Dietary Survey Research Articles

Secular trends in dietary energy, carbohydrate, protein, and fat intake among Korean children and adolescents.

We aimed to analyze the evolving trends in macronutrient intake and dietary composition among Korean children and adolescents over a 10-year period. We utilized cross-sectional data from the Korean National Health and Nutrition Examination Survey (KNHANES) spanning the years 2010-2020. Overall, the study included 11,861 participants aged 6-18 years who completed the 24-h dietary recall survey. Subsequently, we assessed trends in energy consumption and macronutrient intake across population subgroups, including age, sex, and obesity status. Survey-weighted linear regression was employed to determine the beta coefficient and p-value for trends in dietary nutrient consumption, treating the survey year as a continuous variable. KNHANES from 2010 to 2020. 11,861 children and adolescents aged 6-18 years. Total energy intake significantly decreased across the 10-year survey period, with a corresponding decline in the percentage of energy intake from carbohydrates. Conversely, the proportion of energy intake from fat increased during the same period. Subgroup analysis revealed changes in the composition of energy intake across age, sex, and obesity status, with a consistent increase in total fat intake observed across all subgroups. Upon analyzing data on dietary fibers, total sugars, and fat subtypes intake, we found insufficient dietary fiber intake and increased intake of all fat subtypes. This study underscores the gradually changing dietary intake patterns among Korean children and adolescents. Our findings revealed that these transitions in dietary nutrient consumption may pose potential risks of diet-related diseases in the future.

Validation of an App-based Food Frequency Questionnaire: Comparison With 24-hour Diet Recalls Among Women in two Rural Areas of Kenya

A new mobile application with a new semi-quantitative Food Frequency Questionnaire (FFQ) was developed as a quick dietary assessment tool. This study aimed to test the validation of food and nutrient intake measurements from an app-based FFQ, which included 49 dishes and food items, using non-consecutive two-day 24-hour diet recalls as the standard. A total of 179 women aged 19–70 years (mean (SD) = 33.7 (9.9)) from two rural areas of Kenya, Vihiga and Kitui counties, were included. Dietary assessment by the two dietary survey methods was conducted from November to December 2021. The intake of macro- and micronutrients, and food groups between the two methods were compared by Spearman's rank correlation coefficients, cross-classification agreement, and Bland-Altman plots for assessing the validation of the app-based FFQ. The median correlation coefficients between energy-adjusted intakes estimated by the app-based FFQ and the 24-h diet recall were 0.19 (0.10 (protein)–0.26 (fat)) for macronutrients, 0.24 (0.11 (sodium)–0.46 (vitamin B12)) for micronutrients, and 0.26 (0.07 (seasonings)–0.45 (pulses)) for 17-food groups. The median percentage of classification into the same quartiles between the two methods was 31% for macronutrient, 32% for micronutrient and 39% for food group. While 9% for macronutrient, 8% for micronutrient and 10% for the food group were misclassified into the opposite categories. Bland-Altman Plots showed acceptable agreement for macronutrients intake between the two methods. The app-based FFQ was shown to be able to rank or categorize individuals according to their intake of most of the nutrients and food groups we examined. This dietary assessment tool can be used for quantitative dietary data collection. Further research is needed to improve the validation of the app-based FFQ, as it has been shown that intakes of staple foods and sugar are underestimated and others are overestimated, and that estimating intakes of some specific nutrients, such as protein, is challenging. Key words: Diet assessment, food frequency questionnaire, 24-hour diet recall, validation, Kenya

Convergence of Alcohol Consumption and Dietary Quality in US Adults Who Currently Drink Alcohol: An Analysis of Two Core Risk Factors of Liver Disease.

Alcohol consumption and poor dietary habits are on the rise in the United States, posing significant challenges to public health due to their contribution to chronic diseases such as liver failure. While associations between alcohol consumption patterns and diet quality have been explored, the relationship between specific alcoholic beverage types and diet quality remains underexamined. This study aims to compare diet quality among consumers of different alcoholic beverage types. We conducted a cross-sectional analysis of 1917 current alcohol drinkers from the National Health and Nutrition Examination Survey (NHANES) who completed a 24 h dietary recall survey. Diet quality was assessed using the Healthy Eating Index (HEI), with higher scores indicating superior diet quality. Multivariable logistic regression models were employed to assess differences in HEI between consumers of various alcoholic beverage types, using wine-only drinkers as the reference group and controlling for demographic, socioeconomic, lifestyle, and metabolic syndrome variables. Beer-only drinkers were more likely to have lower income, higher rates of cigarette smoking, and insufficient physical activity compared to other alcohol consumers. In the fully adjusted multivariable model, beer-only drinkers had an HEI score that was 3.12 points lower than wine-only drinkers. In contrast, liquor/cocktail-only and multiple-type drinkers had similar HEI scores to wine-only drinkers. Beer-only consumption is associated with poorer diet quality among alcohol drinkers. Targeted patient education and public health campaigns may be effective in addressing the combined impact of alcohol consumption and poor diet quality on chronic disease risk.

Abstract 4130314: High sodium, low potassium diet is associated with incident cardiovascular disease among US Hispanic/Latino adults: results from the Hispanic Community Health Study/Study of Latinos.

Background: Diets high in sodium and low in potassium are associated with increased blood pressure level but associations with cardiovascular disease (CVD) remain controversial. Few studies have evaluated this relationship among Hispanic/Latino adults. Objective: To assess whether dietary sodium and potassium are associated with incident CVD among diverse US Hispanics/Latino adults. Methods: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) is a cohort of 16,415 self-identifying Hispanic/Latino adults aged 18-74 four US urban communities in 2008-2011 (visit 1; V1). V1 included a comprehensive examination with in-person measurement of health information and interviewer administered questionnaires. Dietary sodium (mg/day) and potassium (mg/day) intakes were assessed from the average of two 24-hour dietary recall surveys administered by bilingual registered dietitians. CVD events occurring from V1 through 2019 were adjudicated by an expert panel of clinicians. We used Poisson regression to determine the association (incidence rate ratio, IRR) between sodium, potassium, and the sodium-to-potassium ratio, with CVD, using time to CVD as an offset. Models accounted for HCHS/SOL complex survey design and were adjusted for demographic, including Hispanic/Latino background, socioeconomic, and behavioral factors along with energy consumption, body mass index, cholesterol, and family history of CVD. Results: Among 15,291 participants without self-reported CVD at V1, mean age was 40 years, with 53% female. Mean daily intakes of sodium and potassium were 3,040 mg/day and 2,422 mg/day, respectively. Molar ratio of sodium to potassium was 1.33. Over 9.7 years of follow-up, there were 311 CVD events (2.0 events per 1,000 person years, 95% CI: 1.6, 2.5). In adjusted models, nutrients were associated with increased risk of CVD: by 17% for each 1g/day increment of sodium (IRR: 1.17, 95% CI: 1.03, 1.33); by 29% for each 1g/day decrement of potassium (IRR: 1.29, 95% CI: 1.01, 1.64); and by 112% for each 0.5 molar increment of sodium to potassium ratio (IRR: 2.12, 95% CI: 1.13, 4.11). Conclusions: In a large diverse sample of Hispanic/Latino adults, high dietary sodium and low dietary potassium were independently associated with an increased risk of CVD. Results underscore the importance of intensifying public health interventions to improve nutrient quality, by reducing dietary sodium and increasing dietary potassium consumption as a means of preventing CVD.

Improving diets and multimorbidity prevention.

In 2023, the UK government announced a Major Conditions Strategy, publishing 'The case for change and our strategic framework', which set out the focus on cancers, diabetes, dementia, mental ill health, musculoskeletal disorders, CVD and chronic respiratory diseases. Together, these conditions account for 60% of total disability-adjusted life years lost to early death or ill health in England, and one in four adults has at least two (multimorbidity). This review considers some of the key dietary risks for these major conditions and population policies that may improve diets and reduce risks. UK Government dietary recommendations, based on independent risk assessment and advice from the Scientific Advisory Committee on Nutrition, are encapsulated in the national food model, the Eatwell Guide. Based on key sources of dietary data - chiefly consumption data from the National Diet and Nutrition Survey and consumer purchase data from Kantar - most people do not meet dietary recommendations. This review considers how science and evidence inform health improvement policy. This includes policies that encourage healthier food choices, such as labelling and public procurement standards to those that minimise the impact of the less healthy choice such as sugar and salt reduction and reformulation. The review also considers nutritional approaches to managing some non-communicable diseases. Given the role nutrition and excess weight play in the onset, prognosis and quality of life for those living with one or more of the major conditions, there are huge potential gains from even small dietary improvements across population groups.

Habitual Dietary Patterns of Maintenance Haemodialysis Patients and the Relationship Between Malnutrition Risk-A Multicentre Cross-Sectional Diet Survey.

To identify habitual dietary patterns in maintenance haemodialysis patients and analyse their association with malnutrition. A multicentre cross-sectional dietary survey was conducted among 232 maintenance haemodialysis patients from three centres. A 3-day 24-h diet recall and demographic, clinical and therapeutic information were collected. Factor analysis was used to identify the major dietary patterns among haemodialysis patients. Logistic regression analysis was used to assess the relationship between dietary patterns and malnutrition risk. Three dietary patterns were identified in this study and differed in age, gender and diabetes. An 'animal foods and refined grains' dietary pattern meets guideline requirements. A 'fresh fruits and nuts' dietary pattern had insufficient daily energy and protein intake with the lowest carbohydrates, lipids and minerals intake among haemodialysis patients. A 'dairy products' dietary pattern characterised by low calorie and moderate protein was found to be associated with malnutrition. Habitual dietary patterns of maintenance haemodialysis patients were associated with personal characteristics, specifically age, gender and diabetes. Patients with habitual 'dairy products' dietary patterns may have poor nutritional status. Educating haemodialysis patients about their daily diet pattern, rather than focusing on nutrients, is crucial and will help them to understand it better. Clinical staff can recognise patients at risk of malnutrition by a dietary pattern of lower intake of certain foods. They can recommend a balanced nutritional pattern that increases calories in the total diet and meets protein requirements.

School food policy in secondary schools in England and its impact on adolescents' diets and dental health: the FUEL multiple-methods study.

School food standards are a legal requirement for state-funded schools in England and are designed to promote healthy eating in pupils. However, state-funded academies/free schools established between 2010 and 2014 are exempt from this legislation. To complement the school food standards, the government launched the School Food Plan in 2013, which outlines voluntary actions that schools can take to support healthy eating and increase school meal uptake. There has been little evaluation of the school food standards and School Food Plan in secondary schools. To compare implementation and costs of the school food standards and School Food Plan, and pupil dietary and dental outcomes in two groups of secondary schools: those mandated and those not mandated to comply with the school food standards legislation. An observational, multiple-methods study. We sampled state-funded secondary school academies/free schools, pupils aged 11-15 years, and school staff/governors with a role in food provision/education from the Midlands. We collected qualitative data in four schools. The primary outcome was pupil free sugar intake at lunch; across the school day; and during 24-hours. Secondary outcomes were additional nutritional outcomes and dental caries measures. We assessed school food standards/School Food Plan implementation and costs using researcher observation, document analysis, and surveys with staff/governors, schools and pupils. Dietary intake and dental outcomes were measured online using 24-hour dietary recall and surveys, respectively. In the qualitative study we conducted staff/governor interviews and pupil focus groups in a subsample of schools. We used multilevel analyses to explore variation in pupil outcomes across the school food standards-mandated and school food standards-non-mandated school groups. Data were analysed using the Framework approach. Thirty-six schools (13 school food standards-mandated, 23 school food standards-non-mandated), 2453 pupils and 151 staff/governors participated. On average, schools were compliant with 64% of school food standards and implemented 41% of School Food Plan actions, with no differences across school food standards-mandated/non-mandated schools. There was a wide variation in annual costs of the school food standards and School Food Plan reported by schools (mean of £195 per pupil). Pupils in school food standards-mandated schools had lower lunch intakes of free sugar than those in school food standards-non-mandated schools (adjusted mean difference = -2.78 g, 95% confidence interval -4.66 to -0.90 g). After further adjustment for total energy intake, there was no significant difference in free sugar intake, but the school food standards-mandated group had lower fruit and vegetable intake at all time points, and higher consumption of confectionery during the school day and sugar-sweetened beverages over 24 hours. There were no differences in dental outcomes between the two groups. Twenty-one staff/governors and 137 pupils participated in the qualitative study. Staff described balancing school food standards compliance with conflicting priorities related to financial viability. Some pupils felt that school food did not meet their needs for convenience, speed, value for money and taste, and disliked the lunchtime experience. Little time was afforded to healthy-eating education within the curriculum. There were large numbers of missing data for some study elements, including assessment of some School Food Plan actions and cost data. In the secondary school context, the current school food standards are difficult to comply with and the School Food Plan has not achieved the desired outcomes. We found no evidence to show that school food standards legislation has positively influenced nutritional intake. We need to develop healthy secondary-school food provision models that meet pupils' preferences, and better understand how to situate the food and healthy-eating agenda in secondary schools. This trial is registered as ISRCTN68757496. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/92/39) and is published in full in Public Health Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

Evaluating the impact of the universal infant free school meal policy on the ultra-processed food content of children’s lunches in England and Scotland: a natural experiment

BackgroundThe Universal Infant Free School Meal (UIFSM) policy was introduced in 2014/15 in England and Scotland for schoolchildren aged 4–7 years, leading to an increase in school meal uptake. UK school meals are known to be healthier and less industrially processed than food brought from home (packed lunches). However, the impact of the UIFSM policy on the quantity of ultra-processed food (UPF) consumed at school during lunchtime is unknown. This study aimed to evaluate the impact of the UIFSM policy on lunchtime intakes of UPF in English and Scottish schoolchildren.MethodsData from the UK National Diet and Nutrition Survey (2008–2019) were used to conduct a difference-in-difference (DID) natural experiment. Outcomes included school meal uptake and the average intake of UPF (% of total lunch in grams (%g) and % total lunch in Kcal (%Kcal)) during school lunchtime. The change in the outcomes before and after the introduction of UIFSM (September 2014 in England, January 2015 in Scotland) in the intervention group (4–7 years, n = 835) was compared to the change in an unexposed control group (8–11 years, n = 783), using linear regression. Inverse probability weights were used to balance characteristics between intervention and control groups.ResultsBefore UIFSM, school meal uptake and consumption of UPFs were similar in the intervention and control groups. The DID model showed that after UIFSM, school meal uptake rose by 25%-points (pp) (95% CI 14.2, 35.9) and consumption of UPFs (%g) decreased by 6.8pp (95% CI -12.5,-1.0). Analyses indicated this was driven by increases in minimally processed dairy and eggs, and starchy foods, and decreases in ultra-processed salty snacks, bread and drinks. The differences were larger in the lowest-income children (-19.3 UPF(%g); 95% CI -30.4,-8.2) compared to middle- and high-income children. Analyses using UPF %Kcal had similar conclusions.ConclusionsThis study builds on previous evidence suggesting that UIFSM had a positive impact on dietary patterns, showing that it reduced consumption of UPFs at school lunchtime, with the greatest impact for children from the lowest-income households. Universal free school meals could be an important policy for long term equitable improvements in children’s diet.

Smaller meat portions contribute the most to reducing meat consumption in the United Kingdom.

Reducing meat consumption can help improve environmental and health outcomes, yet the effect of specific meat-reducing strategies is context dependent. Here, using decomposition analysis of National Diet and Nutrition Survey data (2008-2009 to 2018-2019), we found that in the United Kingdom, reduced meat portions had the largest impact on total meat consumption decline (52%), followed by fewer meat-eating days (24%), fewer meat consumers (17%) and fewer meat-eating meal occasions (7%). Understanding meat consumption behaviour patterns is key for more effective policies.

Estimated health benefits, costs, and cost-effectiveness of implementing WHO's sodium benchmarks for packaged foods in India: a modelling study.

Excess dietary sodium intake has been associated with death and disability. WHO has released global sodium benchmarks for packaged foods to support countries to reduce population sodium intake. This study aimed to assess the potential health effect, costs, and cost effectiveness of implementing these WHO sodium benchmarks in India. We used a multiple cohort, proportional multistate, life table (Markov) model to estimate the health gains and cost effectiveness for adults if sodium content in packaged foods complied with the WHO benchmarks compared to the status quo. We used India-specific dietary surveys, food composition tables, foods sales data, and sodium content data from packaged food labels to estimate sodium intake before and after the intervention. Data on blood pressure, cardiovascular disease, and chronic kidney disease burden were obtained from the Global Burden of Diseases, Injuries, and Risk Factors study, and the effect of sodium reduction on blood pressure and disease risk was modelled on the basis of meta-analyses of randomised trials and cohort studies. Intervention and health-care costs were used to estimate net costs, and calculate the incremental cost per health-adjusted life-year (HALY) gained. Costs and HALYs were discounted at 3%. In the first 10 years, compliance with the WHO sodium benchmarks was estimated to avert a mean of 0·3 (95% uncertainty interval [UI] 0·2-0·5) million deaths from cardiovascular diseases and chronic kidney disease, a mean of 1·7 (95% UI 1·0-2·4) million incident cardiovascular disease events, and 0·7 (0·4-1·0) million new chronic kidney disease cases, compared with current practice. Over 10 years, the intervention was projected to be cost saving (100·0% probability), generating 1·0 (0·6 to 1·4) billion HALYs and US$0·8 (95% UI 0·3 to 1·4) million in cost savings. Over the population lifetime, the intervention could prevent 4·2 (2·4-6·0) million deaths from cardiovascular diseases and chronic kidney disease, 14·0 (8·2-20·1) million incident cardiovascular disease events, and 4·8 (2·8-6·8) new chronic kidney disease cases, with an 84·2% probability of being cost-saving and 100·0% probability of being cost-effective. Our modelling data suggest a high potential for compliance with WHO sodium benchmarks for packaged food being associated with substantial health gains and cost savings, making a strong case for India to mandate the implementation of the WHO sodium benchmarks, particularly as packaged food consumption continues to rise. WHO Country Office India.

Factors associated with the consumption of ultra-processed among Brazilian and Portuguese pregnant

Abstract Considering the recent evidence about the negative effect of the consumption of ultra-processed foods (UPF) on current and future generations, and pointing to the development of public food policies adapted to the needs of pregnant women, it is important to identify the factors associated with high consumption of UPF. Cross-sectional comparative study that used data from: 1) a randomized controlled clinical trial conducted with pregnant women treated at Health Units in a city in São Paulo (n = 350), Brazil; and 2) the National Dietary and Physical Activity Survey 2015-2016, Portuguese pregnant women (n = 226). Two 24-hour recall surveys were collected. The UPF were classified according to the Nova. Usual consumption was estimated using the Multiple Source Method software. The percentage of energy coming from UPF was calculated using the mean (±SD) and 95%CI. Adjusted and crude linear regression models were used. The analysis were conducted in SPSS (version 21), considering p < 0.05 as significant. The average age of the total sample was 29.4(±6.3) years and the BMI corresponded to 27.8(±3.4)kg/m². The average daily energy consumption from UPF among Brazilian pregnant women was 449.6(±207.6) kcal, representing 24.2(±8.8)% of the total energy consumed on a usual day; among Portuguese women the average corresponded to 484.2(±242.4)kcal and 22.3(9.3)%, respectively. In crude and adjusted linear regression models, the participation of UPF in total energy was higher among single Brazilian pregnant women compared to married women (3.2[0.8-5.5]p=0.009); Among Portuguese women, an inverse relationship was observed between weekly physical activity (PA) ≥150 minutes and UPF energy consumption (-3.2[-6.0 - -0.3]p= 0, 03). In the studied pregnant women, results showed that being single and practicing less than 150 minutes of PA weekly were factors associated with greater consumption of UPF, characterizing a priority group to receive nutritional interventions during prenatal care. Key messages • Public policies and strategies to reduce the consumption of ultra-processed foods during pregnancy. • Promotion of healthy lifestyle habits and impact on current and future health.

Consumption of low-calorie sweetened products and intakes of free sugar and energy among UK adults

Abstract Background Policies to reduce free sugar intake in the population often suggest alternative low or no sugar products that may contain low-calorie sweeteners (LCS). However, the health effects of LCS are controversial and little is known about whether free sugar and energy intake differ between people with varying levels of LCS product consumption. This study examines the associations between LCS product consumption and free sugar and energy intake in UK adults from 2008 to 2019. Methods Repeat cross-sectional data from the UK’s National Diet and Nutrition Survey (2008/09 to 2018/19) involve 8304 adults aged ≥18 years (mean 48.7, SD 18.3) with 58.4% being women. Consumption of LCS products (grams/day) were obtained from 4-day diet diaries and participants were categorized into four groups (No-LCS, Low-LCS, Mid-LCS, High-LCS) based on LCS consumption tertiles in 2008/09. Linear regression analysed associations with LCS group, year, their interaction, and adjusted for sociodemographic factors. Results All four groups consumed free sugar (relative to total energy intake) above recommended levels (5% kcal/day) throughout the study period. In 2008/09, the mean free sugar intake for the No-LCS group was 58.1 grams/day, and the mean total energy intake was 1855.7 kcal/day, which were not significantly different from the High-LCS group. Over time, free sugar intake declined by -1.0 g/year (95%CI: -1.4, -0.6) whereas total energy intake declined by -6.0 kcal/year (95%CI: -11.4, -2.1) in the No-LCS group. The High-LCS group showed similar declines leading to no significant difference in mean free sugar and total energy intake between the No-LCS and High-LCS groups in 2018/19. Conclusions In this representative study of UK adults, similar levels of free sugars and total energy intake were observed among those with no LCS and those with the highest LCS product consumption from 2008 to 2019. Absence of LCS product consumption in diets were not associated with higher free sugar intake. Key messages • The high level of LCS product consumption was not associated with lower free sugar intake among UK adults. These finding challenges policies promoting LCS to reduce UK adults’ free sugar intake. • The finding that UK adults consistently consumed free sugar above recommended levels highlights the ongoing need for policy interventions.

DII modulates the relationship between SVD3 and NAFLD prevalence, rather than liver fibrosis severity, in hospitalized T2DM population

Type 2 diabetes (T2DM) patients are at high risk for non-alcoholic fatty liver disease (NAFLD). Studies show SVD3 and dietary inflammatory index (DII) are associated with NAFLD. It’s unknown if they interact in T2DM patients with NAFLD. We collected data from 110 hospitalized T2DM patients, measured physiological and biochemical indicators, conducted dietary surveys, and converted data into DII and NFS, FIB-4, and BARD indices. We used logistic regression, mediation effect analysis, and moderation effect analysis to explore the relationship between DII and SVD3 with NAFLD and liver fibrosis in T2DM patients. DII was not significant in either NAFLD incidence in T2DM patients or liver fibrosis in NAFLD patients. SVD3 was positively correlated with NAFLD incidence in T2DM patients, but this correlation became insignificant as DII increased towards pro-inflammation. SVD3 is positively correlated with NAFLD incidence in T2DM patients, but this correlation becomes less significant as DII increases towards pro-inflammation.

A vision-based dietary survey and assessment system for college students in China

Understanding the current dietary habits of college students is essential due to the pressing issues of unbalanced diets and insufficient nutrition. However, traditional approaches frequently depend on recollection, which can introduce unconscious bias and make them difficult to implement. Herein, we introduce a new computer vision system to evaluate the dietary habits of college students in China. A specialized food dataset comprising RGB-D images, recipes with ingredient masses, and nutrient composition was created using data collected from college canteens. First, object detection models were utilized to identify food categories and locations. Subsequently, we introduced a method for automatically estimating the food volume of nonstandard portions using position and depth information. The final nutrients were derived directly or indirectly through the database. Experimental results demonstrate the applicability of the YOLOv8 object detection model and volume estimation method to our tasks. To support the development of devices for detecting food intake and diet management, we have made our dataset publicly available. The College Canteen Food-100 dataset is publicly available at https://github.com/zichengzichengzi/CC-FOOD-100.

Gut Microbiota and Metabolic Alterations Associated with Heart Failure and Coronary Artery Disease.

This study investigates the role of gut microbiota in cardiovascular diseases, with an additional focus on pro-atherogenic metabolites. We use advanced network analysis and machine learning techniques to identify key microbial features linked to coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF). This cross-sectional study included 189 participants divided into three groups: coronary artery disease (n = 93), heart failure with reduced ejection fraction (n = 43), and controls (n = 53). Assessments included physical exams, echocardiography, dietary surveys, blood analysis, and fecal analysis. Gut microbiota composition was analyzed using next-generation sequencing (NGS) and quantitative polymerase chain reaction (qPCR). Statistical analysis methods for testing hypotheses and correlations, alpha and beta-diversity analyses, co-occurrence networks, and machine learning were conducted using Python libraries or R packages with multiple comparisons corrected using the Benjamini-Hochberg procedure. Significant gut microbiota alterations were observed, with higher Bacillota/Bacteroidota ratios in CAD and HFrEF groups compared to controls (p < 0.001). Significant differences were observed in α-diversity indices (Pielou, Chao1, Faith) between disease groups and controls (p < 0.001). β-diversity analyses also revealed distinct microbial profiles (p = 0.0015). Interestingly, trimethylamine N-oxide (TMAO) levels were lower in CAD and HFrEF groups compared to controls (p < 0.05), while indoxyl sulfate (IS) levels were comparable between the study groups. Co-occurrence network analysis and machine learning identified key microbial features linked to these conditions, highlighting complex interactions within the gut microbiota associated with cardiovascular disease.

Plasma levels of polyunsaturated fatty acids and multiple sclerosis susceptibility in a US case-control study

BackgroundThere are plausible mechanisms, yet mixed evidence, that higher polyunsaturated fatty acids (PUFAs) levels reduces the risk of multiple sclerosis (MS). Prior studies relied on dietary surveys to estimate levels. ObjectiveWe tested associations between plasma levels of n-3 and n-6 PUFAs and likelihood of MS onset or clinically isolated syndrome (CIS) using data from the MS Sunshine Study, a case-control study conducted in the United States. MethodsCase participants (n = 589) aged ≥ 18 years and matched control participants (n = 630) were recruited between 2011 and 2015. Plasma phospholipid fatty acid profiling was conducted by gas-liquid chromatography. We used logistic regression to report odds ratios, testing for interactions, adjusting for covariates and correcting for multiple comparisons. ResultsThere was a 6 % lower probability of MS/CIS per unit increase in total n-6 PUFA level, expressed as a percentage of total plasma phospholipid fatty acids (odds ratio = 0.94; 95 % confidence interval = 0.90,0.98; p = 0.012). We found no statistically significant association between individual or total plasma levels of n-3 PUFAs and probability of MS/CIS; however, plasma levels of n-3 PUFAs were low across the cohort. No other individual or aggregate PUFA levels were significantly associated with MS/CIS. ConclusionA higher total n-6 PUFA level may be beneficial in terms of MS susceptibility.Further research is needed to determine whether n-3 PUFAs may be beneficial only above a threshold that is achievable by supplementation.

Adherence to the EAT-Lancet sustainable diet and ultra-processed food consumption: findings from a nationwide population-based study in Brazil.

To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population. The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively. Nationally representative sample of the Brazilian population. The study included 46 164 Brazilians ≥ 10 years old. The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods. Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

Associations of dietary total, heme, non-heme iron intake with diabetes, CVD, and all-cause mortality in men and women with diabetes

BackgroundIron metabolism disorders significantly increase the risk of diabetes and its related complications by inducing oxidative stress, inflammation, insulin resistance, and disturbances in glucose and lipid metabolism. However, whether dietary iron intake can influence progression of diabetes remains unclear. The present study aims to investigate the relationship between total iron, heme iron, and non-heme iron intake and diabetes, CVD, and all-cause mortality among men and women with diabetes in the U.S. population. MethodsA total of 4416 adults with diabetes(2415 men and 2001 women) from the NHANES 2003–2014 were enrolled. Dietary information was collected by 24-h dietary recall during two nonconsecutive days. Dietary total iron intake was measured based on the dietary survey. Dietary heme iron intake was calculated based on its proportion in dietary total iron intake from each food. non-heme iron is the difference between total iron and heme iron. Diabetes, CVD, and all-cause mortality status were identified as main outcomes. Cox models and RCS analysis were performed to estimate the hazard ratios and 95%CIs. ResultsFor men, the participants with a higher dietary heme iron intake were associated with higher risks of CVD (HRheme iron = 1.61,95%CI:1.03–2.51) and all-cause mortality (HRheme iron = 1.42,95%CI:1.10–1.83). For women, participants in the highest quartile of dietary total/heme/non-heme iron intake had a higher diabetes mortality risk ((HRtotal iron = 2.33,95%CI:1.24–4.38; HRheme iron = 1.87,95%CI:1.00–3.49; HRnon-heme iron = 2.28,95%CI:1.19–4.39), compared to those in the lowest quartile. Additionally, the dose–response curve for the relationship between dietary non-heme iron intake and CVD mortality followed a reverse J-shape in women with diabetes. ConclusionsHigher dietary heme iron intake was associated with an increased CVD mortality risk in both men and women with diabetes. Additionally, higher dietary total, heme, and non-heme iron intake was linked to an increased risk of diabetes mortality among women with diabetes. Therefore, women with diabetes should pay more attention on the overconsumption of any type of dietary iron.

The burden of cancer attributable to dietary dioxins and dioxin-like compounds exposure in China, 2000–2020

Dioxin is a typical class of persistent organic pollutants (POPs) that could cause cancer. In China, the contribution of dietary dioxins to the cancer burden remains underexplored. This study evaluates the cancer risk and burden due to dietary dioxins and dioxin-like compounds among Chinese residents from 2000 to 2020. Based on adjustments in China’s dioxin policies, the study period was divided into three stages with split years of 2007 and 2014 to estimate the toxic equivalent (TEQ) of dioxins. Participants in dietary surveys conducted in 31 provinces were included. Dietary exposure to dioxins was estimated in a probability model and compared with the provisional tolerable monthly intake (PTMI). The risk was assessed using carcinogenic slope factors and expressed as the incremental lifetime cancer risk (ILCR). A two-stage model evaluated the burden of cancer attributable to dietary dioxins and dioxin-like compounds. Among all food categories, the highest concentration of dioxins and dioxin-like compounds was observed in aquatic foods at 0.15 pg TEQ/kg. Median dietary exposure to dioxins among Chinese residents decreased from 12.39 pg TEQ/kg/month to 8.72 pg TEQ/kg/month between 2000 and 2020. Consequently, the ILCR due to dietary dioxins declined from 6.44 × 10-5 to 4.53 × 10-5. The health risks were higher in younger groups and among residents of coastal areas (P < 0.001). The burden of cancer attributable to dietary intake of dioxins and dioxin-like compounds in the Chinese population in 2000–2007, 2008–2014, and 2015–2020 was 2.25 (2.09–2.42) per 100,000, 2.20 (2.06–2.35) per 100,000, and 1.68 (1.60–1.77) per 100,000, respectively. Furthermore, the disease burden was highest for prostate cancer in men and for breast cancer in women. The dioxin management policies has reduced the burden of cancer attributable to dietary exposure to dioxins and dioxin-like compounds in China. However, excess exposure in coastal areas and children remains a priority for attention.

The Potential for Bouillon Fortification to Reduce Dietary Micronutrient Inadequacy: Modeling Analyses Using National Survey Data from Cameroon, Ghana, and Haiti

BackgroundBouillon is commonly consumed in some countries where micronutrient deficiencies are prevalent, but it has not been widely adopted as a micronutrient fortification vehicle. ObjectivesWe modeled the potential impacts of bouillon fortification on dietary micronutrient adequacy to inform future discussions around bouillon fortification programs. MethodsWe analyzed the dietary intake of women of reproductive age (WRA) and 1- to 5-y-old children from a national dietary survey in Cameroon, and “apparent intake” (using the nutrient density approach) of WRA, children, and men from 3 household surveys in Cameroon, Ghana, and Haiti. We examined (apparent) intake of bouillon and simulated the impacts of bouillon fortification with varying levels of vitamin A, folic acid, vitamin B12, iron, and zinc on inadequate intake (below the estimated average requirement) and intake above the tolerable upper intake level (UL). Scenarios accounted for current mandatory fortification programs and different assumptions about iron absorption from bouillon. ResultsBouillon was consumed by >67% of households in Ghana and >90% in Haiti and Cameroon. Median (apparent) consumption ranged from 1.6 to 2.1 g/d for WRA, 0.7 to 1.0 g/d for children, and 1.8 to 2.2 g/d for men. Bouillon fortification at the highest micronutrient concentration modeled was predicted to reduce dietary inadequacy by 21–52 percentage points (pp) for vitamin A; 3–47pp for folic acid, and 4–90pp for vitamin B12, depending on the country and population group. In contrast, predicted impacts for iron were modest (2–17pp reduction) but would increase if absorption of iron from bouillon were enhanced. Simulated zinc fortification reduced inadequacy by 12–50pp, but zinc intake above the UL exceeded 10% among children in almost all scenarios. ConclusionsModeling indicates that bouillon fortification could improve dietary micronutrient adequacy beyond existing fortification programs. Further work is needed to identify fortification levels that meet criteria for nutritional benefit, technical and commercial feasibility, affordability, and cost-effectiveness.