Baseline Dietary Data Research Articles

The Association Between Periconceptual Maternal Dietary Patterns and Miscarriage Risk in Women With Recurrent Miscarriages: A Multicentre Cohort Study.

To examine the association between periconceptual maternal diet and miscarriage risk among women with recurrent miscarriages. Prospective multicentre cohort study (Tommy's Net). Three university hospital research centres in the United Kingdom. 1035 women with a baseline history of two or more miscarriages. We analysed baseline dietary data from a 10-item Food Frequency Questionnaire (FFQ). For individual food category analyses, we used multivariable Poisson regression following adjustment for maternal confounders and paternal dietary patterns. For whole diet analyses, ordinal principal component analysis (PCA) was used to identify common dietary patterns. Results were presented as relative risks (RR) with 95% confidence intervals (CI) and accompanying p-values. Miscarriage rate, defined as the rate of spontaneous pregnancy loss (< 24 weeks of gestation) relative to the total number of pregnancies (miscarriages and live births). High consumption of fruit and nuts (almonds and walnuts) was associated with lower miscarriage risk (fruit 226/662 (34.1%) vs. 38/77 (49.4%), RR 0.66, 95% CI 0.51 to 0.85, p = 0.001; nuts 47/152 (30.9%) vs. 220/613 (35.9%), RR 0.73, 95% CI 0.54 to 0.98, p = 0.039). High red meat intake was associated with a possible increase in miscarriage risk (6/12 (50.0%) vs. 165/469 (35.2%), RR 1.86, 95% CI 1.10 to 3.16, p = 0.022). The association with miscarriage risk was unclear for other food groups, including fresh vegetables, white meat, fish, dairy, eggs, soya and chocolate, due to imprecise point estimates. Through PCA, we identified three data-derived dietary patterns. Yet, no distinct relationship emerged between these dietary patterns and miscarriage risk. A maternal diet rich in fresh fruits and nuts is associated with a lower miscarriage risk among women with a history of recurrent miscarriage. Tommy's Net (ISRCTN17732518) https://www.isrctn.com/ISRCTN17732518. Analysis plan (OSF zp7cs) https://osf.io/zp7cs.

Operationalising dietary acceptability: A systematic review on how acceptability is applied in dietary optimisation models

The current environmental, climate and health challenges require critical transitions to diets and food production systems that are more sustainable, in turn providing diets that are adequate nutrition, affordable and environmentally friendly. Recent studies have identified cultural acceptability as an important dimension in sustainable diets(1). Mathematical optimization models have been developed to deal with the complexities of all the dimensions, yet diet acceptability has had limited successful integration into these models(2). This systematic review explored two research questions in the context of dietary optimisation studies; how is acceptability defined and operationalised?; how does including acceptability impact dietary optimisation solutions?A hybrid search strategy was implemented. The first used the PRISMA guidelines to conduct a systematic search on two electronic databases (PubMed, Embase) for articles published between January 2013 and April 2024. Search terms were developed through preliminary readings and included: diet OR diets OR dietary AND modelling OR modeling OR optimisation OR optimization OR optimize OR optimize OR linear programming AND acceptabl*. Articles in English optimising acceptable diets for adults (18+) were included. The second used the snowball method for identifying relevant articles from previous searches(3). Backward snowballing was conducted by identifying references from the initial set and forward snowballing was conducted through Web of Science in June 2023.Fifty-one studies fulfilled the inclusion criteria. European countries had the largest representation (n = 41; 20 from France, 7 from The Netherlands); 43 studies took a population-based modelling approach, 7 on individual-based modelling and 1 study used both approaches. The review identified 12 modelling approaches, where linear programming was most frequently used (n = 26), followed by non-linear programming (n = 7) and quadratic (n = 6). The majority of studies that optimised for acceptability used the minimal deviation from observed diet as the objective function (n = 32). Baseline dietary data for observed diets were primarily from National surveys (n = 36), followed by local surveys (n = 5), however, 25 studies used data that was 8 – 16 years older than the publication date. Majority of studies included at least one acceptability constraint (n = 45), ranging from setting boundaries on certain foods (n = 34), removal of certain foods/food groups (n = 12), limiting deviation (n = 15).The full analysis of the studies is ongoing; however the current results highlight the varying methods used to operationalising ‘acceptable’ diets in diet optimisation literature. A conceptual framework for integrating acceptability into diet optimisation studies is currently under development, aiming to highlight the various ways in which ‘acceptability’ is operationalised through the modelling process from data inputs, models chosen to validation of the solutions. It is anticipated that this work will highlight new opportunities for further modelling for acceptable diets.

Association of Pro-Inflammatory Diet, Smoking, and Alcohol Consumption with Bladder Cancer: Evidence from Case-Control and NHANES Studies from 1999 to 2020.

Diet might be a modifiable factor in preventing cancer by modulating inflammation. This study aims to explore the association between the dietary inflammatory index (DII) score and the risk of bladder cancer (BC). A total of 112 BC patients and 292 control subjects were enrolled in a case-control trial. Additionally, we tracked a total of 109 BC patients and 319 controls, whose propensity scores were obtained from the Nutrition Examination Survey (NHANES) database spanning from 1999 to 2020. The baseline index and dietary intake data were assessed using a food frequency questionnaire (FFQ). DII scores were calculated based on the dietary intake of 20 nutrients obtained from participants and categorized into four groups. The association between the inflammatory potential of the diet and BC risk was investigated using multivariate odds ratios (ORs) and 95% confidence intervals (CIs). High DII scores were associated with a pro-inflammatory diet and a higher risk of BC, with higher DII scores positively associated with a higher risk of BC (quartiles 4 vs. 1, ORs 4.89, 95% CIs 2.09-11.25 p < 0.001). Specifically, this might promote BC development by inducing oxidative stress and affecting DNA repair mechanisms. This result was consistent with the NHANES findings (quartiles 4 vs. 1, ORs 2.69, 95% CIs 1.25-5.77, p = 0.006) and further supported the association of pro-inflammatory diet and lifestyle factors with the risk of BC. Diets with the highest pro-inflammatory potential were associated with an increased risk of BC. By adjusting lifestyle factors, individuals might effectively lower their DII, thereby reducing the risk of developing BC. The results are consistent with the NHANES cohort.

Dietary total antioxidant capacity of Moroccan Type 2 Diabetes Mellitus patients.

A new approach to a healthy diet is the assessment of dietary Total Antioxidant Capacity (TAC). The aim of this study was to assess the dietary TAC among Moroccan Type 2 Diabetes Mellitus (T2DM) patients and identify the main food sources contributing to the total antioxidant capacity intake. A total of 254 patients with T2DM was included in the study. The usual dietary intakes were assessed by means of a validated food frequency questionnaire. The dietary TAC was estimated using published databases of the antioxidant content of foods measured by the FRAP (ferric ion reducing antioxidant potential) method. The mean (SD) dietary TAC of the studied type 2 diabetes patients was 10.86 (3.42) mmol/day. Correlation analyses showed a positive association between dietary TAC and the consumption of healthy food groups, such as fruits and vegetables. Tea and coffee beverages (38.6%), vegetables (21.9%), cereals and pulses (18.8%), fruits and fruit juices (12.4%) were major food sources of dietary antioxidant intake. The relatively short list of twenty food items that contributed most to dietary TAC presented an important explanation of roughly 94%. These included tea, coffee, broad beans, artichoke, pepper, beetroot, sweet potatoes, pomegranate, mandarin, figs, strawberry, orange juice, olives, cashew nuts, almonds, sunflower seeds, dchicha and white beans. This study supplies baseline dietary TAC data for Moroccan T2DM patients that may help to elucidate which aspects of the eating habits and behaviours require improvement and provide the opportunity to develop dietary guidelines as part of the nutritional diabetes management.

Dietary fibre intakes of two cohorts of New Zealand adults with and without constipation

Adequate dietary fibre (DF) intake is recommended to relieve constipation and improve gut health(1). It is often assumed that individuals with constipation have relatively low DF intake and do not meet the recommended adequate intake of 25 g and 30 g for females and males, respectively. The 2008/09 New Zealand Adult Nutrition Survey confirmed that the mean DF was 17.9 grams (g) per day for females and 22.8 g per day for males, which was well below the recommended adequate intake(2). With the continuous shift of dietary patterns over time, we sought to compare the current usual DF intake of two cohorts of New Zealand adults: those who have constipation with those without constipation but with relatively low DF intake. We report baseline dietary data from two randomised controlled dietary studies (Kiwifruit Ingestion to Normalise Gut Symptoms (KINGS) (ACTRN12621000621819) and Bread Related Effects on microbiAl Distribution (BREAD) (ACTRN12622000884707)) conducted in Christchurch, New Zealand in 2021 and 2022, respectively. The KINGS study included adults with either functional constipation or constipation-predominant irritable bowel syndrome to consume either two green kiwifruit or maltodextrin for four weeks. The BREAD study is a crossover study and included healthy adults without constipation but with relatively low DF intake (&lt;18 g for females, &lt;22 g for males) to consume two types of bread with different DF content, each bread for four weeks separated by a two-week washout period. All participants completed a non-consecutive three-day food diary at baseline. Dietary data were entered into FoodWorks Online Professional (Xyris Software Australia, 2021) to assess mean daily DF intake. Fifty-six adults from the KINGS study (n = 48 females, n= 8 males; mean age ± standard deviation: 42.8 ± 12.6 years) and BREAD study (n = 33 females, n= 23 males; mean age: 40.4 ± 13.4 years) completed a baseline food diary. In the KINGS study, females with constipation had a daily mean DF intake of 25.0 ± 9.4 g whilst male participants consumed 26.9 ± 5.0 g per day. In the BREAD study, females without constipation had a mean daily DF intake of 19.4 ± 5.8 g, whereas males had 22.6 ± 8.5 g per day. There was a statistically significant difference in the mean daily DF intake between females with constipation and those without constipation (p &lt; 0.001) but not between males (p = 0.19). These two studies found that DF intakes among females with constipation were not as relatively low as previously assumed, as they met their adequate intake of 25 g. Further data analysis from the KINGS and BREAD studies will reveal the effects of using diet to manage constipation and promote better gut health in these two cohorts of New Zealand adults.

Abstract 2199: Low-carbohydrate diet score and risk of bladder cancer: Findings from the Singapore Chinese Health Study

Abstract Background. Bladder cancer is a leading tumor of urinary tract with annually 570,000+ new cases and 200,000+ deaths worldwide. In the United States, the current incidence rate of bladder cancer is 15.8 per 100,000 population with more than 82,000 new cases and more than 16,000 deaths each year. Although smoking is established as a major risk factor for bladder cancer development, accounting for 30-50% cases, the role of other modifiable risk factors, including dietary in bladder cancer remains unclear. Low-carbohydrate diet (LCD) is a dietary pattern to restrict carbohydrate and to favor protein and/or fat intakes that has recently been well-accepted for weight loss. While its short-term effect to support the weight loss has been popular, its long-term effect on chronic diseases, including cancer, needs to be elucidated. In the current analysis, we sought to determine the association between LCD scores and bladder cancer risk in the Singapore Chinese Health Study (SCHS), an ongoing prospective cohort study consisting of more than 63,000 Chinese Singaporeans, 45- 74 years of age at baseline enrollment period 1995-1998. Methods. Total, animal-based and plant-based LCD scores were derived from the baseline dietary survey data, representing summed intake of carbohydrates, fats and proteins from all dietary, animal- and plant-food sources, respectively. Bladder cancer cases were ascertained using cancer registry. Cox proportional hazard regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for different LCD score levels with risk of bladder cancer. Results. By December 31, 2015, or after 17.6 years of follow-up, 250 bladder cancer cases were developed within the SCHS. Total LCD score was marginally associated with increased risk of bladder cancer (HRQ4vs.Q1=1.43, 95% CI: 0.98-2.09, Ptrend = 0.06). Animal-based LCD score was significantly associated with risk of bladder cancer. The HRs and respective 95% CIs of bladder cancer for quartiles 2, 3, and 4, compared with the lowest quartile, were 1.09 (0.76-1.56), 1.17 (0.81-1.70), and 1.53 (1.09-2.17) (Ptrend=0.01). The positive association was only present in men, ever smokers, never drinkers and individuals without history of type 2 diabetes (All P’sheterogeneity&amp;gt;0.05). Conclusions. In a prospective cohort study of more than 63,000 Chinese Singaporeans, we found that animal-based LCD score, representing a diet with lower carbohydrate and higher animal fat and protein, was significantly associated with increased risk of bladder cancer. Dietary modification is therefore suggested as an effective strategy for primary prevention of bladder cancer. Citation Format: Yen Thi-Hai Pham, Renwei Wang, Aizhen Jin, Woon-Puay Koh, Jian-Min Yuan, Hung N. Luu. Low-carbohydrate diet score and risk of bladder cancer: Findings from the Singapore Chinese Health Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2199.

Association of unsweetened and sweetened cereal consumption with all-cause and cause-specific mortality: a large prospective population-based cohort study.

Background & aims: Although previous observational studies have suggested an association between whole grain consumption (including breakfast cereals) and a reduced risk of death, no study has explored in detail the association between consumption of cereal with or without added sweeteners and death. We therefore aimed to evaluate the association between unsweetened, sugar-sweetened, and artificially sweetened cereals and all-cause and cause-specific mortality. Methods: We conducted a prospective cohort study of 186 419 UK Biobank participants who met the inclusion criteria for this study. Participants with baseline demographic, lifestyle, dietary, and clinical data were recruited from 2006 to 2010 and followed up until 2023. The intake of unsweetened, sugar-sweetened, or artificially sweetened cereals was estimated through repeated 24 hour dietary recalls. The non-linear relationships between daily dosage of cereal and all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality were calculated using a restricted cubic spline curve. Hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality were calculated using Cox regression models. Results: During a median follow-up of 13.6 years, 11 351 all-cause deaths were recorded, including 6176 cancer deaths and 2126 CVD deaths. Cox regression models with restricted cubic splines showed a non-linear association between unsweetened cereals and all-cause and cancer-specific mortality. Compared with non-consumers, consumers of different amounts of unsweetened cereals (0 to 0.5, 0.5 to 1.5, and >1.5 bowls per day) had lower risks of all-cause mortality in the multivariate Cox models, with respective HRs of 0.89 (95%CI: 0.84-0.95), 0.90 (95%CI: 0.86-0.94), and 0.89 (95%CI: 0.82-0.97). However, no association was observed between consumption of sugar or artificially sweetened cereals and the risk of mortality. When cereals were divided into those with or without dried fruit, the findings were consistent with our primary results. Conclusions: Moderate consumption of unsweetened cereals was associated with a reduced risk of all-cause mortality, suggesting caution in consuming cereals with added sugar or artificial sweeteners.

Abstract 16940: Nutrient Intake of Patients With Heart Failure: Different Profiles Reveal Different Intervention Targets

Introduction: Diet quality is an important, but often underappreciated part of heart failure (HF) care. Tailoring of dietary interventions must take into consideration how patients with HF eat. Purpose: To identify distinct dietary profiles representing eating patterns in patients with HF. Methods: This was a secondary analysis of data from a randomized controlled double-blind clinical trial of a nutrition intervention with patients with HF. Baseline dietary data were collected using 24-hour dietary recall that included a weekend and two weekdays. Nutritional data were generated from the Nutrition Data Systems for Research. Nine unique diet components were quantified (along with a total Healthy Eating Index) and included in modeling based on theoretical and empirical knowledge: sodium, added sugars, trans-fat, vitamin C, vitamin D, vitamin E, folate, beta-cryptoxanthin, and lutein + zeaxanthin. Latent class mixture modeling was used to identify distinct dietary profiles among these 9 components representing different eating patterns that could serve as the bases of future interventions. Results: There were 112 participants with an average age 63 ± 12, 59.8% male, and 62.5% with class III or IV HF. Two dietary profiles were identified and were labeled by the prominent dimensional characteristic. The “higher intake” profile (n=79 (69.9% of the sample)) had significantly higher intake levels of sodium, vitamin D, vitamin E, vitamin C, beta-cryptoxanthin, lutein + zeaxanthin, and folate, and a “lower intake” profile (n=34 (30.1% of the sample) had significantly lower intake of these same nutrients. Patients with HF in the lower intake profile also had significant higher quality diets (Healthy Eating Index = 63.7± 13.2) compared with those in the higher intake profile (Healthy Eating Index = 53.9 ± 14.2, p&lt;0.001). Conclusion: Two different nutrient patterns were identified that would be amenable to different interventions; one focused on total calorie reduction and the other focused on optimizing nutrient intake.

Development and Testing of the Novel Sugar Meter for Informing Sugar Intake Guidelines to Parents of Three- to Six-Year-Old Children: A Cross-Sectional Study.

In recent years, the consumption of refined sugar has increased manifold. Added sugar is implicated in dental caries, cardiovascular risk and obesity amongst other conditions. The 1025 World Health Organization (WHO) Sugar Guidelines recommends sugar intake below 10% of energy, but there is limited awareness about the same in the general population. The aim of this study was to test the Novel Sugar Meter for informing the WHO Sugar Guidelines to the parents of three- to six-year-old children. Twenty consenting parents and their three- to six-year-old children from an English-medium school in Navi Mumbai, India, were selected. The parents were asked to record their child's baseline dietary data for three consecutive days including one weekend day. The Novel Sugar Meter, an indigenously developed ready reckoner for identifying the quantity of sugars consumed, was used. The parents were counselled using the Novel Sugar Meter (intervention) and standard instructions on the WHO guidelines (control). The dietary data were recorded again to assess and compare dietary behaviour modifications. Comparison of pre-intervention versus post-intervention sugar consumptions showed a statistically significant reduction in the Novel Sugar Meter group (t(10) = 3.70891; p = .001388) but not in the control group (t(10) = 0.94081, p = 0.35926). Both groups showed a reduction in the frequency of daily sugar exposure, with significantly more reduction in the Novel Sugar Meter group (p = .000049). Novel Sugar Meter-based counselling has the potential for application for reducing the quantity and frequency of sugar consumption in children.

Young Children's Dietary Quality in Family Child Care and in Their Own Home.

Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies have explored these differences among children in less formal family child care. The purpose of this study was to compare dietary quality via the Healthy Eating Index 2015 among children in family child care and in their own home. This was a cross-sectional analysis of baseline dietary intake data from the Childcare Home Eating and Exercise Research study, a natural experiment, using directly observed dietary data in child care and 24-hour recall data in homes among children in South Carolina. Participants were 123 children in 52 family child-care homes between 2018 and2019. The main outcome was total and component Healthy Eating Index 2015 scores. The analysis was a hierarchical linear regression of children nested within family child care homes adjusting for child, provider, facility, and parent characteristics, including sex, age, race, ethnicity, and income, with parameters and SEs estimated via bootstrap sampling. Children had a mean ± SD Healthy Eating Index 2015 score of 60.3 ± 12.1 in family child-care homes and 54.3 ± 12.9 in their own home (P < 0.001). In adjusted analysis and after accounting for clustering of children in family child care homes, total HEI-2015 scores were lower at home than in care (β= -5.18 ± 1.47; 95% CI -8.05 to -2.30; P= 0.003). Children had healthier dietary intake in family child-care homes vs their respective homes.

Associations of diet with survival of patients (pts) with metastatic cancer of the urothelium (mUC) and renal cell carcinoma (mRCC) on immune checkpoint blockade (ICB).

4598 Background: The gut microbiome is an emerging modifiable predictor of ICB efficacy. Diet impacts the gut microbiome and fiber intake is associated with longer progression-free survival (PFS) in advanced melanoma treated with ICB. Whether diet impacts ICB benefit in mUC or mRCC remains unknown. Methods: Using a prospective cohort design, baseline dietary data were collected from pts with mUC or mRCC initiating ICB at Memorial Sloan Kettering Cancer Center using the extensively validated Harvard Willett Food Frequency Questionnaire. Tumor mutational burden (TMB) was estimated by next generation sequencing (MSK-IMPACT). The primary endpoint was radiologist assessed PFS, with secondary endpoint of overall survival (OS). Fiber intake was stratified as high or low using the median intake in our cohort. Associations between fiber intake and clinical outcomes were assessed using Kaplan-Meier curves plus univariable (UV) and multivariable (MV) Cox proportional hazards regression. Models were adjusted for prior ICB exposure. Models for mUC controlled for TMB and Bellmunt risk factors. Models for mRCC controlled for histology (clear vs non-clear cell) and IMDC risk score. Results: From 2/2021-6/2022, 88 pts eligible for analysis were enrolled with median follow-up of 10.1 months (mo) (mUC n = 40; mRCC n = 48). Median fiber intake was 17.5 g/day (interquartile range 12.5-24.5). Among pts with mUC, high fiber intake (≥17.5 g/day) was associated with longer PFS (UV hazard ratio [HR] 0.56, 95% CI 0.26-1.19, p = .13; MV HR 0.39, 95% CI 0.16-0.93, p = .03). Similar trends were observed for mRCC. In subgroup analyses, PFS was numerically longer with high fiber intake among mUC pts on maintenance avelumab (median PFS 6.1 vs 3.0 mo, n = 14) and in pts with mRCC treated with first-line (1L) ipilimumab + nivolumab (median PFS 18.0 vs 5.7 mo, n = 14) and 1L ICB + tyrosine kinase inhibitor (median PFS not reached vs 5.1 mo, n = 21). Among pts with mUC on non-maintenance ICB, pts with high fiber intake had numerically higher PFS at 6 mo (38% vs 14%, n = 26). Conclusions: This pilot study indicates that high fiber intake is associated with longer PFS among pts with mUC on ICB. Trends towards longer PFS and OS with high fiber intake were observed among pts with mRCC. Analyses of the gut microbiome are underway to investigate mechanisms of action. [Table: see text]

Estimated dietary intake of polyphenols from cereal foods and associated lifestyle and demographic factors in the Melbourne Collaborative Cohort Study

Cereal foods are consumed globally and are important sources of polyphenols with potential health benefits, yet dietary intakes are unclear. We aimed to calculate the dietary intakes of polyphenols from cereal foods in the Melbourne Collaborative Cohort Study (MCCS), and describe intakes by demographic and lifestyle factors. We estimated intakes of alkylresorcinols, lignans and phenolic acids in n = 39,892 eligible MCCS participants, using baseline dietary data (1990–1994) from a 121-item FFQ containing 17 cereal foods, matched to a polyphenol database developed from published literature and Phenol-Explorer Database. Intakes were estimated within groups according to lifestyle and demographic factors. The median (25th–75th percentile) intake of total polyphenols from cereal foods was 86.9 mg/day (51.4–155.8). The most consumed compounds were phenolic acids, with a median intake of 67.1 mg (39.5–118.8), followed by alkylresorcinols of 19.7 mg (10.8–34.6). Lignans made the smallest contribution of 0.50 mg (0.13–0.87). Higher polyphenol intakes were associated with higher relative socio-economic advantage and prudent lifestyles, including lower body mass index (BMI), non-smoking and higher physical activity scores. The findings based on polyphenol data specifically matched to the FFQ provide new information on intakes of cereal polyphenols, and how they might vary according to lifestyle and demographic factors.

Dietary inflammatory index and cardiovascular disease risk in Hispanic women from the Women’s Health Initiative

BackgroundTo evaluate the association between the dietary inflammatory index (DII®) and incident cardiovascular disease (CVD) in Hispanic women from the Women’s Health Initiative (WHI), and to determine if body mass index (BMI) interacted with the DII scores.MethodsSecondary analysis of baseline dietary data and long-term CVD outcomes among 3,469 postmenopausal women who self-identified as Hispanic enrolled in WHI. DII scores were calculated from self-administered food frequency questionnaires. The CVD outcomes included coronary heart disease (CHD) and stroke. Stratified Cox regression models were used to assess the relationship between DII scores and CVD in women with and without obesity. Models were adjusted for age, lifestyle risk factors, known risk factors, and neighborhood socioeconomic status.ResultsThe incidence of CHD was 3.4 and 2.8% for stroke after a median follow-up of 12.9 years. None of the DIIs were associated with CVD risk in this sample of Hispanic women. BMI interacted with the DII (p < 0.20) and stratified models showed that the associations between the DII and CVD were only significant in women with overweight (p < 0.05). In this group, higher DII scores were associated with a higher risk of CHD (HR 1.27; 95% CI: 1.08, 1.51) and a higher risk of stroke (HR 1.32; 95% CI: 1.07, 1.64).ConclusionAmong postmenopausal Hispanic women with overweight, greater adherence to pro-inflammatory diets was associated with higher risk of CVD. Additional research is needed to understand how to promote long-term heart-healthy dietary habits to reduce inflammation and prevent CVD in at-risk Hispanic women.

Mortality Associated with Healthy Eating Index Components and an Empirical-Scores Healthy Eating Index in a Cohort of Postmenopausal Women

Studies of diet and chronic disease include a recent important focus on dietary patterns. Patterns are typically defined by listing dietary variables and by totaling scores that reflect whether consumption is encouraged or discouraged for listed variables. However, precision may be improved by including total energy consumption among the dietary variables and by scoring dietary variables empirically. To relate Healthy Eating Index (HEI)-2010 components and total energy intake to all-cause and cause-specific mortality in Women's Health Initiative (WHI) cohorts and to define and evaluate an associated Empirical-Scores Healthy Eating Index (E-HEI). Analyses are conducted in WHI cohorts (n = 67,247) of healthy postmenopausal women, aged 50-79 y, when enrolled during 1993-1998 at 40 US clinical centers, with embedded nutrition biomarker studies. Replicate food-frequency assessments for HEI-2010 ratio variables and doubly labeled water total energy assessments, separated by ∼6 mo, are used as response variables to jointly calibrate baseline dietary data to reduce measurement error influences, using 2 nutrition biomarker studies (n = 199). Calibrated dietary variables are associated with mortality risk, and an E-HEI is defined, using cross-validated HR regression estimation. Of 15 dietary variables considered, all but empty calories calibrated well. Ten variables related significantly (P < 0.05) to total mortality, with favorable fruit, vegetable, whole grain, refined grain, and unsaturated fat associations and unfavorable sodium, saturated fat, and total energy associations. The E-HEI had cross-validated total mortality HRs (95% CIs) of 0.87 (0.82, 0.93), 0.80 (0.76, 0.86), 0.77 (0.72, 0.82), and 0.74 (0.69, 0.79) respectively, for quintiles 2 through 5 compared with quintile 1. These depart more strongly from the null than do HRs for HEI-2010 quintiles, primarily because of total energy. Mortality among US postmenopausal women depends strongly on diet, as evidenced by a new E-HEI that differs substantially from earlier dietary pattern score specifications.

Association of Diet and Physical Activity With All-Cause Mortality Among Adults With Parkinson Disease

Greater diet quality and physical activity level are associated with a lower risk of developing Parkinson disease (PD). However, information regarding the association between lifestyle behaviors and survival after PD diagnosis remains limited. To examine the association of prediagnosis and postdiagnosis overall diet quality and physical activity with all-cause mortality among individuals with PD. This population-based cohort study analyzed male participants in the Health Professionals Follow-up Study from 1986 to 2012 and female participants in the Nurses' Health Study from 1984 to 2012. Participants who were diagnosed with PD and had complete baseline dietary assessment data were included. Data were analyzed from January 2021 to February 2022. Prediagnosis diet quality, assessed by the Alternative Healthy Eating Index (AHEI), and physical activity, assessed by metabolic equivalent task (MET) hours per week reported on questionnaires, were the primary exposures of interest to minimize reverse causation. Mortality, which was followed up until 2018, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of diet and physical activity with mortality individually and jointly, and the models were adjusted for age, total energy intake, caffeine intake, and other lifestyle risk factors. The sample comprised 1251 individuals with PD, which included 652 men (52.1%) with a median (IQR) age at diagnosis of 73.4 (67.5-78.7) years. During the 32 to 34 years of follow-up, 942 participants died. The adjusted hazard ratio (HR) comparing the highest vs the lowest AHEI quartile was 0.69 (95% CI, 0.56- 0.85) for prediagnosis analyses and 0.57 (95% CI, 0.42-0.78) for postdiagnosis analyses. Similar results were obtained for cumulative mean MET hours per week in the prediagnosis analyses (HR, 0.71; 95% CI, 0.57-0.87) and postdiagnosis analyses (HR, 0.47; 95% CI, 0.35-0.63). The inverse association persisted for PD-specific mortality (postdiagnosis AHEI: HR, 0.52 [95% CI, 0.33-0.80]; postdiagnosis physical activity: HR, 0.37 [95% CI, 0.25-0.55]). In the joint analyses of diet quality and physical activity before the PD diagnosis, the adjusted HR was 0.51 (95% CI, 0.36-0.73) for individuals in the highest vs lowest tertiles for both variables. The HR for diet quality and physical activity after the diagnosis was 0.35 (95% CI, 0.23-0.52). Results of this study showed that a healthy dietary pattern and an active lifestyle were associated with a lower rate of all-cause mortality among individuals with PD. Consuming a healthy diet and engaging in physical activity or exercise could be targeted to improve PD outcomes.

Processed meat consumption and associated factors in Chile: A cross-sectional study nested in the MAUCO cohort.

Processed meat consumption is increasing in Latin America. While in developed countries processed meat consumption has been associated with cardiovascular diseases and cancer, our region lacks data associated to its consumption and health impact. We characterized processed meat intake and associated factors in a population-based cohort of a Chilean agricultural county, MAUCO. We analyzed baseline dietary data of 7,841 participants, 4,358 women and 3,483 men (38-77 years), who answered an adapted Mediterranean index food frequency questionnaire. Eight percent of the participants presented high processed meat consumption (≥5 times per week). We explored associations of processed meat consumption with participant characteristics using multinomial logistic regression models. Main factors associated with higher consumption were being men, younger and currently employed, and having a high intake (>4 times per week) of red meat (Odds ratio, 2.71, 95% CI 2.10-3.48), butter/cream (1.96, 1.60-2.41), whole-fat dairy products (1.32, 1.04-1.67) and a high intake (≥1 time per day) of sugary snacks/sweets (2.49, 2.04-3.03) and sugary drinks (1.97, 1.63-2.38). Processed meat consumption associated to chronic diseases, particularly cardiovascular disease (Prevalence ratio, 2.28, 95% CI 1.58-3.29). Obesity mediated this association in a proportion of 5.0%, whereas for diabetes the proportion was 13.9%. In this population, processed meat was associated with other unhealthy dietary and lifestyle factors, as well as with chronic diseases, particularly cardiovascular disease.

Associations Between Global Diet Quality Score (GDQS) and Nutritional Status Among Rural Pregnant Women in Amhara Region, Ethiopia

ObjectivesNutritionally adequate diet during pregnancy is essential to promote the nutrition and health of pregnant women and their fetuses, but there are few measures to assess diet quality. We examined the associations of a new metric, the Global Diet Quality score (GDQS), with nutritional status among pregnant women in rural Amhara, Ethiopia. MethodsWe used baseline dietary data among 2363 pregnant women at ≤ 24 weeks’ gestation enrolled in the Enhancing Nutrition and Antenatal Infection Treatment for Maternal and Child Health (ENAT) study from July 2020 to December 2021. The GDQS was generated using the weekly consumption of 25 food groups. We assigned 0–1 serving/wk (0 point), 2–3 servings/wk (1 point), and ≥ 4 servings/wk (2 points) for 16 healthy foods, and the scoring was reversed for 7 unhealthy foods. One point was given only for 2–3 servings/wk of red meat and whole milk. Points for each group were summed (0–44 points) and categorized into quintiles. Multivariate linear regression or generalized linear models were used to evaluate the association of GDQS with nutritional status: BMI (continuous), underweight (BMI < 18.5 kg/m2 vs. ≥18.5), overweight (BMI > 25.0 vs. ≤25.0), MUAC (continuous; MUAC <23 cm vs. ≥23.0 cm), hemoglobin concentration (continuous; anemia <11 g/dl), systolic and diastolic blood pressure (BP, mmHg), and hypertension (≥130 systolic BP or ≥ 85 diastolic BP). Models were adjusted for socioeconomic and demographic characteristics and health center location. ResultsIn the ENAT cohort, at enrollment (mean 16.6 weeks’ gestation) 17% of pregnant women were underweight, 4.6% were overweight, 28.7% had MUAC < 23.0 cm, 5.8% were anemic, and 2.2% had hypertension. The mean (SD) GDQS was 18.2 (2.5). GDQS was negatively associated with underweight (RR = 0.96 of BMI < 18.5 per 1 point GDQS increment; 95%CI: 0.93, 0.99). GDQS was positively associated with MUAC (continuous: β = 0.05, P = 0.046) and negatively associated with the odds of MUAC (<23 cm) (RR = 0.97 of MUAC < 23 per 1 point GDQS increment; 95%CI: 0.94, 0.99). GDQS or GDQS quintile were not associated with hemoglobin concentration, anemia, BP, and hypertension. ConclusionsGDQS was positively associated with maternal BMI and MUAC among pregnant women in rural Ethiopia, however, did not indicate any association with overweight or diet-related morbidity. Funding SourcesBill & Melinda Gates Foundation.

Association of Sugar-Sweetened, Artificially Sweetened, and Unsweetened Coffee Consumption With All-Cause and Cause-Specific Mortality : A Large Prospective Cohort Study.

Previous observational studies have suggested an association between coffee intake and reduced risk for death, but these studies did not distinguish between coffee consumed with sugar or artificial sweeteners and coffee consumed without. To evaluate the associations of consumption of sugar-sweetened, artificially sweetened, and unsweetened coffee with all-cause and cause-specific mortality. Prospective cohort study. Data were extracted from the UK Biobank. A total of 171616 participants (mean age, 55.6 years [SD, 7.9]) without cardiovascular disease (CVD) or cancer at baseline were eligible. Baseline demographic, lifestyle, and dietary data from the UK Biobank were used, with follow-up beginning in 2009 and ending in 2018. Dietary consumption of sugar-sweetened, artificially sweetened, and unsweetened coffee was self-reported. All-cause, cancer-related, and CVD-related mortality were estimated. During a median follow-up of 7.0 years, 3177 deaths were recorded (including 1725 cancer deaths and 628 CVD deaths). Cox models with penalized splines showed U-shaped associations of unsweetened coffee, sugar-sweetened coffee, and artificially sweetened coffee with mortality. Compared with nonconsumers, consumers of various amounts of unsweetened coffee (>0 to 1.5, >1.5 to 2.5, >2.5 to 3.5, >3.5 to 4.5, and >4.5 drinks/d) had lower risks for all-cause mortality after adjustment for lifestyle, sociodemographic, and clinical factors, with respective hazard ratios of 0.79 (95% CI, 0.70 to 0.90), 0.84 (CI, 0.74 to 0.95), 0.71 (CI, 0.62 to 0.82), 0.71 (CI, 0.60 to 0.84), and 0.77 (CI, 0.65 to 0.91); the respective estimates for consumption of sugar-sweetened coffee were 0.91 (CI, 0.78 to 1.07), 0.69 (CI, 0.57 to 0.84), 0.72 (CI, 0.57 to 0.91), 0.79 (CI, 0.60 to 1.06), and 1.05 (CI, 0.82 to 1.36). The association between artificially sweetened coffee and mortality was less consistent. The association of coffee drinking with mortality from cancer and CVD was largely consistent with that with all-cause mortality. U-shaped associations were also observed for instant, ground, and decaffeinated coffee. Exposure assessed at baseline might not capture changes in intake over time. Moderate consumption of unsweetened and sugar-sweetened coffee was associated with lower risk for death. National Natural Science Foundation of China, Young Elite Scientist Sponsorship Program by CAST, and Project Supported by Guangdong Basic and Applied Basic Research Foundation.

Fat Intake and High Triglyceride-Glucose Index in Individuals at Cardiometabolic Risk: An Isocaloric Substitution Analyses

Background and aims: Insulin resistance (IR) is an important risk factor for cardiovascular diseases, and the triglyceride-glucose index (TyG index) is a potential IR biomarker. Evidence also suggests that fat intake may modulate IR status, but this relationship remains unclear. Thus, the present study aimed to analyze the relationship between the TyG index and isocaloric replacement of macronutrients, including the profile of dietary fatty acids in individuals at cardiometabolic risk. Methods and results: This cross-sectional study enrolled 264 individuals at cardiometabolic risk (age 43.1 ± 16.3 years) who participated in a nutritional intervention study (ReBEC, id: RBR-5n4y2g). The baseline demographic, anthropometric, clinical, dietary, and lifestyle data were used. The TyG index was calculated using the formula ln [fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. Multivariate nutrient density models were used to analyze isocaloric replacement of fatty acids (as 5% of energy). The chance of having a high TyG index (TyG index >8.83, median value) was decreased by 60% after replacing 5% of the energy intake of polyunsaturated fatty acid (PUFA), saturated fatty acid (SFA), and trans fatty acid (TFA) with monounsaturated fatty acid (MUFA) or PUFA and SFA with protein. Conclusion: Isocaloric replacement of PUFA, SFA, and TFA with MUFA and protein was associated with lower chances of having a high TyG index. These results indicate the importance of macronutrient and dietary fat profiles in the dietary planning of individuals at cardiometabolic risk.

Do diets with higher carbon footprints increase the risk of mortality? A population-based simulation study using self-selected diets from the USA.

Are diets with a greater environmental impact less healthy? This is a key question for nutrition policy, but previous research does not provide a clear answer. To address this, our objective here was to test whether American diets with the highest carbon footprints predicted greater population-level mortality from diet-related chronic disease than those with the lowest. Baseline dietary recall data were combined with a database of greenhouse gases emitted in the production of foods to estimate a carbon footprint for each diet. Diets were ranked on their carbon footprints and those in the highest and lowest quintiles were studied here. Preventable Risk Integrated Model (PRIME), an epidemiological modelling software, was used to assess CVD and cancer mortality for a simulated dietary change from the highest to the lowest impact diets. The diet-mortality relationships used by PRIME came from published meta-analyses of randomised controlled trials and prospective cohort studies. USA. Baseline diets came from adults (n 12 865) in the nationally representative 2005-2010 National Health and Nutrition Examination Survey. A simulated change at the population level from the highest to the lowest carbon footprint diets resulted in 23 739 (95 % CI 20 349, 27 065) fewer annual deaths from CVD and cancer. This represents a 1·83 % (95 % CI 1·57 %, 2·08 %) decrease in total deaths. About 95 % of deaths averted were from CVD. Diets with the highest carbon footprints were associated with a greater risk of mortality than the lowest, suggesting that dietary guidance could incorporate sustainability information to reinforce health messaging.