Frontiers in Nutrition最新文献

Background: Critically ill patients with acute coronary syndrome (ACS) concomitant sepsis are at markedly increased risk of mortality. The Triglyceride-Glucose (TyG) index, a simple surrogate marker of insulin resistance, although its predictive in separate cardiovascular or septic cohorts, its prognostic utility and potential mechanistic pathways in the high-risk setting of concurrent ACS concomitant sepsis remain unknown. This study aimed to evaluate the association between the TyG index at ICU admission and hospital mortality in this population and to elucidate underlying metabolic pathways using Bayesian network analysis.

Methods: In a multicenter retrospective cohort of 200 critically ill adults with ACS concomitant sepsis (2013-2023), the TyG index was calculated at ICU admission and stratified into tertiles (T1: <8.81; T2: 8.81-9.45; T3: >9.45). The primary outcome was in-hospital mortality. Multivariable logistic regression and restricted cubic splines were used to assess the independent relationship between the TyG index and mortality. A Bayesian network (BN) model was constructed to infer causal interactions among metabolic variables, the TyG index and mortality.

Results: Overall hospital mortality was 61.0% and increased significantly across TyG tertiles (T1: 54.5%; T2: 55.2%; T3: 73.1%; p = 0.044). After adjustment for confounders including age and peak procalcitonin, each unit increase in the TyG index was independently associated with higher mortality (adjusted odds ratio = 1.59; 95% confidence interval: 1.06-2.38; p = 0.026). A linear dose-response relationship was observed (p for nonlinearity = 0.549). The Bayesian network identified two primary metabolic pathways influencing TyG: Age→Triglycerides→TyG and Age→Diabetes→TyG. Importantly, a direct causal link from the TyG index to mortality (TyG → Mortality) was established. Setting the TyG index to its highest tertile alone predicted a mortality probability of 69.5%, with upstream metabolic factors providing minimal incremental prognostic value.

Conclusion: In critically ill patients with ACS concomitant sepsis, a higher TyG index at ICU admission, reflecting insulin resistance and metabolic dysfunction, is a strong and independent predictor of hospital mortality. It occupies a central position linking age-related metabolic deterioration to fatal outcomes. Incorporation of the TyG index into early risk stratification may help identify patients who could benefit from intensified metabolic monitoring and tailored nutritional therapeutic strategies.

Background: This study investigated the potential association between tea consumption and high-altitude pulmonary hypertension (HAPH) risk in a long-term, high-altitude Tibetan population, which remained unexplored.

Methods: In a hospital-based case-control study, 113 patients with HAPH and 113 controls were included. Data were collected from medical records and a tea consumption questionnaire. Group comparisons were performed using t-tests, Mann-Whitney U, Chi-square, or Fisher's exact test. Univariate and multivariable logistic regression analyses determined the tea-HAPH relationship (p < 0.05).

Results: Patients with HAPH exhibited significant right-heart structural alterations and a distinct metabolic profile characterized by lower lipid and glucose levels. A significant inverse association was observed between tea consumption and HAPH risk. Compared to the control group, patients with HAPH exhibited a significantly lower proportion of tea consumption (45.1% vs. 59.3%, p = 0.033). After adjusting for confounders, including age, hemodynamic, and metabolic parameters, regular tea consumption remained an independent protective factor (adjusted OR = 0.496, 95% CI: 0.258-0.952). Tibetan tea exhibited the strongest protective effect (adjusted OR = 0.300, 95% CI: 0.123-0.735). A significant dose-response relationship was observed, with the significant risk reduction at higher consumption frequency (≥6 days/week: adjusted OR = 0.208), more tea consumption (≥3 cups/day: adjusted OR = 0.305), and longer duration (≥20 years: adjusted OR = 0.210).

Conclusion: Regular Tibetan tea consumption significantly reduces HAPH risk in a dose-response manner. These findings offer new insights into dietary factors in HAPH etiology and can explain Tibetan adaptation to high altitudes.

Methods: This study retrospectively collected data on patients with urosepsis from the MIMIC-IV database and Bijie Hospital of Zhejiang Provincial People's Hospital. Multiple statistical methods were employed to explore the association between the RAR and short-term adverse outcomes, including multivariable Cox regression, restricted cubic spline (RCS) regression, and Kaplan-Meier (KM) survival analyses. Subsequently, three machine learning algorithms were utilized to screen for important features, followed by the construction of a multivariable Cox regression model for risk prediction. The performance of the risk prediction model was evaluated using receiver operating characteristic (ROC) curve analysis, with comparative validation performed via DeLong's test.

Results: This study ultimately included 3,374 patients with urosepsis. The 28-day ICU mortality and in-hospital mortality rates were 15.20 and 13.75%, respectively. In the fully adjusted multivariate models, RAR, whether treated as a continuous or categorical variable, remained significantly associated with both 28-day ICU mortality and in-hospital mortality. For each unit increase in continuous RAR, the hazard ratios (HRs) were 1.10 (95% confidence interval [CI]: 1.05-1.16) and 1.09 (95% CI: 1.04-1.15), respectively. Compared with the low-RAR group, the high-RAR group showed HRs of 1.55 (95% CI: 1.19-2.01) and 1.39 (95% CI: 1.06-1.82) for the two outcomes. RCS analysis indicated a positive dose-response relationship between RAR and short-term adverse prognosis. DeLong's test and ROC curve analysis demonstrated that RAR can appropriately enhance the predictive ability of routine critical illness scores for adverse outcomes. Moreover, a risk-prediction model incorporating RAR Slightly better than traditional severity scores (such as SOFA and SAPS II) in identifying high-risk patients. All findings were validated in an external cohort.

Conclusion: This study suggests that the RAR could serve as a predictor of short-term mortality risk in patients with urosepsis, with potential for translation into a clinical stratification tool to aid early identification of high-risk patients and guide intervention. However, its clinical utility needs to be further validated in larger prospective studies.

Background: This study aimed to investigate the mediating roles of healthy diet adherence and adiposity in the relationship between eating behaviors (uncontrolled or mindful eating) and liver health according to metabolic dysfunction-associated fatty liver disease (MALFD) status.

Methods: Adults with and without MAFLD (150 and 90, respectively) were included. Eating behaviors were assessed using the Mindful Eating Questionnaire (MEQ) and Three-Factor Eating Questionnaire (TFEQ), and Mediterranean diet adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS). Adiposity indices included Body Mass Index (BMI) and Visceral Adiposity Index (VAI). Liver health markers were alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Statistical analyses comprised group comparisons, Spearman correlations, and serial mediation models tested using Hayes' PROCESS macro.

Results: Individuals with MAFLD had higher BMI (median 32 vs. 25 kg/m²), VAI (4.1 vs. 1.1), and ALT levels (83 vs. 20 U/L, all p < 0.001). In unadjusted comparisons, the MAFLD group showed lower MEQ and MEDAS scores, together with higher emotional eating and uncontrolled eating scores on the TFEQ. In multivariable logistic regression analyses, BMI was independently associated with MAFLD status (OR = 1.43, 95% CI: 1.30-1.57), while eating behavior scores were not significant after BMI adjustment. Serial mediation analyses using PROCESS Model 6 showed that the association between uncontrolled eating scores and ALT levels was indirectly transmitted through BMI, with the serial indirect pathway involving MEDAS and BMI reaching statistical significance in the MAFLD group (indirect effect = 0.106; 95% bootstrap CI: 0.019-0.251). Moderated mediation analyses using PROCESS Model 92 further indicated a significant index of moderated mediation for this pathway (IMM = 0.090; 95% bootstrap CI: 0.003-0.233), whereas mediation models based on mindful eating scores did not yield significant moderated mediation effects.

Conclusion: The results support the presence of indirect associations linking eating behavior scores to liver enzyme levels via Mediterranean diet adherence and adiposity, particularly in the context of MAFLD. These pathways point to potentially modifiable behavioral and dietary targets, while underscoring the need for confirmation through prospective and interventional studies.

Background: Pentadecanoic acid (C15:0) is an odd-chain saturated fatty acid that is being marketed as a heart-healthy supplement.

Objective: To test whether plasma C15:0 is related to cardiovascular outcomes including systolic and diastolic blood pressure (SBP and DBP), functional cardiac measures, and development of hypertension and cardiovascular disease (CVD).

Methods: Plasma phospholipid C15:0 levels were assessed by gas chromatography in 3,196 Coronary Artery Risk Development in Young Adults participants (mean age 45 years; 57% female; 45% Black). Generalized linear models estimated associations of plasma C15:0 with SBP, DBP, and echocardiographic indices. Cox regression estimated risk of incident hypertension (SBP/DBP ≥ 140/90 mmHg or BP medication use) or CVD over a median 10-year period. Covariate adjustments were included to control for likely confounders. Significant associations were tested in a replication subcohort of 3,889 White participants of the Atherosclerosis Risk in Communities Study (ARIC) (mean age 54 years; 52% female) using comparable methods. Two-sample Mendelian randomization (MR) tested for potential causality.

Results: Higher plasma C15:0 levels (per SD) were associated with lower SBP (mm Hg) [β = -1.47 (95% CI, -1.99, -0.96)], DBP (mm Hg) [β = -1.13 (95% CI, -1.51, -0.74)], and 10-year risk of incident hypertension [hazard ratio = 0.86 (95% CI, 0.78, 0.95)]. These associations were replicated in the ARIC sample. C15:0 levels were not associated with incident CVD in either cohort or with echocardiographic parameters in CARDIA. Two-sample MR analyses provided no evidence for a causal effect of C15:0 on SBP, DBP, resting heart rate, or hypertension.

Conclusion: Observational associations between plasma C15:0 and cardiovascular risk markers were modest but were not supported by cardiac function or MR findings. The collective evidence is not consistent with a causal cardiovascular benefit of C15:0.

Background: Hypothyroidism can alter the serum lipid profile and the composition of human milk (HM) proteins involved in macronutrient metabolism. We investigated the association between maternal hypothyroidism and HM macronutrient content and fatty acid (FA) composition.

Methods: In this prospective cohort study conducted in Riyadh, Saudi Arabia, HM samples from mothers with hypothyroidism (n = 19) and mothers without hypothyroidism (n = 30) were compared. Eligible participants were breastfeeding mothers of term singleton infants with no history of metabolic disorders or chronic disease. Maternal demographic characteristics, anthropometrics, laboratory markers, dietary intake, and HM samples were collected 4-13 weeks postpartum. Primary outcomes were HM macronutrient content and FA composition, analyzed using the Miris HM analyzer and gas chromatography-flame ionization detection, respectively.

Results: Forty-nine participants were recruited between December 12, 2023, and May 31, 2025. HM macronutrient content and total saturated, monounsaturated, polyunsaturated, and trans FAs (TFAs) did not differ between groups. Among mothers with hypothyroidism, 10 individual FA species differed significantly (eight higher and two lower), characterized by higher industrial TFAs and selected long-chain omega-3 and omega-6 species. Mothers with hypothyroidism had higher levels of docosapentaenoic acid (0.079 ± 0.024% vs. 0.063 ± 0.024%) and elaidic acid (0.286% [0.233-0.439%] vs. 0.118% [0.028-0.220%]), but lower levels of tricosanoic acid (0.00% [0.00-0.00%] vs. 0.011% [0.00-0.022%]) (all p < 0.05). They also had higher low-density lipoprotein cholesterol (3.45 [2.87-3.97] vs. 2.94 [2.35-3.32] mmol/L; p = 0.01), whereas other lipid parameters did not differ significantly.

Conclusion: Maternal hypothyroidism, even when treated with replacement therapy, was associated with altered HM FA composition. These changes may reflect thyroid hormone-related shifts in lipid metabolism, potentially influenced by maternal diet and adipose stores. Future longitudinal research is needed to investigate whether integrating thyroid-aware lactation support and targeted nutritional interventions can effectively modulate these effects and improve breastfeeding outcomes.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 30% of all NHL cases. While serum lipids have been associated with various cancers, their relationship with the risk of DLBCL remains largely unexplored.

Methods: This prospective cohort study included 339,172 participants from the UK Biobank. Baseline serum levels of apolipoproteins A and B (ApoA/B), high-and low-density lipoprotein cholesterol (HDL/LDL), total cholesterol (TC), and triglycerides (TG) were measured. The associations between lipid profiles and DLBCL risk were assessed using Cox proportional hazards models, and restricted cubic spline (RCS) analysis. Subgroup analyses and temporal lipid trajectories were also performed.

Results: Over a median follow-up of 13.8 years, 1,207 participants developed DLBCL. Lower levels of ApoA, HDL, and TC were significantly associated with increased DLBCL risk. RCS analysis revealed non-linear associations for ApoA and HDL, and a linear association for TC (P for non-linearity: 0.048, 0.017, and 0.139, respectively). Subgroup analysis indicated a significant interaction with age. Temporal trajectory analysis showed a gradual decline in ApoA and HDL levels during the 10 years prior to diagnosis, with a steeper drop in the last 5 years.

Conclusion: Reduced levels of ApoA, HDL, and TC are linked to a higher risk of DLBCL. Notably, lipid changes precede clinical diagnosis by several years, suggesting their potential as early indicators for DLBCL risk stratification and preventive strategies.

The labeling of cell-cultured products for food application as "meat" remains contentious, with public perceptions varying across cultural contexts. This study examined how individuals in Japan and the United Kingdom (UK) perceive cell-cultured products, particularly whether they should be called "meat." An online survey was conducted with 1,200 respondents aged 20-59 years (600 in Japan and 600 in the UK). The questionnaire included items on agreement with calling cultured products as "meat," willingness to try cultured meat, images associated with meat, views on life, dietary patterns, and interest in environmentally friendly foods. Multiple correspondence analyzes were performed to identify clusters of opinions. Respondents interested in environmentally friendly food were more likely to support labeling cultured products as "meat" and to express willingness to try them. In Japan, those who have the relational view on life were more likely to show strong willingness to try cultured meat, whereas in the UK, vegetarian respondents were more likely to reject it. The categorical boundaries for ambiguous cell-cultured products are co-occurring with a globally expanding framework of environmental consciousness; however, attitudes are also shaped by culturally specific factors, as demonstrated in Japan and the UK. These findings underscore the importance of cultural context in guiding communication.

Background: Diet quality and physical activity shape chronic-disease risk, yet the alignment between what adults know about nutrition and how they evaluate healthy eating remains unclear.

Methods: Adults in Türkiye (N = 408; 46.3% women, 53.7% men; mean age 28.6 years) completed validated measures of nutrition knowledge (NKS) and attitudes toward healthy nutrition [ASHN; subscales: Information on Nutrition (IN), Emotion for Nutrition (EN), Positive Nutrition (PN), Malnutrition (MP)]. Lifestyle factors included smoking, alcohol use, and 7-day physical activity (sedentary/low/moderate/high). Analyses comprised t-tests, one-way ANOVA with Tukey tests, Pearson correlations, and multiple linear regression.

Results: Knowledge and attitudes were only weakly aligned: higher NKS related to lower ASHN Total (r = -0.18, p < 0.001) and to IN (r = -0.21), PN (r = -0.11), and MP (r = -0.17); EN was null (r = -0.01). In regression, IN (β = -0.17, p = 0.001) and MP (β = -0.16, p = 0.006) were independently associated with lower NKS; overall fit was small (R ² = 0.063; F(4,403) = 6.815, p < 0.001). Attitudes varied strongly by physical activity High > Low/Moderate/Sedentary for ASHN Total (F(3,404) = 10.10, η ² = 0.07), IN (F = 8.10), and PN (F = 11.11); EN showed no group difference. Smoking showed a paradox: knowledge was higher among heavier smokers (F(3,404) = 3.47, p = 0.010), whereas attitudes were less favorable (Never/Former > ≥ 11/day for ASHN Total; F = 6.47, η ² = 0.04). Non-drinkers reported higher ASHN than drinkers (t(406) = 2.48, p = 0.013) with lower MP (t(406) = 3.65, p < 0.001). Education displayed clear stepwise gradients for attitudes (e.g., ASHN Total F = 18.97, η ² = 0.12), but not for knowledge. Age correlated positively with ASHN Total (r = 0.27) and EN/PN/MP, but not with NKS (r = -0.07).

Conclusion: In this adult sample, nutrition knowledge and healthy-eating attitudes were largely distinct. Attitudes especially belief- and practice-oriented facets tracked physical activity and other lifestyle factors, whereas knowledge did not. Interventions should pair education with motivation, self-regulation, and contextual supports to convert knowledge into healthier eating.