Background The role of dietary patterns in the primary prevention of specific autoimmune conditions remains poorly understood. Objective To evaluate the association between Mediterranean Diet (MedDiet) adherence and the risk of incident rheumatoid arthritis and psoriasis. Methods We conducted a prospective analysis of 15,874 IMID-free participants from the SUN Project cohort (median follow-up: 15.1 years). The outcomes were the incidence of rheumatoid arthritis and psoriasis. Adherence to the MedDiet was repeatedly assessed using validated food-frequency questionnaires with the Mediterranean Diet Score (MDS) and classified into energy-adjusted tertiles. Incident cases were identified through biennial questionnaires. Primary analyses used Cox proportional hazards models with cumulative average dietary exposure. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated from multivariable models, stratified by age and follow-up period and adjusted for sociodemographic, lifestyle, and clinical confounders. Results During follow-up, we identified 165 incident cases of psoriasis (0.73 per 1,000 person-years) and 119 incident cases of rheumatoid arthritis (0.52 per 1,000 person-years). High MedDiet adherence (T3 compared with T1) was inversely associated with rheumatoid arthritis risk (HR=0.53; 95% CI: 0.32, 0.89; p-trend=0.020). For psoriasis, higher adherence showed a non-significant inverse association (HR=0.86; 95% CI: 0.57, 1.32; p-trend=0.491). In exploratory item-by-item analyses for rheumatoid arthritis, lower meat intake and higher fruit/nut intake were associated with lower disease risk (HR=0.41; 95% CI: 0.27, 0.61; HR=0.64; 95% CI: 0.43, 0.95, respectively). Conclusions High MedDiet adherence was inversely associated with the risk of incident rheumatoid arthritis among Spanish university graduates, whereas the association for psoriasis remained inconclusive. Clinical Trial Registry number and website where it was obtained Clinical Trials Registry: NCT02669602; Website: https://clinicaltrials.gov/study/NCT02669602
Background Fat-free mass (FFM) loss after metabolic bariatric surgery (MBS) may influence physical function, metabolic health, and quality of life. Whether FFM loss differs by sex and menopausal status and whether it relates to cardiorespiratory fitness (CRF) remain unclear. Objectives This study aimed to investigate patterns of FFM loss in males, premenopausal females, and postmenopausal females after MBS and to assess relationships between FFM and CRF before and after surgery. Methods In this longitudinal cohort study, individuals undergoing primary MBS with ≥18 mo of follow-up were included. Body weight and FFM were measured preoperatively and at intervals ≤72 mo. CRF was assessed using the Åstrand submaximal bicycle test. Changes in total weight loss (%TWL), FFM, and CRF were analyzed using linear mixed models. Associations between FFM and CRF were analyzed using Kendall’s τ and linear mixed models. Results The study included 1022 individuals: 221 males, 614 premenopausal females, and 187 postmenopausal females. Males exhibited the greatest absolute FFM loss, whereas premenopausal females lost the lowest proportion relative to TWL (%FFM/WL). At 24 mo, %FFM/WL was 24.7% in premenopausal females compared with 27.1% in males and 28.7% in postmenopausal females. Despite substantial FFM reductions, maximal oxygen consumption improved significantly in all groups. FFM correlated positively with CRF at baseline and until 24 mo in males and premenopausal females; however, postoperative FFM changes were not independently associated with CRF (β: −0.004; 95% confidence interval: −0.008, 0.001). Conclusions FFM loss after MBS differs by sex and menopausal status: males and postmenopausal females lose a greater proportion of FFM relative to TWL than premenopausal females. Nevertheless, CRF improves across all groups, showing postoperative gains in CRF can occur despite FFM reductions. These findings highlight substantial interindividual variability in the composition of weight loss after MBS, which is not fully explained by biological sex, menopausal status, or baseline adiposity.This trial was registered at Centrale Commissie Mensgebonden Onderzoek (CCMO) as NL751466.018.20 (https://onderzoekmetmensen.nl/en/node/27224/pdf).
Background Associations of the macronutrient composition of the diet with risks of postmenopausal breast and colorectal cancer (CRC) are uncertain, partly because of reliance on self-reported dietary data. Objectives We aimed to study biomarker development for several macronutrient component densities using serum and spot urine metabolomics and, when appropriate, to assess their associations with breast cancer and CRC risks in a Women’s Health Initiative (WHI) cohort of postmenopausal U.S. females. Design and Methods We explored linear biomarker equations for log-transformed macronutrient component densities using fasting serum metabolomic profiles, with and without spot urine, in a WHI feeding study (n=153). We used equations satisfying a cross-validated regression R2 (CV-R2) criterion to calculate potential biomarker values for 577 breast cancer cases and 181 colorectal cancer cases and their 1-1 matched controls. We used Cox regression with baseline stratification on matched pairs to examine dietary composition associations with cancer risk. Results Serum-based biomarker equations for macronutrient component densities had CV-R2 values as follows: polyunsaturated fatty acids (PUFA) 46.7%, monounsaturated fatty acids (MUFA) 36.3%, saturated fatty acids (SFA) 33.6%, carbohydrate 32.3%, and protein 29.4%. The inclusion of spot urine metabolites did not materially improve these values. In analyses including serum-based PUFA, MUFA, SFA and carbohydrate densities the breast cancer hazard ratios (95% CIs) for 20% increments in dietary densities were 0.98 (0.89, 1.07) for PUFA and 1.14 (0.97, 1.33) for MUFA. Corresponding CRC hazard ratios were 0.98 (0.81, 1.17) and 1.46 (1.10, 1.93). Analyses based on food frequency questionnaires differed from these estimates for breast cancer, but tended to agree for CRC. Intakes of dairy and meat products may help to explain observed associations. Conclusions In a population of U.S. postmenopausal females dietary MUFA density was associated with an elevation in CRC risk. Breast cancer associations with biomarker-based macronutrient densities require further developmentThis study is registered with clinicaltrials.gov identifier: NCT00000611 https://clinicaltrials.gov/study/NCT00000611.
BACKGROUND:Type 2 diabetes (T2D) is associated with an increased risk of premature death. Diet may influence long-term health outcomes among individuals with T2D, but prospective evidence on dietary patterns and mortality remains limited. OBJECTIVES:To prospectively examine associations of eleven pre-defined or empirically-developed dietary patterns with all-cause and cause-specific mortality (e.g., cardiovascular disease [CVD] and cancer) among U.S. individuals with T2D. METHODS:We included 7,795 participants with incident T2D in the Nurses' Health Study (1984-2016) and Health Professionals Follow-Up Study (1986-2020), who were free of CVD and cancer at diagnosis. Diet was assessed using a validated food frequency questionnaire and updated every four years. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs. RESULTS:Over 24 years of follow-up, 3,509 deaths were confirmed, including 1,079 from CVD and 649 from cancer. Adherence to healthy dietary patterns after diagnosis (comparing the 90th with the 10th percentile of dietary pattern scores) was consistently associated with lower all-cause mortality, with multivariable-adjusted HRs ranging from 0.78 (95% CI: 0.71, 0.85) for the Planetary Health Diet to 0.92 (95% CI: 0.84, 1.01) for the Dietary Approaches to Stop Hypertension. Furthermore, greater improvements in dietary pattern adherence from pre- to post-diagnosis (comparing the 90th with the 10th percentile of change scores) were also associated with lower all-cause mortality, with HRs (95% CI) ranging from 0.63 (0.58, 0.70) to 0.92 (0.85, 1.01). A similar pattern of inverse associations with CVD mortality was also observed for these dietary scores. Additionally, the reversed Empirical Dietary Index for Hyperinsulinemia was specifically associated with lower cancer mortality. CONCLUSIONS:Adherence to healthy dietary patterns is universally associated with better survival in individuals with T2D. These findings suggest the importance of consuming high-quality diets in the prevention of premature deaths among individuals with T2D.
BACKGROUND:Variations in early-life growth patterns may reflect differences in early postnatal exposures influencing child attention and memory. OBJECTIVE:We identified growth trajectories and explored their associations with attention and memory among infants and young children across time points. METHODS:Anthropometric data were collected from cohorts in Malawi (n=600) and suburban California, USA (n=101) at birth and at 6-9, 8-12, and 11-15 months. Latent class trajectory modeling identified sex-specific growth pattern classes for weight and weight-for-age z-score in both cohorts, and for length, length-for-age, and weight-for-length z-scores in Malawi. In a subgroup (n=458 in Malawi; n=92 in the USA), associations between growth trajectories and cognitive outcomes were assessed with eye-tracking between 6-15 months. The Infant Orienting with Attention task measured attention (reaction time, task error); Visual Paired Comparison task measured memory (novelty preference, peak look duration, shift rate; only in Malawi). Mixed effects models evaluated associations, adjusting for child, parental, and household characteristics, with trajectories closest to WHO standards used as reference groups. RESULTS:Growth trajectories varied by cohort, aligning with WHO standards and others showing acceleration or deceleration. In Malawi, girls with lowest-linear trajectories had slower reaction times at 6-9 months; differences ranging from 69.84 (95% CI: 21.49, 118.19) to 86.57 ms (25.32, 147.82). Boys with low-linear trajectories showed faster reaction times [-25.72 (-48.99, -2.46) to -54.69 ms (-90.36, -19.02)] but lower shift rate (-0.06 shifts/s; -0.12, 0.00). In the USA, boys with high-weight trajectory had slower reaction times by 24.85 ms (1.29, 48.41) at 11-12 months. At 12-15 months, boys with high-weight trajectory in Malawi demonstrated poorer novelty preference (-0.14 on a 0-1 scale; -0.24, -0.04). CONCLUSIONS:Exploratory findings suggest that early growth patterns are linked to attention and memory especially among boys, highlighting the importance of longitudinal sex-specific evaluation. CLINICAL TRIAL REGISTRY NUMBER:NCT03385252 (Mazira study; https://clinicaltrials.gov/study/NCT03385252), NCT03229863 (IMiND study; https://clinicaltrials.gov/study/NCT03229863).
BACKGROUND:Microbial fermentation of undigested proteins in the large intestine can produce potentially harmful metabolites. While protein intake increases large intestinal protein inflow, the effects of dietary protein composition and digestibility are largely unknown. OBJECTIVE:To investigate the effects of protein sources differing in amino acid (AA) composition and digestibility on protein fermentation biomarkers (primary outcomes), digesta transit, and gut microbiome composition (secondary outcomes), by contrasting protein and precursor AA delivery into the large intestine using two purified protein sources. METHODS:Fifteen healthy adults participated in a randomized, controlled, crossover dietary intervention consuming bovine plasma protein (BPP, poorly digestible) or whey protein isolate (WPI, highly digestible) at 30g/d, divided over 3 meals, for 7-days. Intervention periods were separated by a 7-day washout. Plasma, urine, and fecal samples were analyzed for protein fermentation biomarkers, followed by linear mixed-effects-model analysis. RESULTS:In vitro degree of hydrolysis did not differ between BPP and WPI (32.6±1.38% vs. 26.3±0.05%, P=0.10). Postprandial plasma total AA concentrations were also similar (BPP: 8997±2673 μM, WPI: 9787±3380 μM, P=0.57, n=13). Compared with WPI, BPP consumption induced higher plasma concentrations of p-cresyl sulfate (41.0±27.4 vs 28.5±19.6, P<0.01), phenyl sulfate (2.1±0.6 vs 1.8±0.4, P=0.03), phenylacetyl-L-glutamine (2.3±1.5 vs 1.7±1.2, P<0.01), and indoxyl sulfate (4.8±1.8 vs 3.6±1.4, P=0.03). Urinary p-cresyl sulfate (111.4±63.6 vs 90.9±56.7, P=0.03), phenyl sulfate (13.6±6.1 vs 9.7±2.6, P=0.03), and phenylacetyl-L-glutamine concentrations (55.1±32.2 vs 41.6±25.6, P=0.01) were also higher during BPP consumption. Protein source did not affect fecal ammonia, BCFA, or microbial diversity. BPP consumption tended to prolong colonic transit time (11:54 hh:mm, P=0.07). CONCLUSIONS:Consumption of BPP resulted in higher plasma and urinary concentrations of aromatic AA-derived microbial metabolites than WPI. These differences were most likely driven by AA composition rather than digestibility, as in vitro digestibility and postprandial AA responses differed less than expected between the protein sources. CLINICAL TRIAL REGISTRY NUMBER:NCT06161155 (https://clinicaltrials.gov/study/NCT06161155).
BACKGROUND:Maternal protein intake during pregnancy may influence long-term obesity risk in mothers and offspring, but the role of specific dietary protein sources remains unclear. OBJECTIVE:To examine associations of major dietary protein sources during pregnancy with maternal postpartum weight retention (PPWR) and offspring overweight/obesity, and to evaluate isocaloric substitution between sources. METHODS:In 59,791 mothers from the Danish National Birth Cohort (1996-2002), diet at gestational week 25 was assessed by a validated food-frequency questionnaire. Log-binomial regression and isocaloric substitution models estimated adjusted relative risks (RRs) for maternal PPWR >5 kg at 6-18 months postpartum and offspring overweight/obesity at ages 7-11 years. RESULTS:Overall, 10,678 (22.1%) mothers had PPWR >5 kg and 8,287 (19.0%) offspring developed overweight/obesity. Comparing highest with lowest quintile of intake (% energy), higher total plant (RR 0.86; 95% CI 0.81, 0.91), grain (0.87; 0.82, 0.91), legume and nut (0.93; 0.88, 0.98), poultry (0.90; 0.85, 0.95), and fish protein (0.90; 0.86, 0.95) were associated with lower maternal PPWR risk, whereas higher red meat protein intake with higher risk (1.11; 1.05, 1.17). For offspring overweight/obesity, higher total animal (1.12; 1.05, 1.19), red meat (1.06; 1.00, 1.13), and dairy protein (1.11; 1.04, 1.17) were associated with higher risk, whereas poultry (0.95; 0.89, 0.99) and fish protein (0.93; 0.88, 0.99) with modestly lower risk. Replacing 1% of energy from total animal protein with plant protein, or from red meat or dairy protein with poultry, fish, or grain protein, was associated with 4-6% lower maternal PPWR risk; corresponding substitutions with poultry or fish protein were associated with 3-4% lower offspring risk. CONCLUSIONS:During pregnancy, substituting poultry or fish protein for red meat or dairy protein was associated with lower risks of both maternal PPWR and offspring overweight/obesity, supporting consideration of protein source in food-based dietary guidance.
BACKGROUND:Medication administration via enteral feeding tubes is a complex process and is often associated with preventable errors that may affect treatment effectiveness and patient safety. OBJECTIVE:This study aimed to develop an evidence-based care bundle and evaluate its impact on medication errors in hospitalized patients. METHODS:This 13-month quality improvement study was conducted in internal medicine wards of a tertiary care hospital and included observation, bundle development, and implementation. Medication administrations via enteral feeding tubes were prospectively observed, and nurse-related factors, including fatigue measured using the Occupational Fatigue Exhaustion Recovery Scale and knowledge levels, were evaluated. A four-parameter care bundle (medication appropriateness, preparation, administration, and monitoring for enteral feeding tubes) was developed using the Knowledge-to-Action framework and Institute for Healthcare Improvement care bundle methodology, including problem identification, evidence synthesis, and expert consensus. After training, medication error rates per dose were compared before and after implementation, using negative binomial regression to account for overdispersion, with results expressed as incidence rate ratios. RESULTS:A total of 2,064 medication administrations were evaluated in a predominantly geriatric, multimorbid patient population. Preparation and administration errors decreased from 3.8±2.3 to 0.6 ± 0.8 per dose (84% reduction; incidence rate ratio=6.19, 95% confidence interval: 5.44-7.04, p<0.001). Monitoring errors were no longer observed after implementation. Key high-risk practices, including inadequate flushing, inappropriate crushing, and dose loss, were largely eliminated. Error severity shifted toward lower National Coordinating Council for Medication Error Reporting and Prevention categories, with no severe events observed after implementation. No tube occlusions occurred during implementation; bundle adherence was 98.3-100%. CONCLUSIONS:The evidence-based care bundle developed through the framework substantially improved medication safety during enteral feeding tube administration. High adherence supports its feasibility and potential as a standardized quality improvement strategy in clinical practice.
BACKGROUND:Alcohol consumption is common behavior among US veterans, yet its impact on long-term health outcomes remains incompletely understood. OBJECTIVE:We conducted a cohort study to examine the associations between alcohol consumption versus abstention and major adverse cardiovascular events (MACE; myocardial infarction, stroke, or cardiovascular death), cancers, and total mortality. METHODS:Self-reported alcohol consumption was collected from 438,442 participants from the prospective Million Veteran Program Study (MVP 2011-2024). The outcomes included total mortality and indent cancer and MACE. RESULTS:A J-shaped association was observed between alcohol and risk of mortality (both Ps for linear trend and curvature<0.0001) and risk of MACE (P for curvature<0.0001; P for linear trend = 0.24). Compared to never drinkers, the hazard ratio (HR) for mortality was 0.86 (0.84, 0.89) for current drinkers with alcohol 0.1-30g/d, and 0.84 (0.80, 0.89) for MACE. The HR for cancer was positively associated with higher daily intake among current drinkers: 1.03 (0.99, 1.17) [0.1-30g/d], 1.06 (1.00, 1.12) [31-60g/d], 1.20 (1.12, 1.29) [61-90g/d] and 1.28 (1.12, 1.47) [>90g/d] (P for curvature =0.06, P for linear trend<0.0001). Compared to participants who reported never smoking and never drinking, the HR for head and neck cancer was 3.21 (2.17, 4.74) among current smokers with moderate alcohol consumption (females up to 14g/d and males up to 28g/d) and 5.69 (3.76, 8.62) among current smokers with heavy drinking (P for interaction=0.03). CONCLUSIONS:Among US Veterans, alcohol consumption was associated with mortality and MACE in a J-shaped pattern, with lower risk observed at moderate consumption levels compared to abstinence or heavier drinking. However, alcohol consumption demonstrates a linear dose-response relationship with cancers, with increased risks for alcohol-related cancers even at moderate consumption levels. The alcohol and head and neck cancer association was significantly exacerbated by smoking.
BACKGROUND:The Planetary Health Diet Index (PHDI) was developed as a measure of adherence to the Planetary Health Diet proposed by the EAT-Lancet Commissions, however, its construct validity for accurately reflecting a healthy diet as compared to other global dietary measures remains to be evaluated. OBJECTIVE:The construct validity of PHDI was assessed by comparing the strength of its associations with reference metrics of nutrient adequacy and moderation of foods associated greater risks of diet-related non-communicable diseases against food group diversity score (FGDS) and Global Diet Quality Score (GDQS) and its Positive (GDQS+) and Negative (GDQS-) sub-metrics. METHODS:Cross-sectional quantitative 24-hour recall and food record data from 152,004 non-pregnant females and males (≥15 years) from 45 surveys in 26 countries accessed from the FAO/WHO Global Individual Food Consumption Data Tool were analysed. Multilevel linear and modified Poisson regression models quantified associations between PHDI, FGDS, GDQS+, and GDQS- with reference measures [e.g., mean adequacy ratio (MAR), % energy from ultra-processed food (UPF)] or indicators of a healthy diet [e.g., ≥400 g/day of fruit and vegetables (F&V)], respectively. RESULTS:Adherence to PHDI was highest in low-income (LIC) and lower-middle income countries (LMIC), and lowest in upper-middle (UMIC) and high income countries (HIC). One-SD increments in PHDI were associated with higher MAR (β: 5.49 percentage points (pp); 95% confidence interval (CI): 3,65, 7.33 in LIC to 1.41 (1.23, 1.58) in UMIC), appropriate F&V intakes (relative risk (RR): 2.41 (1.85, 2.49) in UMIC to 1.19 (1.05, 1.34) in LMIC), lower unprocessed red meat (β: -10.0 g/day (-11.4, -8.73) in LIC to -6.86 (-7.54, -6.17) in UMIC), and lower proportions of energy from UPF (β: -2.47 pp (-3.77, -1.18) in LMIC to -1.21 (-2.32, 0.105) in LIC), however, one-SD increases in FGDS and GDQS+ outperformed PHDI in predicting measures of nutrient adequacy, particularly MAR (β for FGDS: 11.2 pp (9.13, 13.3) in LIC to 8.57 (8.42, 8.72) in UMIC; β for GDQS+: 9.82 (7.26, 12.4) in LMIC to 7.18 (6.00, 8.36) in HIC) and appropriate F&V intakes (RR for FGDS: 2.78 (2.26, 3.41) in LMIC to 1.63 (1.22, 2.19) in HIC; RR for GDQS+: 2.39 (1.89, 2.89) in LMIC to 1.55 (1.16, 1.96) in LIC). CONCLUSIONS:PHDI may serve as a robust, dual purpose measure for monitoring adherence to diets that are both sustainable and healthy in contexts with regular quantitative dietary intake assessments and low burdens of diet-related undernutrition, however, simpler food group-based measures such as FGDS often show stronger associations with healthy diet sub-constructs such as nutrient adequacy, and are more feasible for large-scale, routine monitoring of diets.
BACKGROUND:Plant-based diets may protect against adverse cardiovascular outcomes, but the level of protection may differ by dietary composition and individual characteristics. Black and rural Americans-2 groups with high burden of cardiovascular morbidity and mortality-have had limited representation in plant-based diet research. OBJECTIVES:This prospective cohort study examined associations between plant-based diets and stroke incidence, coronary artery disease (CAD) incidence, and CAD mortality among participants in the REasons for Geographic and Racial Differences in Stroke study. METHODS:This study included 14,776 adults. Three plant-based diet scores were calculated from food frequency questionnaires: plant-based diet index (PDI), healthy plant-based diet index (hPDI), and unhealthy plant-based diet index (uPDI). Cox proportional hazards models estimated associations of quintiles of each plant-based diet score and cardiovascular outcomes, adjusting for sociodemographic characteristics, health risk factors, and caloric intake. RESULTS:Between baseline (2003-2007) and 2019, there were 700 cases of incident stroke, 1047 cases of incident CAD, and 944 CAD deaths. Plant-based diets were not associated with stroke. Comparing the highest to lowest quintile, higher hPDI was associated with lower CAD incidence [hazard ratio (HR): 0.72; 95% confidence interval (CI): 0.58, 0.90; P-trend = 0.03]. An interaction (P = 0.03) between hPDI and sex for CAD mortality revealed an inverse association between hPDI and mortality among females only. PDI was associated with lower CAD-related mortality (HR: 0.73; 95% CI: 0.59, 0.90; P-trend = 0.001), but higher risk of incident CAD (HR: 1.60; 95% CI: 1.09, 2.33; P-trend = 0.009). An interaction (P = 0.006) was found between PDI and urban status for incident CAD, with higher PDI associated with higher CAD among nonrural adults only. The uPDI was not associated with CAD incidence or mortality. Associations did not differ by race. CONCLUSIONS:In this study, greater adherence to healthy plant-based diets was associated with lower CAD risk, but overall plant-based diets had heterogeneous associations with CAD incidence and mortality. Healthy plant-based diets appear to support heart health.
BACKGROUND:The WHO recommends that pediatric energy requirements be estimated as the sum of total energy expenditure and the energy content of tissue deposited through growth. WHO growth estimates for children aged 2+ y are based on an assumed 2 kcal/g tissue gained, and do not address age or sex variability in the composition of accreted tissue. We revisited growth costs using objective body composition data. METHODS:We conducted a secondary data analysis of United Kingdom reference data. Using 7 centiles for fat-free mass and fat mass, we calculated fat and protein deposition rates and their energy costs. We generated new centiles for total body energy content from body composition data, where velocities indicate total growth energy costs. Median values were compared with WHO reference values. RESULTS:Compared with WHO values, the median United Kingdom child deposits more energy in infancy and through childhood from 2 y in females. Median protein deposition declines through infancy before rising in adolescence, peaking at 12 y (females) and 14 y (males). Median fat deposition declines through infancy and is relatively constant in both sexes through childhood, although higher centiles differ by sex. United Kingdom children have higher median growth costs than WHO values for males in late infancy and for females at most ages. Older children, measured more recently (2001-2010), had greater adiposity and growth costs than younger children (1987-1996). Individual children showed a degree of trade-off between fat and protein deposition. CONCLUSIONS:We provide new centiles for total energy costs of growth and for fat and protein accretion rates and costs. Growth energy requirements in United Kingdom children, especially females, differ from WHO values, due primarily to greater fat deposition in more recent cohorts. Our approach may be applied to other centile data to improve understanding of variability in growth costs across populations and time periods.
BACKGROUND:Evidence linking food-based diet quality indicators to micronutrient biomarkers during adolescence in rural sub-Saharan Africa remains limited. OBJECTIVES:To examine associations between baseline diet quality and 6-mo changes in hemoglobin (Hb), iron-related biomarkers, and vitamin A status among rural schoolgirls in northern Ghana. METHODS:This secondary analysis used data from the Ten2Twenty-Ghana randomized controlled trial, which included 300 girls aged 10 to 17 y from 19 schools. Dietary intake was assessed using a quantitative 24-h recall. Diet quality indicators included the Global Diet Quality Score (GDQS), Minimum Dietary Diversity for Women (MDD-W), and gram-weighted intakes of NOVA (food classification system based on the nature, extent, and purpose of food processing) food groups. Multilevel linear and modified Poisson regression models examined associations between diet quality indicators and biomarkers of iron and vitamin A status, adjusting for baseline biomarkers, inflammation, height-for-age and BMI-for-age z-scores, household factors, energy intake, treatment allocation, and school clustering. RESULTS:Participants had a mean age of 12.7 ± 1.9 y; mean GDQS was 20.4 ± 3.3, and mean MDD-W was 3.8 ± 1.2, with 29.5% achieving MDD-W ≥5. At baseline, 38% had anemia, including 6.2% with iron-deficiency anemia (IDA) and 2.7% with vitamin A deficiency (VAD). Higher intake of whole or minimally processed foods was positively associated with soluble transferrin receptor (sTfR) concentrations [β: 3.0%; 95% confidence interval (CI): 1.0%, 6.2%], whereas ultraprocessed food intake was negatively associated with sTfR concentrations (β: -3.9%; 95% CI: -5.8%, -1.0%). Higher GDQS, GDQS+ (positive submetric of the GDQS), and MDD-W scores were inversely associated with ferritin concentrations but not with Hb, sTfR, or vitamin A biomarkers. No significant associations were observed with anemia or with risk of VAD. CONCLUSIONS:Conventional diet quality indicators and processing-based dietary measures were associated with iron-related biomarkers, although associations differed by biomarker. These findings suggest that dietary diversity and food processing capture complementary dimensions of diet quality in rural Ghanaian adolescents. This trial was registered at clinicaltrials.gov as NCT03368053.
Background Growing research suggests that food insecurity, a condition of not having adequate access to healthy foods, is associated with poor cognition; however, prior studies have been limited to the effects of food insecurity in later life. Objectives We aimed to examine the associations of mid-life and later-life food insecurity on probable dementia in a large, prospective cohort study of United States adults. Methods Data came from 2051 adults from the Panel Study of Income Dynamics, the longest running nationally representative household panel survey. Food insecurity was assessed biennially using the United States Household Food Security Survey Module from 1999 to 2003 and 2015 to 2019. Mid-life food insecurity was defined as food insecurity from 1999 to 2003; later-life food insecurity was defined as food insecurity from 2015 to 2019. Dementia was assessed using the Eight Item Interview to Differentiate Aging and Dementia (AD8) in 2019 and 2021. Probable dementia was defined as an AD8 score ≥2. We examined associations between food insecurity and probable dementia using generalized estimating equations, adjusting for baseline and time-varying sociodemographic and health covariates. Results In the analytic sample, 3% had mid-life food insecurity only, 5.2% had later-life food insecurity only, and 5.0% had mid-life and later-life food insecurity. After multivariable adjustment, food insecurity in later life only [odds ratio (OR) = 1.85, 95% confidence interval (CI): 1.06, 3.23] and food insecurity in mid-life and later life (OR = 2.18, 95% CI: 1.15, 4.11) were both associated with higher probable dementia. Mid-life food insecurity only was not significantly associated with probable dementia. In subsequent analyses, cumulative episodes of food insecurity (≥2) in later life were associated with probable dementia, but there were no significant associations between cumulative episodes of food insecurity in mid-life and probable dementia. Conclusions Findings suggest that the association between food insecurity and dementia is strongest with later life, but not mid-life, exposure to food insecurity.
BACKGROUND:Circulating fatty acid profiles are linked to cardiovascular disease risk and mortality. Short-term interventions suggest that low-carbohydrate diets (LCDs) promote cardioprotective shifts in circulating fatty acids in obesity. OBJECTIVES:We examined whether a 6-mo, non-calorie-restricted, LCD high in fat similarly improves circulating fatty acid composition in adults with type 2 diabetes. METHODS:In an open-label, randomized, controlled trial, 71 individuals with type 2 diabetes were randomly assigned 2:1 to an LCD [maximum of 20 E% (energy per cent) carbohydrates] or a control diet (50-60 E% carbohydrates) for 6 mo with no restriction in energy intake. The prespecified secondary outcomes were the mean difference in change between groups in serum phospholipid fatty acids in weight percentage (wt%) measured by gas chromatography and reported as 95% confidence intervals (CIs) and significance adjusted for multiple comparisons (q value). RESULTS:LCD reduced total saturated [-0.6 (CI: -0.9, -0.2)] and monounsaturated fatty acids [-0.9 (CI: -1.4, -0.3)] and increased total polyunsaturated fatty acids [1.3 (CI: 0.6, 2.0)] compared with the control diet (all q < 0.05). Importantly, LCD reduced palmitoleic acid (16:1n-7) [-0.13 (CI: -0.21, -0.06)], a marker of de novo lipogenesis, by 23% and dihomo-γ-linolenic acid (20:3n-6) [-0.38 (CI: -0.67, -0.09)] by 12%, whereas it increased arachidonic acid (20:4n-6) [1.1 (CI: 0.3, 2.0)] by 9% compared with the control diet (all q < 0.05). Moreover, the LCD improved estimated desaturase activities by lowering stearoyl-coenzyme A desaturase 1 [-0.5 (CI: -0.7, -0.2)] and Δ6 desaturase [-0.6 (CI: -0.9, -0.2)] and increasing Δ5 desaturase [1.05 (CI: 0.3, 1.79)] activities, respectively (all q < 0.01). These changes occurred despite a 2.6-fold higher intake of saturated fatty acids in the LCD group. CONCLUSIONS:A 6-mo, non-calorie-restricted LCD modified the circulating composition of fatty acids in adults with type 2 diabetes in a manner consistent with a potentially favorable cardioprotective profile. This trial was registered at www. CLINICALTRIALS:gov as NCT03068078.
Background Adopting a plant-based diet may compromise protein intake and impair skeletal muscle mass in older adults. Objectives To compare the impact of a 12-wk self-selected vegan diet with that of an omnivorous diet and a self-selected vegan diet with resistance exercise (RE) on skeletal muscle mass, strength, and muscle protein synthesis (MPS) rates in older adults. Methods This randomized controlled trial included 3 parallel study arms in which 72 healthy older adults aged ≥65 y were randomly assigned to follow 1) a self-selected vegan diet (VEG), 2) their habitual omnivorous diet (OMNI), or 3) a self-selected vegan diet with RE (VEG-RE). At baseline and after 12 wk, thigh muscle volume, thigh muscle fat infiltration, and body fat distribution were assessed using magnetic resonance imaging, appendicular lean mass with dual x-ray absorptiometry, and muscle strength via Biodex. MPS rates were assessed during the first 10 d using a deuterium oxide protocol. Other outcome measures were body mass, dietary intake, and physical activity. Linear mixed models were applied to test differences between VEG and the other groups. Results are presented as estimated marginal mean or change in estimated marginal mean [95% confidence interval (CI)]. Results VEG reduced protein intake with ‒27.7 g/d (95% CI: ‒37.3, ‒18.2 g/d), ‒22.0 g/d (95% CI: ‒31.7, ‒12.4 g/d), and ‒19.3 g/d (95% CI: ‒29.2, ‒9.37 g/d) in weeks 1, 6, and 12 (all P < 0.0001 compared with baseline), which was similar to the decrease in VEG-RE (P > 0.05), but different from OMNI (P < 0.0001), in which protein intake did not change. Thigh muscle volume and appendicular lean mass significantly reduced in VEG [‒0.61 L (95% CI: ‒0.72, ‒0.50 L); ‒1.15 kg (95% CI: ‒1.46, ‒0.85 kg)] compared to OMNI [‒0.01 L (95% CI: ‒0.11, 0.09 L); +0.05 kg (95% CI: ‒0.23, 0.32 kg); both P < 0.0001] and VEG-RE [‒0.35 L (95% CI: ‒0.47, ‒0.24 L), P = 0.0038; ‒0.62 kg (95% CI: ‒0.93, ‒0.32 kg), P = 0.0033]. MPS was lower in VEG [1.09 %/d (95% CI: 1.01, 1.17 %/d)] compared with OMNI [1.27 %/d (95% CI: 1.18, 1.35 %/d); P = 0.0073] and VEG-RE [1.24 %/d (95% CI: 1.16, 1.33 %/d); P = 0.0246]. Conclusions A self-selected vegan diet reduces protein intake, skeletal muscle mass, and MPS in older adults. The negative impact of a vegan diet on skeletal muscle mass can be mitigated by RE.This trial was registered at clinicaltrials.gov as NCT05809466. (https://clinicaltrials.gov/study/NCT05809466).
BACKGROUND:Undernutrition in older adults is associated with adverse health outcomes including cognitive decline, yet evidence for effective preventive strategies is limited. OBJECTIVES:The objective of this study was to investigate effects of a protein-enriched Mediterranean diet, with and without exercise, on nutritional status and cognitive performance in "at risk" community-dwelling older adults. METHODS:A total of 105 participants (69% female; aged 67.7 ± 6.1 y) at risk of undernutrition and cognitive decline were randomized to 1 of 3 groups: 1) PROMED-EX (personalized dietary counseling plus home-based exercise); 2) PROMED (personalized dietary counseling only); or 3) CON (healthy eating leaflet). The primary outcome was change in nutritional status at 6 mo, measured by the Mini Nutritional Assessment (MNA; 0-30 points). Secondary outcomes included neurocognitive test battery (NTB) z-score, PROMED diet quality score (0-14), physical performance, and health-related quality of life. Analyses followed an intention-to-treat approach using linear regression to assess between-group differences in 6-mo outcomes. RESULTS:At baseline, the mean MNA score was 22.5 ± 2.3. After 6 mo, nutritional status improved significantly in both intervention groups compared with CON: mean differences in MNA were 2.7 [95% confidence interval (CI): 1.3, 4.2] for PROMED and 2.9 (95% CI: 1.5, 4.3) for PROMED-EX (both P < 0.001). Cognitive function also improved, with NTB z-score differences of 0.3 (95% CI: 0.1, 0.5; P = 0.01) in PROMED and 0.2 (95% CI: 0.0, 0.4; P = 0.02) in PROMED-EX compared with CON. Diet quality scores significantly increased with mean differences of 4.0 (95% CI: 2.9, 5.0) for PROMED and 3.9 (95% CI: 2.8, 4.9) for PROMED-EX compared with CON (both P < 0.001). Despite low adherence to exercise, additional benefits were observed for physical performance and quality of life. CONCLUSIONS:Dietary intervention improved nutritional status in community-dwelling older adults at risk of undernutrition. Correcting undernutrition could help to slow cognitive decline and promote physical health and quality of life during aging. This study was registered at clinicaltrials.gov as NCT05166564.
BACKGROUND:Evidence linking maternal organophosphate ester (OPE) exposure during early gestational weeks with infant birth weight outcomes remains limited. OBJECTIVES:This prospective cohort study examined associations of maternal serum OPE concentrations at 9 to 13+6 weeks of gestation with infant birth weight, large for gestational age (LGA), and small for gestational age (SGA). METHODS:Among 1039 pregnant females in a Qingdao birth cohort, 16 serum OPEs were measured using gas chromatography-tandem mass spectrometry. Individual OPEs were evaluated per interquartile range increase in ln-transformed concentration using multivariable linear regression and modified Poisson regression. Quantile g-computation (Qgcomp), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression assessed OPE mixtures. RESULTS:Tris(isobutyl) phosphate (TIBP) and tris(2-ethylhexyl) phosphate (TEHP) were associated with higher birth weight [TIBP: β = 77 g, 95% confidence interval (CI): 37, 117; TEHP: β = 40 g, 95% CI: 18, 63]. TEHP was associated with higher LGA risk [adjusted risk ratio (aRR) = 1.27, 95% CI: 1.09, 1.48] and lower SGA risk (aRR = 0.71, 95% CI: 0.57, 0.90); p-cresyl diphenyl phosphate was also associated with lower SGA risk (aRR = 0.69, 95% CI: 0.53, 0.91). In Qgcomp models, total OPE mixture exposure was associated with higher LGA risk (aRR = 1.41; 95% CI: 1.10, 1.80). Alkyl-substituted OPE mixture was associated with higher LGA risk in Qgcomp and higher birth weight in WQS; halogenated OPE mixture showed no significant associations. CONCLUSIONS:Maternal serum concentrations of selected OPEs at 9 to 13+6 weeks of gestation, particularly alkyl-substituted OPEs, were associated with higher birth weight and LGA risk. These findings warrant confirmation in studies with repeated exposure assessment and additional longitudinal fetal growth indicators.
