Journal of the American Nutrition Association最新文献

Introduction: This case report presents the methodology and the outcomes of a Personalized Nutrition intervention with a menopausal female over seven weeks and two online consultations. The report details the pathophysiological reasoning approach to the patient assessment and the recommendation of interventions with the supporting clinical evidence and learnings.

Case: A 47 year old working mother (Patient A) with maternal family history (FH) of osteoporosis (OP), a body mass index (BMI) of 24.2 kg/m² and a waist-to-hip ratio (WHR) of 0.86. Patient A had seen her medical practitioner (MP) regarding fatigue, lack of concentration and low mood and was prescribed hormone replacement therapy (HRT). Patient A's sleep and mood remained unstable, and she presented with late afternoon fatigue, lower belly bloating and mild headaches. A chiropractor had diagnosed scoliosis. Patient A was seeking support for energy and bone health. Analysis of dietary recall and frequency data indicated that her current macronutrient intake was contributing to blood sugar imbalance, influencing energy levels and impacting hypothalamic-pituitary-adrenal (HPA) axis function, potentially exacerbated by a change in estrogen levels. A FH of OP encouraged the practitioner to promote bone health. Adjusted macronutrient intake was recommended to support blood sugar balance, increase and sustain energy and promote muscle synthesis. A supplementation plan with regular weight-bearing exercise aimed to support bone mineral density. Caffeine reduction, yoga and meditation to help rebalance the HPA axis. Patient A reported an increase in energy, a reduction in snacking and improved sleep. There was no change to her mood and bloating persisted. Her headaches worsened and the MP prescribed amitriptyline (10 mg) toward the end of the therapy period. Her bone health was not measured.

Conclusions: This case provides observational evidence of the potential efficacy of personalized nutrition utilizing pathophysiological reasoning to assess health status, an evidence-based approach to support intervention decisions and coaching skills to embed dietary change.

Objective: Osteoporosis is a growing public health burden. Trabecular bone score (TBS) from dual-energy X-ray absorptiometry (DXA) reflects trabecular microarchitecture and predicts fractures beyond bone mineral density (BMD). The relationship between Healthy Eating Index 2020 (HEI-2020) and TBS is unknown.

Methods: We modeled the HEI-2020 in relation to TBS in a cross-sectional sample from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 (n = 7,007), using multivariable linear regression, restricted cubic splines for nonlinearity, stratified and interaction analyses for effect modification, and mixture and clustering analyses.

Results: Higher HEI-2020 scores were positively associated with TBS. Per 10-point increase: β = 0.0052 (95% CI 0.0026-0.0079). The highest versus lowest tertile had higher TBS (β = 0.0133, 95% CI 0.0063-0.0204; P for trend = 0.0242). The dose-response was linear. Associations were stronger in males and individuals with obesity, with significant interaction by sex (p = 0.0262) and body mass index (BMI; p < 0.0001). Mixture and clustering analyses supported positive dietary pattern effects, with the high-quality dietary cluster showing higher TBS (β = 0.0133, 95% CI 0.0053-0.0212). Sensitivity analyses confirmed robustness.

Conclusion: Higher HEI-2020 scores were linearly associated with higher TBS, with effect modification by sex and BMI. While these cross-sectional findings suggest better diet quality may benefit trabecular bone microarchitecture, longitudinal studies are needed to establish causality.

Background: Exogenous ketone supplementation acutely elevates circulating beta-hydroxybutyrate (R-BHB), but the impact of chronic repeated dosing on exercise performance, cognition, mood, and cardiometabolic health remains unclear.

Purpose: To evaluate the effects of 31 days of thrice-daily ketone monoester (KME) supplementation (90 g/day; high-dose) on exercise performance, executive function, mood, metabolism, body composition, blood pressure, and tolerability in recreational runners.

Methods: In a single-blind, randomized-controlled trial, 18 runners consumed either (R)-3-hydroxybutyl (R)-3-hydroxybutyrate (KME; 30 g/dose; n = 9) or an isocaloric, flavor-matched placebo (PLA; 30 g/dose; n = 9) three times daily for 31 days. Outcomes included 5-km time trial (5KTT) performance, cognitive function, mood, body composition, blood pressure, and tolerability. Metabolism and substrate oxidation (rest and graded exercise) were performed after 31-d supplementation was completed to assess metabolic responses following 31 days of repeated exogenous ketone exposure.

Results: 31-day KME did not alter 5KTT performance, but improved cognitive function, as evidenced by faster Stroop Incongruent (p = 0.015) and Switching task responses (p = 0.038). Mood and quality of life scores were unchanged. Metabolically, the KME reliably elevated post-ingestion R-BHB (∼3.0 mM; p < 0.001) and lowered glycemia by 15% (p < 0.001). After the 31-day KME supplementation stopped, KME-treatment preserved mean absolute VO₂ during graded exercise testing (p = 0.029), without accompanying improvements in running performance.

Conclusion: High-dose KME administration for 31-days did not alter running performance, but increased cognitive function and oxygen uptake during maximal graded exercise even after ketone administration stopped, indicating that selected physiological measures differed between groups when assessed after the supplementation period.

Background and objective: Controversies exist regarding the effects of calcium supplementation on lipid metabolism, and the time-specific effects and underlying mechanisms remain unclear. This study aims to elucidate the differential impacts of calcium intervention at different times (morning/evening) on hepatic lipid metabolism and the molecular mechanisms involved.

Methods: Forty female CD-1 (ICR) mice were randomly divided into four groups: Morning Control Group (MCN), Morning Calcium Intervention Group (MCI, intragastric administration of calcium carbonate at 08:00), Evening Control Group (ECN), and Evening Calcium Intervention Group (ECI, intragastric administration of calcium carbonate at 20:00). Mice were fed a normal calcium or low-calcium diet for 10 wk. In vitro experiments used HepG2 cells, which were divided into groups simulating whole-day (CON), daytime (DC, high calcium from 08:00 to 20:00), and nighttime (NC, high calcium from 20:00 to 08:00) calcium exposure. PER1 was knocked down using siRNA. Serum/hepatic/cellular lipid levels, hepatic pathology, transcriptome, and gene/protein expressions (PER1, PPARα, CPT1A, APOA5, etc.) were detected.

Results: Morning calcium intervention (MCI) in mice significantly increased serum and hepatic total cholesterol (TC), triglyceride (TG), and low-density lipoprotein (LDL) levels, and induced lipid droplet deposition and swelling in hepatocytes. Transcriptome and validation experiments showed upregulated hepatic PER1 expression in the MCI group, while PPARα and its downstream lipid metabolism genes (CPT1A, APOA5) were downregulated. In HepG2 cells, nighttime calcium incubation (NC) significantly increased intracellular TG and LDL contents, upregulated PER1 expression, and inhibited PPARα, CPT1A, and APOA5 expressions. Knocking down PER1 reversed the abnormal gene expression and lipid-elevating effects in the NC group. Collectively, our findings demonstrate that the circadian timing of calcium intake critically regulates hepatic lipid homeostasis via the PER1-PPARα axis, highlighting the importance of chrono-nutrition in metabolic health.

Objective: Various bacterial Bacillaceae and Bacillus strains have demonstrated health benefits, but less is known about probiotic characteristics of strains of Bacillus velezensis. In this randomized, double-blind, placebo-controlled clinical trial, we investigated the safety and efficacy of B. velezensis BV379 supplementation for 8 weeks (2 × 10⁹ colony-forming units (CFU)/day).

Methods: During the baseline and final weeks, GI symptoms were recorded daily using the 8-item Gastrointestinal Tolerance Questionnaire (GITQ). The primary outcome was the proportion of participants showing an improvement from baseline to week 8 in the 7-day, 3-item composite score for abdominal distention/bloating, burping, and gas/flatulence. Plasma chemistry, hematology, intestinal permeability, and fecal metagenomes were also investigated.

Results: Eighty participants (54% female; age: 50.3 ± 10.1 years) were randomized to BV379 (n = 39) or placebo (n = 41). At end of study, no significant difference was observed in the percentage of participants with improvement in the 3-item composite GITQ score (BV379: 36.1%; placebo: 28.2%; p = 0.46). Analysis of individual GI symptoms showed that more participants experienced improvement in abdominal distention/bloating with BV379 compared to placebo (38.9% vs 17.9%; p = 0.044). There were no clinically meaningful changes in plasma chemistry, hematology, or intestinal permeability between groups. Fecal metagenomic analyses showed no overall shifts in microbial composition between groups. In addition to B. velezensis, a few commensal species such as Lacticasei bacillus casei were significantly enriched in the BV379 group.

Conclusion: Despite not significantly improving the composite GITQ score of distention/bloating, burping, and gas/flatulence, BV379 supplementation was a well-tolerated approach to specifically lower abdominal bloating.

Background: The relationship between obesity and glenohumeral joint osteoarthritis (GJO) remains unclear, and the metabolic mechanisms involved are not well understood. This study investigated the prospective association between central obesity, assessed by waist-to-height ratio (WHtR), and GJO incidence, and examined whether triglycerides (TG) mediate this relationship.

Methods: We analyzed data from 32,881 UK Biobank participants enrolled between 2006 and 2014, with a median follow-up of 8.85 years (IQR: 7.15-10.75). Cox proportional hazards models and causal mediation analysis were used to estimate the direct and indirect effects of WHtR and TG on GJO risk, adjusting for demographic, socioeconomic, lifestyle, and comorbidity variables.

Results: Both WHtR and TG levels at baseline were significantly associated with higher GJO risk (p < 0.05). Compared to individuals with normal WHtR, those with severe central obesity had a 1.52-fold higher GJO risk (AHR = 1.52, 95% CI: 1.02-2.27, p = 0.038), independent of BMI. Similarly, participants in the highest TG tertile had a 1.46-fold increased risk compared to the lowest tertile (AHR = 1.46, 95% CI: 1.06-2.02, p = 0.022). These associations were consistent across subgroups by age, sex, physical activity, work intensity, and BMI. Mediation analysis showed that TG explained 21.9% of the WHtR-GJO association. The mediating effect was stronger in younger adults, women, and physically inactive individuals, but not significant in those with normal BMI or low physical workload.

Conclusions: Central obesity, as measured by WHtR, is an independent risk factor for GJO. TG partially mediates this association, suggesting that lipid toxicity may contribute to the metabolic pathogenesis of GJO.

Objectives: Nutrition during pregnancy is an important issue that should be investigated as it directly affects the health of the mother and the baby. Factors such as socioeconomic status, education, and health literacy influence nutrition. The aim of this study is to evaluate the relationship between diet quality and health and digital healthy diet literacy, cooking and food preparation skills of pregnant women.

Methods: This study carried out 310 volunteer pregnant women in their third trimester who applied to the obstetrics and gynecology outpatient clinic. The data was obtained through a questionnaire applied by face-to-face interview. The survey consists of socio-demographic characteristics, health status and nutritional habits, Health Literacy Scale-Short Form (HLS-SF12) and Digital Healthy Diet Literacy (DDL) Scale, Cooking and Food Preparation Skills (CS and FS) Scale, anthropometric measurements and 24-h food consumption records. Nutrient Adequacy Ratio (NAR) and Mean Adequacy Ratio (MAR) scores, which evaluate the adequacy of the diet in terms of nutrients, were calculated.

Results: The total scores of the CS and FS scales in pregnant women differed significantly based on their education level, income level, cooking frequency, and BMI groups (p < 0.05). There was a significant association between the MAR score and the sub-dimension score of CS (p < 0.05). However, there was no significant relationship between the MAR score and the HL and DDL indices (p > 0.05).

Conclusion: While a relationship was identified between pregnant women's diet quality and cooking skills, no relationship was found between diet quality and health and digital healthy diet literacy. This study supports the view that pregnant women's cooking and food preparation skills may improve their diet quality.

Objective: Assessing the nutrition risk of preschoolers is crucial for promoting their healthy growth and development. This study aimed to develop a Korean version of NutriSTEP^® by assessing its feasibility, validity, and reliability.

Methods: A quantitative cross-sectional study was conducted with parents of preschoolers aged 3-6 years. Five scholars independently translated the English version of NutriSTEP^® into Korean. One-on-one online cognitive interviews were conducted with 10 parents, and an expert panel review with the five scholars was conducted using an item content validity index. A total of 201 parents participated in an online survey, and the criterion validity of NutriSTEP^® was assessed using receiver operating characteristic (ROC) curves. Construct validity was examined through item analysis using the Rasch model and known-groups validity, while internal consistency was assessed using the test-retest reliability.

Results: Eight items were revised to improve cultural acceptability and comprehensibility. Each item of NutriSTEP^® had an Item-content validity index (I-CVI) of 1.0, and the area under the curve for the ROC curve was 90.5%. A cut-point of NutriSTEP^® score to determine moderate risk (> 25) had a sensitivity of 90.5% and specificity of 71.7%, compared to the moderate nutrition risk (≥ 5). The Korean version of NutriSTEP^® was unidimensional, and scores varied significantly based on parents' income levels (F = 11.154, p < .001) and children's physical activity levels (t = -4.107, p < .001). The test-retest reliability was .661.

Conclusion: This study confirms that NutriSTEP^® is a valid and reliable tool for assessing Korean preschooler's nutrition risk. Using NutriSTEP^® could offer valuable insights for promoting healthy dietary behaviors in preschoolers.

Objective: Despite the increasing prevalence of obesity and diet-related chronic diseases, nutrition education has been historically lacking in medical education. With increasing access to effective diet-related chronic disease treatments, physicians have an increasingly important role to play in nutrition counseling. We evaluated the attitudes and comfort related to nutrition and nutrition counseling among a cohort of internal medicine residents at a large academic training program.

Methods: An online survey was administered to internal medicine residents on nutrition attitudes and counseling practices using a previously validated questionnaire. The survey was open for responses following an outpatient didactic session in March 2023. Responses were captured using Qualtrics and analyzed using descriptive statistics.

Results: The survey was distributed to 70 trainees. Of the 40 residents from all levels of training who completed the survey 60% reported having received no prior nutrition training in their educational background. Residents generally strongly agreed that nutritional assessments and counseling should be included in any routine appointments, just like diagnosis and treatment of patients, and that physicians can have an effect on patient's dietary behavior if they take the time to discuss the problem. Residents also strongly agreed that most physicians are not adequately trained to discuss nutrition effectively with patients and had low comfort with nutrition counseling across all areas.

Conclusions: Internal medicine residents recognize nutrition counseling as a priority, but report lacking education and comfort to effectively provide adequate nutrition education to patients. This highlights the need for more nutrition education in all levels of general medical training.

Objective: Dietary and nutrient intake directly impact health, whereby adherence to certain dietary patterns is linked to positive outcomes. Traditional methods like the Food Frequency Questionnaire (FFQ) and 24-hour recall are subjective, highlighting the need for advanced techniques that incorporate phenotypic and metabolic data. This pilot exploratory study aimed to assess the feasibility of using machine-learning techniques that integrate routinely collected phenotypic and biochemical data to predict adherence to well-characterized dietary quality indices.

Method: A total of 138 participants were recruited in the Dietary Deal cross-sectional study to collect data on dietary intake (FFQ, 24-hour recall), biochemical markers, physical activity estimation, quality-of-life questionnaires, and anthropometric determinations. The Mediterranean Diet Adherence Screener (MEDAS 17p), the Alternative Healthy Eating Index (AHEI), the Dietary Approaches to Stop Hypertension (DASH), and a pro-vegetarian model were tested as quality indices. Biochemical and dietary data were integrated using adjusted logistic regressions through STATA (v. 18.0) statistical program to identify biochemical markers associated with food consumption to predict dietary quality. Subsequently, an algorithm based on machine-learning techniques was developed, and the predictive capacity of the obtained models was determined using receiver operating characteristic (ROC) curves and related metrics (area under the curve).

Results: A computational algorithm was created for probability classification, adjusted for age, sex, body mass index, physical activity, and SF-36. Key biochemical parameters included glucose, triglycerides, high-density lipoprotein cholesterol, homocysteine, and albumin. Homocysteine (p = 0.007 for AHEI, p = 0.040 for pro-vegetarian), folate (p = 0.039 for DASH, p = 0.019 for pro-vegetarian), and vitamin C (p < 0.001 for AHEI, p = 0.023 for DASH) emerged as significant variables across diet quality indices. The explanatory capacity of the fully adjusted model ranged from R² = 22.07% to 35.76%, depending on the index. The model's accuracy ranged from 72.46% to 78.26%, with ROC values between 0.79 and 0.87, indicating moderate to good predictive validity of the training data on itself.

Conclusions: This pilot exploratory analysis demonstrates the feasibility of integrating dietary and biochemical data to suitably predict adherence to validated dietary quality indices, Although not intended as a deployable prediction tool, the study provides preliminary evidence supporting the potential of routinely collected clinical data to inform personalized precision dietary advice through objective computational algorithms for precision nutrition implementation.