Nutrition Journal最新文献

Background: Gallstone disease (GSD) is a prevalent gastrointestinal disorder, few studies have examined the combined effects of dietary and lifestyle factors on GSD. This study aims to investigate the relationship between oxidative balance score (OBS) and GSD, and explores the potential mediating role of oxidative stress.

Methods: Cross-sectional data from 6,196 participants in the NHANES 2017-2020 were analyzed. OBS, encompassing 16 dietary and 4 lifestyle factors, was assessed alongside GSD prevalence. Weighted multivariate logistic regression, restricted cubic spline (RCS) analysis were used to explore the relationship between OBS and GSD and mediation analysis was used to test the indirect effect of oxidative stress indicators. Subgroup analysis and sensitivity analysis were used to determine the stability of results.

Results: A higher OBS was significantly associated with a reduced risk of GSD (OR: 0.701, 95% CI: 0.492-0.999, P < 0.05). RCS analysis revealed a linear association between OBS and GSD risk. Mediation analysis indicated significant mediating effects of albumin and uric acid, with a combined mediation proportion of 19.540% (P < 0.05). Subgroup analysis revealed differences and interrelationships based on education level, providing additional insights into the relationship between OBS and GSD and sensitivity analysis confirmed the stability of these associations.

Conclusions: A higher OBS is associated with a reduced risk of GSD, especially among higher education levels groups, and albumin, uric acid may act as mediators of this association. These findings underscore the potential role of oxidative stress in GSD and the significance of maintaining a healthy diet and lifestyle to decrease GSD risk.

Background: mHealth, i.e. mobile-health, strategies may be used as a complement to regular care to support healthy dietary habits in primary care patients. We evaluated the effect of a 12-week smartphone-based dietary education on overall diet quality (primary outcome), and dietary intake and cardiometabolic risk markers (secondary outcomes) in people with type 2 diabetes.

Methods: In this two-armed randomized clinical trial, people with type 2 diabetes were recruited within a primary care setting and randomized 1:1 to a smartphone-delivered dietary education for 12 weeks or a control group receiving regular care only. Dietary intake and cardiometabolic risk markers were measured at baseline and after 3 months. Diet was assessed using a 4-day dietary record and a food frequency questionnaire (FFQ). Overall diet quality was estimated with a Nordic Nutrition Recommendation (NNR) score and specific dietary intake was estimated for 13 food groups/nutrients. We used linear regression models to examine differences in change from baseline to the 3-month follow-up between the intervention and control group, adjusted for baseline values of each outcome variable.

Results: The study included 129 participants (67 in the intervention group and 62 controls), of whom 61% were men. At baseline, mean age was 63.0 years and mean body mass index was 29.8 kg/m². When analyzing dietary record data, we found no effect of the intervention on diet quality or intake, however, the control group had increased their score by 1.6 points (95%CI: -2.9, -0.26) compared to the intervention group. In the analyses of FFQ data, the intervention group had lowered their daily intake in grams of saturated (β = -4.1, 95%CI: -7.9, -0.2) and unsaturated (mono- and polyunsaturated) (β = -6.9, 95%CI: -13.5, -0.4) fat more than the control group. The intervention group also presented lower serum triglycerides levels than the controls (β = -0.33, 95%CI: -0.60, -0.05). No statistical differences were found in any other dietary variables or cardiometabolic risk markers.

Conclusion: While we found no effect on overall diet quality, our findings suggest that a smartphone-based dietary education might impact dietary fat intake and corresponding cardiometabolic risk markers in people with type 2 diabetes. Our results should be considered hypothesis-generating and need to be confirmed in future studies.

Trial registration: Registered at ClinicalTrials.gov ( NCT03784612 ). Registered 24 December 2018.

Background: Chronic kidney disease (CKD) is prevalent among elderly patients with type 2 diabetes mellitus (T2DM). The association between dietary patterns and CKD in elderly T2DM patients remains understudied. This study aimed to investigate the relationship between dietary patterns and CKD in elderly Chinese patients with T2DM.

Methods: This community-based cross-sectional study included 5,713 elderly T2DM patients (aged ≥ 65 years) from Xiangcheng District, Suzhou, China. Dietary intake was assessed using a validated food frequency questionnaire, and dietary patterns were identified using factor analysis. Each participant was assigned a score for each identified dietary pattern, with higher scores indicating a greater alignment of their diet with the respective pattern. Quartiles of these pattern scores were utilized as the primary exposures in the analysis. CKD was defined as albuminuria, reduced estimated glomerular filtration rate (eGFR), or both. Logistic regression models assessed CKD prevalence across quartiles of dietary pattern scores, expressed as adjusted odds ratios (ORs) with 95% confidence intervals (CIs).

Results: CKD prevalence was 45.7%. Four dietary patterns were identified: "traditional southern", "high-protein", "balanced" and "imbalanced". A balanced dietary pattern, featured with high intake of fruits, dairy products, eggs, snacks, crab and shellfish, and fish and shrimp, was associated with lower CKD prevalence. The adjusted ORs for CKD across ascending quartiles were 0.99 (95% CI: 0.85-1.16), 0.89 (95% CI: 0.76-1.04), and 0.73 (95% CI: 0.62-0.86). The imbalanced dietary pattern, characterized by high intake of green leafy vegetables, refined grains, and red meat but low dietary diversity, was associated with increased CKD prevalence, with ORs of 1.01 (95% CI: 0.86-1.18), 1.15 (95% CI: 0.98-1.35), and 1.25 (95% CI: 1.07-1.46) across quartiles. No significant associations were observed for "traditional southern" or "high-protein" dietary patterns.

Conclusions: Dietary patterns were associated with CKD prevalence in elderly Chinese T2DM patients. A "balanced dietary pattern", consistent with local dietary customs, was associated with a lower risk of CKD. Further longitudinal and intervention studies are needed to confirm these associations.

Information about how ultra-processed foods (UPF) contribute to the intake of energy and nutrients and environmental impact is important for future food policies and dietary recommendations. This study assessed the contribution of the four NOVA food groups, including UPF, to energy intake, nutritional quality, and climate impact in Norwegian adults' diet. We used dietary data from 348 participants in the Norkost 4 pilot study, collected through two non-consecutive 24-h dietary recalls. Foods, beverages, and dietary supplements were classified using the NOVA system. The NOVA system has four groups; NOVA 1: Unprocessed or minimally processed foods, NOVA 2: Processed culinary ingredients, NOVA 3: Processed foods, and NOVA 4: UPF. UPF contributed to 48% of the total energy intake, NOVA 3 with 19%, and NOVA 1 with 28%. Within UPF, bread contributed the most to energy intake. Foods in NOVA 1 had the highest nutrient density (expressed as amount of nutrients provided per unit of energy) for protein, fiber, and several essential micronutrients. UPF had the highest nutrient density for added sugar, fats, and sodium. UPF contributed to 32% of total GWP from the diet, while NOVA 1 contributed to 38%. In conclusion, UPF contributed to about half of the energy intake of Norwegian adults, and had lower nutritional quality compared to NOVA 1. UPF also accounted for about one-third of the GWP from the total diet. These findings emphasize the importance of addressing the intake of UPF in dietary policies and recommendations to improve nutritional quality and reduce environmental impact.

Background: Although emerging evidence suggests that indole derivatives, microbial metabolites of tryptophan, may improve cardiometabolic health, the effective metabolites remain unclear. Also, the gut microbiota that involved in producing indole derivatives are less studied. We identified microbial taxa that can predict serum concentrations of the key indole metabolite indole-3-propionic acid (IPA) at population level and investigated the associations of indole derivatives and IPA-predicting microbial genera with cardiometabolic risk markers.

Methods: In a cohort of 318 community-dwelling adults, serum indole metabolites and fecal microbiota (16S ribosomal RNA) were measured at baseline. Total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and fasting blood glucose were repeatedly measured at baseline and again after 1 year. Brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) were measured after 1 year. The association between indole derivatives and the 1-year changes in blood lipids and glucose, and association of indole derivatives with baPWV and ABI were investigated using linear regression models.

Results: Each 1 µmol/L increase in indole-3-acetic acid (IAA) levels was associated with 5.08% (P = 0.046) decrease in LDL-C. IPA levels were inversely associated with baPWV (percentage difference = -1.32%, P = 0.036). Per 1 µmol/L increase in Indole-3-aldehyde (IAld) levels was associated with 1.91% (P = 0.004) decrease in TC and 0.58% (P = 0.019) increase in ABI, but 1.79% decrease in HDL-C with borderline significance (P = 0.050). We identified 18 bacterial genera whose relative abundance was positively associated with serum IPA concentrations (P_FDR < 0.05) and constructed a microbial score to reflect the overall IPA-producing potential. This score was inversely associated with baPWV (percentage difference = -0.48%, P = 0.007).

Conclusions: Our results suggest that IAA, IPA, IAld, and IPA-predicting microbial score are favorably associated with several cardiometabolic risk markers, although IAld may decrease HDL-C levels.

Background: The Mediterranean diet pattern has been consistently associated with health benefits but less is known about the association with environmental and economic sustainability in the United States (US). This information is needed to support sustainable policy agendas and provide consumers with evidence-based information needed to make informed food choices. This study fills this research gap by evaluating the environmental sustainability and diet cost associated with adherence to the Mediterranean diet pattern in the US.

Methods: Dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 17,079) were merged with data on environmental impacts (greenhouse gas emissions, cumulative energy demand, water scarcity footprint), agricultural resource demand (land, fertilizer nutrients, and pesticides), and food prices from multiple publicly available databases. The Mediterranean Diet Score was used to evaluate adherence to the Mediterranean diet pattern. Multivariable linear regression models were used to evaluate the association between adherence to the Mediterranean diet pattern and environmental impacts, agricultural resource demand, and diet cost. Sensitivity analyses were used to evaluate adjustment of loss and waste and food-away-from-home prices.

Results: Greater adherence to the Mediterranean diet pattern was associated with lower greenhouse gas emissions (p < 0.001), land use (p < 0.001), fertilizer nutrient use (p < 0.001), and pesticide use (p < 0.001), higher water scarcity footprint (p < 0.001) and diet cost (p < 0.001), and no change in cumulative energy demand (p = 0.147). These changes were driven primarily by reduced intake of animal-sourced foods such as beef dishes, meat sandwiches, and dairy, as well as decreased intake of refined carbohydrate foods such as refined grain dishes and soft drinks.

Conclusions: This nationally representative study demonstrates that greater adherence to the Mediterranean diet pattern is associated with sustainability trade-offs. These findings have implications for the development of sustainable dietary guidelines and clinical practice guidelines that can be used to inform consumer food choices.

Background: Flavonoids are believed to have potential anti-aging effects due to their anti-inflammatory and antioxidant properties. However, the effectiveness of dietary flavonoids and their subclasses in delaying aging has yet to be confirmed. Our study intends to examine relationship between them.

Methods: Data from three survey cycles (2007-2008, 2009-2010, and 2017-2018) of the National Health and Nutrition Examination Survey (NHANES) was used to investigate the relationship between PhenoAgeAccel and dietary flavonoid intake. Weighted linear regression was conducted to evaluate the relationship between dietary flavonoid intake and PhenoAgeAccel, and the dose-response relationship was investigated by limited cubic spline (RCS) analysis. Mixed effects were explored using weighted quantile sum (WQS) regression. Further, the subgroup analyses were also conducted.

Results: A total of 5391 participants were included, after multivariable adjustments, a negative association was found with total dietary flavonoid, flavan-3-ols, flavanone, flavones and flavonols with a β (95% CI) of -0.87 ( -1.61, -0.13), -0.83 (-1.95, -0.08), -1.18 (-1.98, -0.39), -1.64 (-2.52, -0.77) and - 1.18 (-1.98, -0.39) for the higher quintile compared to the lowest quintile. The RCS analysis show a non-linear relationship between flavan-3-ols (P for nonlinear = 0.024), flavanones (P for nonlinear = 0.005), flavones (P for nonlinear < 0.001), flavonols (P for nonlinear < 0.001) and total flavonoid intake (P for nonlinear < 0.001) and PhenoAgeAccel. WQS regression indicated that flavones had the primary effect on the mixture exposures (52.72%). Finally, the subgroup analysis indicated that participants without chronic kidney disease are more likely to benefit from dietary flavanone and flavone intake in mitigating aging, while the benefits of flavanone intake are more significant in participants with a lower body mass index.

Conclusion: Our study suggested that dietary flavonoid intake is negatively associated with accelerating aging in adults of American, and the most influential ones are flavones, flavanones, flavan-3-ols and flavonols.

Importance: Evidence from systematic reviews of the cardioprotective effect of omega-3 polyunsaturated fatty acid (PUFA) remains controversial, and interventions including PUFAs dietary supplements or prescription medications cannot accurately reflect the role of PUFA RX in cardiovascular disease (CVD) prevention.

Objective: We conducted a meta-analysis of randomized clinical trials (RCTs) to evaluate the efficacy of PUFA prescription medication in preventing CVD.

Methods: Two reviewers conducted a literature search of Embase, MEDLINE/PubMed, and the Cochrane Library from their inception to September 2023. The inclusion criteria were RCTs evaluating long-term supplementation (≥ 1 year) with PUFA prescriptions and reporting cardiovascular outcomes. Data were extracted independently by two authors, and the certainty of evidence for each outcome was assessed using the GRADE system. Random-effects models were used to estimate the risk ratios (RRs) and 95% confidence intervals (CIs). The primary outcomes were cardiovascular events. Secondary endpoints included major adverse cardiovascular events (MACEs), cardiac death, all-cause mortality, myocardial infarction, stroke, and revascularization. Subgroup analyses were performed based on PUFA components, dosage, follow-up duration, and risk status.

Results: Twelve RCTs involving 99,830 participants were included. The mean age of participants ranged from 59.4 to 74.0 years, with a follow-up period varying from 1 to 6.2 years. Compared with placebo and statins, PUFA prescription medication was associated with a reduced risk of cardiovascular events (8 RCTs, n = 75,929, RR, 0.88 [95% CI, 0.81-0.95]; P = 0.0007; I² = 45%), cardiac death (10 RCTs, n = 95,440, RR, 0.91 [95% CI, 0.84-0.99]; P = 0.02; I² = 23%), myocardial infarction (9 RCTs, n = 94,877, RR, 0.84 [95% CI, 0.73-0.96]; P = 0.009; I² = 62%), and revascularization (9 RCTs, n = 91,242, RR, 0.91 [95% CI, 0.84-0.99]; P = 0.02; I² = 63%).

Conclusions and relevance: PUFA prescription medication could lower the risks of cardiovascular events, cardiac death, myocardial infarction and revascularization. This research provides insight into the efficacy of PUFA prescription medications in CVD prevention and contributes to the ongoing debate on the role of PUFA products in cardiovascular outcomes.

Background: Rheumatoid arthritis (RA) is a complex multifactorial autoimmune disease affected by genetics and environmental factors. The relationship between alcohol consumption and RA remains controversial. This study aimed to assess the association between alcohol consumption and RA risk using cross-sectional analysis and Mendelian randomization (MR).

Methods: We investigated the association between alcohol consumption and RA risk through multivariate linear regression and subgroup analyses. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 which involved 32,308 participants. Subsequently, a two-sample MR study was conducted to assess the causal effect of spirits intake on RA. Instrumental variables (IVs) for spirits intake were screened from genome-wide association study (GWAS) datasets, including 69,949 individuals from the UK Biobank study, while summary statistics relating to RA were obtained from a GWAS meta-analysis of 417,256 participants. The primary inverse variance weighted (IVW) method and other supplementary MR methods were used to estimate the causal association between spirits intake and RA. Sensitivity analyses were performed to confirm the robustness and reliability of the results.

Results: In the cross-sectional analysis, we observed that alcohol consumption was significantly positively linked with RA risk (odds ratio [OR] = 1.030; 95% confidence interval [CI], 1.025-1.034). According to subgroup analyses stratified by age, sex, race, smoking status, marital status, education attainment, and body mass index (BMI), consistently showed a positive relationship between alcohol consumption and RA risk in each subgroup (all OR > 1, P < 0.05). Furthermore, MR analysis indicated a causal association between spirits intake and RA (OR = 1.043, P < 0.05). Sensitivity analyses supported the robustness and reliability of these findings (all P > 0.05).

Conclusion: This study indicated that alcohol consumption is correlated with an increased risk of RA, but further studies are necessary to clarify the exact association.

Background: Plant-based diets have been found to be associated with hypertension. Dietary intake is a dynamic and changing process that can be better characterized by trajectories of dietary indices. However, the associations between plant-based diet trajectories and hypertension over time remained unknown.

Methods: We used data from the China Health and Nutrition Survey 2004-2015 to analyze a cohort of Chinese adults ≥ 18 years of age who had no hypertension at baseline. Plant-based diets were measured by an overall plant-based diet index (PDI), healthful plant-based diet index (hPDI), and unhealthful plant-based diet index (uPDI) based on three 24-hour recalls. Trajectories of PDI, hPDI, and uPDI (2004 to 2011) were identified using group-based trajectory modeling. The associations between trajectories of PDIs and the risk of new-onset hypertension were estimated using Cox proportional hazard models.

Results: We identified three trajectories for PDI, two for hPDI, and four for uPDI among the 2853 participants with a mean follow-up of 9.6 years. Compared with the PDI "low and stable" class, the PDI "high and decreasing" class had a 23% decreased risk (HR: 0.77; 95% CI: 0.62-0.95) of hypertension. There was no significant association with PDI "low and increasing" class. Compared with the hPDI "low and stable" class, the hPDI "high and stable" class had a 24% decreased risk (HR: 0.76; 95%CI: 0.64-0.91). For uPDI trajectories, compared with the "low and decreasing" class, the "high and increasing," "high and stable," and "low and increasing" classes had increased risks of 43% (HR: 1.43; 95% CI: 1.06-1.94), 77% (HR: 1.77; 95% CI: 1.26-2.49), and 72% (HR: 1.72; 95% CI: 1.26-2.33), respectively.

Conclusions: This study underscores the importance of maintaining high intakes of healthful plant-based diets and low intakes of unhealthful plant-based diets overtime for hypertension prevention.