes. Further, it proposes a framework for the eventual implementation of precision nutrition and discusses key challenges for the application of this approach in the prevention of diabetes. One implication of this approach is that precision nutrition would not exclude the parallel goal of population-based healthy dietary advice. Nevertheless, the shift in prioritising precision nutrition is needed to reflect the dynamic nature of responses to dietary interventions that vary among individuals and change over the life course.
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Affiliation(s)
- Jordi Merino
- Diabetes Unit and Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Programs in Metabolism and Medical & Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
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Ridoutt BG, Baird D, Hendrie GA. The importance of protein variety in a higher quality and lower environmental impact dietary pattern. Public Health Nutr 2022; 25:1-6. [PMID: 36210777 PMCID: PMC9991774 DOI: 10.1017/s1368980022002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/17/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Eating a variety of nutritious foods is fundamental to good nutrition. However, this principle is challenged when recommendations seeking to improve the environmental sustainability of diets call for avoidance of foods considered to have a higher environmental footprint, such as animal-sourced foods. Our objective was to assess the implications for nutritional adequacy of protein choice across Australian adult diets preselected as having higher quality and lower environmental impact scores. DESIGN Each individual diet was assessed for variety of food choice within the 'Fresh meat and alternatives' food group defined in the Australian Dietary Guidelines, which includes protein-rich foods such as eggs, nuts, tofu and legumes in addition to animal meats. Diets were grouped according to variety score and whether they included only animal meats, only alternatives or a variety of meat and alternatives. Nutrient content was assessed relative to estimated average requirements (EAR). SETTING Australia. PARTICIPANTS 1700 adults participating in the Australian Health Survey. RESULTS For diets with higher diet quality and lower environmental impact, the likelihood of achieving nutrient EAR significantly increased as variety of food choice in the 'Fresh meat and alternatives' food group increased (P < 0·001). Variety score and number of serves were also correlated (r = 0·52, P < 0·001) which is relevant since most diets did not meet the recommended minimum number of serves for this food group. CONCLUSIONS Greater variety within the 'Fresh meat and alternatives' food group is beneficial to meeting EAR and lower environmental impact diets can include three or more selections including foods of animal origin.
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Affiliation(s)
- Bradley G Ridoutt
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Agriculture and Food, Clayton South, VIC3168, Australia
- Department of Agricultural Economics, University of the Free State, Bloemfontein, South Africa
| | - Danielle Baird
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
| | - Gilly A Hendrie
- CSIRO Health and Biosecurity, Adelaide, South Australia, Australia
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de Oliveira MFB, Martins CA, de Castro IRR. The (scarce and circumscribed) culinary content in food-based dietary guidelines around the world: 1991-2021. Public Health Nutr 2022; 25:1-9. [PMID: 36073171 PMCID: PMC9991562 DOI: 10.1017/s1368980022001938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 07/14/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the culinary content of key messages contained in food-based dietary guidelines (FBDG) available at the global online repository of the FAO of the UN. DESIGN Document analysis was conducted in August 2021 with data extraction of key messages explicitly related to cooking present in FBDG. Data were analysed inductively using thematic analysis. SETTING The FAO's global repository of FBDG. PARTICIPANTS Not applicable. RESULTS Just over half (n 39; 53·4 %) of the seventy-three FBDG analysed included at least one key message about cooking. The Latin American and Caribbean FBDG presented the greatest amount and variety of content about cooking in the key messages, whereas the Near East and North America placed less emphasis on cooking. We identified three themes: (i) healthy food preparation (n 35; 61·4 % of the fifty-seven culinary key messages identified); (ii) food hygiene (n 14; 24·6 %) and (iii) the promotion of culinary practices (n 7; 12·3 %). Albania's key message covered two themes (food hygiene and healthy food preparation) (n 1; 1·8 %). CONCLUSION FBDG are official documents that express recommendations for a healthy diet. As most of these recommendations throughout the world include foods that must be cooked prior to consumption, culinary content should gain more visibility and be presented more broadly in these official documents.
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Affiliation(s)
- Mariana Fernandes Brito de Oliveira
- Institute of Food and Nutrition, Multidisciplinary Center of Federal University of Rio de Janeiro-Macaé, Av. Aluizio da Silva Gomes, 50, Novo Cavaleiros, Macaé, RJ, Brazil
| | - Carla Adriano Martins
- Institute of Food and Nutrition, Multidisciplinary Center of Federal University of Rio de Janeiro-Macaé, Av. Aluizio da Silva Gomes, 50, Novo Cavaleiros, Macaé, RJ, Brazil
- Center for Epidemiological Research in Nutrition and Health (NUPENS), University of São Paulo, São Paulo, SP, Brazil
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Juul F, Deierlein AL, Vaidean G, Quatromoni PA, Parekh N. Ultra-processed Foods and Cardiometabolic Health Outcomes: from Evidence to Practice. Curr Atheroscler Rep 2022. [PMID: 36070170 DOI: 10.1007/s11883-022-01061-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Poor diet quality is the leading risk factor related to the overall cardiometabolic disease burden in the USA and globally. We review the current evidence linking ultra-processed foods and cardiometabolic health risk and provide recommendations for action at the clinical and public health levels. RECENT FINDINGS A growing body of evidence conducted in a variety of study populations supports an association between ultra-processed food intake and increased risk of metabolic syndrome, hypertension, type 2 diabetes, overweight and obesity trajectories, and cardiovascular disease. The strongest evidence is observed in relation to weight gain and obesity among adults, as this association is supported by high-quality epidemiological and experimental evidence. Accumulating epidemiologic evidence and putative biological mechanisms link ultra-processed foods to cardiometabolic health outcomes. The high intake of ultra-processed foods in all population groups and its associated risks make ultra-processed foods an ideal target for intensive health promotion messaging and interventions.
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Chen GC, Chai JC, Xing J, Moon JY, Shan Z, Yu B, Mossavar-Rahman Y, Sotres-Alvarez D, Li J, Mattei J, Daviglus ML, Perkins DL, Burk RD, Boerwinkle E, Kaplan RC, Hu FB, Qi Q. Healthful eating patterns, serum metabolite profile and risk of diabetes in a population-based prospective study of US Hispanics/Latinos. Diabetologia 2022; 65:1133-1144. [PMID: 35357561 PMCID: PMC9890970 DOI: 10.1007/s00125-022-05690-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/25/2022] [Indexed: 02/03/2023]
Abstract
AIMS/HYPOTHESIS We aimed to evaluate associations of multiple recommended dietary patterns (i.e. the alternate Mediterranean diet [aMED], the Healthy Eating Index [HEI]-2015 and the healthful Plant-based Diet Index [hPDI]) with serum metabolite profile, and to examine dietary-pattern-associated metabolites in relation to incident diabetes. METHODS We included 2842 adult participants free from diabetes, CVD and cancer during baseline recruitment of the Hispanic Community Health Study/Study of Latinos. Metabolomics profiling of fasting serum was performed using an untargeted approach. Dietary pattern scores were derived using information collected by two 24 h dietary recalls. Dietary-pattern-associated metabolites were identified using multivariable survey linear regressions and their associations with incident diabetes were assessed using multivariable survey Poisson regressions with adjustment for traditional risk factors. RESULTS We identified eight metabolites (mannose, γ/β-tocopherol, N1-methylinosine, pyrraline and four amino acids) that were inversely associated with all dietary scores. These metabolites were detrimentally associated with various cardiometabolic risk traits, especially insulin resistance. A score comprised of these metabolites was associated with elevated risk of diabetes (RRper SD 1.54 [95% CI 1.29, 1.83]), and this detrimental association appeared to be attenuated or eliminated by having a higher score for aMED (pinteraction = 0.0001), HEI-2015 (pinteraction = 0.020) or hPDI (pinteraction = 0.023). For example, RR (95% CI) of diabetes for each SD increment in the metabolite score was 1.99 (1.44, 2.37), 1.67 (1.17, 2.38) and 1.08 (0.86, 1.34) across the lowest to the highest tertile of aMED score, respectively. CONCLUSIONS/INTERPRETATION Various recommended dietary patterns were inversely related to a group of metabolites that were associated with elevated risk of diabetes. Adhering to a healthful eating pattern may attenuate or eliminate the detrimental association between metabolically unhealthy serum metabolites and risk of diabetes.
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Affiliation(s)
- Guo-Chong Chen
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jin Choul Chai
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jiaqian Xing
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jee-Young Moon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Zhilei Shan
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Bing Yu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yasmin Mossavar-Rahman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniela Sotres-Alvarez
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jun Li
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Josiemer Mattei
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL, USA
| | - David L Perkins
- Department of Medicine, University of Illinois, Chicago, IL, USA
| | - Robert D Burk
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Pediatrics, Department of Microbiology and Immunology, Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Frank B Hu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
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Scheffers FR, Boer JM, Wijga AH, van der Schouw YT, Smit HA, Verschuren WM. Substitution of pure fruit juice for fruit and sugar-sweetened beverages and cardiometabolic risk in European Prospective Investigation into Cancer and Nutrition (EPIC)-NL: a prospective cohort study. Public Health Nutr 2022; 25:1504-14. [PMID: 33641692 DOI: 10.1017/S1368980021000914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Dietary guidelines on pure fruit juice differ between countries regarding the question whether pure fruit juice (without added sugars) is an acceptable substitute for fruit or should be avoided because of its comparable sugar content with that of sugar-sweetened beverages (SSB). We modelled whether substituting pure fruit juice for fruit or SSB was associated with cardiometabolic risk. DESIGN Prospective cohort study. SETTING Based on a validated FFQ at baseline, we calculated the relative contribution of pure fruit juice to total consumption of fruit and pure fruit juice (${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{fruit}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$) and to total consumption of SSB and pure fruit juice (${{{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\;\left( {{\rm{g}}/{\rm{day}}} \right)} \over {{\rm{SSBs}}\; + \;{\rm{pure}}\;{\rm{fruit}}\;{\rm{juice}}\;\left( {{\rm{g}}/{\rm{day}}} \right)}}$). In multivariate analyses (Cox regression), we assessed associations with incidence of type 2 diabetes, CVD, CHD and stroke after an average follow-up of 14·6 years. PARTICIPANTS About 35 000 participants from the EPIC-NL study, aged 20-70 years at enrolment. RESULTS Substitution of pure fruit juice for SSB was associated with lower risk of all endpoints. For type 2 diabetes and CHD, for example, drinking 75-100 % (as compared with 0-<25 %) of total SSB + pure fruit juice as pure fruit juice showed hazard ratio (95 % CI) of 0·74 (95 % CI 0·64, 0·85) and 0·85 (95 % CI 0·76, 0·96), respectively. Substitution of pure fruit juice for fruit was not associated with the risk of type 2 diabetes, CVD, CHD and stroke. CONCLUSIONS Substituting pure fruit juice for SSB was associated with lower cardiometabolic risk, whereas substituting pure fruit juice for fruit was not associated with cardiometabolic risk.
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Nasreddine L, Hwalla N, Al Zahraa Chokor F, Naja F, O'Neill L, Jomaa L. Food and nutrient intake of school-aged children in Lebanon and their adherence to dietary guidelines and recommendations. BMC Public Health 2022; 22:922. [PMID: 35534814 PMCID: PMC9088130 DOI: 10.1186/s12889-022-13186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lebanon, an Eastern Mediterranean country, is witnessing a remarkable nutrition transition, and the diets of school-aged children may be amongst those most affected. However, limited studies have examined the food consumption patterns and nutrient adequacy in this age group. OBJECTIVES The present study aimed to evaluate the dietary intakes of school-aged children in Lebanon and assess their adherence to nutrition guidelines and recommendations. METHODS This study used data for 4-13 y-old children (n = 711) from a national cross-sectional survey conducted in 2014-2015 on a representative sample of Lebanese households with children. Dietary intake was assessed using single 24-h recall method. Estimated food group and nutrient intakes were compared to dietary recommendations and age-specific dietary reference intakes (DRI), including Estimated Average Requirements (EAR) and Acceptable Macronutrient Distribution Range (AMDR). Food group, energy, macro- and micro-nutrient intakes were presented for all children in the sample and stratified by age (4-8 y and 9-13 y) and sex. RESULTS Mean energy intake of 4-13-year-old children was 1804 kcal/d. Almost half of the energy was provided by carbohydrates while 12% of children had protein intakes below EAR. Approximately three-quarters of children (4-13 y) exceeded the AMDR for total fat and saturated fats, and a similar proportion over consumed added sugars. The main sources of energy intake (EI) among children were the sweets, sweetened beverages and desserts followed by grains and mixed dishes. No significant differences were noted in %EI from different food groups, by sex, in either age groups. The highest adherence of children to food group recommendations was observed for the grains' food group (47.2-54.4%EI), while the lowest adherence was found for vegetables (3.1-14.1%EI). A high prevalence of vitamin and mineral inadequacies was noted amongst 4-13 y old children for key micronutrients, including vitamin D (99%), calcium (81%), and vitamin A (69.5%). Risk of inadequate micronutrient intakes was significantly increased among the older age group (p-value < 0.05). CONCLUSION Nutrient intakes of school-aged children in Lebanon reflect suboptimal nutrition. Educational and public health interventions are needed to promote healthier diets among children and prevent micronutrient deficiencies during this critical phase.
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Affiliation(s)
- Lara Nasreddine
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, 11-0236, Lebanon
| | - Nahla Hwalla
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, 11-0236, Lebanon
| | - Fatima Al Zahraa Chokor
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, 11-0236, Lebanon
| | - Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, 27272, Sharjah, United Arab Emirates.,Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, P.O. Box 11-0236, Beirut, 1107-2020, Lebanon
| | - Lynda O'Neill
- Nestlé Institute of Health Sciences, Nestlé Research, Société Des Produits Nestlé S.A, Vers-Chez-Les-Blancs, 1000 Lausanne 26, Lausanne, Switzerland
| | - Lamis Jomaa
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, 11-0236, Lebanon. .,Department of Human Sciences, College of Health and Sciences, North Carolina Central University, Durham, NC, 27707, USA.
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Mialon M, Serodio PM, Crosbie E, Teicholz N, Naik A, Carriedo A. Conflicts of interest for members of the US 2020 dietary guidelines advisory committee. Public Health Nutr 2022; 27:e69. [PMID: 35311630 DOI: 10.1017/s1368980022000672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To measure incidence of conflicts of interest (COI) with food and pharmaceutical industry actors on the advisory committee for the 2020-2025 US Dietary Guidelines for Americans (DGA) and assess the adequacy of current mechanisms to disclose and manage COI among the committee's members. DESIGN We compiled longitudinal data from archival sources on connections between members of the DGA's advisory committee and actors. We hypothesised that these committee members, who oversee the science for the most influential dietary policy in the USA, might have significant COI that would be relevant to their decision making. Disclosure of COI on this committee was recommended in 2017 by the National Academies of Sciences in order to increase transparency and manage bias, but public disclosure of the committee's COI does not appear to have taken place. SETTING The committee was composed of twenty experts. PARTICIPANTS None. RESULTS Our analysis found that 95 % of the committee members had COI with the food and/or pharmaceutical industries and that particular actors, including Kellogg, Abbott, Kraft, Mead Johnson, General Mills, Dannon and the International Life Sciences, had connections with multiple members. Research funding and membership of an advisory/executive board jointly accounted for more than 60 % of the total number of COI documented. CONCLUSIONS Trustworthy dietary guidelines result from a transparent, objective and science-based, process. Our analysis has shown that the significant and widespread COI on the committee prevent the DGA from achieving the recommended standard for transparency without mechanisms in place to make this information publicly available.
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Affiliation(s)
- Mélissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | | | - Eric Crosbie
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
- Ozmen Institute for Global Studies, University of Nevada, Reno, NV, USA
| | | | - Ashka Naik
- Corporate Accountability, Boston, MA, USA
| | - Angela Carriedo
- World Public Health and Nutrition Association, London, United Kingdom
- Department for Health, University of Bath, Bath, United Kingdom
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Wilson JE, Blizzard L, Gall SL, Magnussen CG, Oddy WH, Dwyer T, Venn AJ, Smith KJ. Associations between diet quality and DSM-IV mood disorders during young- to mid-adulthood among an Australian cohort. Soc Psychiatry Psychiatr Epidemiol 2022; 57:319-330. [PMID: 33961077 DOI: 10.1007/s00127-021-02086-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Many studies have reported associations between diet and depression, but few have used formal diagnoses of mood disorder as the outcome measure. We examined if overall diet quality was associated cross-sectionally or longitudinally with DSM-IV mood disorders among an adult cohort. METHODS Participants from the Australian Childhood Determinants of Adult Health study were followed up during 2004-06 (n = 1974, age 26-36 years), 2009-11 (n = 1480, 31-41 years), and 2014-19 (n = 1191, 36-49 years). Dietary Guidelines Index (DGI) scores were calculated from food frequency questionnaires at each time-point (higher DGI reflects better diet quality). DSM-IV mood disorders (dysthymia or depression) during the periods between, and 12 months prior to each follow-up were determined using the Composite International Diagnostic Interview. Sex-stratified risk and prevalence ratios (PR) and 95% confidence intervals (CI) were estimated using log-binomial regression. Covariates included age, self-perceived social support index score, marital status, parenting status, education, occupation, physical activity, BMI, and usual sleep duration. RESULTS A 10-point higher DGI was cross-sectionally associated with lower prevalence of mood disorders at the third follow-up only (females PR = 0.73, 95% CI = 0.56, 0.95; males PR = 0.72, 95% CI = 0.53, 0.97), but was attenuated after covariate adjustment (females PR = 0.92, 95% CI = 0.73, 1.16; males PR = 0.92, 95% CI = 0.69, 1.22). Adjustment for social support in the final model had attenuated the association for both sexes from 18% reduced prevalence to 8%. DGI scores were not longitudinally associated with mood disorder risk. CONCLUSIONS Crude cross-sectional associations between diet quality and mood disorders at ages 36-49 years were explained by sociodemographic and lifestyle factors, particularly social support.
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Affiliation(s)
- Johanna E Wilson
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, FIN-20520, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, FIN-20520, Turku, Finland
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
- The George Institute for Global Health, University of Oxford, Oxford, OX1 3QX, UK
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Kylie J Smith
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
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Salman E, Kadota A, Okami Y, Kondo K, Yoshita K, Okuda N, Nakagawa H, Saitoh S, Sakata K, Okayama A, Chan Q, Elliott P, Stamler J, Ueshima H, Miura K. Investigation of the urinary sodium-to-potassium ratio target level based on the recommended dietary intake goals for the Japanese population: The INTERMAP Japan. Hypertens Res 2022; 45:1850-1860. [PMID: 36344663 PMCID: PMC9659487 DOI: 10.1038/s41440-022-01007-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 11/09/2022]
Abstract
Growing epidemiological evidence has shown an association of the urinary sodium (Na) to potassium (K) ratio (Na/K ratio) with blood pressure and cardiovascular diseases. However, no clear cutoff level has been defined. We investigated the cutoff level of the urinary Na/K ratio under different dietary guidelines for Japanese individuals, especially that endorsed by the 2020 revised Japanese Dietary Reference Intakes (DRIs). A population of 1145 Japanese men and women aged 40 to 59 years from the INTERMAP study was examined. Using high-quality standardized data, the averages of two 24 h urinary collections and four 24 h dietary recalls were used to calculate the 24 h urinary and dietary Na/K ratios, respectively. Associations between the urinary and dietary Na/K ratios were tested by sex- and age-adjusted partial correlation. The optimal urinary Na/K ratio cutoff level was determined by receiver operating characteristic (ROC) curves and sex-specific cross tables for recommended dietary K and salt. Overall, the average molar ratio of 24 h urinary Na/K was 4.3. We found moderate correlations (P < 0.001) of the 24 h urinary Na/K ratio with 24 h urinary Na and K excretion (r = 0.52, r = -0.49, respectively) and the dietary Na/K ratio (r = 0.53). ROC curves showed that a 24 h urinary Na/K ratio of approximately 2 predicted Na and K intake that meets the dietary goals of the Japanese DRIs. The range of urinary Na/K ratios meeting the dietary goals of the Japanese DRIs for both Na and K was 1.6‒2.2 for men and 1.7‒1.9 for women. Accomplishing a urinary Na/K ratio of 2 would be desirable to achieve the DRIs dietary goals for both Na and K simultaneously in middle-aged Japanese men and women accustomed to Japanese dietary habits. This observational study is registered at www.clinicaltrials.gov as NCT00005271.
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Affiliation(s)
- Ebtehal Salman
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan ,grid.471243.70000 0001 0244 1158OMRON Healthcare Co., Ltd, Kyoto, Japan
| | - Aya Kadota
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Yukiko Okami
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Keiko Kondo
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsushi Yoshita
- grid.261445.00000 0001 1009 6411Department of Food Science and Nutrition, Graduate School of Human Life Science and Nutrition, Osaka City University, Osaka, Japan
| | - Nagako Okuda
- grid.258797.60000 0001 0697 4728Department of Health Science, Kyoto Prefectural University, Kyoto, Japan
| | - Hideaki Nakagawa
- grid.411998.c0000 0001 0265 5359Medical Research Institute, Kanazawa Medical University, Kanazawa, Japan
| | - Shigeyuki Saitoh
- grid.263171.00000 0001 0691 0855School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Kiyomi Sakata
- grid.411790.a0000 0000 9613 6383Department of Hygiene and Public Health, Iwate Medical University, Yahaba, Japan
| | - Akira Okayama
- grid.272242.30000 0001 2168 5385Department of Non-Communicable Diseases, Research Institute of Strategy for Prevention, Tokyo, Japan
| | - Queenie Chan
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- grid.7445.20000 0001 2113 8111Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Jeremiah Stamler
- grid.16753.360000 0001 2299 3507Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Hirotsugu Ueshima
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
| | - Katsuyuki Miura
- grid.410827.80000 0000 9747 6806NCD Epidemiology Research Center, Shiga University of Medical Science, Shiga, Japan
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Zucchinelli M, Sporchia F, Piva M, Thomsen M, Lamastra L, Caro D. Effects of different Danish food consumption patterns on Water ScarcityFootprint. J Environ Manage 2021; 300:113713. [PMID: 34547567 DOI: 10.1016/j.jenvman.2021.113713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
Food production and consumption have been recognized as a major source of environmental impacts. To ensure food security and a sustainable food system, dietary changes have been identified as one of the valuable strategies to reduce impacts on the environment while promoting human health. The vast majority of scientific literature has been focused on the effects of food consumption on climate change while neglecting to assess the degree of water scarcity impacts due to water consumption embodied in food. The research paper investigates the nexus between food consumption and impacts on water consumption adding important findings to a more recent growing body of studies estimating the water footprint (WF) of different dietary scenarios. This study uses the Water Footprint Network methodology and the AWARE (Available Water REmaining) characterization model to assess both the WF and the blue WSF (water scarcity footprint), respectively, of four Danish diets: standard, carnivore, vegetarian and vegan. In order to make them comparable, a total intake of 2000 kcal person-1 day-1 was set as energetic reference for all the diet scenarios considered. Using detailed trade and production data of agri-foods, we were able to assess the location of primary production and consequently to reveal countries mainly affected by water scarcity associated with import to satisfy Danish diets consumption. We found that while the vegan scenario scored the best environmental profile requiring 1489 L/cap/day calculated with the volumetric WF approach, it has the largest potential impacts on blue WSF of 10,477 LH20-eq/cap/day. This study has shown that more than 90% of impacts on water consumption occur outside the national borders, as a consequence of large quantities of fruits and nuts imported by countries already threatened by high water scarcity conditions such as USA and Mediterranean regions. This methodological approach may be used to compare environmental performances of recommended dietary guidelines and to assess impact scenarios of new trade policies, protecting local water scarcity levels.
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Affiliation(s)
- Maria Zucchinelli
- Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122, Piacenza, Italy
| | - Fabio Sporchia
- Research Group on EcoIndustrial System Analysis, Department of Environmental Science, Aarhus University, Frederiksborgvej 399, Postboks 358, DK-4000, Roskilde, Denmark; Aarhus University Centre for Circular Bioeconomy, Denmark
| | - Mariacristina Piva
- Department of Economic Policy, Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122, Piacenza, Italy
| | - Marianne Thomsen
- Research Group on EcoIndustrial System Analysis, Department of Environmental Science, Aarhus University, Frederiksborgvej 399, Postboks 358, DK-4000, Roskilde, Denmark; Aarhus University Centre for Circular Bioeconomy, Denmark
| | - Lucrezia Lamastra
- Department for Sustainable Food Process, Università Cattolica del Sacro Cuore, Via Emilia Parmense 84, 29122, Piacenza, Italy.
| | - Dario Caro
- Research Group on EcoIndustrial System Analysis, Department of Environmental Science, Aarhus University, Frederiksborgvej 399, Postboks 358, DK-4000, Roskilde, Denmark; Aarhus University Centre for Circular Bioeconomy, Denmark; European Commission, Joint Research Centre, Directorate Growth and Innovation, Circular Economy and Industrial Leadership Unit, Seville, Spain
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Jacobs I, Taljaard-Krugell C, Wicks M, Badham JM, Cubasch H, Joffe M, Laubscher R, Romieu I, Biessy C, Gunter MJ, Rinaldi S, Huybrechts I. Adherence to the South African food based dietary guidelines may reduce breast cancer risk in black South African women: the South African Breast Cancer (SABC) study. Public Health Nutr 2021; 25:1-17. [PMID: 34839846 PMCID: PMC9991845 DOI: 10.1017/s1368980021004675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the level of adherence and to assess the association between higher adherence to the South African food based dietary guidelines (SAFBDG) and breast cancer risk. DESIGN Population-based, case-control study (the South African Breast Cancer study) matched on age and demographic settings. Validated questionnaires were used to collect dietary and epidemiological data. To assess adherence to the SAFBDG, a nine-point adherence score (out of eleven guidelines) was developed, using suggested adherence cut-points for scoring each recommendation (0 and 1). When the association between higher adherence to the SAFBDG and breast cancer risk was assessed, data-driven tertiles among controls were used as cut-points for scoring each recommendation (0, 0·5 and 1). OR and 95 % CI were estimated using multivariate logistic regression models. SETTING Soweto, South Africa. PARTICIPANTS Black urban women, 396 breast cancer cases and 396 controls. RESULTS After adjusting for potential confounders, higher adherence (>5·0) to the SAFBDG v. lower adherence (<3·5) was statistically significantly inversely associated with breast cancer risk overall (OR = 0·56, 95 % CI 0·38, 0·85), among postmenopausal women (OR = 0·64, 95 % CI 0·40, 0·97) as well as for oestrogen-positive breast cancers (OR = 0·51, 95 % CI 0·32, 0·89). Only 32·3 % of cases and 39·1 % of controls adhered to at least half (a score >4·5) of the SAFBDG. CONCLUSIONS Higher adherence to the SAFBDG may reduce breast cancer risk in this population. The concerning low levels of adherence to the SAFBDG emphasise the need for education campaigns and to create healthy food environments in South Africa to increase adherence to the SAFBDG.
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Affiliation(s)
- Inarie Jacobs
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Christine Taljaard-Krugell
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | - Mariaan Wicks
- Centre of Excellence for Nutrition, North-West University, Private Bag X6001, Potchefstroom2520, South Africa
| | | | - Herbert Cubasch
- Department of Surgery, Faculty of Health Sciences, University of Witwatersrand, Houghton, Johannesburg, South Africa
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg, South Africa
| | - Maureen Joffe
- Non-Communicable Diseases Research Division, Wits Health Consortium (PTY) Ltd, Parktown, Johannesburg, South Africa
- MRC Developmental Pathways to Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Ria Laubscher
- Biostatistics Unit, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Isabelle Romieu
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- Hubert Department of Global Health, Emory University, Atlanta, GA, USA
| | - Carine Biessy
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
| | - Marc J Gunter
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
| | - Sabina Rinaldi
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
| | - Inge Huybrechts
- Nutrition and Metabolism Branch, International Agency for Research on Cancer – WHO, Albert Thomas, Lyon, France
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Patriota P, Marques-Vidal P. Retirement is associated with a decrease in dietary quality. Clin Nutr ESPEN 2021; 45:206-212. [PMID: 34620319 DOI: 10.1016/j.clnesp.2021.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Retirement has been associated with changes in dietary intake. We evaluated dietary intake and compliance to dietary guidelines after retirement in a population-based survey. METHODS Data from a prospective study conducted in Lausanne, Switzerland. Dietary intake was assessed using a validated food frequency questionnaire in 2009-2012 (first survey) and 2014-2017 (second survey). Total energy intake (TEI), macro and micronutrients, foods, dietary scores and compliance to dietary guidelines were assessed. Three approaches were used comparing changes in dietary intake: 1) before and after retiring (paired analysis); 2) in participants who retired with gender- and age-matched participants who did not retire (two-group comparison), and 3) in participants who retired, who did not retire or who were retired at both surveys (analysis of variance). RESULTS Using the first approach, newly retired participants (n = 215) increased their intake of total (median and [interquartile range]: 15.2 [13.7-17.5] vs. 14.9 [13.3-17.1] % of TEI) and animal (11.1 [9.1-13.0] vs. 10.0 [8.5-12.6] %TEI) protein; total (35.8 [32.1-40.7] vs. 34.6 [30.0-39.1] %TEI), saturated and monounsaturated fat; alcohol; cholesterol; vitamin D and fish, and decreased their intake of vegetable protein; total carbohydrates and monosaccharides, and of the Mediterranean diet score. Those findings were confirmed for total and saturated fat, alcohol, total carbohydrates and monosaccharides; vitamin D and fish intake, and of the Mediterranean diet score in the other two approaches. CONCLUSION Retirement was associated with an unhealthier dietary intake.
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Affiliation(s)
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, University of Lausanne, 46 Rue du Bugnon, 1011, Lausanne, Switzerland.
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Maki KC, Dicklin MR, Kirkpatrick CF. Saturated fats and cardiovascular health: Current evidence and controversies. J Clin Lipidol 2021; 15:765-772. [PMID: 34649831 DOI: 10.1016/j.jacl.2021.09.049] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 12/18/2022]
Abstract
A diet high in saturated fatty acids (SFA) is a suspected contributor to atherosclerotic cardiovascular disease (ASCVD) risk, in large part because of an effect to raise the low-density lipoprotein cholesterol (LDL-C) concentration. Most dietary guidance from health authorities advocates limiting intake of SFA, particularly for people with clinical ASCVD, dyslipidemia, or diabetes mellitus. However, recent reviews have highlighted controversies regarding SFA intake and cardiovascular health. This brief editorial commentary includes a discussion of the evidence regarding SFA intake and cardiovascular health, outlines gaps in the available evidence, and proposes tentative conclusions based on what is known today about SFA consumption and ASCVD risk. Results from observational studies demonstrate that dietary patterns with lower average intakes of SFA are associated with favorable cardiovascular outcomes. Additionally, although the number of randomized controlled trials testing the effects of reducing SFA intake on ASCVD outcomes is limited, the available evidence supports the view that replacing SFA with unsaturated fatty acids, particularly polyunsaturated fatty acids, may reduce ASCVD risk. Beyond raising LDL-C and atherogenic lipoprotein particle concentrations, higher intakes of SFA may influence pathways affecting inflammation, cardiac rhythm, hemostasis, apolipoprotein CIII production, and high-density lipoprotein function. However, the impacts of these effects on ASCVD risk remain uncertain. In the authors' view, the totality of the evidence supports the current recommendation to limit SFA intake to <10% of total daily energy for the general healthy population and further (e.g., to 5-6% of total daily energy) for patients with hypercholesterolemia.
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Affiliation(s)
- Kevin C Maki
- Indiana University, Department of Applied Health Science, School of Public Health, 1025 East 7th Street, Suite 111, Bloomington, IN 47405, USA; Midwest Biomedical Research, 211 East Lake Street, Suite 3, Addison, IL 60101, USA.
| | - Mary R Dicklin
- Midwest Biomedical Research, 211 East Lake Street, Suite 3, Addison, IL 60101, USA.
| | - Carol F Kirkpatrick
- Kasiska Division of Health Sciences, Idaho State University, 921 South 8th Avenue, Pocatello, ID 83209, USA.
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Clifford Astbury C, Aguirre E, Cullerton K, Monsivais P, Penney TL. How supportive is the global food supply of food-based dietary guidelines? A descriptive time series analysis of food supply alignment from 1961 to 2013. SSM Popul Health 2021; 15:100866. [PMID: 34307827 PMCID: PMC8283034 DOI: 10.1016/j.ssmph.2021.100866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 07/04/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND FAO/WHO have encouraged national governments to create food-based dietary guidelines (FBDGs) to support healthy diets. However, little is known about the extent to which food supply composition aligns with FBDGs, thereby structurally supporting or undermining population-level adherence. It is also unclear how this alignment has evolved over time. The aim of this study was to determine to what extent the global food supply aligns with FBDGs, and to examine historical trends. METHODS Descriptive time series analysis of food supply alignment (FSA), 1961-2013. FSA was characterised as a ratio dividing country-level food supply data by FBDG across four food groups: fruit and vegetables (FV); sugar (SU); fish and seafood (FS); and red and processed meat (RP). FBDG data was collected from guidance produced by international bodies, and from countries with published FBDGs. The food supply was estimated using yearly FAOSTAT data. A population-weighted average of this ratio was created for all countries included in the analysis, and stratified by region and country income. FINDINGS FBDGs from 89 countries were included. Of those, 80% had country guidelines for FV, 34% for SU, 44% for FS, and 21% for RP. FSA (1.0 = perfect alignment) based on global guidelines showed a higher supply than recommended for FV (1.2), SU (1.2) and RP (1.1). FSA based on country guidelines showed a lower supply than recommended for FV (0.9) and a higher supply than recommended for SU (2.3), RP (2.3) and FS (1.4). FSA also showed substantial differences in levels and trends across region and country income. INTERPRETATION As of 2013, food supplies were not aligned with national and international FBDGs and misalignment persisted across five decades with subtantial variation in trends based on geography and country income. The long running nature of these trends suggest that the transition toward sustainable and healthful food systems represent a signifiant global challange. Additionally, acknowledging the degree of misalignment between macro-level structural factors, such as the composition of the food supply, in relation to national or global food policy aims may further aid efforts for population level adherence.
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Affiliation(s)
- Chloe Clifford Astbury
- Global Food Systems and Policy Research, School of Global Health, Faculty of Health, York University, 4700, Keele St., Toronto ON, M3J 1P3, Canada
- Global Strategy Lab, Faculty of Health, York University, Canada
| | - Emilie Aguirre
- University of Chicago Law School, Chicago, USA
- Harvard Business School, Cambridge, USA
| | | | - Pablo Monsivais
- Department of Nutrition & Exercise Physiology, Washington State University, USA
| | - Tarra L. Penney
- Global Food Systems and Policy Research, School of Global Health, Faculty of Health, York University, 4700, Keele St., Toronto ON, M3J 1P3, Canada
- Global Strategy Lab, Faculty of Health, York University, Canada
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Schwingshackl L, Schünemann HJ, Meerpohl JJ. Improving the trustworthiness of findings from nutrition evidence syntheses: assessing risk of bias and rating the certainty of evidence. Eur J Nutr 2021; 60:2893-2903. [PMID: 33377996 PMCID: PMC8354882 DOI: 10.1007/s00394-020-02464-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
Suboptimal diet is recognized as a leading modifiable risk factor for non-communicable diseases. Non-randomized studies (NRSs) with patient relevant outcomes provide many insights into diet-disease relationships. Dietary guidelines are based predominantly on findings from systematic reviews of NRSs-mostly prospective observational studies, despite that these have been repeatedly criticized for yielding potentially less trustworthy results than randomized controlled trials (RCTs). It is assumed that these are a result of bias due to prevalent-user designs, inappropriate comparators, residual confounding, and measurement error. In this article, we aim to highlight the importance of applying risk of bias (RoB) assessments in nutritional studies to improve the credibility of evidence of systematic reviews. First, we discuss the importance and challenges of dietary RCTs and NRSs, and provide reasons for potentially less trustworthy results of dietary studies. We describe currently used tools for RoB assessment (Cochrane RoB, and ROBINS-I), describe the importance of rigorous RoB assessment in dietary studies and provide examples that further the understanding of the key issues to overcome in nutrition research. We then illustrate, by comparing the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach with current approaches used by United States Department of Agriculture Dietary Guidelines for Americans, and the World Cancer Research Fund, how to establish trust in dietary recommendations. Our overview shows that the GRADE approach provides more transparency about the single domains for grading the certainty of the evidence and the strength of recommendations. Despite not increasing the certainty of evidence itself, we expect that the rigorous application of the Cochrane RoB and the ROBINS-I tools within systematic reviews of both RCTs and NRSs and their integration within the GRADE approach will strengthen the credibility of dietary recommendations.
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Affiliation(s)
- Lukas Schwingshackl
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center, University of Freiburg, Freiburg, Germany.
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, Department of Medicine, McMaster University, Hamilton, Canada
| | - Joerg J Meerpohl
- Faculty of Medicine, Institute for Evidence in Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Macias W, English AE. The vegetable divide: Americans' knowledge of dietary guidelines and willingness to make healthy changes. Health Mark Q 2021; 39:119-134. [PMID: 34436972 DOI: 10.1080/07359683.2021.1965815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We aimed to (a) better understand Americans' awareness and attitudes towards the Dietary Guidelines for Americans (DGA) from 2005-2015; (b) identify how the public obtains that knowledge, (c) measure their willingness to make healthy changes; and (d) identify important contextual factors that impact knowledge of DGA and nutrition. Quantitative survey data from nationally-representative online panel samples indicate the already low awareness of DGA declined over the last decade. This study fills a gap in the literature and can help guide communication strategies employed by the DGA governing bodies (USDA and HHS), including a consistent brand image incorporating updates over time.
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Affiliation(s)
- Wendy Macias
- Department of Strategic Communication, Texas Christian University's Schieffer College, Fort Worth, TX, USA
| | - Ashley E English
- Department of Strategic Communication, Texas Christian University, Fort Worth, TX, USA
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Trestini I, Sperduti I, Caldart A, Bonaiuto C, Fiorio E, Parolin V, Zambonin V, Zanelli S, Tregnago D, Avancini A, Cintoni M, Pilotto S, Mele MC, Gasbarrini A, Scambia G, Milella M, Tortora G, Bria E, Carbognin L. Evidence-based tailored nutrition educational intervention improves adherence to dietary guidelines, anthropometric measures and serum metabolic biomarkers in early-stage breast cancer patients: A prospective interventional study. Breast 2021; 60:6-14. [PMID: 34454324 DOI: 10.1016/j.breast.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The impact of the adherence to dietary guidelines of early-stage breast cancer (EBC) patients on body composition changes during treatment is not entirely defined. This study aimed to evaluate the role of an evidence-based nutrition educational intervention, according to adherence to dietary guidelines, in EBC patients. METHODS This prospective study included EBC patients, candidates for neoadjuvant/adjuvant therapy. Patients received an evidence-based tailored nutrition educational intervention. The adherence to dietary guidelines, anthropometric and dietary assessments, and blood glucose and lipid profile tests were evaluated at baseline and after a 12-months nutritional intervention. RESULTS Two hundred and forty-three patients were enrolled. At baseline, 38.3% and 23.9% of patients were overweight and obese, weight gain ≥5% (compared to 6-months before enrollment) and central obesity were observed in 47.3% and 52.7% of patients, respectively. Adherence to dietary guidelines was low (median Med-Diet score: 6 [IQR 4-8]). After the nutritional intervention (median follow-up: 22 months [range 12-45]), adherence to dietary guidelines significantly increased (median Med-Diet score: 12 [IQR 8-13]), p < 0.0001). High adherence to dietary guidelines (defines as Med-Diet score ≥10) significantly correlated with: 1) overall weight loss ≥5% (21.8% vs. 2.5%, p = 0.003); 2) median BMI drop (from 25.6 kg/m2 to 24.4 kg/m2, p = 0.003); 3) lower prevalence of central obesity (38.2% vs. 7.2%, p = 0.01); 4) improvement in blood glucose levels and lipid profile. CONCLUSION This study suggests that an evidence-based tailored nutrition educational intervention during treatment for EBC significantly increases overall adherence to dietary guidelines, and it improves both anthropometric measures and serum metabolic biomarkers in patients with high adherence.
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Sammarchi S, Li J, Yang Q. Dietary shifts and nitrogen losses to water in urban China: the case of Shanghai. Environ Sci Pollut Res Int 2021; 28:40088-40102. [PMID: 32405944 DOI: 10.1007/s11356-020-09184-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
China's extraordinary economic development has provided the country's growing population with easier access to animal food products, especially in densely populated urban agglomerations. Increased consumption of such products translates in a higher amount of nitrogen (N) excreted in the form of human manure. Depending on the connection to a sewerage system, or lack thereof, and the N removal efficiency from wastewater treatment plants (WWTPs), a share of the excreted N gets ultimately discharged to water bodies, causing eutrophication. In heavily urbanised areas, N losses from household food consumption account for a dominant portion of total N losses to water. In this study, we firstly estimate dietary N intake, excretion and consequent N losses to water from the residents of Shanghai in 2012. We then explore different scenarios to 2030, in terms of further dietary modifications and different levels of development of the city's sewerage system and WWTPs. In 2012, Shanghai's residents excreted a total of 148.4 Gg N, 54% of which ultimately reached the city's water bodies in diffused N form. The urban population contributed for the majority of the N losses (93%) and showed a higher per capita N load, due to limited N removal efficiency from WWTPs and the significant portion (27%) of residents not connected to the sewerage and directly discharging their excreta to water. The vast majority of the scarce rural population were not connected to the sewerage system and showed a much lower per capita N load, mainly due to the common practice of recycling excreta for agricultural practices. We identify two main approaches to reduce dietary N losses: (1) improving N removal efficiency and sewerage connection rates towards the levels of OECD countries; (2) managing the increase of dietary N intake by promoting healthy and sustainable consumption, as recommended by recent dietary guidelines. According to our scenario analysis, technological improvements can potentially achieve a more significant reduction of total N losses and are easier to implement. Managing demand of animal food and consequent N intake would only stabilise N losses around 2012's levels. On the other hand, a dramatic increase of animal food consumption could have detrimental effects on the city's water bodies, more so if the expected population growth will not be met by an adequate development of a more capillary sewerage system. This study provides valuable insights on dietary N losses in one of China's most developed mega cities, strongly advocating for the necessity of improving N removal efficiency from WWTPs and reducing the percentage of urban residents directly discharging their waste to water bodies.
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Affiliation(s)
- Sergio Sammarchi
- China-UK Low-Carbon College, Shanghai Jiao Tong University, Shanghai, China.
| | - Jia Li
- China-UK Low-Carbon College, Shanghai Jiao Tong University, Shanghai, China.
| | - Qiang Yang
- China-UK Low-Carbon College, Shanghai Jiao Tong University, Shanghai, China
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Dimitratos SM, Hercules M, Stephensen CB, Cervantes E, Laugero KD. Association between physiological stress load and diet quality patterns differs between male and female adults. Physiol Behav 2021; 240:113538. [PMID: 34314759 DOI: 10.1016/j.physbeh.2021.113538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
A promising, yet relatively unexplored factor that may influence a person's stress response, is diet. Diet can affect the physiological response to stress, but relationships between diet quality and the chronic stress marker allostatic load (AL) are insufficiently studied. Furthermore, sex, age, and BMI may interact with diet quality to influence AL. 358 adults were recruited across predetermined sex, age, and BMI ranges. Cluster analysis of 13 Healthy Eating Index (HEI) sub-scores across all participants revealed six distinct diet quality patterns (HEI-P). We found sex and HEI-P interacted (PHEIxSex = 0.0232) to affect AL, reflecting a significantly different AL between women and men consuming a diet more closely aligned with the Dietary Guidelines for Americans for dairy, refined grains, and sodium consumption, but less aligned for added sugar, saturated fat, and fruits/vegetables intake. Sex and HEI-P also interacted to affect cholesterol (PHEIxSex = 0.0157), norepinephrine (PHEIxSex = 0.0315), epinephrine (PHEIxSex = 0.0204), and systolic blood pressure (PHEIxSex = 0.0457) but, compared to total allostatic load, no individual component of this biomarker explained the entire array of sex by HEI-P interactions. Our results suggest that differences in HEI-P and sex interact to influence physiological stress load which, in turn, may help resolve discrepancies in diet and sex-related disease risk.
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Castro TG, Gerritsen S, Teixeira JA, Pillai A, Marchioni DML, Grant CC, Morton SMB, Wall CR. An index measuring adherence to New Zealand Infant Feeding Guidelines has convergent validity with maternal socio-demographic and health behaviours and with children's body size. Br J Nutr 2021;:1-13. [PMID: 34212833 DOI: 10.1017/S0007114521001720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Using data from a nationally generalisable birth cohort, we aimed to: (i) describe the cohort’s adherence to national evidence-based dietary guidelines using an Infant Feeding Index (IFI) and (ii) assess the IFI’s convergent construct validity, by exploring associations with antenatal maternal socio-demographic and health behaviours and with child overweight/obesity and central adiposity at age 54 months. Data were from the Growing Up in New Zealand cohort (n 6343). The IFI scores ranged from zero to twelve points, with twelve representing full adherence to the guidelines. Overweight/obesity was defined by BMI-for-age (based on the WHO Growth Standards). Central adiposity was defined as waist-to-height ratio > 90th percentile. Associations were tested using multiple linear regression and Poisson regression with robust variance (risk ratios, 95 % CI). Mean IFI score was 8·2 (sd 2·1). Maternal characteristics explained 29·1 % of variation in the IFI score. Maternal age, education and smoking had the strongest independent relationships with IFI scores. Compared with children in the highest IFI tertile, girls in the lowest and middle tertiles were more likely to be overweight/obese (1·46, 1·03, 2·06 and 1·56, 1·09, 2·23, respectively) and boys in the lowest tertile were more likely to have central adiposity (1·53, 1·02, 2·30) at age 54 months. Most infants fell short of meeting national Infant Feeding Guidelines. The associations between IFI score and maternal characteristics, and children’s overweight/obesity/central adiposity, were in the expected directions and confirm the IFI’s convergent construct validity.
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Van Mierlo K, De Ridder K, Geeraerd A. Identifying Belgian protein consumption typologies by means of clustering and classification to move towards personalized advices for sustainable and nutritious food choices. Appetite 2021; 166:105583. [PMID: 34217759 DOI: 10.1016/j.appet.2021.105583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/23/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022]
Abstract
Protein sources are determinant for the environmental impact and nutritiousness of our food consumption patterns. Dietary advices, in terms of nutritional values and, more recently, the associated environmental impacts, are mostly formulated at nationwide level. However, actual food consumption patterns are variable between individuals within nations, leading to a need for more personalized dietary advices to ensure the feasibility of potential dietary changes. This research addresses the variability within Belgian food consumption patterns by identifying different "protein consumption typologies": consumer groups with different consumption frequencies of different protein sources. Hereto, both statistical clustering and classification were applied to food consumption data, the latter using predefined criteria related to meat consumption. The obtained typologies were further analyzed based on personal characteristics and compliance to nutritional guidelines. Five clusters and five classes were identified, with each survey participant belonging to one cluster and to one class. The clusters differed mainly in milk- and grain product intake, while the classes differed in the intake of meat products from the onset. Both clustering and classification showed that only a small part of the Belgian population frequently adopts plant-based protein sources, that meat products are predominant and that compliances to dietary guidelines are generally low. The typologies are the starting point for more personalized dietary advices to lower environmental impacts while ensuring adequate nutritional value, moving away from nationwide advices.
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Schwingshackl L, Zähringer J, Beyerbach J, Werner SS, Nagavci B, Heseker H, Koletzko B, Meerpohl JJ. A Scoping Review of Current Guidelines on Dietary Fat and Fat Quality. Ann Nutr Metab 2021; 77:65-82. [PMID: 34139694 DOI: 10.1159/000515671] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/04/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We conducted a scoping review of dietary guidelines with the intent of developing a position paper by the "IUNS Task force on Dietary Fat Quality" tasked to summarize the available evidence and provide the basis for dietary recommendations. METHODS We systematically searched several databases and Web sites for relevant documents published between 2015 and 2019. RESULTS Twenty documents were included. Quantitative range intake recommendations for daily total fat intake included boundaries from 20 to 35% of total energy intake (TEI), for monounsaturated fat (MUFA) 10-25%, for polyunsaturated fat (PUFA) 6-11%, for saturated-fat (SFA) ≤11-≤7%, for industrial trans-fat (TFA) ≤2-0%, and <300-<200 mg/d for dietary cholesterol. The methodological approaches to grade the strength of recommendations were heterogeneous, and varied highly between the included guidelines. Only the World Health Organization applied the GRADE approach and graded the following recommendation as "strong": to reduce SFA to below 10%, and TFA to below 1% and replace both with PUFA if SFA intake is greater than 10% of TEI. CONCLUSION Although the methodological approaches of the dietary guidelines were heterogeneous, most of them recommend total fat intakes of 30-≤35% of TEI, replacement of SFA with PUFA and MUFA, and avoidance of industrial TFA.
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Affiliation(s)
- Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jasmin Zähringer
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jessica Beyerbach
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah S Werner
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Helmut Heseker
- Department of Sports and Health, Paderborn University, Paderborn, Germany
| | - Berthold Koletzko
- Division of Metabolic and Nutritional Medicine, Department of Paediatrics, Dr. von Hauner Children's Hospital, LMU - Ludwig-Maximilians-Universität Munich, University of Munich Medical Center, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
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Chaltiel D, Julia C, Chaltiel R, Baudry J, Touvier M, Deschamps V, Latino-Martel P, Fezeu L, Hercberg S, Kesse-Guyot E. Prospective association between adherence to the 2017 French dietary guidelines and risk of death, CVD and cancer in the NutriNet-Santé cohort. Br J Nutr 2021;:1-11. [PMID: 34016201 DOI: 10.1017/S0007114521001367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Non-communicable diseases, such as cancers and CVD, represent a major public health concern, and diet is an important factor in their development. French dietary recommendations were updated in 2017, and an adherence score, the Programme National Nutrition Santé Guidelines Score (PNNS-GS2), has been developed and validated using a standardised procedure. The present study aimed to analyse the prospective association between PNNS-GS2 and the risk of death, cancer and CVD. Our sample consisted of French adults included in the prospective NutriNet-Santé cohort (n 67 748, 75 634 and 80 269 for the risk of death, cancer and CVD, respectively). PNNS-GS2 (range: -∞ to 14·25) was calculated from the 24-h dietary records of the first 2 years of monitoring. Association between PNNS-GS2 (in quintiles, Q) and the risk of death, cancer and CVD was studied using Cox models adjusted for the main confounding factors. The sample included 78 % of women, aged on average 44·4 years (sd 14·6) with on average 6·6 (sd 2·3) dietary records. Average PNNS-GS2 was 1·5 (sd 3·4) and median follow-up was 6·6 years for cancers and 6·2 years for CVD and deaths. PNNS-GS2 was significantly associated with the risk of death (hazard ratio (HR)Q5vsQ1: 0·77 (95 % CI 0·60, 1·00), 828 cases), cancer (HRQ5vsQ1 = 0·80 (95 % CI 0·69, 0·92), 2577 cases) and CVD (HRQ5vsQ1 0·64 (95 % CI 0·51, 0·81), 964 cases). More specifically, PNNS-GS2 was significantly associated with colorectal and breast cancer risks but not prostate cancer risk. Our results suggest that strong adherence to the 2017 French dietary recommendations is associated with a lower risk of death, cancer or CVD. This reinforces the validity of these new recommendations and will help to promote their dissemination.
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Choi YJ, Crimmins EM, Kim JK, Ailshire JA. Food and nutrient intake and diet quality among older Americans. Public Health Nutr 2021; 24:1638-1647. [PMID: 33557974 PMCID: PMC8094430 DOI: 10.1017/s1368980021000586] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/14/2021] [Accepted: 02/04/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. DESIGN Cross-sectional secondary analysis. SETTING USA. PARTICIPANTS A nationally representative sample of 5614 community-dwelling older adults over age 54 in the Health and Retirement Study - Health Care and Nutrition Survey. RESULTS Overall, only 10·7 % of respondents had a good quality diet (Healthy Eating Index score 81 and above); the majority had diets considered poor or needing improvement. Less than 50 % of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socio-economic status, fewer psychosocial resources and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. CONCLUSIONS Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality.
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Affiliation(s)
- Yeon Jin Choi
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218C, Los Angeles, CA90089, USA
| | - Eileen M Crimmins
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218C, Los Angeles, CA90089, USA
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218C, Los Angeles, CA90089, USA
| | - Jennifer A Ailshire
- Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue #218C, Los Angeles, CA90089, USA
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Ridoutt BG, Baird D, Anastasiou K, Hendrie GA. An assessment of the water use associated with Australian diets using a planetary boundary framework. Public Health Nutr 2021; 24:1570-5. [PMID: 33622458 DOI: 10.1017/S1368980021000483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Agriculture accounts for around 70 % of global freshwater withdrawals. As such, the food system has been identified as a critical intervention point to address water scarcity. Various studies have identified dietary patterns that contribute less to water scarcity. However, it is unclear what level of reduction is necessary to be considered sustainable. The pursuit of unnecessarily aggressive reductions could limit dietary diversity. Our objective was to assess the sustainability of water use supporting Australian dietary habits and the adequacy of current dietary guidelines. DESIGN Dietary intake data were obtained from the National Nutrition and Physical Activity component of the Australian Health Survey. For each individual daily diet, the water scarcity footprint was quantified, following ISO14046:2014, as well as a diet quality score. Water scarcity footprint results were compared with the planetary boundary for freshwater use downscaled to the level of an individual diet. SETTING Australia. PARTICIPANTS 9341 adults participating in the Australian Health Survey. RESULTS Dietary water scarcity footprints averaged 432·6 L-eq (95 % CI 432·5, 432·8), less than the 695 litres/person per d available to support the current global population of 7·8 billion, and the 603 litres/person per d available for a future population of 9 billion. Diets based on the Australian Dietary Guidelines required 521 L-eq/d, or 379 L-eq/d with lower water scarcity footprint food choices. CONCLUSIONS Diets based on the Australian Dietary Guidelines were found to be within the freshwater planetary boundary. What is needed in Australia is greater compliance with dietary guidelines.
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Jang H, Im J, Park K. Adherence to Dietary Guidelines among Diabetes Patients: Comparison between Elderly and Non-Elderly Groups. Clin Nutr Res 2021; 10:14-23. [PMID: 33564649 PMCID: PMC7850814 DOI: 10.7762/cnr.2021.10.1.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 01/01/2021] [Accepted: 01/13/2021] [Indexed: 11/19/2022] Open
Abstract
This study aimed to compare adherence to dietary guidelines between elderly and non-elderly individuals with type 2 diabetes mellitus (T2DM) in Korea. Data of 4,577 participants with T2DM were collected from the 1998-2015 Korea National Health and Nutrition Examination Surveys. The participants were classified into two groups based on age: non-elderly T2DM group comprising participants aged 30-64 years and elderly T2DM group comprising participants aged ≥ 65 years. Adherence to dietary guidelines was assessed using the Korean Diabetes Association-Korean Ministry of Health and Welfare (KDA-KMHW) index, comprising six components of dietary guidelines for T2DM patients. Multivariable generalized linear regression analysis was performed to analyze the KDA-KMHW index scores. The adherence levels to the individual components of the KDA-KMHW index were mostly lower in non-elderly group (p < 0.001) than elderly group, except for moderate carbohydrate consumption. The total KDA-KMHW index score was significantly lower in non-elderly T2DM group than in the elderly T2DM group (p < 0.001). The study results suggest the need for developing patient-specific education programs that focus on adherence to dietary guidelines, particularly for non-elderly patients, to adequately intervene with the difficulties experienced in T2DM dietary management.
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Affiliation(s)
- Haeun Jang
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
| | - Jihyun Im
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
| | - Kyong Park
- Department of Food & Nutrition, Yeungnam University, Gyeongsan 38541, Korea
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