Dietary Guidelines Research Articles

Slovenia’s Food-Based Dietary Guidelines 2024: Eating for Health and the Planet

The dietary guidelines of Slovenia, ‘12 Steps to Healthy Eating’, were first published in 2000 and revised in 2011. The ‘Food Guide Pyramid’ was initially published in 2000 and subsequently revised in 2015. ‘The Healthy Plate’ was first introduced in 2007. In February 2023, the Slovenian Strategic Council for Nutrition proposed new Food-Based Dietary Guidelines (FBDGs) that integrate both health and environmental considerations. In September 2023, the creation of new FBDGs was included in the Action Plan for implementing the Resolution on the National Program on Nutrition and Physical Activity for Health 2015–2025. In October 2023, the Ministry of Health of Slovenia appointed the core working group of 10 multidisciplinary experts from fields such as nutrition, food science medicine, public health, environment, pharmacy, and agriculture led by Prof. Dr. Nataša Fidler Mis, who drafted the guidelines. In February 2024, the World Health Organization Regional Office for Europe organized a virtual international workshop to assist Slovenia in developing food-based dietary guidelines. In May 2024, an international expert meeting was organized by the Ministry of Health of Slovenia, the Ministry of the Environment, Climate, and Energy, and the National Institute of Public Health of Slovenia to present the first scientific draft of the SLO FBDG for external international peer review. The meeting included lectures from world-leading experts to present healthy diets from sustainable food systems, integrate climate and sustainability aspects into the new SLO FBDG, discuss the findings with the Slovenian core working group, extended working group of the SLO FBDG, and invited experts. The final version of SLO FBDG is expected to be released by the end of 2024.

What is a sustainable diet in the Norwegian context?

Introduction: Sustainable diets promote health and wellbeing and have low environmental impact. They should be accessible, affordable, safe, equitable and culturally acceptable. Translating these general principles into Norwegian-specific dietary recommendations is essential, as foods beneficial for health tend to also be environmentally sustainable. Following the dietary recommendations is an important step towards sustainability. Aim: To identify challenges and potential solutions for transitioning towards more sustainable diets in Norway. Methods: We used scientific articles, reports, policy documents, and statistics on Norwegian food production and consumption to discuss a sustainable diet in a Norwegian context. Results and discussion: There is a large gap between dietary guidelines and actual consumption. More than 60% of the calories in the Norwegian diet are based on imported foods and feed. Changing people’s diet is identified as central in transforming the food system to become more sustainable, as is prioritizing the use of local resources. Good animal health and welfare are also fundamental premises for a sustainable food system. Conclusions: Transitioning to a more sustainable diet requires comprehensive efforts at multiple levels. There is considerable room for action to increase the use of Norwegian resources in a sustainable and responsible way. Potential strategies include reducing meat intake in favour of plant-based foods and fish, consuming more local products, decreasing food waste and supporting agricultural practices that promote environmental and social sustainability. A more sustainable diet may also lead to significantly increased self-sufficiency and food security in Norway.

The Price of Foods, Beverages, and Diets in Australia: An Updated Systematic Review

Abstract Context The price and affordability of food are priorities for public health and health equity; however, Australia lacks a consistent method to evaluate healthy versus unhealthy diets, creating a gap in routine food price reporting. Objective This review aimed to identify and summarize recent methods used to assess and monitor the price and/or affordability of food and beverages in Australia using a health lens. Data Sources Four academic databases (MEDLINE Complete, Global Health, CINAHL Complete, and Business Source Complete) were searched in English from 2016 to 2022. Relevant gray literature was searched through Google Scholar and government websites. Data Extraction Five reviewers screened titles and abstracts, and full-text screening was conducted by 1 reviewer, with eligibility confirmed by a second reviewer. The quality of studies was assessed using the Joanna Briggs Institute “Checklist for Analytical Cross-Sectional Studies.” Data Analysis Twenty-five eligible studies were identified. Eleven studies used a version of the Healthy Diets Australian Standardized Affordability and Pricing protocol to collect prices for a “healthy” diet modelled on dietary guidelines and an “unhealthy” diet based on a habitual Australian diet. These studies consistently found unhealthy diets to be more expensive than healthy diets. Other identified methods included assessing the price of household diets across healthy baskets (n = 6), store types (n = 5), a planetary health diet (n = 1), packaged foods according to their Health Star Rating (n = 1), a fruit and vegetable basket (n = 1), school canteen foods against a traffic light system (n = 1), and weekly healthy meal plans (n = 1). Healthy diets tended to be less costly than less healthy diets, but both diets were often unaffordable in regional areas, for people on low incomes, and for First Nations peoples. Conclusion Consistent country-wide application of methods for monitoring the price and affordability of foods and diets in Australia is needed—including tailored approaches for priority groups. Systematic Review Registration PROSPERO registration no. CRD42022333531.

Diet quality from early pregnancy through 1-y postpartum: a prospective cohort study

BackgroundAlthough diet quality during pregnancy and postpartum is important for multiple parent and child outcomes, within-person changes in diet quality throughout these periods have not been extensively examined. ObjectivesThis study investigated diet quality from early pregnancy through 1 y postpartum and examined differences by sociodemographic characteristics in participants receiving obstetric care in Chapel Hill, North Carolina, United States. MethodsParticipants completed 24-h dietary recalls at 6 study visits (each pregnancy trimester and 6 wk, 6 mo, and 1 y postpartum) (n = 383). Between-visit mean Healthy Eating Index-2015 (HEI) scores (min = 0, max = 100) were compared using the population ratio (PR) method. The NCI usual intakes method estimated the distribution of HEI scores in pregnancy and postpartum; unpaired t-tests compared usual mean HEI scores by covariates; paired t-tests compared differences between mean pregnancy and postpartum. ResultsThe total HEI mean ± standard error scores (NCI method) were 61.4 ± 0.8 in pregnancy and 61.7 ± 0.9 in postpartum. Mean HEI scores differed by sociodemographic characteristics, particularly education, marital status, and federal assistance participation. The highest scores were observed in participants with at least a bachelor’s degree (64.1 ± 0.9 in pregnancy, 64.5 ± 1.0 in postpartum, n = 257) and those with other non-Hispanic White race/ethnicity (64.7 ± 1.8 in pregnancy, 66.4 ± 2.2 in postpartum). There were no between-visit differences in mean total HEI scores (PR). Although differences were observed in some mean HEI component scores between pregnancy and postpartum visits, they were small (mostly <1 point) in magnitude and in inconsistent directions. ConclusionsStable total HEI mean scores suggest that adherence to dietary guidelines was consistent throughout pregnancy and postpartum in this sample. Although some sociodemographic characteristics may identify individuals at greater risk of diet-related pregnancy complications, low diet quality was pervasive throughout all subgroups and reflects an urgent need for widespread improvement.

Development of the ‘Healthy Eating Index for Older People’ to Measure Adherence to Dietary Guidelines in Healthy Older New Zealand Adults

Development of the ‘Healthy Eating Index for Older People’ to Measure Adherence to Dietary Guidelines in Healthy Older New Zealand Adults

Higher sweet beverage consumption was associated with increased gestational weight gain and birth weight: A Chinese cohort study

Diet during pregnancy is crucial to maternal metabolism and fetal development, so exploring the most potent food risk factor could improve maternal and child health. In this study, we investigated the diet and lifestyle of 833 healthy pregnant women in the second trimester from November 2020 to August 2021. Based on the Tianjin Antenatal Care System in China, we followed up with these women and recorded their gestational weight gain (GWG) and newborn birth weight. We conducted a dietary survey through FFQ based on the food groups recommended by the Chinese Dietary Guidelines and included common ultra-processed foods. We collected 219 semi-quantitative FFQs and 614 self-reported FFQs for analysis. According to the consumption frequency of 12 food groups, 4 dietary patterns were extracted by principal component analysis. We analyzed the associations of food energy, consumption frequency, and dietary patterns with GWG and birth weight, especially GWG in the first and second trimesters (f-GWG). The results showed that f-GWG was positively correlated with food energy. Beverage consumption was associated with f-GWG (r = 0.288, P = .026) in obese pregnant women. A dietary pattern that favors high consumption of ultra-processed foods (fried foods, baked desserts, and sweet beverages) was associated with increased GWGs. Non-obesity women with high consumption of baked desserts and sweet beverages had higher GWGs (P < .05). After adjusting for confounding factors (including total energy, physical activity, and sleep quality), only sweet beverage consumption was associated with f-GWG (β 0.498, 95%CI 0.153-0.843) and birth weight (β 0.124, 95%CI 0.009-0.240). Sweet beverage consumption is a key adjustable risk factor for prenatal care.

A review of policy levers to reduce meat production and consumption

It is increasingly apparent that we require a substantial reduction in animal production and consumption for the sake of the environment and public health. In this paper, we conducted a systematic review to explore the policy levers available for governments to reduce animal farming and the consumption of meat. The policy levers generated by the review are categorised by four main types of interventions: Financial measures, Command- and-control, Informational, and Behavioural. First, we explore four financial measures: taxes on meat is the most-studied intervention, and the least publicly accepted in polling, sometimes being implemented indirectly via measures such as carbon taxes or rescinding VAT exemptions; subsidies for animal product alternatives are considered as a more publicly acceptable alternative approach, and would reduce long-term demand for meat by making alternatives more competitive; agricultural carbon trading schemes are discussed, and may represent a politically feasible way to hold livestock producers accountable for negative externalities; and buyouts of animal farms can be an impactful way to compensate producers to leave the industry, but must be done with care to avoid unintended social and market consequences. Second, we explore two command-and-control measures: regulating animal production with standards such as animal welfare requirements and health and safety rights for agricultural workers is amongst the most well-supported policies, and is an impactful way to ensure minimum standards of production are met; however, restrictions on animal consumption, such as meat–free days in public catering, are less publicly accepted. Third, we discuss three informational measures: food product labels, such as animal welfare or environmental impact labels, fulfil consumers’ expectations to have this information, and although there is limited evidence that they impact consumer behaviour directly, such labels may nonetheless incentivise producers to competitively improve; likewise, national dietary guidelines appear to have little direct impact on food choices, but can impact other institutions such as schools and medical institutions; policies on information campaigns can help or hurt meat reduction efforts, with some jurisdictions prohibiting meat advertisements, while others spend millions on campaigns to promote meat consumption. Fourth, we explore a range of behavioural measures which could be implemented in public catering settings and/or incentivised in food service, including presentation and positioning of meat- and plant-based dishes, and altering the food options on offer – we find that adding more high-quality plant-based options to menus and presenting these options as the default wherever the format allows are highly impactful and tractable behavioural policies that could reduce meat consumption. Informational and behavioural measures can complement traditional fiscal and command-and-control measures to reduce animal production and consumption. We discuss the implications for researchers and policymakers.

Plant-based diets-impacts of consumption of little or no animal-source foods on human health.

The world, in 2024, faces both climate and biodiversity crises, and the food system does contribute significantly to these crises. For some, the solution is simple - intakes of animal source foods (ASFs) should be considerably reduced, and consumption of plant-source foods (PSFs) should be greatly increased. Advocates for such a dietary transformation express confidence that plant-based diets will not only benefit planetary health, but will provide nutrient adequacy for all, and will also result in considerable protection from chronic non-communicable diseases (NCDs). However, as described in this perspective, the dramatic reductions in ASFs, entailed by many plant-based diets, will worsen already prevalent micronutrient and protein deficiencies. The protections provided by plant-based diets against NCDs appear to be more strongly associated with reduced intakes of calories and salt, and increased intakes of fruit, vegetables, nuts and whole grains, rather than with reduced intakes of ASFs. Any possible absolute adverse effects of red and processed meat consumption on NCDs are very small and uncertain. Other ASFs either appear to have no impact on NCDs (poultry meat and eggs), or are associated with protections against obesity, cardiovascular events, brain disorders and some cancers (seafood and dairy). Rigorous randomized controlled trials of all newly proposed environmentally-protective plant-based diets are required, so as to provide clear-cut evidence of micronutrient and protein adequacy, with or without, supplementation, fortification and/or biofortification. In the meantime, dietary guidelines should advise moderating excessive consumption, rather than substantially limiting or excluding ASFs from the human diet.

A nutrition-focused review of the interventions in US-living Latino communities with type II diabetes.

Type 2 diabetes (T2D) is a chronic, debilitating disease that disproportionally affects the Hispanic/Latino community residing in the United States. Optimal nutrition therapy is fundamental to the proper management of T2D and must be culturally adapted to facilitate permanent behavior change in this population. This review selected and assessed the nutrition components of interventions aimed to improve T2D outcomes in US-based Latinos/Hispanics, published from 2002 to 2023. An overview of the participant characteristics, nutrition intervention, and dietary assessment and outcomes is included. Nutrition interventions in this community benefit from the inclusion of bicultural registered dietitian nutritionist (RDNs) to assure the counseling team promotes culturally tailored nutrition recommendations based on current dietary guidelines. Nutrition assessment and outcomes should be captured with the use of validated dietary assessment tools and dietary quality indices appropriate to their target population. Standardizing these practices will facilitate intervention comparability and replicability and ultimately better target the needs of this community.

Associations between the nutritional quality of snacks, overall diet quality and adiposity: findings from a nationally representative study of Australian adolescents.

The primary aim of this study was to examine the association between snack nutritional quality, overall diet quality and adiposity among Australian adolescents. The secondary aim was to assess the distribution of discretionary foods (i.e. energy-dense and nutrient-poor foods and beverages) and intakes from the five food groups at different levels of snack nutritional quality. Dietary data collected from nationally representative adolescents (12-18 years old) during a 24-h dietary recall in the National Nutrition and Physical Activity Survey were analysed (n 784). Snacks were defined based on participant-identified eating occasions. Snack nutritional quality was assessed using the Nutrient Profiling Scoring Criterion (NPSC), whereas diet quality was evaluated using the Dietary Guideline Index for Children and Adolescents. Adiposity was assessed through BMI Z-score waist circumference and waist:height ratio (WHtR). Higher nutritional quality of snacks, as assessed by the NPSC, has been associated with higher diet quality among both boys and girls (P < 0·001). However, there is no association between snacks nutritional quality with BMI Z-score, waist circumference and WHtR. Among both boys and girls, the consumption of fruits, vegetables and legumes/beans at snacks increased with improvement in snack nutritional quality. Conversely, the consumption of discretionary foods at snack decreased with improvement in snack nutritional quality. In conclusion, improved snack quality was associated with better diet quality in adolescents. However, there was no association between snack nutritional quality and adiposity. Future, snack nutrition quality indices should consider optimum snack characteristics related with adiposity and diet quality.

Food-based dietary guidelines for optimizing calcium intakes for reproductive-aged women in Ethiopia using local foods.

Increasing dietary calcium intakes of Ethiopian women of reproductive age (WRA) is a public health priority for reducing pre-eclampsia in pregnancy. Using linear programming, we determined whether locally available foods consumed by WRA in nine regions (urban and rural) and two administrative cities of Ethiopia could provide 1000mg/day of dietary calcium, and we identified food-based recommendations (FBRs) to improve dietary calcium adequacy in each region. Results showed that diets providing 1000mg/day of calcium were feasible in eight regions (40%) of the target populations examined. It would, however, require marked changes for most populations (90%), increasing the number of servings per week of several food groups to levels close to those of high consumers in each population. The selected calcium-specific FBRs integrate well into the 2022 Ethiopian Dietary Guidelines, requiring additional messages to consume green leafy vegetables, milk, root crops, or teff (Eragrostis tef) or to consume a higher number of servings of vegetables than currently recommended, depending on the population. In conclusion, these analyses show that a food-based approach can be used to achieve dietary calcium adequacy among WRA in 40% of the populations examined. For the other populations, food-based interventions alone may be inadequate and other interventions are likely needed.

Effect of time restricted eating versus current practice in dietetics on glycaemic control and cardio-metabolic outcomes in individuals at risk of developing type 2 diabetes: Protocol for a multi-centre, parallel group, non-inferiority, randomised controlled trial

BackgroundTime restricted eating (TRE) is a dietary strategy that may improve metabolic health. However, no studies have compared TRE with current practice (CP) in dietetics. HypothesisTRE will not be inferior to CP to improve glycaemic control in individuals at risk of type 2 diabetes (T2D). MethodsThis parallel group, randomised, non-inferiority, controlled trial randomised 247 participants by site and glycated haemoglobin (HbA1c) into TRE or CP (1:1) for 12 months. Participants were aged 35–70 years, with a body mass index (BMI) >25 but <45 kg/m2, and score ≥15 on the Australian type 2 diabetes risk (AUSDRISK) assessment, without a diagnosis of T2D. Study visits were balanced between groups and all participants received five consultations at 0, 0.5, 1, 2 and 3 months. TRE followed a self-selected 9 h eating window (≥0600 and ≤1900), whereas CP followed Australian dietary guidelines. OutcomesThe primary endpoint is the estimate of group mean difference (TRE vs CP) of HbA1c at 4 months in a covariate linear regression adjusting for stratification factors and sex. Secondary efficacy outcomes at 4 and 12 months are changes in fasting glucose, fasting insulin, HOMA-IR and nocturnal glucose by continuous glucose monitor incremental area under the curve and change in HbA1c at 12 months. Other endpoints are exploratory and will not be adjusted for multiplicity. ConclusionsWe will determine whether TRE is an alternate strategy to current practice in dietetics to improve glucose control.Trial registration:NCT04762251; 21 Feb 2021.

Association Between Periconceptional Diet Quality and Hypertensive Disorders of Pregnancy: The Japan Environment and Children's Study.

Little is known about the relationship of healthy diets, which are widely recommended to prevent diseases in general populations, with the risk of hypertensive disorders of pregnancy (HDP), particular among non-Western populations with different dietary habits. We aimed to investigate the association between periconceptional diet quality and the risk of HDP among pregnant Japanese women. Dietary intake over 1 year before the first trimester of pregnancy was assessed using a validated, self-administered food frequency questionnaire among 81 113 pregnant Japanese women who participated in a prospective cohort of the Japan Environment and Children's Study. Overall diet quality was assessed by the Balanced Diet Score (BDS) based on adherence to the country-specific dietary guidelines and the Dietary Approaches to Stop Hypertension (DASH) score. Cases of HDP were identified by medical record transcription. The association between diet quality and HDP risk was examined using Bayesian logistic regression models with monotonic effects. We identified 2383 (2.9%) cases of HDP. A higher BDS was associated with a lower risk of HDP. When comparing the highest with the lowest quintile of the BDS, the adjusted odds ratio (aOR) of HDP was 0.83 (95% credible interval [CrI], 0.73-0.94). The DASH score and HDP risk were inversely associated in a monotonic dose-response manner (aOR per 1-quintile increase in the DASH score, 0.92 [95% CrI, 0.89-0.95]). A high-quality diet, which is recommended for disease prevention in general populations, before conception may also reduce the risk of HDP among pregnant Japanese women.

Impact of Nutrition and Exercise on Kidney Health: How to Prevent Kidney Stones?

IntroductionKidney stone disease, characterized by the formation of calculi in the kidneys, is becoming an increasingly common urinary tract disorder in developed countries. Although kidney stone disease may be caused by metabolic disorders, anatomical, functional, and genetic factors, diet plays a crucial role in its formation. Changing dietary habits has become a primary tool in the treatment and prevention of kidney stone disease. ObjectiveThe aim of this study is to present research on the impact of diet and its individual components on the risk of kidney stone formation. Special attention is given to the role of vitamins, minerals, and dietary habits in the pathogenesis and prevention of this condition. Materials and MethodsThe study involves a review of the scientific literature, considering research published in reputable medical and scientific journals regarding the impact of diet on the risk of kidney stones, focusing on key dietary components such as calcium, magnesium, sodium, vitamins C and D, as well as the role of physical activity and proper hydration. ConclusionsA balanced diet, proper hydration and maintaining a healthy body weight are fundamental elements in preventing of kidney stone disease. Adequate hydration is crucial; high fluid intake, especially water, dilutes urine and reduces the concentration of lithogenic substances.Calcium and magnesium intake are particularly important as they influence the absorption and excretion of oxalates, and excessive supplementation with vitamins C and D should be avoided. A diet rich in fruits and vegetables, and the limitation of animal protein and salt, can significantly reduce the risk of kidney stone formation. Ultimately, dietary changes and lifestyle modifications, including weight control and physical activity, play a crucial role in preventing kidney stone disease. However, further research is needed to develop effective dietary guidelines tailored to the individual needs of patients.

Dietary Influence on Bladder Pain Syndrome: A Systematic Review.

Bladder Pain Syndrome (BPS) is a chronic condition characterized by discomfort or pain in the bladder region, often exacerbated by bladder filling and alleviated by voiding. Despite numerous theories regarding its etiology, the potential dietary influence on BPS symptoms has not been thoroughly elucidated. This systematic review aimed to synthesize evidence on the relationship between nutritional factors and the exacerbation or amelioration of BPS symptoms. An extensive search was conducted across multiple electronic databases, including PubMed/MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, CINAHL, and Google Scholar, to identify studies exploring the impact of diet on interstitial cystitis/bladder pain syndrome(IC/BPS). Comparative analysis was employed to synthesize data from the selected studies, focusing on identifying corroborative and conflicting evidence regarding diet and IC/BPS. The analysis revealed recurring themes across the eight selected studies, including the association of certain foods and beverages with the worsening of IC/BPS symptoms. Patients frequently reported dietary sensitivities, particularly to acidic and spicy foods, caffeine, and alcohol. Evidence from the studies suggests that dietary modifications, both self-directed and structured interventions, may improve symptom severity and overall patient quality of life. Additionally, tools developed and validated for assessing dietary sensitivities could facilitate better management of IC/BPS through personalized diet plans. The impact of individual substances such as caffeine and tea was underscored, indicating their potential as modifiable risk factors in IC/BPS symptomatology. The collective evidence from the reviewed studies confirms the importance of dietary influence on IC/BPS symptom management. An individualized approach to dietary counseling based on patient sensitivities could be beneficial. However, the diversity in study methodologies and outcomes indicates a need for more uniform research to establish standardized dietary guidelines for IC/BPS patients.

Nutrition and Periodontitis: A Cross-Sectional Study from a Practice-Based Research Network.

Despite clinical interventional studies on the influence of diet on periodontal inflammatory parameters, there has been no practice-based cross-sectional study from a German population to date that has conducted both a comprehensive dental and periodontal examination and a thorough validated assessment of dietary behavior. Therefore, the aim of this pilot study was to evaluate, in a proof of concept, whether there is a correlation between the overall periodontal inflammatory surface area (PISA), periodontal clinical parameters (pocket probing depths (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), furcation involvement (FI), tooth mobility (TM)), and the dietary behavior of patients with periodontal disease when utilizing a practice-based research network. The primary outcome was the correlation between the periodontal inflammatory surface (PISA) and the dietary assessment data. The practice-based research network, consisting of eight Master's graduates, recruited patients who met the inclusion and exclusion criteria and performed a periodontal examination together with the assessment of dietary behavior using a digital version of the validated retrospective dietary recall (DEGS/RKI). Statistical analyses included linear regression models adjusted for age and smoking and unpaired t-tests, conducted using STATA 17.0 with a significance level of 5%. In addition, the data obtained were classified according to the currently recommended amounts of daily intake. A total of 1283 teeth were analyzed, with 60.25% (773 teeth) requiring treatment. The average PISA was 753.16 mm2 (SD ± 535.75 mm). Based on dietary guidelines, the studied population consumed excessive amounts of extrinsic sugars and fats, while their fiber and legume intake was insufficient. The intake of certain nutrients, including water-soluble fibers, specific fatty acids, vitamins (D, B1, B2, B6, and B12), iron, and zinc, was associated with reduced PISA, PPD, CAL, and BOP. Within the limits of the current study, including its cross-sectional design and cohort size, the outcomes demonstrated the influence of nutrition on periodontal health.

28 Integrating homeostasis in practical mineral supplementation recommendations

Abstract A long-established objective in ruminant nutrition is an accurate supply of the 4 main trace metal nutrients Zn, Cu, Mn, and Fe, respecting bioavailability, nutritional interactions, and nutrient tolerance. Although, current dietary supplementation practices, justified by the multiple uncertainties of trace metal supply, results in dietary levels that widely exceed nutritional guidelines. Additionally, reference feeding recommendations are defined assuming fixed and highly conservative uptake coefficients, an approach that disregards the opportunity, and limitations, of absorptive regulation, the main homeostatic mechanism of these nutrients. Mitigating deficiency risks by generous supplementation can result in a generally overlooked risk, exceeding tolerable trace metal availability. Complete nutrient balance studies have recently described the overwhelming homeostatic downregulation of trace metals at dietary levels that are not uncommon in practice. This finding calls for a novel approach to define supplementation that resolves this conundrum of trace metal adequacy. This approach integrated 3 elements: a stochastic analysis of native dietary supply; a stochastic analysis of net nutrient requirements; and the identification of the upper and lower boundaries of homeostatic regulation for these 4 nutrients in the bovine species. This last, aims to resolve the main limitation of current dietary guidelines, using the potential maximum uptake rates in homeostatic upregulation, and the minimum uptake rates achievable by downregulation, instead of assuming fixed uptake rates. As result, this approach delivers dietary supply ranges of adequate supply, instead of a minimum dietary level to meet dietary adequacy. The probability distribution of nutrient supply was determined by dry-matter intake variability, diversity in dietary composition, and variability of nutrient occurrence in feedstuffs. The probability distribution of net nutrient requirements was defined by the variability of the components of a classic factorial requirement approach applied to different animal conditions. A maximum apparent absorption efficiency was determined to define lower supply boundaries using published datasets. Upper boundaries were defined as the dietary supply level beyond which apparent absorption empirically has shown to exceed net requirements. As expected, this risk-based approach resulted in much lower supplementation recommendations than current reference models. However, it supports the value of preventive supplementation of Zn and Cu to growing and lactating animals, and Cu to non-lactating non-growing cows. This assessment also indicates merit in Mn supplementation to growing bovines. Furthermore, it confirms that under all circumstances native dietary Fe meets nutritional needs, but it also illustrates a tolerance risk to native Fe supply under multiple productive scenarios. Most interestingly, this analysis illustrates the risk of exceeding trace metal tolerance boundaries with common levels of supplementation under common conditions. This approach offers a novel perspective to trace metal supplementation, pointing at an opportunity to improve nutritional adequacy by reconsidering supplementation practices.

Effects of Replacing Cow's Milk with Plant-Based Beverages on Potential Nutrient Intake in Sustainable Healthy Dietary Patterns: A Case Study.

More consumers are replacing cow's milk (CM) with plant-based drinks (PBD), but data indicating the nutritional impact are limited. This theoretical study aims to assess the effect of substituting CM with PBD sold in Italy on nutrient intake within two dietary patterns: one aligned with the EAT-Lancet Commission reference diet adapted to Italian food habits (EAT-IT) and another one in line with the Italian Dietary Guidelines (IDG). Nutrition information from 368 PBD were collected and categorized according to their descriptive name and their fortification or not with calcium (Ca- and nCa-fortified). The substitution of CM with each PBD category in both dietary patterns was conducted, and an analysis of nutrient content and adequacy was performed. Substituting CM with all PBD resulted in reduced protein intake, except for nCa-fortified soy drinks, decreased saturated fat and vitamins B2 and B12, and increased fiber intake. Replacing CM with nCa-fortified PBD within both diets decreased Ca intake. Following the substitution of CM with Ca-fortified PBD, variations in vitamin D intake depended on the PBD category. The main risk of nutritional inadequacy was observed in Ca and vitamin D levels, which may even be amplified considering the different bioavailability based on the source of nutrients. This study highlighted the important role of CM in meeting calcium requirements and the potential unintended consequences of substituting CM with PBD without considering their nutritional differences.

Role of Dietary Patterns in the Progression and Management of Heart Failure in Pakistani Patients: A Multicenter Study.

Heart failure (HF) is a chronic condition with increasing prevalence in Pakistan due to common cardiovascular risk factors. Dietary interventions are known to influence HF outcomes, but data specific to Pakistani patients are limited. This study aimed to evaluate the impact of dietary patterns on HF progression and management in Pakistani patients, alongside the effects on quality of life and biochemical markers. A prospective cohort study was conducted across four medical centers in Pakistan, enrolling 170 HF patients. Dietary patterns were assessed using a validated Food Frequency Questionnaire (FFQ) tailored to the South Asian population. The primary outcomes measured were changes in the ejection fraction, New York Heart Association (NYHA) class, and hospitalization rates. Secondary outcomes included changes in quality of life and biochemical markers. Multivariate logistic regression was used to adjust for confounding variables, and Bonferroni corrections were applied to account for multiple comparisons. Adherence to a heart-healthy diet significantly improved the ejection fraction (from 35% to 38%, p = 0.04), reduced hospitalization rates (22%, p = 0.03), and improved NYHA class (45%, p = 0.05). Subgroup analysis showed a 10% reduction in mortality among patients over the age of 65 (p = 0.01) and 18% in diabetic patients (p = 0.02). Dietary interventions play a critical role in HF management among Pakistani patients. Culturally tailored dietary guidelines should be integrated into clinical practice to improve patient outcomes.

Nutritional Characteristics of Menus in State Prisons.

Nutrition-related health disparities plague prisons in the United States. Unregulated and inadequate prison menus may contribute to noncommunicable chronic health conditions in this vulnerable population. The purpose of this research was to assess nutrition offerings provided by prison menus. Researchers requested the most current version of all master menus and associated nutrition analyses for gendered and age-centric (pediatric vs geriatric) menus. Menu and nutrient data were extracted and entered into a spreadsheet for analysis. Prisons serve gendered or nongendered menus to the general population, and 52.9% of prisons offer nongendered menus where males and females receive the same meals. This approach provides excess calories and saturated fat to females. Sodium was served in excess to both males and females. Fruit and vegetable servings on all gendered menus fell short of recommendations. The average prison menu inappropriately offers calories, sodium, and fruit and vegetable servings in a one-size-fits-all menu development method without considering gender, age, and physical activity. Interpretation and application of Dietary Guidelines for Americans are inconsistent. Nutrition guidelines recommending appropriate nutrients and food groups should be developed and available to corrections systems and dietitians. Current prison menu development practices yield inappropriate nutrition for prison populations.