Evidence-based Dietary Recommendations Research Articles

Exploring the Therapeutic Potential of Traditional Medicinal Foods in Cancer Treatment: Molecular Evidence and Bioactivities.

Traditional medicinal foods derived from natural sources have gained increasing attention in recent years due to their perceived health benefits and potential therapeutic properties and are deeply rooted in cultural practices. This review aimed at understanding their potential health benefits, emphasizes the need to identify the key bioactive substances in traditional home medicine. We have discussed the bioactive properties, molecular targets, and anti-cancer effects of various compounds such as curcumin, genistein, berberine, resveratrol, and, quercetin present in traditional medicinal foods. Our study highlights the potential of traditional medicinal food in the prevention and management of various health conditions, including cardiovascular diseases, cancer and neurodegenerative disorders as evident from in vitro, in vivo and clinical trials. Additionally, our study explores the mechanistic action of various bioactive constituents of grapes, rosemary, barberry, turmeric and garlic that have been shown to interfere with cancer growth, proliferation, metastasis, angiogenesis, and induce apoptosis by targeting various pathways and the cell cycle. Additionally, a wide range of healing abilities of medicinal foods including their impact on cancer cells demonstrate their direct anti-tumor potential along with antioxidant and antiinflammatory properties. To summarize, the present review highlights that integrating the insights of contemporary science with the age-old wisdom of traditional medicine in a systematic way holds immense potential for developing alternate and effective approaches to cancer therapeutics and offering evidence-based dietary recommendations.

Dietary fiber for the prevention of childhood obesity: a focus on the involvement of the gut microbiota.

Given the worldwide epidemic of overweight and obesity among children, evidence-based dietary recommendations are fundamentally important for obesity prevention. Although the significance of the human gut microbiome in shaping the physiological effects of diet and obesity has been widely recognized, nutritional therapeutics for the mitigation of pediatric obesity globally are only just starting to leverage advancements in the nutritional microbiology field. In this review, we extracted data from PubMed, EMBASE, Scopus, Web of Science, Google Scholar, CNKI, Cochrane Library and Wiley online library that focuses on the characterization of gut microbiota (including bacteria, fungi, viruses, and archaea) in children with obesity. We further review host-microbe interactions as mechanisms mediating the physiological effects of dietary fibers and how fibers alter the gut microbiota in children with obesity. Contemporary nutritional recommendations for the prevention of pediatric obesity are also discussed from a gut microbiological perspective. Finally, we propose an experimental framework for integrating gut microbiota into nutritional interventions for children with obesity and provide recommendations for the design of future studies on precision nutrition for pediatric obesity.

Dairy and Headaches: What is the Connection?

Headaches represent a prevalent and burdensome health condition, affecting individuals of all ages worldwide. While dietary factors have been implicated in headache pathophysiology, the association between dairy consumption and headaches remains controversial and inadequately understood. This comprehensive review systematically examines the existing literature to elucidate the relationship between dairy intake and headaches, addressing methodological challenges, potential biases, and gaps in the current knowledge. A thorough search of electronic databases identified relevant observational studies, clinical trials, and mechanistic investigations exploring the impact of dairy consumption on headache incidence, frequency, severity, and duration. Methodological considerations, including study design, measurement of exposure and outcome variables, confounding factors, and sources of bias, were critically evaluated to assess the strength of evidence and validity of findings. Despite heterogeneity across studies, emerging evidence suggests a complex and multifaceted relationship between dairy intake and headaches, influenced by individual characteristics, dietary patterns, headache subtype, and study context. While some studies report a positive association between dairy consumption and headaches, others indicate no significant effect or potential therapeutic benefits of dairy restriction. Mechanistic insights suggest plausible biological mechanisms, including neuroinflammatory pathways, neurotransmitter modulation, vascular effects, and gut-brain interactions, which may mediate the observed associations. Future research directions encompass longitudinal studies, mechanistic investigations, stratified analyses, randomized controlled trials, and exploration of the gut microbiota to further elucidate the underlying mechanisms and inform evidence-based dietary recommendations for headache management. This integrative review underscores the importance of interdisciplinary collaboration and personalized approaches to address the complex interplay between diet, headaches, and overall health.

The Impacts of the Low-FODMAP Diet on the Management of Irritable Bowel Syndrome Symptoms: Possibilities, Feasibility, and Alternatives

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) condition characterized by a myriad of GI symptoms (e.g., diarrhea, nutrient malabsorption) that vary in severity. Due to its complex and individual nature, there is no known cure for IBS, but many diets have been assessed for their viability in managing symptoms. The low-FODMAP diet has recently been investigated for its potential benefits for IBS patients. FODMAPs, or Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols are short- and medium-chain carbohydrates that are poorly absorbed in the small intestine and are prone to absorb water and ferment in the colon. Consumption of these FODMAPs correlates with increasing severity of IBS symptoms. The purpose of this randomized controlled trial systematic review was to compile various evidence-based dietary recommendations for the low-FODMAP diet for adult patients suffering from IBS from randomized controlled and clinical trials. The possibilities, feasibilities, and potential alternatives are proposed to determine if there is sufficient evidence to recommend the low-FODMAP diet for this patient population. Over 1,000 studies were screened and 6 were reviewed to determine the benefits of this diet. It was found that the low-FODMAP diet has demonstrated efficacy in delivering IBS symptom relief by changing patients’ metabolomes, microbiomes, and physiology. Specifically, this diet showed a greater overall decrease in abdominal pain, bloating, stool consistency, frequency, and urgency. Greater diversity of actinobacteria was found in the stool samples of these patients. Nociceptive neurons were also shown to be less sensitive and GI gas production was also markedly decreased. Despite these benefits, the low-FODMAP diet is more recommended for acute flare-ups due to its difficult adherence and attrition. Instead, we conclude that the balanced Mediterranean diet contains aspects of the traditional Mediterranean and low-FODMAP diet that can relieve IBS symptoms for daily life, while the low-FODMAP diet can be an effective treatment to ameliorate conditions when severe symptoms are experienced.

Dietary Interventions and Supplementation in Patients With an Ileal Pouch-Anal Anastomosis: A Systematic Review.

Lay Summary The restorative proctocolectomy with ileal pouch–anal anastomosis is the preferred surgery for patients with medically refractory ulcerative colitis. Although the ileal pouch–anal anastomosis provides gastrointestinal continuity and is an excellent alternative to a permanent end ileostomy, it is not without its complications including acute pouchitis, which occurs in up to 80% of patients. Diet may have a significant impact on pouch function and the development of pouchitis by virtue of its impact on motility and the microbiome. Multiple studies have evaluated the ability of different diets and supplements to improve pouch function and manage pouchitis, yet results are conflicting; thus, evidence-based dietary recommendations are lacking. Patients with an ileoanal pouch routinely ask about dietary interventions to maintain pouch health, and it is crucial that concrete evidence-based recommendations are identified to provide guidance. The goal of this systematic review is to summarize the available data on dietary patterns in patients with an ileoanal pouch, dietary interventions in this cohort, and the impact of supplements on pouch function and pouchitis.

Diet and the gut microbiota-immune axis in the context of perinatal mental health: Protocol for a prospective cohort study.

Physiological and psychosocial changes experienced by women during the perinatal period may put them at risk for postpartum mental health disturbances. Accumulating evidence suggests that dietary patterns may influence mental health through the modulation of the gut microbiota and its effects on host immune activity. Thus, targeting the gut microbiota via dietary intake could serve as both a preventative and therapeutic strategy in improving perinatal mental health. Here, we present a protocol for a prospective cohort study that primarily aims to determine if diet quality during pregnancy is protective against postpartum depression severity. Secondary objectives will examine if microbiota- and blood-based inflammatory markers may be associated with the relationship between prenatal diet quality and postpartum depression severity, as well as with associations between additional dietary and mental health outcomes. Dietary patterns and mental health symptoms will be documented in 100 pregnant women at 4 time points during pregnancy and postpartum. Participants will also provide stool and blood samples at the same time points to determine microbiota composition and predicted function and inflammatory factors, respectively. Stool microbiota will be analyzed using 16S ribosomal RNA gene sequencing and bioinformatics tools (QIIME 2/PICRUSt2). Inflammatory factors will be determined using high-sensitivity antibody-based immunoassays. Statistical analyses will include linear mixed models and hierarchical linear mixed effect models. The study was approved by the Research Ethics Boards of the Royal Ottawa Health Care Group (#2022002) and of the University of Ottawa (#H-06-22-8013). Informed consent will be obtained from all participants before their enrollment. Findings from this study will help develop evidence-based dietary recommendations and potential interventions for women susceptible to or suffering from postpartum mental health issues that are accessible, noninvasive, and have potential to play a role in prevention and treatment.

Abstract P336: Sodium, Potassium And Calories: Implications For Implementing A Recommended Diet In Adults With Hypertension. A Cross Sectional Analysis Of NHANES 1999-2020.

Background: Evidence-based dietary recommendations for sodium and potassium have been made for adults with hypertension. Foods high in sodium are typically low in potassium and vice versa. This study aimed to investigate the relationship between these dietary components and their implication for simultaneously achieving recommended daily dietary intakes in individuals with hypertension. Methods: Data on hypertensive adults was pooled from ten National Health and Nutrition Examination Surveys (1999 - 2020) and weighted to provide national estimates. Dietary electrolyte intake was stratified as: 1) sodium ≤ 2300 mg/d [recommended] or ≤ 3000 mg/d [adequate], and 2) potassium > 4700 mg/d [recommended] or 3400 mg/d (men) and > 2600 mg/d (women) [adequate]. Results: Few hypertensives met recommended intakes of sodium (25.7%) and potassium (6.4%) with virtually none meeting both levels (0.1%). Fewer individuals met potassium recommendations after the 2015 Dietary Guidelines for Americans were made (2015-2020 vs. earlier, p =0.006) with those meeting recommended sodium remaining similar (p = 0.97). Meeting adequate intakes of sodium (44.1%), potassium (33.1%), and both intakes simultaneously (6.6%) was more common. The correlations between sodium and potassium, calories and sodium, and calories and potassium were 0.63, 0.77, and 0.74, respectively. However, individuals who met adequate potassium levels (and not sodium) had the highest calorie intake (median [IQR] = 2912 [2368, 3666]), with those meeting adequate sodium levels only having the lowest (1402 [1083, 1757]), and those who met neither intake (2254 [1854, 2717]) and those meeting both adequate intakes in between (1866 [1568, 2256], p < 0.001). Meeting adequate sodium only results in the lowest potassium intake (1680 mg [1241, 2152]), while meeting adequate potassium only results in the highest sodium intake (4801 mg [3840, 6215]). Conclusion: Hypertensives almost never meet both recommended intakes of sodium and potassium with higher intakes of potassium associated with high sodium and calories. Altering contemporary diets to augment potassium while reducing sodium will require strategies that decouple the positive association of potassium with both sodium and calories.

Potential benefits of spicy food consumption on cardiovascular outcomes in patients with diabetes: A cohort study of the China Kadoorie Biobank

ObjectivesDietary capsaicin from spicy foods has potential benefits for those with cardiometabolic diseases (CMDs). However, to our knowledge there is no evidence linking spicy food consumption with cardiovascular outcomes in individuals with diabetes. The aim of this study was to explore the association between spicy food consumption and the incidence of major adverse cardiovascular events (MACEs) in individuals with diabetes from the CKB (China Kadoorie Biobank) study and to provide evidence-based dietary recommendations for those with CMDs. MethodsThis prospective study enrolled 26 163 patients from the CKB study who had diabetes without coronary heart disease, stroke, or cancer to our knowledge. Of the 26 163 patients enrolled, 17 326 never or rarely ate spicy food (non-spicy group), and 8837 ate spicy food ≥1 d/wk (spicy group). The primary outcomes were MACEs, including cardiac death, non-fatal myocardial infarction, and stroke. Cox proportional hazards models were used to estimate the hazard ratio (HR) of MACEs and their associated 95% confidence intervals (CIs). ResultsDuring a median follow-up of 8.5 y, MACEs occurred in 5465 participants (20.9%), with 3820 (22%) and 1645 (18.6%) cases occurring in the non-spicy and spicy groups, respectively. Spicy food consumption was independently associated with a decreased tendency for MACEs, with an adjusted HR of 0.94 (95% CI, 0.89–1.00; P = 0.041). Subgroup analysis showed consistency in the results that the regular spicy eating groups were associated with significantly lower incidence of MACEs than the non-spicy group. There was no statistical difference in the incidence of MACEs among the three different spicy eating frequency groups. ConclusionThis cohort study revealed that the consumption of spicy food was independently associated with a reduced incidence of adverse cardiovascular events in Chinese adults with diabetes, suggesting a beneficial effect on cardiovascular health. Further studies are needed to confirm the association between the consumption of different doses of spicy food and cardiovascular outcomes and the exact mechanism of action.

Effects of ileocolonic delivered vitamin B2, B3 and C (ColoVit) or the Groningen anti-inflammatory diet on disease course and microbiome of patients with Crohn’s disease (VITA-GrAID study): a protocol for a randomised and partially blinded trial

BackgroundDiet plays a pivotal role in the onset and progression of Crohn’s disease (CD). Nutritional interventions revealed effects on intestinal inflammation and gut microbial composition. However, data from well-designed and...

Short-Term Tomato Consumption Alters the Pig Gut Microbiome toward a More Favorable Profile.

Diets rich in fruits and vegetables have been shown to exert positive effects on the gut microbiome. However, little is known about the specific effect of individual fruits or vegetables on gut microbe profiles. This study aims to elucidate the effects of tomato consumption on the gut microbiome, as tomatoes account for 22% of vegetable consumption in Western diets, and their consumption has been associated with positive health outcomes. Using piglets as a physiologically relevant model of human metabolism, 20 animals were assigned to either a control or a tomato powder-supplemented diet (both macronutrient matched and isocaloric) for 14 days. The microbiome was sampled rectally at three time points: day 0 (baseline), day 7 (midpoint), and day 14 (end of study). DNA was sequenced using shotgun metagenomics, and reads were annotated using MG-RAST. There were no differences in body weight or feed intake between our two treatment groups. There was a microbial shift which included a higher ratio of Bacteroidota to Bacillota (formerly known as Bacteroidetes and Firmicutes, respectively) and higher alpha-diversity in tomato-fed animals, indicating a shift to a more desirable phenotype. Analyses at both the phylum and genus levels showed global microbiome profile changes (permutational multivariate analysis of variance [PERMANOVA], P ≤ 0.05) over time but not with tomato consumption. These data suggest that short-term tomato consumption can beneficially influence the gut microbial profile, warranting further investigation in humans. IMPORTANCE The composition of the microorganisms in the gut is a contributor to overall health, prompting the development of strategies to alter the microbiome composition. Studies have investigated the role of the diet on the microbiome, as it is a major modifiable risk factor contributing to health; however, little is known about the causal effects of consumption of specific foods on the gut microbiota. A more complete understanding of how individual foods impact the microbiome will enable more evidence-based dietary recommendations for long-term health. Tomatoes are of interest as the most consumed nonstarchy vegetable and a common source of nutrients and phytochemicals across the world. This study aimed to elucidate the effect of short-term tomato consumption on the microbiome, using piglets as a physiologically relevant model to humans. We found that tomato consumption can positively affect the gut microbial profile, which warrants further investigation in humans.

Nutrition Education, Understanding, and Counseling Practices Among Physiatrists: A Survey Study.

Introduction: Nutritional counseling is relevant to physiatry practice. However, physiatrists’ nutrition knowledge base and their frequency of incorporating nutritional education into routine clinical encounters are currently unknown. The objective of this study was to assess physiatrists’ nutrition education, nutrition knowledge, willingness to implement nutrition counseling in clinical practice, and perceived barriers to providing nutritional counseling to patients, using an online survey. The hypothesis was that few physiatrists offer dietary counseling to their patients on a routine basis and that barriers likely include time constraints in a typical office visit, lack of provider confidence in providing dietary recommendations, and lack of provider reimbursement.Methods: This study was a cross-sectional online survey that was distributed via email to a convenience sample of 179 resident, fellow, and attending physiatrists associated with two major academic institutions. The survey consisted of 26 questions regarding demographics, nutrition counseling practices and attitudes, basic nutrition knowledge, and perceived barriers to providing nutrition counseling.Results: Of 59 participants, 78% reported receiving education in nutrition and/or behavioral counseling in medical school. In contrast, 39% of participants did not feel adequately trained to discuss nutrition and diet-related issues with patients. Barriers to providing nutritional counseling were time constraints (83%), socioeconomic factors outside of patients’ control preventing them from adhering to a healthier diet (76%), and not having enough nutrition knowledge to do so appropriately (62%). Respondents (86%) either agreed or strongly agreed that additional training in nutrition would allow them to provide better clinical care in the prevention of progressive cardiovascular and neurovascular disease. Further, respondents (85%) either agreed or strongly agreed that they would be interested in a web-based continuing medical education training in nutrition behavioral counseling and evidence-based dietary recommendations.Conclusions: The findings refuted the hypothesis that few physiatrists in the sample offer dietary counseling to their patients on a routine basis. Results demonstrated that many of them acknowledge its relevance and would be interested in further education on the subject. Physiatrists also appear to have perceived barriers to offering nutritional counseling, but some of them varied by the amount of medical experience. Based on these findings, this study demonstrated that it would be worthwhile to develop such a continuing medical education activity with a focus on populations commonly treated by physiatrists.

Impact of α-Linolenic Acid, the Vegetable ω-3 Fatty Acid, on Cardiovascular Disease and Cognition

ABSTRACTGiven the evidence of the health benefits of plant-based diets and long-chain n–3 (ω-3) fatty acids, there is keen interest in better understanding the role of α-linolenic acid (ALA), a plant-derived n–3 fatty acid, on cardiometabolic diseases and cognition. There is increasing evidence for ALA largely based on its major food sources (i.e., walnuts and flaxseed); however, this lags behind our understanding of long-chain n–3 fatty acids. Meta-analyses of observational studies have shown that increasing dietary ALA is associated with a 10% lower risk of total cardiovascular disease and a 20% reduced risk of fatal coronary heart disease. Three randomized controlled trials (RCTs) [AlphaOmega trial, Prevención con Dieta Mediterránea (PREDIMED) trial, and Lyon Diet Heart Study] all showed benefits of diets high in ALA on cardiovascular-related outcomes, but the AlphaOmega trial, designed to specifically evaluate ALA effects, only showed a trend for benefit. RCTs have shown that dietary ALA reduced total cholesterol, LDL cholesterol, triglycerides, and blood pressure, and epidemiologic studies and some trials also have shown an anti-inflammatory effect of ALA, which collectively account for, in part, the cardiovascular benefits of ALA. A meta-analysis reported a trend toward diabetes risk reduction with both dietary and biomarker ALA. For metabolic syndrome and obesity, the evidence for ALA benefits is inconclusive. The role of ALA in cognition is in the early stages but shows promising evidence of counteracting cognitive impairment. Much has been learned about the health benefits of ALA and with additional research we will be better positioned to make strong evidence-based dietary recommendations for the reduction of many chronic diseases.

The role of nutrition in the management of inflammatory bowel disease

Health writer Francesca Ramadan discusses the importance of appropriate nutritional management in patients with inflammatory bowel disease, highlighting the need for evidence-based dietary recommendations.

Adherence to a Mediterranean Diet and Geographic Atrophy Enlargement Rate: Age-Related Eye Disease Study 2 Report 29

To determine whether closer adherence to a Mediterranean diet was associated with altered speed of geographic atrophy (GA) enlargement. Post hoc analysis of a cohort within the Age-Related Eye Disease Study 2. The study included 1155 eyes (850 participants; mean age, 74.9 years) with GA at 2 or more visits. Geographic atrophy area was measured from color fundus photographs at annual visits. An alternative Mediterranean Diet index (aMedi) was calculated for each participant by food frequency questionnaire. Mixed-model regression of square root GA area was performed by aMedi. Change in square root of GA area over time. Over a mean follow-up of 3.1 years, the mean GA enlargement rate was 0.282 mm/year (95% confidence interval, 0.270-0.293). Enlargement was significantly slower in those with higher aMedi at 0.256 mm/year (0.236-0.276), 0.290 (0.268-0.311), and 0.298 (0.280-0.317; P = 0.008) for aMedi tertiles 3, 2, and 1, respectively. Of the 9 aMedi components considered separately, significant differences in enlargement rate were observed for 4 (whole fruit [P = 0.0004], red meat [P = 0.0002], alcohol [P = 0.006], and monounsaturated fatty acid to saturated fatty acid ratio ([MUFA:SFA] [P = 0.040]) but not for fish (P = 0.14). Enlargement was slower in those with higher whole fruit, lower red meat, moderate alcohol, and higher MUFA:SFA intake. In the 768 eyes with noncentral GA, aMedi was not associated with slower progression to central involvement: hazard ratios were 1.11 (0.83-1.48) and 0.95 (0.71-1.26) for tertiles 2 and 3, respectively. A Mediterranean-type diet was associated with slower GA enlargement. Diet patterns like this may therefore lead to clinically meaningful delays in vision loss. Several components seemed to contribute most to this association in a pattern that differed from those most associated with decreased progression to GA. Hence, the Mediterranean diet is associated with protection against both faster progression to GA and faster enlargement of GA but for partially distinct reasons. These findings may help inform evidence-based dietary recommendations. Understanding the mechanisms responsible may provide insights into the underlying biology and lead to the development of nutritional supplements.

Cardiometabolic health benefits of dairy-milk polar lipids.

Low-quality dietary patterns impair cardiometabolic health by increasing the risk of obesity-related disorders. Cardiometabolic risk relative to dairy-food consumption continues to be a controversial topic, due to recommendations that endorse low-fat and nonfat dairy foods over full-fat varieties despite accumulated evidence that does not strongly support these recommendations. Controlled human studies and mechanistic preclinical investigations support that full-fat dairy foods decrease cardiometabolic risk by promoting gut health, reducing inflammation, and managing dyslipidemia. These gut- and systemic-level cardiometabolic benefits are attributed, at least in part, to milk polar lipids (MPLs) derived from the phospholipid- and sphingolipid-rich milk fat globule membrane that is of higher abundance in full-fat dairy milk. The controversy surrounding full-fat dairy food consumption is discussed in this review relative to cardiometabolic health and MPL bioactivities that alleviate dyslipidemia, shift gut microbiota composition, and reduce inflammation. This summary, therefore, is expected to advance the understanding of full-fat dairy foods through their MPLs and the need for translational research to establish evidence-based dietary recommendations.

Are recommended dietary patterns equitable?

Dietary recommendations (DR) in the USA may be inadequate at improving diets in racial/ethnic minority communities and may require redesign of the systems driving their development over the long term. Meanwhile, cultural adaptation of evidence-based DR may be an important strategy for mitigating nutrition disparities, but less is known about the adaptability of these recommendations to meet the needs of diverse groups. We examined the content and origin of major DRs - aspects that provide context on their potential universality across populations and evaluated their potential for cultural adaptation. Case studies of Dietary Approaches to Stop Hypertension (DASH), the Mediterranean diet (MD), the EAT-Lancet diet (EAT) and the NOVA classification system. United States. Racial/ethnic minority populations. Current DR differ in their origin/evolution but are similar in their reductionist emphasis on physical health. DASH has been successfully adapted for some cultures but may be challenged by the need for intensive resources; MD may be more beneficial if applied as part of a broader set of food procurement/preparation practices than as just diet alone; EAT-Lancet adaptation may not honor existing country-specific practices that are already beneficial to human and environmental health (e.g. traditional/plant-based diets); evidence for cultural adaptation is limited with NOVA, but classification of levels of food processing has potential for widespread application. For DR to equitably support diverse populations, they must move beyond a Eurocentric or 'general population' framing, be more inclusive of cultural differences and honour social practices to improve diet and reduce disparities.

Dietary Modification for the Restoration of Gut Microbiome and Management of Symptoms in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder leading to chronic debilitating issues. A healthy diet plays an integral role in maintaining the gut microbiota equilibrium, thus promoting digestive health. The structure and function of gut microbiota are affected by genetics and environmental factors, such as altered dietary habits, gastroenteritis, stress, increased use of alcohol and drugs, and medication use. Whereas there are various management approaches cited in the literature to manage symptoms of IBS, the purpose of this article is to focus on dietary options that will restore the gut microbiome and help in managing IBS symptoms. Some of the diets that are discussed in this article include a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, gluten-free/wheat-free diet, high-fiber diet, dietary and herbal supplements (psyllium, peppermint oil), and probiotics/prebiotics/synbiotics. The clinical practice guidelines recommended by the American College of Gastroenterology outlines evidence-based dietary recommendations for patients with IBS to manage symptoms. Recent advancements in the dietary management of IBS highlighting the use of a patient-centered, personalized nutrition approach along with lifestyle changes, pharmacological therapies, and psychosocial and behavioral interventions are also reviewed and discussed.

Controversies and discrepancies in the effect of dietary fat and cholesterol on cardiovascular risk.

Cardiovascular disease (CVD) is the leading cause of death worldwide. The top ten causes of death in Singapore include many cardiovascular-related diseases such as ischaemic heart disease. The increasing prevalence of CVD poses a burden to both the economy and healthcare system of a country. Dietary habits, in particular dietary fats and cholesterol intake, have been shown to greatly influence CVD risks. Therefore, reference and adherence to relevant dietary guidelines could be crucial in CVD prevention. Recent research findings have provided novel insights into the relationship between certain dietary fats or cholesterol intake and CVD risks, challenging or reinforcing previous guidelines. These findings may, however, be conflicting, and there are still controversies over the effects of dietary fats and cholesterol as well as their association with cardiovascular risk. This review paper aims to evaluate common controversies, identify gaps in relevant research areas and summarise evidence-based dietary recommendations.

Implementation of evidence-based nutritional management in primary health care settings: a systematic scoping review.

Scientific evidence is used to inform clinical nutritional guidelines in order to prevent diseases and promote health. However, little is known about the process of implementing evidence-based clinical nutritional guidelines in health services. This scoping review aims to map the steps in the implementation of evidence-based nutritional management within primary health care, as well as the facilitators and barriers to implementation. Electronic databases and the grey literature were searched for original studies on the implementation of evidence-based dietary recommendations and/or nutritional counselling in primary health care settings conducted by health practitioners. Studies were selected by independent reviewers. Extracted data were analysed and grouped into thematic categories and are presented in a narrative synthesis. In all, 26 studies were included. A review of the studies demonstrated four steps in the process of implementing evidence-based nutritional management in primary care: (1) acknowledging health needs in the catchment area and determining the characteristics of services and health professionals; (2) developing continuing education aimed at practitioners; (3) integrating nutritional management into interprofessional practice; and (4) adapting the interventions using a patient-centred care approach. The predominant facilitators were providers' pre-intervention training and the provision of support materials. Barriers included time constraints, a lack of resources and an incompatibility of the interventions with living conditions and patients' health needs.

Migraine and Diet.

Migraine is characterized by recurrent attacks of disabling headaches, often accompanied by sensory and motor disturbances. Clinical manifestations of migraine are influenced by dietary behaviors and dietary elements. Several dietary triggers for migraine have been identified, leading to the definition of strategies such as elimination diets, ketogenic diets, and comprehensive diets, mainly to help prevent migraine. Although inconsistency is present in the literature and no consensus exists, the available data are promising in supporting beneficial dietary interventions for some migraine patients. Several factors influence the net outcome, including age, sex, genetics, and environmental factors. Advancement in understanding the underlying mechanisms of migraine pathogenesis and how dietary factors can interfere with those mechanisms has encouraged investigators to consider diet as a disease-modifying agent, which may also interfere with the gut–brain axis or the epigenetics of migraine. Future work holds potential for phenotyping migraine patients and offering personalized recommendations in line with biopsychosocial models for the management of migraine. Diet, as an important element of lifestyle, is a modifiable aspect that needs further attention. Well-designed, systematic, and mechanism-driven dietary research is needed to provide evidence-based dietary recommendations specific to migraine. This narrative review aims to present the current status and future perspective on diet and migraine, in order to stimulate further research and awareness.