Poor diet quality is strongly associated with elevated cardiovascular disease morbidity and mortality risk. This American Heart Association scientific statement for food-based cardiovascular health optimization and cardiovascular disease risk reduction guidance summarizes available evidence and provides contextual guidance for the key features of heart-healthy dietary patterns. It enumerates collateral benefits of adopting a heart-healthy dietary pattern in terms of nutrient intake adequacy and compatibility with other chronic disease risk reduction guidance. The features of a heart-healthy dietary pattern include (1) adjusting energy intake and expenditure to achieve and maintain a healthy body weight; (2) eating plenty of vegetables and fruits and choosing a wide variety; (3) choosing foods made mostly with whole grains rather than refined grains; (4) choosing healthy sources of protein; (5) choosing sources of unsaturated fats in place of sources of saturated fat; (6) choosing minimally processed foods instead of ultraprocessed foods; (7) minimizing intake of added sugars in beverages and foods; (8) reducing sodium intake by choosing foods low in sodium and preparing foods with minimal or no salt; and (9) if alcohol is not consumed, do not start; if alcohol is consumed, limit intake.

Background: Nutrient needs increase during pregnancy, and diet quality may predict maternal and infant health outcomes. Objective: To assess diet quality and select nutrients during pregnancy among mothers who followed different diet patterns in the FeFiFo-MOMS study. Methods: Pregnant women randomized to one of four diets (high fiber, high fermented foods, both, or control) completed three 24-hour dietary recalls at baseline (12-22 weeks of gestation), mid-pregnancy (26-30 weeks), and late pregnancy (34-38 weeks) collected using Nutrition Data System for Research. Healthy Eating Index-2015 (HEI-2015) scores, macronutrient distribution, and key micronutrients of interest during pregnancy (folate, calcium, iron, zinc, DHA, choline, vitamin D) were evaluated at each timepoint. Linear mixed models compared intake levels across diet groups. Results: Of 122 participants, mean nutrient intake levels at baseline without supplementation were below recommendations for iron (15.8 mg), folate (437 mcg), DHA (0.17 g), choline (376 mg), and vitamin D (5.3 mcg). Overall, participants reported increases in calcium (+10.8%) and vitamin D (+13.7%) throughout pregnancy, both p<0.05. Comparing baseline to late pregnancy, the combined fiber and fermented foods group reported greatest increases in daily calcium (mean±SEM 997.5±59.4 --> 1199.2±71.7 mg), iron (14.6±1.1 --> 18.4±1.2 mg), folate (433.5±36.0 --> 476.5±28.8 mcg), and zinc (10.8±0.7 --> 13.0±0.7 mg), with significant detection of time x group interactions (all p<0.01). HEI-2015 scores were highest at mid-pregnancy and in the high fiber and combined groups (69.6±2.0 and 70.3±1.5 points), respectively representing +14.6% and +9.6% increases from baseline, which were greater than the control and fermented foods only groups showing minimal change (p<0.001). Only the high fiber group sustained this improvement through late pregnancy (70.1±2.0), while the fermented foods only group showed the lowest diet quality throughout (58.5±1.7 at late pregnancy). Conclusions: A combined high fiber and fermented foods diet provided greatest increases in key nutrients during pregnancy, while high fiber alone yielded most sustained diet quality improvements. Dietary fiber intake remains a key component of optimal diet quality during pregnancy.

Some research suggests that transitioning from an omnivorous to a plant-based diet does not significantly change athletic performance for endurance or resistance athletes, implying comparability to animal-based diets for athletic goals. However, there is a relative paucity of these studies and widespread social media misinformation suggesting insufficient calorie, protein, and micronutrient intake of plant-based diets to meet the demands of athletic performance. This multi-site study, conducted in collaboration with the Menus of Change University Research Collaborative (MCURC), investigates the impact of plant-based diets in several university dining halls on athletic performance among recreational athletes. In this crossover study, recreational runners and resistance trainers were recruited from four universities: Stanford, Rutgers, Vanderbilt, and the University of Reading (n = 36; runners = 16, resistance trainers = 20). Participants were assigned to complete two 4-week diet interventions, Omnivore and Plant-based, in random order. Primary outcomes for runners (12-minute timed run) and resistance trainers (3-rep maximum test for chest press, lat pulldown, and leg press) were collected at baseline and after each diet. Paired t-tests and linear regression models were used to compare performance between diets. Mean differences between Omnivore and Plant-based diets in 12-minute timed run (− 36.2 m; 95

BACKGROUND:An emerging concern is that weight-loss interventions can lead to disproportionate muscle loss. Few studies accurately quantify changes in lean soft tissue (LST) after weight loss or investigate associated molecular signatures. OBJECTIVES:The objectives of this study were to quantify LST change after a diet-based weight-loss intervention and identify protein biomarkers associated with LST retention. METHODS:Using the Diet Intervention Examining The Factors Interacting with Treatment Success cohort, we analyzed LST from dual-energy X-ray absorptiometry in three ways: 1) by body region (appendicular and total body), 2) after removing bias from fat-free adipose tissue (FFAT), and 3) relative to body size (percentage predicted LST). We also assessed 242 proteins measured in Olink Cardiovascular II, III, and Inflammation panels as predictors of LST change. RESULTS:A total of 374 participants (61% female; mean age ± standard deviation (SD): 39.4 ± 6.7 y; mean body mass index ± SD: 32.3 ± 3.2 kg/m2) who had been randomly assigned to healthy low-fat or low-carbohydrate diets were pooled and analyzed at baseline and 6 mo. Total mass changed by -5.9 kg (95% confidence interval [CI]: -6.51, -5.29) in females and -7.18 kg (95% CI: -8.2, -6.16) in males. Appendicular LST change was modest at -0.80 kg (95% CI: -0.92, -0.69) in females and -1.02 kg (95% CI: -1.22, -0.83) in males. Appendicular LST losses comprised <10% of total mass loss after adjusting for FFAT. Appendicular LST relative to body size also increased at 6 mo (P < 0.001). Changes in 10 proteins in females and 27 in males predicted LST change (5% false discovery rate), with protein delta homolog 1 (DLK1)-an inhibitor of adipogenesis-as the top predictor. CONCLUSIONS:Change in appendicular LST, a surrogate for skeletal muscle, was modest after 6 mo of diet-based weight loss. DLK1, an inhibitor of adipogenesis, emerged as the top protein biomarker linked to LST retention. This trial was registered at clinicaltrials.gov as NCT01826591.

The advent of an operational definition of "ultraprocessed foods" (UPFs) intrinsic to the Nova classification has meaningfully advanced research on the topic. A large volume of studies, including metabolic ward trials, have begun to enumerate the many potential harms of UPFs. This inventory of harms is in turn conducive to public policy responses. The connection between the two is on clear display in the 2025 Dietary Guidelines for Americans, which inveigh directly against consumption of "hyperprocessed food," generally interpreted to mean UPFs. The harms of UPFs, however, are no less subject to the "instead of what?" consideration than any other component of diet. Whereas most UPFs displace more wholesome, more nutrient dense, more satiating alternatives from the diet; and whereas most foods in this category may be expressly engineered to minimize satiety and maximize consumption in the service of profit - there are notable exceptions with regard to intention, substitution, and effects. Salient among these is the category of plant-based meats, expressly designed to substitute for meat, and beef most particularly. The case is made that application of "instead of what?" as a use-case filter helps to differentiate between the majority of UPFs apt to confer net harm, and the rarer but potentially important exceptions to that rule. Another key consideration is variation by population and culture; the net effects of a subset of UPFs on overall diet quality could conceivably be favorable in one population, detrimental in another. These distinctions suggest the importance of nuance in the development of public policies responsive to the harms of UPFs, allowing for use cases with the potential to confer net benefit. Optimal policy responses to the burgeoning study of UPFs will accommodate the limited, but important, heterogeneity of that food class.

ABSTRACTBACKGROUNDCardiorespiratory fitness (CRF), measured by peak oxygen uptake (VO2peak), is a strong predictor of mortality. Despite its widespread clinical use, current reference equations for VO2peak show distorted calibration in obese individuals. Using data from the Fitness Registry and the Importance of Exercise National Database (FRIEND), we sought to develop novel reference equations for VO2peak better calibrated for overweight/obese individuals - in both males and females, by considering body composition metrics.METHODS AND RESULTSGraded treadmill tests from 6,836 apparently healthy individuals were considered in data analysis. We used the National Health and Nutrition Examination Survey equations to estimate lean body mass (eLBM) and body fat percentage (eBF).Multivariable regression was used to determine sex-specific equations for predicting VO2peak considering age terms, eLBM and eBF. The resultant equations were expressed as VO2peak (male) = 2633.4 + 48.7✕eLBM (kg) - 63.6✕eBF (%) - 0.23✕Age2(R2=0.44) and VO2peak (female) = 1174.9 + 49.4✕eLBM (kg) - 21.7✕eBF (%) - 0.158✕Age2(R2=0.53). These equations were well-calibrated in subgroups based on sex, age and body mass index (BMI), in contrast to the Wasserman equation. In addition, residuals for the percent-predicted VO2peak (ppVO2) were stable over the predicted VO2peak range, with low CRF defined as < 70% ppVO2and average CRF defined between 85-115%.CONCLUSIONSThe derived VO2peak reference equations provided physiologically explainable and were well-calibrated across the spectrum of age, sex and BMI. These equations will yield more accurate VO2peak evaluation, particularly in obese individuals.

Food choices shape both human and planetary health; yet, designing foods that are delicious, nutritious, and sustainable remains challenging. Here we show that generative artificial intelligence can learn the structure of the human palate directly from large-scale, human-generated recipe data to create novel foods within a structured design space. Using burgers as a model system, the generative AI rediscovers the classic Big Mac without explicit supervision and generates novel burgers optimized for deliciousness, sustainability, or nutrition. Compared to the Big Mac, its delicious burgers score the same or better in overall liking, flavor, and texture in a blinded sensory evaluation conducted in a restaurant setting with 101 participants; its mushroom burger achieves an environmental impact score more than an order of magnitude lower; and its bean burger attains nearly twice the nutritional score. Together, these results establish generative AI as a quantitative framework for learning human taste and navigating complex trade-offs in principled food design.

Abstract Background Patient and clinician interest in using diet in inflammatory bowel disease (IBD) is strong, but high-quality data is limited. Cycles of a short intermittent calorie restricted diet (IRCD) have been shown to improve inflammatory and metabolic outcomes in healthy subjects, but how this translates to patients with IBD is unclear. We conducted a randomized control trial to assess the effects of IRCD on disease activity in Crohn’s disease (CD). Methods We analyzed data from 97 patients with mild to moderate CD (Crohn’s Disease Activity Index, CDAI 151-450) between the ages of 18-70 years. They were block randomized 2:1 to IRCD and control arms. Patients in the IRCD arm consumed a reduced calorie diet for only 5 consecutive days in a month (1050 calories on day 1, 800 calories for days 2-5) for 3 consecutive months, while patients in the control arm continued their usual diet. Standard of care therapy was continued during the study period. CDAI, short IBD questionnaire (SIBDQ), and patient reported outcomes (PROs) were recorded. The primary endpoint of clinical response was defined as a composite of reduction in CDAI of at least 70 points or a CDAI≤150 at the end of the 3rd 5-day diet cycle. All analyses were done by intention to treat. Results Baseline median CDAI was 198 in the IRCD group and 197 in the control arm. Forty-one patients in the IRCD arm (67.2%) and 15 patients in the control arm (44.1%) met the primary endpoint (p=0.03). Thirty-eight patients in the IRCD arm (62.3%) and 12 patients in the control arm (35.3%) achieved clinical remission (CDAI≤150) at the end of the treatment phase (p=0.018). There were no significant changes in ESR or CRP during the study period. In a post-hoc analysis, a significantly higher proportion of participants in the IRCD arm saw a decrease in baseline fecal calprotectin of at least 50% at the end of treatment versus control (p=0.019). Patients in the IRCD arm had a greater response in SIBDQ compared to the control arm at the end of treatment (p=0.01). Thirty-five patients (57.4%) in the IRCD arm and 9 patients in the control group (25.7%) reported remission by PRO (composite of ≤3 BMs/day and abdominal pain ≤1 on a 0-4 scale, p=0.032). Of note, there was no difference in therapy escalation between IRCD and control arms. Conclusion There was a significantly greater clinical response in the IRCD arm versus the control arm (p=0.03). A significant difference was also seen in key clinical secondary endpoints in favor of IRCD. The high placebo response rate could be due to several factors including standard of care therapy changes. References 1.Wei M, Brandhorst S, Shelehchi M, et al. Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease. Sci Transl Med. 2017;9(377). 2.Gubatan J, Kulkarni CV, Talamantes SM, Temby M, Fardeen T, Sinha SR. Dietary Exposures and Interventions in Inflammatory Bowel Disease: Current Evidence and Emerging Concepts. Nutrients. 2023;15(3):579.

OBJECTIVE:This study aimed to determine whether APOA2 genotypes and saturated fatty acid (SAT) intake affect weight-loss response to healthy low-carbohydrate (HLC) and healthy low-fat (HLF) diets. METHODS:This is a secondary analysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) study, a 12-month randomized clinical trial of HLC or HLF diets in 609 adults aged 18 to 50 years with BMI values between 28 and 40 kg/m2. The current study examined 3-, 6-, and 12-month weight loss in participants with different APOA2 genotypes (TT vs. C allele carriers, CT + CC) at variant rs5082 who met the SAT intake criterion of ≥22 g/day for an HLC diet and < 22 g/day for an HLF diet at all three study time points. RESULTS:Participants with the TT APOA2 genotype lost significantly more weight consistently on an HLC diet than on an HLF diet at 3, 6, and 12 months, whereas C allele carriers lost more weight only at 3 months and not at 6 or 12 months. APOA2 genotype-by-SAT intake interaction affecting weight loss was observed only at 12 months. Among participants who did not consistently meet the SAT intake criterion, there were no significant weight-loss differences among APOA2 genotypes. CONCLUSIONS:This study highlights the importance of evaluating genotype-diet interactions in weight-loss trials to better inform precision nutrition interventions. CLINICAL TRIAL REGISTRATION:NCT01826591.

Background:Omnivorous, vegan, and other diet patterns contain combinations of healthy and less-healthy foods. One aspect of equipoise in designing nutrition intervention studies is to emphasize high diet quality for all dietary patterns being contrasted. Objectives:This secondary analysis of an 8-wk long study was designed to qualitatively examine the alignment of participant diet assessment data with the original study design goal of achieving adherence to study diets that were both healthy and yet meaningfully different from one another. Methods:In this diet intervention, 22 pairs of identical twins were randomly assigned to a vegan or omnivorous diet and to consume either delivery-service meals (weeks 0-4) or prepare their own diet-appropriate meals/snacks (weeks 4-8). Data from 24-h dietary recalls at weeks 0, 4, and 8 were used to compare changes in intake of select food groups and nutrients. Linear mixed modeling evaluated changes in Healthy Eating Index-2015 (HEI) scores at weeks 4 and 8 compared with baseline, accounting for repeated measurements. Results:Both groups showed significant increase in their HEI scores during the study. Relative to baseline, mean changes in HEI total scores increased at 4 wk for both vegans (14.2) and omnivores (9.0), and these increases were largely maintained at 8 wk for both vegans (12.0) and omnivores (7.9). Healthy aspects similar for both groups included more vegetables and less added sugars. Differentiating factors included more legumes and fiber for vegans and more cholesterol and vitamin B-12 for omnivores. Conclusions:In this secondary analysis of a diet intervention trial, it is demonstrated that both the vegan and omnivore groups improved their diet quality during the study, while at the same time achieving substantive differences between the 2 groups in key nutrients/food groups. This allowed us to meaningfully contrast healthy versions of the 2 diets for their effects on previously reported health end points.This trial was registered at clinicaltrials.gov as NCT05297825.