Diet Quality Research Articles

Meal timing and risk of metabolic syndrome in the prospective French NutriNet-Santé biobank

Abstract Background Circadian rhythm disruption has been associated with higher risks of cardiometabolic diseases and several cancers. Mistimed eating patterns can desynchronize circadian rhythms, and could therefore influence metabolic health. However, long-term associations between meal timing and the metabolic syndrome remain unclear. The aim of this study was to evaluate the prospective associations between meal timing and the risk of developing metabolic syndrome. Methods We used measured biological and clinical data from 16 353 adults (51 years ± 13.72) in the NutriNet-Santé biobank (2011-2014), and examined the associations between meal timing, assessed with repeated 24-hour dietary records during the first two years of follow-up (starting 2009), and the risk of metabolic syndrome, using modified Poisson regression models, adjusted for main confounders. Results At the end of follow-up (mean 2.1 years (SD = 1.2)), a later timing of the first meal of the day was associated with a moderately higher risk of metabolic syndrome (1,788 cases; RR per 1-hour delay = 1.05; 95% CI: 1.00-1.10). However, after adjusting for overall diet quality, this association was attenuated (RR: 1.04; 95% CI: 0.99-1.09). Overall, we found no evidence of an association between the occurrence of metabolic syndrome and the time of the last meal (RR: 0.99; 95% CI: 0.95-1.05), the number of eating occasions (RR: 1.00; 95% CI: 0.98 - 1.03), or night-time fasting duration (RR: 1.03; 95% CI: 0.99 1.07). Conclusions In this large prospective study, timing of the first meal showed modest associations with metabolic syndrome. Further investigations using a longer follow-up are needed to elucidate how meal timing influences metabolic health. Key messages • Beyond the nutritional quality of meals, meal timing, particularly time of first meal, may be an accessible prevention strategy for metabolic health. • More largescale prospective and intervention studies are needed to better understand the links between meal timing and metabolic health.

Independent associations of educational attainment and its joint associations with LE8 score for risk of cardiovascular disease incidence and mortality among Chinese people

Abstract Background/Introduction Educational attainment is a social determinant of health. Quantifying its associations with risk of cardiovascular disease (CVD) incidence and mortality has public health importance. Recently, the American Heart Association introduced the Life’s Essential 8 (LE8) score to evaluate CVD risk. However, it remains unclear how educational attainment and the LE8 score interact in their joint associations with CVD and mortality. Purpose To examine the associations of educational level with the incidence of CVD, including coronary heart disease (CHD) and stroke, and total mortality. Also, we examined the joint associations of educational level and the LE8 score with CVD incidence and total mortality. Methods We prospectively followed 91,744 Chinese adults from the Kailuan Study (2006-2021), who were free of CVD at baseline. Information on educational level, diet, lifestyle, and health conditions was collected every 2 years. LE8 score was calculated based on eight components: diet quality, physical activity, smoking status, sleep health, body mass index, blood lipids, blood glucose, and blood pressure. We used time-dependent Cox models to assess the associations of educational level with the outcomes as well as the joint associations of educational level and LE8 score, with adjustments for demographics, dietary and lifestyle factors, and medical history. Results During a mean follow-up of 13.1 years, there were 12,916 incident CVD cases and 13,090 deaths. Compared with the participants who only received illiteracy or elementary education, those who received high school education and above had a lower risk of CVD incidence (HR = 0.82, 95% CI = 0.76, 0.88), stroke incidence (0.72, (0.66, 0.79)), and total mortality (0.73, (0.68, 0.77)). Educational level was not associated with risk of CHD. Furthermore, significant additive interactions between educational attainment and LE8 score on the risk of CVD and mortality were observed (all p values for additive interactions <0.01). Compared with the participants who only received illiteracy or elementary education and had a low LE8 score, those who only received illiteracy or elementary education but had a high LE8 score still had a 27%-47% lower risk of CVD and total mortality, while those who received high school education and above and had a high LE8 score had a 51%-74% lower risk of CVD and total mortality. Conclusions Higher educational level was associated with a lower risk of CVD and mortality. These inverse associations were most apparent among participants with both a high educational level and a high LE8 score, while the participants with a low educational level but with a high LE8 score still had a significantly lower risk. These findings highlight the importance of improvement in educational attainment in preventing CVD events and deaths, and suggest that CVD events and deaths attributable to lower levels of education may be reduced by improving LE8 score.

Do shift-working nurses’ work-life quality relate to their physical health and diet quality?

Abstract Background Shift work negatively affects work-related quality of life and this situation causes significant labour force losses and decreased productivity in the society, especially health problems in nurses. This study was conducted to determine the relationship between work-related quality of life, physical health level and nutritional behaviours of nurses working in shifts. Methods This descriptive and relationship-seeking study was conducted with 312 nurses selected by quota sampling in Istanbul. Data were collected between December 2022 to July 2023 using the The Professional Quality of Life Scale (ProQOL), Physical Health Questionnaire and Food Consumption Frequency Questionnaire. Descriptive statistics and Pearson correlation tests were conducted on IBM SPSS 25.0. BeBIS 7.1 software were used for calculation diet index. Results Compassion Satisfaction (CS), Burnout (B) and Compassion Fatigue (CF) scores of nurses was examined, a relationship was found between CS score and B score (r=-0.39 p < 0.05) and between B score and CF score (r = 0.58 p < 0.05). CS score correlated with Cardiovascular Risk Level score (r=-0.15 p < 0.05) and diet index score (r = 0.15 p < 0.05). B score correlated with Gastrointestinal Risk Level score (r = 0.27 p < 0.05) and Cardiovascular Risk Level score (r = 0.38 p < 0.05). There was a correlation between the score of CF and Gastrointestinal Risk Level score (r = 0.25 p < 0.05) and Cardiovascular Risk Level score (r = 0.31 p < 0.05). Daily energy, fibre, vitamin B1 and C, folate, calcium and magnesium intakes of nurses were lower than the recommended. Conclusions Research results support that the gastrointestinal and cardiovascular systems have a direct relationship with stress and emotional states. In the policies to be developed within the scope of occupational health nursing practices, it is recommended to carry out studies to improve the physical health and nutritional behaviours of nurses in order to improve their work-related quality of life. Key messages • Nurses are a risky occupational group in terms of burnout. Protection studies should be prioritised to prevent burnout. • Gastrointestinal and cardiovascular system complaints of nurses should be paid special attention during recruitment and periodic examinations.

Sex differences in association between dietary sodium intake and white matter hyperintensity volume

Abstract Background There is limited evidence on the relationship between dietary sodium intake (dNa) and brain health, and very little on sex differences in associations. Purpose To study the relationship between dNa and imaging measures of brain health in men and women from the INSIGHT 46 substudy of the MRC National Survey of Health and Development (British 1946 birth cohort). Methods Participants had measurements (dNa using 5-day food diary, anthropometrics, blood pressure (BP) body mass index (BMI)) at 60-64years. Whole-brain and hippocampal volumes, white matter hyperintensity volume (WMHV) and florbetapir amyloid-β positivity were measured using MRI-PET imaging at 69-71years. Associations (β (95% confidence intervals)) were estimated separately in men and women using generalized linear models with robust standard errors adjusted for potential confounders (age, diet quality, energy intake, socioeconomic status) or potential mediators (BMI, BP). Results Participants’ characteristics are shown in Table 1. In women but not men dNa was positively associated with higher WMHV (β[women]=32(1, 72) %/g; p=0.043; β[men]=-10(-27, 11)%/g; p=0.342); this relationship in women was independent of BMI (β = 32(1, 72)%/g; p = 0.043) or systolic BP (β = 31(1, 70)%/g; p=0.041). dNa was not associated with total brain volume, hippocampal volume or amyloid-β positivity in either sex. Conclusions Elevated sodium consumption in the diet is associated with cerebral small vessel disease in older age women but not men. This association was independent of BMI or BP.Table 1

Predicting food consumption using contextual factors: An application of machine learning models

Abstract Background Improving diet quality relies on making manageable adjustments to eating behaviours. Personalised nutrition interventions hold promise for modifying behaviour. Machine learning (ML) offers a novel approach to examining dietary behaviours in personalised nutrition by leveraging data on past behaviours and environmental contexts. This study aims to investigate whether contextual factors at eating occasions (EO) can predict food consumption to enhance diet quality. Methods Cross sectional data from the Measuring Eating in Everyday Life Study (MEALS) were analysed (n = 675, 18-35y). A smartphone food diary app recorded dietary intakes at EO for 3-4 non-consecutive days, also capturing social-environmental (e.g., activity) and physical-environmental factors (e.g., consumption location). Participant characteristics were collected via an online survey. Food groups intake (servings per EO) followed Australian Dietary Guidelines. This study benchmarked two established models, gradient boost decision tree and random forest, which have previously shown high performance in similar tasks. Performance was evaluated using 10-fold cross-validation, measuring mean absolute error (MEA), root mean square error (RMSE), and R squared. Feature importance analysis identified key variables for predicting food consumption. Results ML predicts most food groups at EO using contextual factors, with slight differences between actual and predicted consumption (<1 serving per EO). For fruits, dairy, and meat, MEA values were 0.35, 0.34, and 0.56 servings, respectively (RMSE values: 0.61, 0.50, and 0.80 servings). Self-efficacy, age and consumption location were influential in most ML models. Conclusions ML offers insights into contextual factors and food consumption, suggesting directions for precision nutrition interventions. Future research should identify positive influences of contextual factors on dietary behaviours and incorporate these insights into interventions. Key messages • Machine learning can effectively predict food consumption based on contextual factors at eating occasions. • Understanding the influence of contextual factors such as consumption location on food consumption can inform the development of precision nutrition interventions aimed at improving diet quality.

Ultra-processed food intake and type 2 diabetes: A dose-response meta-analyses of prospective studies

Abstract Studies suggested a positive association between ultra-processed food (UPF) intake and risk of type 2 diabetes (T2DM). However, the magnitude of association varies across studies due to differences in population characteristics and methodological issues. It is also unclear about the exact shape of the association and whether the association is independent of diet quality and adiposity. We conducted a dose-response meta-analysis of prospective studies to summarize the association between UPF intake and T2DM risk. PubMed/MEDLINE, Web of Science, and Embase were searched through Jan. 2024 to identify relevant studies. Using random-effects models, summary relative risks (RRs) and 95% confidence intervals (CIs) were estimated for each of the following unit increment in UPF intake: 10% (of total g/d), 100-g/d, and 1-serving/d. A non-linear dose-response meta-analysis was conducted using restricted cubic spline analysis. After screening 569 publications, 12 prospective cohort studies were included in this study. The summary RRs associated with every 10%, 100-g, and 1-serving increment in UPF intake were 1.13 (95% CI = 1.10-1.16), 1.05 (95% CI = 1.03-1.06), and 1.04 (95% CI = 1.03-1.05), respectively. The positive associations remained statistically significant after additional adjustment for diet quality, BMI, and total energy intake. The dose-response curve for g/d of UPF intake suggested evidence of nonlinearity (p-nonlinearity=0.0005), showing a steeper increase in risk at UPF intake >300 g/d. However, evidence for non-linearity was not observed with % and serving/d of UPF intake. The association did not significantly vary by method and timing of UPF assessment. Higher summary RRs were observed among studies from Europe and North America compared with those from other countries (p-heterogeneity=0.048). Our data suggest that higher UPF intake may increase T2DM risk, independent of diet quality and adiposity. Key messages • Higher intake of ultra-processed food is positively associated with the risk of type 2 diabetes. • Public health strategies should encourage healthier dietary choices by emphasizing reduction of UPF intake in dietary guidelines and implementing regulations on manufacturing and labeling of UPF.

Characterising users of community-based interventions designed to improve the food practices

Abstract Promoting affordable ways to help low-income families improve dietary behaviours and achieve a healthy weight represents a priority for UK public health policy. For such interventions to be appropriately tailored and targeted, it is important to better understand the intended recipients. The present study aimed to assess the dietary practices and psychosocial characteristics of users of Aberdeen City community-based interventions (e.g., food banks, pantries, social cafés) designed to support low-income communities in accessing food and engaging in healthier food practices. From January to June 2023, a cross-sectional survey was conducted employing convenience sampling among users of community-based interventions (N = 105; 73 females). The questionnaire assessed diet quality (SFFQ), household food insecurity (HFIAS), mental health (PHQ-4), well-being (Cantril Ladder), intention and self-efficacy toward healthy eating, and sociodemographic variables. Data were analysed using descriptive statistics, group comparisons, correlations, and regression analyses. Results indicated that community-based food provision users are highly vulnerable to food insecurity. Among participants, 53.3% reported severe food insecurity, and 18.1% reported moderate levels. Service users’ diets were high in discretionary foods and drinks (26% consume daily >1 portion of fizzy juice, 18.2% sweets, 16.7% crisps vs. 11.5% fruits and 10.6% vegetables). The mean dietary quality score was 9.48 (SD = 1.90) from a possible 15. Higher food insecurity and lower diet quality were significantly associated with greater mental distress (r=.41, p<.001; r=-.287, p=.005;) and poorer well-being (r=-.460, p<.001; r=.19, p=.049;). This study is part of a larger project aiming to optimise community-based dietary interventions for low-income populations. The results provide a clearer picture of the intended beneficiaries of such interventions and highlight user needs that can be prioritised in optimisation efforts. Key messages • Community-based food provision users are highly vulnerable to food insecurity and related negative health experiences. • The burden of poor diet and its associated health consequences disproportionately affect those living in the most deprived communities.

The updated nutrient profile underlying the Nutri-Score label and adult weight gain: A cohort study

Abstract Introduction Nutrient profiling systems are key tools in the development of nutrition-related policies. Their prospective associations with health outcomes are a crucial step in assessing their validity as public health measures. In 2023, the nutrient profiling system underlying the Nutri-Score -a nutrition front-of-pack label used in the European Union- was updated. The present study aims to investigate the updated nutrient profile’s association with weight gain, overweight and obesity. Methods The dietary and anthropometric data of 75,775 participants of the Nutrinet-Santé cohort study was retrieved for this study. Standardized dietary indices derived from both nutrient profiling systems (the 2015 NS-NPM DI (initial profile) and 2023 NS-NPM DI (updated profile)) were computed based on at least 3 24-hour dietary records upon the first two years of inclusion in the cohort. The associations between these indices and the risk of developing overweight and obesity were assessed using Cox proportional hazard models and weight gain using mixed models. Results Participants with a higher 2023 NS-NPM DI (i.e. a poorer nutritional quality of diet) were more likely to gain BMI over time (T3 vs. T1: +0.23% points of BMI/year, p < 0.0001), had a higher risk of developing overweight (HR T3 vs. T1: 1.33 [95% CI: 1.24-1.43]) and obesity (HR T3 vs. T1: 1.29 [95% CI: 1.14-1.45]). Overall, the 2015 NS-NPM DI displayed similar associations and effect sizes with the outcomes and the predictive ability of the two indices on overweight and obesity risk was not significantly different (p = 0.32 for overweight risk, p = 0.09 for obesity risk). Conclusions These results constitute a step in the validation of the recently updated nutrient profiling system and help support its use in public policies for non-communicable diseases prevention. Key messages • The 2023 updated nutrient profiling system underlying the Nutri-Score was associated with weight gain and obesity, two important risk factors in the development of non-communicable diseases. • The 2015 and 2023 NS-NPM DI showed similar prospective associations with overweight and obesity risk.

A repositioning nudge to encourage healthier snack purchases at a supermarket in a deprived area

Abstract Background Diet quality positively correlates with socio-economic position (SEP). While nudges are often proposed as promising policy tools for promoting health behavior among lower SEP groups, research addressing their impact within lower SEP groups is limited. This study aimed to 1) examine the efficacy of a checkout repositioning nudge in a supermarket in a deprived area in encouraging purchases of healthier snacks, and 2) describe customers’ preferences and needs regarding grocery shopping and healthy eating. Methods Daily sales data were collected over four-week control and intervention periods. During the intervention, unhealthy snacks at the checkout were replaced by healthier snacks. Additionally, questionnaires were administered among customers (N = 90). Results The intervention led to a significant increase in daily sales of healthier snacks (M = 3.14, SD = 2.45) compared to the control period (M = 0.54, SD = 0.96), t(27) = 5.62, p < .001. Despite a statistically significant nudge-effect, the absolute daily sales of healthier snacks remains extremely low. No difference in daily sales of unhealthy snacks was observed between both periods. Questionnaire data showed that customers report to seldomly purchase snacks at the checkout, find it important to eat healthily, think well about what they buy in a supermarket, and long for a healthier and more affordable food offer within the supermarket. Conclusions Interventions that are effective among higher SEP groups, such as repositioning nudges, may not be suitable for the circumstances and needs of lower SEP groups. To combat existing health inequalities, interventions must be tailored to lower SEP groups. More system-level interventions that target the healthiness and affordability of the offer may be needed. Key messages • Although nudging is often proposed as a promising policy approach for improving health behavior among lower SEP groups, repositioning nudges may not suit their circumstances and needs. • To combat health inequalities, interventions must be tailored to lower SEP groups and integrated with system-level policies (e.g., targeting the healthiness and price of the offer in supermarkets).

Vitamin C intake, psychological distress and health outcomes in patients with heart failure

Abstract Background Patients with heart failure (HF) have lower dietary vitamin C intake than healthy adults, which may increase oxidative stress and worsen important patient-reported health outcomes (functional status and quality of life [QOL]). Patients with HF are more likely to have higher levels of psychological distress (anxiety and depressive symptoms). However, it is not known whether psychological distress is a link in the association of dietary vitamin C with health outcomes. Objective To examine the inter-relationships among dietary vitamin C intake, psychological distress (anxiety and depressive symptoms), and health outcomes (functional status and QOL) in patients with HF. Method We performed a secondary analysis of baseline data from 206 adults with HF (female: 33%, age: 61±12, NYHA class III/IV: 44%) with complete data on dietary vitamin C intake, anxiety, depressive symptoms, functional status, and QOL. Dietary vitamin C intake was assessed using a 4-day food diary and analyzed using the Nutrition Data System for Research software program. Low dietary vitamin C intake was defined as averaged daily intake below the estimated average requirement (EAR) from the Institute of Medicine of 75 mg/day for men and 60 mg/day for women. Anxiety was assessed using the Brief Symptom Inventory Anxiety subscale. Depressive symptoms were assessed using the Beck Depression Inventory II. Functional status was measured using the Duke Activity Status Index. Quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. Linear regression was conducted using the PROCESS macro in SPSS. Results Eighty-four patients (41%) had low dietary vitamin C intake based on the EAR standard. In bivariate analyses, patients with low dietary vitamin C intake had higher levels of anxiety, depressive symptoms, poorer functional status, and worse QOL (all p <.005). In the mediation regression model, low dietary vitamin C intake was directly associated with higher levels of anxiety, but not with depressive symptoms. Depressive symptoms were directly associated with functional status and QOL. Dietary vitamin C intake was not directly associated with functional status or QOL. Low dietary vitamin C intake was indirectly associated with poor functional status through higher levels of anxiety and depressive symptoms (Figure 1). Similarly, low dietary vitamin C intake was indirectly associated with worse QOL (Figure 2). Conclusion Anxiety and depressive symptoms link the relationship between dietary vitamin C intake and functional status and between dietary vitamin C intake and QOL. Our findings highlight the importance of including interventions to enhance diet quality and psychological well-being as part of HF treatment to improve health outcomes.Vitamin C and functional statusVitamin C and quality of life

Mediterranean Diet, ultra-processed food consumption and semen quality in healthy young men

Abstract Background Diet quality can have beneficial effects on male reproductive health, although studies are still limited, and little is known on the potential impact of ultra-processed foods (UPFs) on semen quality parameters. Methods A cross-sectional analysis was run on 126 participants (mean age 20.0 ± 1.2 y) from the FAST randomized controlled trial in 2018-2019. Food intake was assessed through a FFQ. UPF was defined following the Nova classification and calculated as the ratio (weight ratio) between UPF (g/d) and total food (g/d). Adherence to the Mediterranean Diet (MD) was ascertained by the Mediterranean Diet Score (MDS). The semen analyses were performed using a microscope for optical evaluation with a Makler counting chamber and two automated semen analysers. The primary outcomes were sperm volume, concentration, motility and morphology. A hierarchical mixed model approach was utilized to accommodate the within-subject correlation arising from the triple temporal repetition of measurements. Results Highest UPF consumption (Q4), compared to lowest (Q1), was associated with lower sperm concentration (β=-54.1×106 spz./ml; 95%CI: -92.9 to -15.4; p-trend=0.002 across quarters), and progressive motility (β=-14.2%; 95%CI: -28.2 to -0.09; p-trend=0.036). The percentage of cells with normal morphology tended to be reduced in young men consuming more UPF compared to lowest intake (β=-2.93%; 95%CI: -6.22 to 0.37; p-trend=0.071). The MDS was not associated with any of the parameters under study. Conclusions A larger dietary share of UPF was inversely associated with sperm concentration and progressive motility in young men of reproductive age. MD adherence was not associated with semen quality parameters, and this is possibly due to the low variability of MD adherence in this sample. Dietary recommendations for improving sperm health should prioritize limiting UPF in the diet. Key messages • Ultra-processed food (UPF) intake was unfavourably associated with semen quality parameters amongst young men. • Dietary recommendations for improving sperm health should recommend limiting UPF.

Food insecurity is associated with poor mental health and health risk behaviors in Czechia

Abstract Background Food insecurity (FI) is one of social determinants of health and a profound public health concern because it leads to malnutrition and hence poor health. COVID-19 impacted people disproportionately and exacerbated preexisting social and health inequalities. The aim of this study was to understand how socioeconomic and health conditions affected one’s FI in Czechia during the pandemic using a representative panel of Czech adults from a longitudinal survey, Life During the Pandemic collected in October 2022 as part of a Czech longitudinal survey. Methods A study sample of 1,499 respondents was included in our multiple logistic regression models. Depressive symptoms and anxiety symptoms were assessed using validated questionnaires PHQ-2 and DAG-2. Results Approximately one third of the study sample (32.4%) reported being food insecure. In the fully-adjusted model, adults with depressive symptoms (OR 2.37, CI 1.49, 5.02), problems with sleeping (OR 2.20, CI 1.64, 2.96), smoking habit (OR 2.27, CI 1.68, 3.07), lower fruit and vegetable consumption (OR 1.50, CI 1.04, 2.17) had greater odds of experiencing FI. The lowest income group was associated with 6.2 times greater odds of reporting FI as compared to the high-income group (CI 3.96, 9.67). Lower education attainment also had higher odds of experiencing FI (OR 2.15, CI 1.40, 3.31). Anxiety was not a significant predictor for FI. Conclusions Our study highlights that food insecurity is associated with depressive symptoms, poor quality of sleep and lower consumption of fruit and vegetables among adults. Food insecurity was also evident among lower income and lower education attainment. Funding source This study was supported by The Charles University Grant Agency (GA UK). Key messages • Our study suggests that adults with poor mental health and diet quality experience food insecurity. • Given the established link between a balanced diet and mental well-being, interventions should encompass not only food security but also the quality of dietary intake.

Comparison of diet quality indices for predicting metabolic syndrome in Iran: cross-sectional findings from the persian cohort study

BackgroundThe metabolic syndrome (MetS) comprises metabolic irregularities, including hypertension and central obesity, which are influenced by genetic, metabolic, environmental, and dietary factors. As diet and lifestyle are risk factors for MetS, it is important to know which diet quality index better predicts MetS. The aim of this study is to compare the ability of different diet quality indices in predicting MetS and to identify the most effective one.MethodsThis cross-sectional study involved 5,206 participants aged 35 to 70 engaged in the Prospective Epidemiological Research Study in Iran (PERSIAN) cohort. Assessment of one year’s food intake via a validated 134-item semi-quantitative food frequency questionnaire (FFQ) facilitated the calculation of adherence to five diet quality indices: Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), Dietary Inflammatory Index (DII), and Diet Quality Indices (DQI). While bivariate Pearson correlation and binary logistic regression aided in identifying the strongest correlation and predictor for MetS among the indices.ResultsThis study showed a significant association between adhering to the DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, and the odds of developing MetS (OR: 0.94, (95% CI: 0.93–0.95), OR: 0.85, (95% CI: 0.81–0.89), OR: 0.84, (95% CI: 0.80–0.89), OR: 1.22, (95%CI: 1.11–1.34), OR: 0.95, (95%CI 0.94–0.96) respectively). Therefore, with each unit increase in DASH diet score, Mediterranean diet score, MIND diet score, DII score, and DQI score, the odds of MetS was reduced by 5.4%, 14.5%, 15.6%, 22%, 5%, respectively. All the indices were correlated with the intake of most of the micronutrients, with the strongest correlations being observed in the DII. DASH diet score aligned with the most favourable MetS biomarker risk, while DII score primarily associated with MetS and could be considered as a predictor for MetS.ConclusionThe present study’s findings reveal that between all these five diet quality indices, the DASH diet score correlates strongly with a favourable biomarker risk profile, while the DII score is predominantly linked to MetS.

Association of a healthy plant-based heart-protective diet with reduced cardiovascular disease incidence and mortality: findings from the UK Biobank Study

Abstract Importance Previous research examining the effects of omnivorous and plant-based diets on CVD outcomes has produced inconsistent findings, and the importance of diet quality is overlooked. Objective To assess the relation between adherence to a healthy plant-based, heart-protective diet and the risk of cardiovascular disease (CVD) events. Design: Prospective cohort study. Methods and Results 192,274 (mean age: 56.3±7.9 years, 43.3% males) participants in UK Biobank without CVD at baseline who completed a 24-hour recall questionnaire. Using data generated by Oxford WebQ, we developed a novel heart-protective diet score (HPDS) based on 22 food groups. Cox proportional hazard models were used to study associations. During a median follow-up of 12.3 years, there were 20,692 CVD events and 1,131 CVD deaths. After adjusting for demographics, Townsend deprivation index, lifestyle factors, and history of chronic diseases, participants in the top quartile of the HPDS were at the lower risk of overall CVD (HR: 0.92, 95% CI: 0.88 to 0.95), ischemic heart disease (HR: 0.88 [95% CI: 0.83 to 0.93]), myocardial infarction (HR: 0.82, 95% CI: 0.74 to 0.90), and heart failure (HR: 0.86, 95% CI: 0.78 to 0.95) than those in the bottom quartile. Participants who adhered closely to a healthy plant-based heart-protective diet had the lowest risk of overall CVD (HR: 0.72, 95% CI: 0.61 to 0.86), ischemic heart disease (HR: 0.68, 95% CI: 0.52 to 0.89), myocardial infarction (HR: 0.65, 95% CI: 0.46 to 0.91), and heart failure (HR: 0.51, 95% CI: 0.30 to 0.85) mortality. Conclusions and relevance: Adherence to a healthy plant-based heart-protective diet rich in non-starchy vegetables, fruits, whole grains, legumes, and fish, is associated with a reduced cardiovascular disease incidence and mortality. Further research in diverse ethnic populations is necessary to validate our findings and enhance their generalizability.

Does Contract Farming Improve Diet Quality? The Case of Senegalese Smallholders

ABSTRACTThe institution of contract farming has gained prominence in most developing countries owing to its numerous benefits. While several studies have already highlighted the welfare benefits of contract farming, very few have investigated the effects on diet quality, despite poor quality diets being a serious challenge in most parts of the developing world. Moreover, such existing studies deal with contract farming in speciality crops, although contract farming in staple crops may have different effects on diet quality. Therefore, this study evaluates the role of staple crop contracts on diet quality, proxied by two measures of dietary diversity. Using cross‐sectional data from rice‐producing households in Senegal, we employ linear models through ordinary least squares to estimate the relationship between contract farming and diet quality. Our results show that participation in contract farming is positively associated with household dietary diversity and hence, diet quality. Our results further show that income is the main pathway through which contracts and diet quality are associated. With increasing calls for agriculture to be nutrition‐sensitive, our results suggest that the institution of contract farming can play an important role in this regard by improving diet quality.

Ultra-Processed Food Consumption and Its Relationship with Diet Quality Among Malaysian Young Adults

The global rise in ultra-processed food (UPF) consumption presents potential public health challenges. UPFs, laden with additives and extensively marketed, are increasingly prevalent in modern diets. However, there is limited research on UPF consumption among Malaysian young adults, particularly its relationship with diet quality. This cross-sectional study aimed to investigate the relationship between UPF consumption and diet quality among 177 young adults aged 18 to 29 years from Terengganu, Johor, and Perak. A two-day 24-hour dietary recall was used to assess UPF intake, classified by the NOVA system, while diet quality was evaluated using the Standardised-Malaysian Healthy Eating Index (S-MHEI). The S-MHEI was adopted with the scores for each food group (adequacy component) calculated according to the recommended servings per food group expressed per 1,000 kcaL. Statistical analyses, including Spearman correlation, were conducted using SPSS version 25 to determine the relationship between UPF consumption and diet quality with statistical significance set at p<0.05. The median total energy intake was 1,417 kcaL (IQR=735.38), with UPFs contributing 38.6% of this intake. The median S-MHEI score was 44.65 (IQR=12.77), indicating that 74.6% of participants had poor diet quality. Statistical analysis found no significant relationship between UPF consumption and diet quality (p=0.395). Although no significant association was found, this study lays the groundwork for further research on nutrition and health among Malaysian young adults.

Dietary patterns among European children and their association with adiposity-related outcomes: a multi-country study.

Children's diets in school-age are inherently unhealthy, with few meeting dietary recommendations. Yet, little is known about similarities and differences on dietary patterns across countries and their association with obesity. We aimed to derive dietary patterns in childhood and explore their association with adiposity-related outcomes in childhood and adolescence. This study included data from six European countries (Spain, France, UK, Greece, Lithuania and Norway) during childhood (n = 1597) and adolescence (n = 803). Using a food frequency questionnaire, we derived data-driven dietary patterns through exploratory factor analyses and calculated the Mediterranean KIDMED index. We assessed body mass index z-score (zBMI), fat mass proportion and waist-to-height ratio at both visits. Associations were estimated using generalized linear regressions, adjusted for key-confounders. "Meat", "Dairy", "Western", "Healthy" and "Sweets and fats" dietary patterns were derived. Norwegian children showed better diet quality, with higher consumption of fruits and vegetables, and highest "Healthy pattern" adherence, and Lithuanian children, the worst, with higher sweets consumption, and highest "Western pattern" adherence. Children with lower intake of healthy foods (vegetables, fruits, fish) tended to have higher adiposity, e.g., children with average or low "Healthy pattern" adherence (vs. high) had higher fat mass proportion in childhood (average: β (95% CI) 1.44 (0.48; 2.39), low: 1.10 (0.09; 2.12)). Low adherence to a "Healthy pattern" (vs. high) was associated with increased adolescent zBMI, and child and adolescent waist-to-height ratio. Low "Dairy pattern" adherence (vs. high), was associated with lower zBMI and fat mass in childhood, but not in adolescence. No significant associations were seen with the KIDMED index. Many European children have poor diets and a low adherence to a healthy diet pattern may be of concern for adiposity-related outcomes. Assessment of children's dietary patterns can help tailor dietary advice and provide support for families aiming to prevent future excess weight gain.

Combined association between dietary antioxidant quality score and leisure-time physical activity on sleep pattern in cancer survivors: a cross-sectional study of NHANES database.

This study aimed to explore the combined association between the dietary antioxidant quality score (DAQS) and leisure-time physical activity on sleep patterns in cancer survivors. Data of cancer survivors were extracted from the National Health and Nutrition Examination Surveys (NHANES) database in 2007-2014 in this cross-sectional study. Weighted multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association of DAQS and leisure-time physical activity on sleep patterns. The combined association was also assessed in subgroups of participants based on age, and use of painkillers and antidepressants. Among the eligible participants, 1,133 had unhealthy sleep patterns. After adjusting for covariates, compared to low DAQS level combined with leisure-time physical activity level <600 MET·min/week, high DAQS level combined with leisure-time physical activity ≥600 MET·min/week was associated with lower odds of unhealthy sleep patterns (OR=0.41, 95%CI: 0.23-0.72). Additionally, the association of high DAQS level combined with high leisure-time physical activity with low odds of unhealthy sleep patterns was also significant in <65 years old (OR=0.30, 95%CI: 0.13-0.70), non-painkiller (OR=0.39, 95%CI: 0.22-0.71), non-antidepressant (OR=0.49, 95%CI: 0.26-0.91) and antidepressant (OR=0.11, 95%CI: 0.02-0.50) subgroups. DAQS and leisure-time physical activity had a combined association on sleep patterns in cancer survivors. However, the causal associations of dietary nutrient intake and physical activity with sleep patterns in cancer survivors needs further clarification.

Integrating environmental sustainability into food-based dietary guidelines in the Nordic countries.

The overall aim of this paper was to provide background knowledge to the Nordic Nutrition Recommendations 2023 Committee for integrating environmental sustainability in a framework for national Food-Based Dietary Guidelines (FBDG) within the Nordics and Baltics. Additionally, this paper aims to give an overview of recent Nordic scientific literature on environmental impact of foods and dietary patterns and of the FBDG of the Nordics. Finally, we suggest methods for developing national sustainable FBDG. Nordic and Baltic studies on sustainability of diets were searched in August 2022 and complemented with additional relevant literature. The studies show that current diets are far from environmentally sustainable, exceeding planetary boundaries for most impact categories; meat and dairy products being the largest contributors to dietary greenhouse gas emissions (GHGEs) and land use. Scenario, modelling, optimisation and intervention studies confirm the potential of shifting towards more plant-based diets to improve overall diet quality in terms of both health and environmental sustainability. Such diets comprised of vegetables, fruits, legumes, potatoes, whole grain and refined cereal products, nuts, seeds and vegetable oils, with animal foods in moderate or limited amounts. The FBDG in the Nordics promotes more plant-based diets than the current average diet but could improve from further integration of environmental sustainability. To form basis for sustainable FBDG dietary modelling at the national level, prioritising health outcomes and nutritional adequacy is essential. Second, integrating environmental sustainability involves estimating the impact of food choices and amounts on GHGE, land and water use, eutrophication and biodiversity loss. Exploring positive and negative implications of fortified foods and supplementation in relation to nutrient intake, health and environmental sustainability may be needed. Implementing dietary transition requires solutions beyond FBDG to ensure affordability, acceptability and ease of adaption.

Sleep, dietary intake and physical activity changes with onset of shift work in intern paramedics

Paramedic work is associated with high staff turn-over, insufficient sleep and adverse health outcomes. Our understanding of the relationship between paramedic work and the health behaviours that may precede adverse health outcomes is limited, as few longitudinal studies have examined health behaviours in workers before they commence on the road work. Such research is needed to inform evidence-based recommendations specifically for new paramedics. The current observational cohort study examined self-reported sleep, dietary intake and physical activity in 21 intern paramedics: 15 female and 6 male (median age: 23.0 years [interquartile range (IQR): 4.0]) from an Australian ambulance service. A subset of participants ( n = 16) provided fasting blood samples for cardiometabolic markers (cholesterol, triglycerides and fasting glucose). Data were collected quarterly (pre-shift work, 3 months, 6 months, 9 months and 12 months post commencement). Linear mixed models showed that the first 12 months of shift work were associated with poorer sleep quality ( p = .036), consumption of fewer kilojoules ( p = .026), reduced saturated fat consumption ( p = .005) and lower sodium ( p = .043) and sugar ( p = .038) intake. There were significant increases in leisure time physical activity ( p = .008). This study shows negative changes in sleep quality and improvements in diet and leisure time physical activity during the first 12 months of paramedic work. Individual differences observed in this study, and ongoing suboptimal dietary intake, highlight a need for larger studies with more participants and a focus on personalised strategies for new recruit paramedics.