Nutrition Journal最新文献

Background: Multimorbidity has posed growing global health burdens, yet evidence on modifiable dietary risk factors remains limited. To explore the dietary factors influencing multimorbidity risk, a longitudinal study was conducted in the UK Women's Cohort.

Methods: The cohort initiated from 1995 to 1998 has recruited 35,372 women aged 35-69 years at baseline. Daily consumption of foods and a modified Mediterranean diet was evaluated based on a validated food frequency questionnaire with 217 items. Charlson comorbidity index (CCI) was used to assess multimorbidity based on diagnostic ICD codes from Hospital Episode Statistics. Associations between diet and multimorbidity were estimated using Cox's proportional hazards models. Subgroup analyses stratified by age at baseline and body mass index were additionally explored.

Results: During 486,656 person-years of follow-up (mean 19.7 years), 7,516 of 24,703 participants (30.4%) developed incident multimorbidity. Compared with women with low adherence to Mediterranean diet, those with moderate or high adherence had 6% (hazard ratio = 0.94, 95% confidence interval: (0.89, 0.99)) or 14% (0.86 (0.80, 0.92)) lower risk of multimorbidity in the fully-adjusted models, respectively. Increased risk of multimorbidity was observed to be associated with each additional 10 g/MJ intake of processed meat (1.60 (1.37, 1.87)), red meat (1.19 (1.12, 1.26)), and total meat (1.12 (1.08, 1.17)). Above associations remained in subgroup analyses stratified by age at baseline or body mass index (BMI), except in the subgroup aged ≥ 60 years where the association between adherence to Mediterranean diet and risk of multimorbidity was attenuated significantly. Additionally, there was no significant evidence on effect modification of age at baseline or BMI on the dietary factors (all P-interaction > 0.05).

Conclusions: Adherence to Mediterranean diet was inversely, but consumption of meat especially processed meat was positively, associated with risk of multimorbidity. These modifiable dietary factors represent promising prevention targets, warranting further investigation in diverse populations.

Background: The increasing intake of sugar-sweetened (SSBs) and artificially sweetened beverages (ASBs) raises concerns over their potential impact on cardiovascular health. This umbrella meta-analysis examines their association with cardiovascular outcomes, synthesizing existing evidence comprehensively.

Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar databases, covering studies published up to November 2024. Eligible meta-analyses were synthesized using a random-effects model to calculate pooled effect sizes and 95% confidence intervals. Subgroup and sensitivity analyses were performed, and the methodological quality of studies was evaluated using AMSTAR 2 tools.

Results: Nineteen meta-analyses encompassing 67 datasets met the inclusion criteria. ASB consumption was associated with a 10% increased risk of mortality (RR: 1.10; 95% CI: 1.07 to 1.12), including an 8% increased risk of cardiovascular disease (CVD) mortality (RR: 1.08; 95% CI: 1.05 to 1.11). SSB intake was linked to a 9% higher overall mortality risk (RR: 1.09; 95% CI: 1.07 to 1.11) and a 10% increased CVD mortality risk (RR: 1.10; 95% CI: 1.07 to 1.13). Additional cardiovascular risks associated with both beverages included hypertension (RR range: 1.12-1.19), coronary heart disease (RR range: 1.09-1.20), metabolic syndrome (RR range: 1.19-1.31), and stroke (RR range: 1.06-1.25).

Conclusion: The results underscore a clear link between the intake of sweetened beverages and elevated risks of mortality and major cardiovascular outcomes, suggesting an urgent need to reduce their consumption as part of public health initiatives. Targeted strategies, including consumer education and policy interventions, may help mitigate these risks and improve cardiovascular health outcomes.

Background: Muscle loss is linked to multiple adverse outcomes, but its impact on rheumatoid arthritis (RA) prognosis is unclear. This study aimed to examine the association between muscle mass and mortality in RA patients.

Methods: RA patients from the NHANES database were followed for survival until December 31, 2021. Muscle mass was measured using dual X-ray absorptiometry, low muscle mass was defined as appendicular skeletal muscle mass index (ASMI) < 7.0 kg/m² in men or < 5.5 kg/m² in women. The relationship between ASMI and mortality was analyzed using weighted Cox regression.

Results: The study included 892 participants (weighted mean [SE] age 52.22 [0.59] years, 57.36% female). During a median (SE) follow-up of 11.44 (0.33) years, 291 deaths (32.62%) were recorded, of which 197 (28.23%) were attributed to cardiovascular disease. In fully adjusted models, a 1 kg/m²increase in ASMI was associated with decreased all-cause and cardiovascular mortality risk by 34% (HR = 0.66, 95% CI 0.50-0.86) and 40% (HR = 0.60, 95% CI 0.38-0.93), respectively. When ASMI stratified, RA with low muscle mass had a 1.42-fold higher risk of all-cause mortality (HR = 1.42, 95% CI 1.01-2.00) and a 2.58-fold higher risk of cardiovascular mortality (HR = 2.58, 95% CI 1.18-5.62) than those with normal muscle mass. Restricted cubic spline analysis showed a nonlinear association between ASMI and cardiovascular (P_nonlinear = 0.04) but not for all-cause mortality (P_nonlinear = 0.25).

Conclusions: Muscle loss in RA patients is linked to higher mortality risk, underscoring the need to recognize its harmful effects.

Background: The quest towards more feasible, low-cost yet accurate dietary assessment methods has led to the development of the new Experience Sampling-based Dietary Assessment Method (ESDAM). ESDAM is an app-based quantitative dietary assessment method to assess habitual dietary intake over a period of 2 weeks. ESDAM prompts three 2-hour recalls daily requesting to provide dietary intake on meal and food group level. The ESDAM allows to measure dietary intake near real-time in a rapid, low-cost and feasible manner. Following the user experience evaluation of the ESDAM, the validity of the ESDAM will now be assessed against objective biomarkers.

Methods: This protocol describes the validation of the ESDAM against three 24-hour dietary recalls (24-HDR), doubly labeled water, urinary nitrogen, serum carotenoids, and erythrocyte membrane fatty acids. The primary outcomes include energy intake and protein intake measured by the ESDAM in relation to energy expenditure measured by the doubly labeled water method and protein intake derived from urinary nitrogen analysis respectively. Secondary outcomes include nutrient and food group consumption derived from ESDAM and repeated 24-HDR's, beta-carotenoids as biomarker of fruit and vegetable consumption and erythrocyte membrane fatty acid composition as biomarker of dietary fatty acid composition. Blinded continuous glucose monitoring will serve as method to assess compliance to ESDAM prompts. A target sample of 115 healthy volunteers will be recruited. Validity will be evaluated by mean differences and spearman correlations between nutrient and biomarker reference values. Bland-Altman plots will be developed to assess agreement. Method of triads will allow quantifying measurement error of the ESDAM, 24-HDR's and biomarkers in relation to the (unknown) 'true dietary intake'.

Discussion: This protocol describes an extensive validation study of a newly developed Experience Sampling-based Dietary Assessment Method against both self-reported and objective reference methods. The main strength is the use of the state-of-the-art validation techniques using doubly labeled water, urinary nitrogen, carotenoids and erythrocyte membrane fatty acids as biomarkers for dietary intake. A limitation of the study is that the evaluation of reproducibility of the ESDAM is not included.

Registration: This study is registered at ClinicalTrials.gov on (NCT06485960, date: 07/02/2024).

Background: Kiwifruit is widely recognized for its nutritional value and health benefits, yet reliable and objective methods for assessing kiwifruit intake in populations remain limited.

Objective: This study aimed to identify urinary biomarkers of kiwifruit intake and develop an optimal biomarker panel for differentiating consumers within days.

Methods: A randomized, controlled, crossover dietary intervention was conducted among 17 healthy volunteers. The intervention included four phases: run-in, single-exposure, repeat-exposure, and follow-up. Urine samples at multiple time-point and fruit samples were prepared and analyzed using untargeted metabolomics via dual-column ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS). Candidate biomarkers were identified through a systematic statistical strategy on kinetic profiles within 24 h, and annotated for potential fruit-derived origin through spectral matching. Machine learning algorithms were employed to establish an optimal biomarker panel for assessing kiwifruit intake under habitual diet conditions.

Results: Twenty-three urinary metabolites showed significantly elevated kinetic profiles, among which 15 were matched to compounds detected in the original fruit or in vitro digestion samples. These metabolites mainly included polyphenol-related metabolites and plant-derived amino acid derivatives. The excretion of many metabolites turned to be delayed compared to those typically observed for other fruits. For example, 2-isopropylmalic acid usually peaked in urine or blood within 6 h of consuming other fruits, but in our study urinary level at 24 h was much higher compared to 6 h. Most of the selected candidates are not specific to kiwifruit based on existing literature, such as hippuric acid. In this regard, an XGBoost algorithm-based model using 7 metabolites achieved substantial discriminative performance (accuracy = 0.88) in predicting kiwifruit intake within two days.

Conclusions: This study identified potential biomarkers of kiwifruit and developed a prediction model that may differentiate consumers. Further validation is necessary to confirm the reliability and generalizability of our findings.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2100048279. Registered on July 5, 2021.

Background: Gestational diabetes mellitus (GDM) is a significant pregnancy complication, and its relationship with serum levels of B vitamins and homocysteine (Hcy) remains unclear. This study aims to investigate the causal associations between genetically predicted serum levels of B vitamins (vitamin B6, B12, and folate) and Hcy with GDM risk.

Methods: Independent single nucleotide polymorphisms (SNPs) associated with Hcy (n = 14), Hcy (independent of BMI) (n = 11), vitamin B6 (n = 16), vitamin B12 (n = 8), folate (n = 14), and folate (independent of BMI) (n = 13) were selected as instrumental variables (IVs) based on genome-wide significance. Summary-level data for GDM were sourced from the FinnGen consortium.

Results: The MR analysis demonstrated a significant association between serum Hcy levels and GDM risk [OR (95% CI) = 1.28 (1.09, 1.51), p = 0.003] using the inverse variance weighting (IVW) method. Following the exclusion of BMI-related IVs, a suggestive association was observed between serum Hcy levels and GDM risk [OR (95% CI) = 1.26 (1.04, 1.54), p = 0.019].

Conclusions: Our study indicates a suggestive association between Hcy levels and GDM, emphasizing the necessity for additional research to explore the role of Hcy in GDM management.

Background: Sugar-sweetened beverages (SSBs) are calorie-dense, a possible surrogate for obesogenic food environment, and associated with cardiometabolic diseases. The burden of type 2 diabetes mellitus (T2DM) associated with a diet high in SSBs on a global scale remain unclear. In this study, we examined global trends of disability adjusted life years (DALYs) and mortality of T2DM associated with diet high in SSBs, and explored their associations with age, period, and birth cohort.

Methods: Using data from Global Burden of Disease (GBD) 2021, we estimated the global trends and average annual percentage changes (AAPCs) in age-standardized DALYs and age-standardized mortality of T2DM attributable to diet high in SSBs from 1990 to 2021. Diet high in SSBs was defined as daily consumption of beverages with ≥ 50 kcal per 226.8 g serving on average. Age-period-cohort analyses were conducted to assess the individual contribution of age, period and cohort effects on DALYs and mortality. We used the Nordpred age-period-cohort analysis to forecast global DALYs and mortality for the next 25 years.

Results: From 1990 to 2021, there was a continuous annual increase of 2.23% in global age-standardized T2DM DALYs attributable to diet high in SSBs, and a fluctuating increasing trend in mortality with an annual increase of 0.86%. People aged < 60 years experienced a larger increase (AAPC in DALYs and mortality: 2.69% and 1.35%;) in disease burden when compared with adults aged ≥ 60 years (AAPC in DALYs and mortality: 1.86% and 0.74%). The temporal rates were higher in more recent periods (rate ratios for DALYs and mortality: 1.37 and 1.13) and more recently born cohorts (rate ratios for DALYs and mortality: 3.72 and 1.71). The largest DALYs was observed in high socio-demographic index (SDI) countries (56.12 per 100,000 population in 2021). The T2DM burden attributable to diet high in SSBs was projected to increase further, with 22.00% increase in DALYs and 3.02% increase in mortality by 2046.

Conclusion: The disease burden of T2DM associated with diet high in SSBs remains a growing health problem globally, especially in younger people. High SDI countries with highest DALYs and elevated mortality require special attention for public health and policy interventions targeting SSBs.

Background and objective: Eggs are rich in choline and other methyl donors that may influence metabolic health, yet their effects on circulating metabolites such as choline, betaine, and trimethylamine N-oxide (TMAO) remain unclear. Understanding these effects is critical due to potential links with cardiometabolic risk. This study aimed to systematically evaluate and quantitatively synthesize the effects of egg consumption on plasma levels of choline, betaine, and TMAO in randomized controlled trials (RCTs), and to explore potential effect modifiers.

Methods: A systematic search of electronic databases was conducted to identify RCTs examining the effects of egg consumption on circulating choline, betaine, and TMAO. Data were pooled using random-effects meta-analyses. Subgroup analyses were performed based on age, body mass index, health status, study design, duration, and egg dosage. Meta-regression was conducted to assess the influence of age, dose, and duration. Publication bias was evaluated using Egger's and Begg's tests, funnel plots, and trim-and-fill analysis. The certainty of evidence was assessed using the NutriGRADE tool, which is specifically recommended for nutrition meta-analyses.

Results: Six RCTs (n = 5 for betaine and TMAO; n = 6 for choline) were included. Multi-arm trials were combined into single pairwise comparisons per outcome, as per Cochrane Handbook Sect. 23.3.4, to avoid unit-of-analysis errors. No significant overall effects were observed for choline (WMD = 0.10; 95% CI: - 0.92 to 1.12; p = 0.847), betaine (WMD = 0.21; 95% CI: - 8.50 to 8.92; p = 0.962), or TMAO (WMD = - 0.08; 95% CI: - 0.47 to 0.32; p = 0.692). High heterogeneity was noted for choline and betaine (I² > 85%), but low for TMAO (I² = 23%). Subgroup analyses showed significant choline increases among older adults (> 45 years) and individuals with metabolic syndrome or obesity. Meta-regression revealed a negative association between egg dose and both choline and betaine levels (p < 0.001). Publication bias was suggested for betaine but not for choline or TMAO. The NutriGRADE assessment indicated moderate certainty of evidence for choline (score 7.75), betaine (7.05), and TMAO (7.25), with downgrades mainly due to imprecision and heterogeneity.

Conclusions: No clear effect of egg consumption on circulating choline, betaine, or TMAO levels could be demonstrated. Age and metabolic status may influence choline responses, and higher egg doses may attenuate choline and betaine levels. Based on NutriGRADE, the overall certainty of evidence was rated as moderate for all three outcomes. Further long-term, high-quality RCTs are needed to clarify these associations.

Background: Dietary patterns are an important research focus for evaluating associations with disease risk. However, studies investigating secular trends in dietary patterns among Korean adults remain limited. Therefore, we aimed to identify the major dietary patterns in the Korean population and to assess how these patterns have changed over the past 16 years.

Methods: This study included 33,408 men and 46,628 women aged 19 years or older who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2022. Dietary intake was assessed using a single 24-hour dietary recall. Dietary patterns were derived using cluster analysis based on the percentage contribution of 28 food groups to total energy intake. Subgroup analyses were conducted to examine secular trends in dietary patterns by sex and age group. Survey-weighted multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for cardiometabolic risk factors according to dietary patterns.

Results: Three dietary patterns were identified through cluster analysis: (1) Traditional, (2) Red Meat & Alcohol, and (3) Flour-based Foods & Sweets. The overall trend in dietary patterns among Korean adults has undergone a gradual transition from traditional to Westernized dietary patterns. Since 2013, the Flour-based Foods & Sweets pattern has become the most prevalent (p < .0001), and this pattern was more commonly observed aged 19-29 years and among women. After multivariate adjustment, men adhering to the Red Meat & Alcohol pattern had the highest odds of cardiometabolic risk factors, including hyperglycemia (OR = 1.35, 95% CI: 1.24-1.48), high blood pressure (1.33, 1.23-1.45), hypertriglyceridemia (1.16, 1.07-1.26), hypercholesterolemia (1.17, 1.07-1.27), abdominal obesity (1.18, 1.05-1.32), and overall obesity (1.28, 1.18-1.38). In women, adherence to the Flour-based Foods & Sweets Pattern was associated with higher odds of hypercholesterolemia (1.14, 1.08-1.20) and high LDL-cholesterol (1.08, 1.03-1.15).

Conclusions: A transition from traditional to Westernized dietary patterns occurred among Korean adults from 2007 to 2022, which may have differential impacts on cardiometabolic health according to sex and age, underscoring the need for tailored nutritional interventions and sex-specific public health strategies.