Dietary factors, particularly nut consumption, play an important role in health outcomes. Nuts, including almonds, have been studied for their cardiovascular benefits due to their nutrient density, favourable lipid profiles, and antioxidant content (1) . Their high content of unsaturated fats, fibre, vitamin E, riboflavin, and magnesium may also exert neuroprotective effects and support mood regulation. Despite evidence linking overall nut consumption to cognitive and mood outcomes(2-3), research examining the impact of nuts on mental health—and almonds specifically—remains limited. Therefore, this study aims to examine associations between almond intake and a range of mental health outcomes in the ZOE PREDICT 3 cohort. We conducted a cross-sectional analysis of 163,015 UK and US participants with complete dietary, mental health, and covariate data from the ZOE PREDICT 3 cohort (ClinicalTrials.gov identifier: NCT04735835). Almond intake was assessed via food frequency questionnaire and analysed both as a continuous variable (g/day) and as categorical groups (none; tertiles 1–3 defined separately for the UK and US sub-cohorts). Mental health outcomes included a composite measure of overall mental health, broader subcategories of psychiatric/psychological and neurological/neurodegenerative conditions, 17 specific DSM-5 diagnostic categories, and a composite comorbidity measure. Associations were evaluated using Firth logistic regression to address rare outcomes and separation issues, adjusting for demographic, lifestyle, clinical and dietary covariates. Trend analyses were performed using median intake per category. All models were corrected for multiple comparisons using false discovery rate (FDR) adjustment. In fully adjusted models, higher almond intake, when modelled continuously (g/day, including non-consumers), was associated with lower odds of neurological/neurodegenerative conditions (n=5,721; OR=0.94; 95% CI:0.91–0.97; FDR p < 0.001), but showed no association with psychiatric outcomes (n=25,025; OR=0.998; 95% CI:0.99–1.01; FDR p=0.68). However, categorical analyses indicated a small but consistent dose–response trend, with higher almond intake associated with slightly lower odds of psychiatric conditions per category increase relative to non-consumers (OR=0.995; 95% CI:0.991–0.999; p=0.009). Subtype analyses showed that higher almond intake was associated with lower odds of anxiety disorders (n=7,360; OR=0.94; 95% CI:0.91–0.97; FDR p < 0.001) and somatic symptom disorders (n=462; OR=0.97; 95% CI:0.95–0.99; FDR p=0.03). Associations with depressive disorders (n=11,696; OR=0.98; 95% CI:0.96–0.997; unadjusted p=0.03; FDR p=0.16) and obsessive–compulsive disorders (n=590; OR=0.91; 95% CI:0.83–0.998; unadjusted p=0.045; FDR p=0.19) were nominally significant but did not survive FDR correction. No associations were observed for other mental health subtypes. These findings suggest that almond intake is associated with a reduced likelihood of anxiety-related conditions and support the inclusion of almonds as part of a healthy diet. As this study is cross-sectional, causal inference is not possible. Ongoing work will investigate underlying mechanisms, including gut–microbiome pathways, while future longitudinal studies are needed to establish causality.

The impact of repeated heating of seed-based culinary oils on cardiometabolic health has not been well established. Heating oils to high temperatures (> 150°C) causes lipid peroxidation, thus generating potentially harmful compounds that may impair vascular function. This randomized, single-blind, crossover study investigated the acute effects of a high-fat meal containing either repeatedly heated (at 180°C, over 10 days, with 5 potato fries per day) sunflower oil-palm olein blend, compared with an unheated blend (containing 23.8% and 7.2% polar compounds respectively), on postprandial lipids and vascular function in 19 healthy male participants. Participants consumed each test meal on separate days, with measurements of flow-mediated dilation (FMD; primary outcome), arterial stiffness, plasma triacylglycerol (TAG), non-esterified fatty acid (NEFA), and glucose concentrations over 4 h. Postprandial vascular (FMD and arterial stiffness) responses as well as NEFA and glucose concentrations were comparable between meals. The postprandial TAG increase was lower after heated versus unheated oil (p < 0.001). These findings indicate that repeated heating of oil modifies postprandial lipaemia without acutely impairing vascular function. However, these short-term results do not address the potential cumulative effects of chronic, long-term consumption.

Precision Nutrition relies heavily on multimodal data to account for factors that drive variability in response to nutrition and develop more precise dietary recommendations. Despite the promising potential to improve the overall health of individuals, its implementation is not without ethical and practical challenges. To realize its potential, Precision Nutrition must be paired with measures that foster responsible innovation. Building on this premise, we present a normative yet practical roadmap that emphasizes the central role of high-dimensional, multimodal, and harmonized data in enabling Precision Nutrition initiatives, structured around 5 phases: 1) data acquisition, 2) data modeling, 3) data translation, 4) data communication, and 5) data evaluation. For each phase of this roadmap, we identify core challenges and propose initial strategies to address such challenges. We expect this roadmap to serve as a reference for researchers, practitioners, and policymakers, as well as a blueprint for future research and governance.

Importance:Early-onset colorectal cancer (EOCRC) (diagnosed age <50 years) incidence is increasing globally, in parallel with increased consumption of ultraprocessed foods (UPFs). The role of UPFs in early-onset colorectal neoplasia remains underexplored. Objective:To evaluate the association between UPF consumption and risk of EOCRC precursors. Design, Setting, and Participants:This prospective cohort study included participants of the Nurses' Health Study II, an ongoing US prospective cohort of female registered nurses established in 1989. Participants were followed up from June 1, 1991, through June 1, 2015. Data were analyzed from October 2024 to July 2025. UPF intake, derived from food-frequency questionnaires administered every 4 years and classified using the Nova system, was modeled as quintiles of energy-adjusted servings per day. Of the nurses enrolled, those who had completed the baseline 1991 food-frequency questionnaire, undergone at least 1 lower endoscopy before age 50 years after baseline, had no history of cancer (except for nonmelanoma skin cancer) before endoscopy, and no colorectal polyp or inflammatory bowel disease were included. Main Outcomes and Measures:Incidence of EOCRC precursors, including conventional adenomas and serrated lesions, confirmed via medical records and pathology reports. Multivariable logistic regression models with generalized estimating equations for clustered data were used to estimate adjusted odds ratios (AORs) and 95% CIs, accounting for known and putative risk factors. Results:Among 29 105 female participants (mean [SD] age, 45.2 [4.5] years) over 24 years of follow-up, 1189 cases were documented of early-onset conventional adenomas and 1598 serrated lesions. UPFs provided 34.8% of total daily calories (median, 5.7 [IQR, 4.5-7.4] servings per day). Participants with higher UPF intake had an increased risk of early-onset conventional adenomas (highest vs lowest intake: AOR, 1.45; 95% CI, 1.19-1.77; overall P < .001) but not serrated lesions (AOR, 1.04; 95% CI, 0.89-1.22; P = .48 for trend). Findings were consistent after further adjustment for body mass index, type 2 diabetes, dietary factors (fiber, folate, calcium, and vitamin D), and Alternative Healthy Eating Index-2010 score. Conclusions and Relevance:In this study, higher UPF intake was associated with increased risk of early-onset colorectal conventional adenomas. These data highlight the important role of UPFs in early-onset colorectal tumorigenesis and support improving dietary quality as a strategy to mitigate the increasing burden of EOCRC.

Anxiety conditions are common and contribute substantially to reduced quality of life and healthcare burden (1) . While dietary behaviours may differ by anxiety status (2) , evidence linking specific food choices and anxiety—either causally or as consequences of anxiety—remains limited. Nuts are a widely consumed, nutrient-dense food that have been associated with better mental health outcomes such as depression (3) , but it is unclear whether nut consumption differs between individuals with and without anxiety. Understanding how anxiety relates to everyday food choices may therefore provide insight into behavioural patterns relevant to prevention, management, and public health messaging. We conducted a cross-sectional analysis of up to 122,195 UK and US participants from the ZOE PREDICT 3 cohort (ClinicalTrials.gov identifier: NCT04735835) to investigate associations between nut consumption and anxiety disorders. Anxiety status was defined based on self-reported lifetime anxiety disorders, classified according to DSM-5 diagnostic categories. Intake of almonds, walnuts, cashews, pistachios, and total nuts was derived from food frequency questionnaire data and categorised as regular consumption (≥4 g/day) versus non-consumption (0 g/day). Associations were examined using Firth logistic regression models adjusted for sociodemographic factors, lifestyle behaviours, clinical characteristics, and total energy intake. Overall diet quality was additionally controlled for using a modified and rescaled Mediterranean–DASH Intervention for Neurodegenerative Delay (MIND) dietary score from which nut components were removed to avoid overadjustment. To account for multiple testing across nut exposures, false discovery rate (FDR) correction was applied. Across the cohort, nut consumption was positively associated with overall diet quality, as reflected by higher modified MIND scores (r up to 0.34). After adjustment for diet quality and relevant covariates, consumption of all nut types examined was associated with 9–12% lower odds of lifetime prevalent anxiety. Specifically, individuals with anxiety had lower odds of consuming almonds (n= 89,387; OR=0.91; 95% CI: 0.85–0.98; FDR p = 0.018), cashews (n=87,702; OR=0.90; 95% CI: 0.84–0.97; FDR p = 0.008), pistachios (n=105,144; OR=0.91; 95% CI: 0.83–0.99; FDR p = 0.037), walnuts (n=122,195; OR=0.91; 95% CI: 0.86–0.97; FDR p = 0.007), and total nuts (n=117,651; OR=0.88; 95% CI: 0.81–0.95; FDR p = 0.006), relative to individuals without anxiety. Associations were consistent in direction across nut types and strongest for total nut consumption. In this large cross-sectional study, individuals with anxiety were less likely to report regular nut consumption compared with those without anxiety, even after accounting for overall diet quality. These findings suggest that anxiety status is associated with differences in eating behaviours, including nut consumption, independent of overall diet quality. While causality and directionality cannot be inferred, the results highlight the importance of considering specific food choices alongside broader dietary patterns when examining diet–mental health relationships.

As plant-based diets gain traction, interest in their impacts on the gut microbiome is growing. However, little is known about diet-pattern-specific metagenomic profiles across populations. Here we considered 21,561 individuals spanning 5 independent, multinational, human cohorts to map how differences in diet pattern (omnivore, vegetarian and vegan) are reflected in gut microbiomes. Microbial profiles distinguished these common diet patterns well (mean AUC = 0.85). Red meat was a strong driver of omnivore microbiomes, with corresponding signature microbes (for example, Ruminococcus torques, Bilophila wadsworthia and Alistipes putredinis) negatively correlated with host cardiometabolic health. Conversely, vegan signature microbes were correlated with favourable cardiometabolic markers and were enriched in omnivores consuming more plant-based foods. Diet-specific gut microbes partially overlapped with food microbiomes, especially with dairy microbes, for example, Streptococcus thermophilus, and typical soil microbes in vegans. The signatures of common western diet patterns can support future nutritional interventions and epidemiology. Using 21,561 individuals, the authors present a cross-sectional study of how gut microbiome signatures are associated with dietary intake patterns and with host health outcomes.

Factors to balance when considering osteoporosis screening in nonagenarians.

Over 12 years in the US and 26 years in Ontario, Canada, we found major differences in osteoporosis medications used. In both countries, osteoporosis medication initiation has not returned to pre-2008 levels; however, denosumab use is increasing. Future work should determine whether targeted screening or undertreatment drives these trends. Concerns about adverse events caused a rapid decline in osteoporosis medication use globally between 2008 and 2012. Trends in use in recent years have not been described. We aimed to describe and compare trends over time in the initiation and overall use of osteoporosis medications among older adults in the US and Ontario, Canada. We conducted a serial cross-sectional study leveraging two data sources: healthcare administrative data for all older adult residents of Ontario, Canada (ON) and Medicare claims and enrollment data for a 20

Patterns of oral anticoagulant use for atrial fibrillation following transition to long-term care.

The average age of menopause (cessation of menstruation for minimum 12 months) is 51 years, accounting for over one-third of a woman’s lifespan (1, 2). The transitional period known as perimenopause, characterised by menstrual irregularities due to female sex hormone deficiency, occurs from around 45 years. Menopausal changes significantly impact health, increasing prevalence of metabolic syndrome, cardiovascular risk factors, cognitive decline, and cause wide-ranging burdensome symptoms such as mood changes and sleep disturbances (1). Considering the recognised influence of nutrition on these health variables, a specific, reliable tool to assess menopausal symptoms would enable further research into potential lifestyle interventions, such as diet, for effective symptom management. The Kupperman Index, Menopause Rating Scale, Menopause Specific Quality of Life questionnaire and the Greene Climacteric Scale are the most widely recognised instruments for assessing menopausal symptoms (3). However, these scales were published between 1950 and 1996, when large-scale studies of menopausal experiences were lacking. This study examined menopause symptoms using the new MenoScale questionnaire, completed by peri- and postmenopausal women within two weeks of its launch on 4th September 2024, at https://zoe.com/menoscale. The MenoScale, developed with support from the British Menopause Society, considers 20 symptoms across four domains (vasomotor, sexual, psychological, somatic) and subjective impact on quality of life (QoL). The MenoScale score ranges from 0 to 100. It improves on existing tools by uniquely combining prevalence-informed symptoms, modern language, assessing QoL, and offering open online access. Descriptive statistical analysis was performed on the collected responses. The questionnaire was completed by 61,866 individuals. Average scores were 35.8 (95% CI 35.6, 36.0) for perimenopausal (N = 21,695) and 35.2 (95% CI 35.0, 35.4) for postmenopausal (N = 20,228) respondents. Nearly all (99.9%) peri- and post-menopausal women reported experiencing at least one symptom, with most reporting up to 10 symptoms (89.5% peri-, 87.0% postmenopausal). Furthermore, 8.6% of peri- and 9.5% of postmenopausal women reported all 20 symptoms. Most common symptoms for perimenopausal women were “tiredness and fatigue” (93.3%), “irritability” (88.4%), and “memory problems” (87.2%), and for postmenopausal women “tiredness and fatigue” (89.5%), “loss of interest in sex” (87.5%) and “sleep problems” (87.2%). As all stages of menopause involve various fluctuating symptoms and subjective experiences, reliable and accessible monitoring methods are essential for establishing dietary, lifestyle and pharmacological interventions that alleviate symptom burden. This open-access and online questionnaire allows real-time symptom monitoring and periodic reassessment to increase understanding of menopause, empowering women to track and manage their menopause experience, and facilitate data-backed conversations with healthcare providers. Investigations into the validity and reliability of the MenoScale in comparison to existing widely used tools is currently underway. Future research should include collecting dietary data alongside the MenoScale to investigate how adherence to dietary guidelines is related to menopausal symptom experiences.

Microbiome composition may differ according to menopause status, which may be partially mediated by diet (1). Peri- and post-menopausal symptom burden is associated with diet quality (2), however, knowledge on the association between menopause symptoms and gut microbiome composition is limited (3). This study investigates the associations between gut microbiome composition and menopause symptoms. Data was analysed from 70,399 peri- (N = 27,926) and post-menopausal women (N = 42,473) from the PREDICT 3 cohort (NCT04735835), examining the gut microbiome composition (using metagenomic sequencing) and diet quality using Healthy Eating Index (HEI) scores derived from the PREDICT Food Frequency Questionnaire. Data was also collected on menopause symptoms, grouped into vasomotor, sexual, psychological and somatic domains. A Menopause Symptom Tracker Score (MSTS) (0-100) was used to capture symptom prevalence (out of 20 symptoms) and impact on quality of life (0-not at all, 1-a little, 3-quite a bit and 5-extremely), with higher score values reflecting greater symptom burden (4). Using random forest machine learning (ML) models, we found that microbiome composition was predictive of the MSTS (AUCall = 0.70; AUCperi = 0.66; AUCpost = 0.65), as well as physical (e.g., fatigue, weight gain and slowed metabolism, thinning hair) and psychological (e.g., low mood or depression, anxiety and mood changes) domain scores (AUCall = 0.70; AUCperi = 0.66; AUCpost = 0.68 and AUCall = 0.70; AUCperi = 0.65; AUCpost = 0.66 respectively). Microbiome was also predictive of diet quality (HEI; AUCall = 0.77; AUCperi = 0.77; AUCpost = 0.75). Subsequently, we compared the top 50 species predictive for the HEI and MSTS respectively, and identified 32 common predictive species. Notably, the top predictive species for both HEI and MSTS was the not-yet-characterised Lachnospiraceae species-level genome bin SGB4964. To the best of our knowledge, this is the first time associations between menopause symptoms and the gut microbiome have been identified. Further work is needed to unravel diet-microbiome-symptom interrelationships and investigate a potential causal role of microbiome in menopause symptom burden. This knowledge could ultimately lead to novel, microbiome-based strategies for improving the quality of life for women during and after the menopausal transition.

BACKGROUND:High psychological resilience is associated with improved functional outcomes for older adults recovering from hip fractures. The objective of this study was to identify factors associated with increased psychological resilience in older women after hip fracture. METHODS:In total, 129 women aged ≥65 years with recent surgically repaired hip fractures were enrolled in a trial of exercise and testosterone therapy. The Brief Resilience Scale (BRS) measured baseline resilience and was categorized as low (BRS < 4) or high (BRS ≥ 4). Sociodemographic (eg, education), medical, and neuropsychological factors (eg, cognition by Short Blessed Test, mental health by a Global Mental Health Score (PROMIS-GMH), and depressive symptoms by Geriatric Depression Score (GDS)) were considered as independent variables. Individual factors were evaluated for their association with resilience using bivariate regression, and those having a significance level of p ≤ .10 were entered into age-adjusted multivariate logistic regression models. RESULTS:A total of 57 women (44%) reported high resilience. Neither education nor cognition was significantly associated with resilience. Lower GDS and better PROMIS-GMH scores were associated with high resilience in adjusted models. For every one-point worsening in GDS, the adjusted odds ratio (AOR) for high versus low resilience was 0.76 (95% CI, 0.61,0.93). In a model with GDS, PROMIS-GMH, and age, positive mental health remained significantly associated with higher resilience (AOR 1.34, 95% CI, 1.14,1.58). CONCLUSIONS:In older women after hip fracture, fewer depressive symptoms and better mental health were associated with higher psychological resilience. Addressing overall mental health when recovering from a hip fracture could contribute to increasing psychological resilience thereby maximizing recovery potential.

Although diet is a substantial determinant of the human gut microbiome, the interplay between specific foods and microbial community structure remains poorly understood. Coffee is a habitually consumed beverage with established metabolic and health benefits. We previously found that coffee is, among >150 items, the food showing the highest correlation with microbiome components. Here we conducted a multi-cohort, multi-omic analysis of US and UK populations with detailed dietary information from a total of 22,867 participants, which we then integrated with public data from 211 cohorts (N = 54,198). The link between coffee consumption and microbiome was highly reproducible across different populations (area under the curve of 0.89), largely driven by the presence and abundance of the species Lawsonibacter asaccharolyticus. Using in vitro experiments, we show that coffee can stimulate growth of L. asaccharolyticus. Plasma metabolomics on 438 samples identified several metabolites enriched among coffee consumers, with quinic acid and its potential derivatives associated with coffee and L. asaccharolyticus. This study reveals a metabolic link between a specific gut microorganism and a specific food item, providing a framework for the understanding of microbial dietary responses at the biochemical level.

Diet impacts human health, influencing body adiposity and the risk of developing cardiometabolic diseases. The gut microbiome is a key player in the diet-health axis, but while its bacterial fraction is widely studied, the role of micro-eukaryotes, including Blastocystis, is underexplored. We performed a global-scale analysis on 56,989 metagenomes and showed that human Blastocystis exhibits distinct prevalence patterns linked to geography, lifestyle, and dietary habits. Blastocystis presence defined a specific bacterial signature and was positively associated with more favorable cardiometabolic profiles and negatively with obesity (p < 1e-16) and disorders linked to altered gut ecology (p < 1e-8). In a diet intervention study involving 1,124 individuals, improvements in dietary quality were linked to weight loss and increases in Blastocystis prevalence (p = 0.003) and abundance (p < 1e-7). Our findings suggest a potentially beneficial role for Blastocystis, which may help explain personalized host responses to diet and downstream disease etiopathogenesis.

Cereal products contribute significantly to dietary intake of essential minerals. In wheat, iron and zinc are stored in specific grain structures including the aleurone, scutellum and embryo. Wheat cell walls are resistant to digestion in the human gastrointestinal tract and therefore this study investigated the hypothesis that physical disruption of the cell walls would increase the bioaccessibility and bioavailability of iron and zinc from wheat-based foods. Flour was micronized using a combination of roller milling and a micro-mill and this reduced median particle size by two-thirds. Hydrothermally processed wheat flour doughs were subjected to in vitro digestion to determine mineral bioaccessibility. Mineral bioavailability from food digests was measured using human intestinal Caco-2 cells. Iron (but not zinc) bioavailability from wheat foods made using the micronized flour (2.5 ± 0.5 nmol/mg cell protein) was increased significantly compared with foods produced from standard milled flour (1.3 ± 0.1 nmol/mg cell protein; P = 0.031). Micronization of wheat flour has the potential to increase the absorption of the endogenous iron present in cereal foods and this might have health benefits for population groups with poor iron status.

Leveraging whole genome sequencing data of 1751 individuals from the UK and 2587 Qatari subjects, we suggest here an association of rare variants mapping to the sour taste-associated gene KCNJ2 with reduced low-density lipoprotein cholesterol (LDL-C, P = 2.10 × 10−12) and with a 22% decreased dietary trans-fat intake. This study identifies a novel candidate rare locus for LDL-C, adding insights into the genetic architecture of a complex trait implicated in cardiovascular disease.