BMJ Nutrition, Prevention and Health最新文献

Background: Erectile dysfunction (ED) is a common male health issue influenced by vascular and neurological factors. Although prior studies have linked micronutrients to ED, the role of thiamin (vitamin B₁) remains underexplored. Given its key role in energy metabolism and nervous system function, this study aimed to investigate the association between dietary thiamin intake and ED among men in the USA.

Methods: In this study, data from two cycles (2001-2002, 2003-2004) of the National Health and Nutrition Examination Survey were used, which included information on daily riboflavin intake from food and self-reported ED. For the assessment of clinical ED, participants were categorised as those who reported being 'sometimes able' or 'never' to maintain an erection based on a single question. Daily food intake and consumption data were obtained through questionnaires and 24-hour recall interviews. The relationship between daily food thiamin intake and ED was analysed using logistic regression models and smooth curve fitting.

Results: We found that higher food thiamin intake was significantly associated with lower incidence of hypertension, diabetes, coronary heart disease, stroke and ED (all p trend <0.05). Compared with participants with thiamin intake <1.3 μg, the full-adjusted ORs and 95% CIs for participants with thiamin intake >1.3 μg were 0.782 (0.651 to 0.940) (p<0.05). These findings suggest that dietary thiamin intake may play a protective role in the development of ED and other cardiometabolic disorders. Increasing thiamin consumption through dietary modification or supplementation could represent a potential strategy for ED prevention and management.

Conclusions: Greater dietary thiamin intake demonstrated a statistically significant association with reduced incidence of ED. Our findings suggest that a lower intake of thiamin is an independent risk factor with ED. We can consider increasing the intake of thiamine in daily food.

Purpose: Psychosocial factors contributing to the continued failure of adolescents to follow the US Dietary Guidelines for Americans (2020-2025) remain poorly understood. This study investigated the relationships of adolescents' autonomous motivation, self-efficacy and social support with the healthy eating index (HEI) total (primary outcome), whole fruit, total fruit, vegetable, sodium, added sugar and caloric intake (secondary outcomes).

Methods: A secondary analysis of baseline data from a randomised controlled trial was conducted. A total of 935 5th-8th graders, aged 10-14 years, were enrolled. Generalised linear models and structural equation models examined relationships of motivation, social support and self-efficacy for healthy eating with healthy eating behaviours.

Results: In this sample (51% female, mean age=12.08±0.99), 48.24% were black/African American, and 48.2% were overweight/obese. In generalised linear models, family social support was significantly associated with HEI fruit (β=0.16, p=0.02) and higher caloric intake (β=44.09, p=0.03). Additionally, friend social support was significantly associated with HEI sodium (lower sodium intake; β=0.23, p=0.01). Structural equation models showed that through motivation, social support indirectly improved HEI total (β=0.09, p=0.006) and whole fruit intake (β=0.07, p=0.04) and increased HEI added sugar (lower added sugar intake; β=0.07, p=0.04). Through self-efficacy, social support was indirectly associated with lower HEI sodium (higher sodium intake; β=-0.04, p=0.04).

Discussion: These findings add to the growing body of research on adolescent nutrition by emphasising the complex interplay of psychosocial factors in shaping specific dietary behaviours.

Trial registration number: NCT04213014.

Background and aim: Sustained lifestyle changes are crucial for the remission of type 2 diabetes (T2D) but remain challenging. Citizen initiatives using peer coaching and self-management may offer a promising alternative to professional medical care. This study evaluated Your Lifestyle As Medicine (YLAM), a Dutch citizen initiative for people with T2D. We aimed to assess its impact on metabolic parameters and to examine participants' engagement.

Methods: This observational study analysed self-reported data on weight, waist circumference, fasting glucose and glycated haemoglobin (HbA₁c) from participants in YLAM's online community. Participants could report their self-measured data on a weekly basis. Linear mixed-model analyses, stratified by sex, were used to assess changes in metabolic parameters over time. Additionally, we evaluated participants' engagement through reporting duration and weekly reporting rates.

Results: We assessed all 232 people with T2D who reported multiple measurements for at least 3 months. The median reporting duration was 11.2 months (IQR 4.6-26.5). Weekly reporting rates were 59% for weight, 55% for waist circumference and 52% for fasting glucose, and 12-weekly reporting rates were 49% for HbA₁c. Overall, mean weight, waist circumference, fasting glucose and HbA₁c improved in the first year in both women and men. More specifically, weight decreased by 7.2 kg in women (95% CI -7.6 to -6.8) and by 7.4 kg in men (95% CI -8.0 to -6.8). This represented a mean relative weight loss of 9.0% (SD 7.7) and 8.6% (SD 6.5), respectively. Waist circumference decreased by 8.9 cm in women (95% CI -9.4 to -8.5) and by 8.5 cm in men (95% CI -9.1 to -7.8). Fasting glucose decreased by 1.15 mmol/L in women (95% CI -1.32 to -0.98) and by 0.49 mmol/L in men (95% CI -0.75 to -0.23). HbA₁c decreased by 14.5 mmol/mol in women (95% CI -17.4 to -11.6) and by 9.1 mmol/mol in men (95% CI -13.2 to -5.0). Of all participants, 44% reported data for longer than a year and demonstrated sustained improvements in weight and waist circumference in the long term.

Conclusion: This study provides evidence for substantial and sustained improvements in self-reported metabolic parameters in people with T2D engaged in a citizen initiative without medical supervision. Initiatives like YLAM offer a promising, accessible and scalable strategy to address the growing burden of lifestyle-related diseases.

Background: The serum uric acid to high-density lipoprotein cholesterol ratio (UHR) is a marker reflecting systemic inflammation and metabolic dysregulation. This study aimed to explore the association of UHR with all-cause and cause-specific mortality in a community-based Chinese cohort.

Methods: This study included 9448 participants from the community-based prospective cohort study conducted in Pudong New Area, Shanghai, China. We employed Cox proportional hazards regression to assess the associations between UHR quartiles and mortality risks. Nonlinear trends were examined through restricted cubic spline Cox regression, while bivariate exposure-response surface plots showed the joint effects of UHR and age. Model performance improvements were evaluated using C-index changes, integrated discrimination improvement and net reclassification improvement.

Results: During a median follow-up of 10.77 years, 987 deaths occurred. Compared with the lowest quartile (Q1), the highest UHR quartile (Q4) exhibited a 37% increased risk for all-cause mortality (HR=1.37, 95% CI: 1.14 to 1.65, p=0.001) and a 49% increased risk for cardiovascular mortality (HR=1.49, 95% CI: 1.10 to 2.00, p<0.01). The correlation between UHR and all-cause mortality risk exhibited an inverted L-shaped curve, whereas no significant nonlinear pattern was observed for cardiovascular mortality. Bivariate response analysis revealed a significant synergistic effect between UHR and age on all-cause mortality (p<0.05). The addition of UHR significantly improved the prediction performance of conventional models for all-cause and cardiovascular mortality.

Conclusions: Our findings establish UHR as an independent risk factor for all-cause and cardiovascular mortality, and the impact of UHR on all-cause mortality varies with age.

Background: Frequent consumption of out-of-home (OOH) foods, including takeaways, is linked to higher energy intake and poorer diet quality. In April 2022, calorie labelling was mandated in England for large OOH businesses to support healthier choices. This paper aimed to explore knowledge and use of calorie labelling when ordering takeaway food online and other factors influencing food choices, overall and by sociodemographic characteristics.

Methods: A cross-sectional survey of 1040 takeaway consumers in England from an OOH purchase panel assessed knowledge and awareness of calorie labelling legislation, self-reported impact on online takeaway choices, and key drivers of takeaway consumption. Data were analysed using descriptive statistics, logistic regressions and thematic analysis.

Results: Over 27% of respondents ordered takeaways once or more per week. Respondents aged 35 years and older were less likely (OR 0.28-0.52, p<0.05), while those with obesity were more likely (OR 2.01, p<0.001) to report frequent takeaway purchases. Women were more knowledgeable about the recommended energy meal content than men (OR 2.06, p<0.001), yet only 15% of respondents knew the guideline amount. Awareness of calorie labelling regulations was 63% overall, but was less likely in middle socioeconomic groups (OR 0.56-0.63, p<0.05). During past online orders, 23% noticed calorie labels; of these, 26% reduced food calories ordered, and 10% reduced drink calories ordered. Taste and price were key drivers of takeaway choices, while health and sustainability were less influential. Strong support emerged for healthier menu options and traffic light labelling to help improve the healthiness of takeaway orders.

Conclusion: Given the limited reported impact, calorie labels may only benefit a minority. As meal healthiness was ranked as a relatively less important driver for takeaway choices, further policies are required to complement calorie labelling in promoting healthier food environments.

Objective: Dairy intake has been reported to be both pro-inflammatory and anti-inflammatory; this inconsistency has led to uncertainty in the field. We aimed to address this using genetic data to perform a causal analysis of the link between lactose intolerance, rheumatoid arthritis (RhA) and body mass index (BMI). Lactose intolerance necessarily leads to reduced dairy intake. RhA is an autoimmune disease, which has been linked to both increased and reduced dairy intake. Dairy intake has also been associated with elevated BMI, which is itself pro-inflammatory and is associated with increased risk of RhA.

Methods: We separately considered congenital lactose intolerance, and adult-onset lactose intolerance where a prolonged period of dairy intake has already occurred. We combined Mendelian randomisation (MR) and rare genetic variant association testing to determine the relationship between genetic liability to lactose intolerance, risk of RhA and BMI. As a positive control to optimise instruments for measurement of lactose intolerance, we used the causal link between lactose intolerance and osteoporosis. Rare variant analysis was performed under a recessive model. Conditional analysis of the effect of lactose intolerance on the risk of RhA via BMI used multivariable MR.

Results: We observed an opposite effect of congenital and adult-onset lactose intolerance on RhA risk. Congenital lactose intolerance increases the risk of RhA, but adult-onset lactose intolerance reduces the risk of RhA. The protective effect of adult-onset lactose intolerance on RhA is conditional on reduced BMI.

Discussion: We conclude that dairy intake is anti-inflammatory, which explains why congenital lactose intolerance and lifetime avoidance of dairy foods increases the risk of RhA. However, adult-onset lactose intolerance can reduce the risk of RhA because of an association with reduced BMI, which is also anti-inflammatory.

Background: Breastfeeding is a cornerstone of child health. We investigated the associations of any breastfeeding initiation and duration with physical, mental and behavioural health conditions among children aged 3-5 years in the USA.

Methods: Data were derived from the 2016 to 2022 National Survey of Children's Health, which is a national, population-based, cross-sectional study. A total of 40 280 children aged 3-5 years were included. Any breastfeeding initiation and duration, physical (asthma, allergies, arthritis, cerebral palsy, diabetes, epilepsy or seizure disorder, heart conditions or severe headaches), mental (anxiety or depression) and behavioural (Tourette syndrome, attention-deficit/hyperactivity disorder or behavioural/conduct problems) health conditions were measured using parent-reported questionnaires.

Results: Any breastfeeding was significantly associated with lower odds of behavioural health conditions (OR=0.76, 95% CI: 0.58 to 0.99) and marginally with mental health conditions (OR=0.70, 95% CI: 0.48 to 1.02, p=0.067). There was a significant non-linear trend between any breastfeeding duration and having a mental or behavioural health condition (all P_non-linear<0.001). The intervals of significant associations were 7.3-23.4 months for mental condition and 6.8-24.1 months for behavioural condition (the most associated points at 15.6 and 15.3 months). There were no significant associations of any breastfeeding initiation and duration with physical health.

Conclusions: Any breastfeeding was linked to better behavioural health and marginally to mental health, with no association found for physical health among children aged 3-5 years in the USA. Any breastfeeding duration of approximately 15 months appears to have the strongest association with promoting children's mental and behavioural health.

Background: Photo-based nutrition diaries might be useful to assess dietary intake without much effort and maybe even without nutrition expertise. This proof-of-concept study aimed to investigate the principle of 'the wisdom of crowds' by examining how accurately both nutrition experts and non-experts can rate nutritional values of meals presented in digital pictures.

Methods: An online survey was conducted among adults in Germany from 2016 to 2017. Participants rated a random selection of six meal pictures according to their nutritional values (energy, carbohydrates, sugar and fat content) and their healthiness. Rating results were compared with the nutritional value calculated by the German Nutrient Database or according to the manufacturer's information ('truth'). Descriptive statistical analysis, Mann-Whitney-U test and multiple linear regression analysis were performed using RStudio.

Results: In total, 110 (92.7 % women, mean age: 38.7±14.0 years) nutrition experts and 233 (31.3 % women, mean age: 21.2±2.6 years) non-experts participated. Overall meal pictures, experts overestimated the average content of all nutritional values (sugar: 3.8 %, energy: 4.9 %, carbohydrates: 4.9 % and fat: 10.4 %). Non-experts overestimated the average energy content by 10.4 %, fat content by 17.1 % and sugar content by 27.5%. The average carbohydrate content was underestimated by 9.0%. A statistically significant difference between the two crowds' ratings was found for energy (p=0.03), carbohydrates (p<0.001) and sugar (p<0.001), but not for fat (p=0.44). An increasing deviation of nutritional value ratings from the truth towards overrating was associated with decreasing rating of healthiness (all p<0.001).

Conclusion: This study suggests that both experts and non-experts rate nutritional values of meals in digital pictures in an appropriate manner, although both crowds occasionally deviated significantly from the truth, especially over-rating occurred with decreasing rating of healthiness. Due to the proof-of-concept approach and the limited generalisability of the results, the principle of 'the wisdom of crowds' is not fully supported. Studies with a large representative population are necessary. However, findings suggest that crowd-based meal picture ratings could be a method of digital dietary self-monitoring in combination with gamification elements.

Objectives: To elucidate longitudinal changes of body composition among type 2 diabetes (T2D).

Methods: This was a retrospective study designed. A total of 6164 (mean age, 52.4±9.4 years) Taiwan T2D adults. The mean follow-up duration was 19.3±12.2 months. Body compositions were assessed using bioelectrical impedance analysis. Six body composition indicators were defined using body weight (BW), body mass index (BMI); appendicular skeletal muscle mass (ASM), skeletal muscle index (SMI); body fat mass (BFM) and percent body fat (PBF).

Results: This study demonstrated that among individuals with T2D, their BW, BMI, ASM and SMI decreased progressively with age, with more pronounced annual declines observed in men compared with women. In contrast, changes in BFM and PBF exhibited a nonlinear trend: while both declined before the age of 65 years, they showed a shift towards stabilisation or increase after the age of 65 years. This upward trend was more evident in women compared with men, particularly for BFM.

Conclusion: Muscle tissue within the body composition of T2D patients experiences a decline with increasing age, while it is important to observe that adipose tissue demonstrates a rebound phenomenon after the age of 65 years.

Background: Gut microbiota is strongly associated with hypertension. The Dietary Index of Gut Microbiota (DI-GM) is a newly proposed indicator of the diversity of gut microbiota in the diet. However, the relationship between DI-GM and hypertension is unclear.

Methods: Data for this study were obtained from the National Health and Nutrition Examination Survey (2007-2020). Dietary data were used to calculate DI-GM and grouped into three tertile groups. Survey logistic regression and restricted cubic spline (RCS) were used to analyse the association between DI-GM and hypertension.

Results: A total of 20 804 participants (age ≥20 years) were enrolled in the study. After adjusting for all covariates, the ORs for hypertension in the medium DI-GM group (second quartile, 4-5) and high DI-GM group (third quartile, >5) were 0.94 (95% CI: 0.83 to 1.06) and 0.87 (95% CI: 0.76 to 0.99) compared with the low DI-GM group (first quartile, <4). Additionally, results from the RCS analysis indicated a linear association between DI-GM and hypertension (p value for non-linearity=0.57).

Conclusion: Our findings suggest that higher DI-GM dietary patterns are associated with a lower prevalence of hypertension in a representative sample of US adults. These results suggest that dietary patterns characterised by a higher DI-GM may represent a potential strategy for the prevention of hypertension.