American Journal of Clinical Nutrition最新文献

Background: In Canada, by 2026, prepackaged foods high in saturated fat, sodium, or sugar require a front-of-package warning symbol (FOPS). However, evidence on ultra-processed foods (UPFs) raises concerns about whether this approach fully captures all foods of concern-particularly for individuals with hypertension or hypercholesterolemia, for whom dietary changes are crucial. It is also important to assess whether medication use diminishes the benefits of limiting such foods.

Objective: We examined the joint association of consuming foods of concern-defined as UPFs or foods with FOPS-medication use, and cardiovascular disease (CVD) risk in adults with hypertension and/or hypercholesterolemia from the CARTaGENE cohort.

Methods: This prospective cohort study included 2,123 participants free of CVD but with hypertension and/or hypercholesterolemia at baseline (2009-2010). Using food frequency questionnaire data (2012), UPFs were identified using Nova, and foods with FOPS using Health Canada criteria. Cholesterol- and blood pressure (BP)-lowering medication use was self-reported. Incident CVDs were identified using administrative databases, from FFQ completion to December 31^st, 2021. Associations between intake of foods of concern, medication use, and CVD risk were assessed using multivariable-adjusted Cox proportional hazards models.

Results: In multivariable-adjusted analyses-including medication use, energy intake and BMI-the hazard ratio (HR) for CVD risk associated with a 10% lower difference in UPF consumption-accompanied by a proportional higher difference in non-UPF-was 0.87 (95% CI: 0.78, 0.97). For foods with FOPS, the corresponding HR was 0.80 (95% CI: 0.70, 0.93), with no evidence that this estimate differed significantly from that for UPF (P=0.42). There was no evidence of departure from additivity between medication use and the consumption of foods of concern relative to CVD risk.

Conclusion: In individuals with hypertension or hypercholesterolemia, lower consumption of UPFs or foods with FOPS was similarly associated with lower CVD risk, independent of concomitant medication use.

Background: The influence of plasma docosahexaenoic acid (DHA) and overall omega-3 long chain polyunsaturated fatty acids (LC-PUFA) on child cognitive development is unclear.

Objective: We examined if plasma LC-PUFA levels are prospectively associated with academic performance in primary school children and if diet patterns modulate the relationship.

Methods: Children were from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Fasting LC-PUFA concentrations were measured using nuclear magnetic resonance (NMR) spectroscopy at 8 years of age (n=557). Dietary patterns were derived using principal component analysis from a validated food frequency questionnaire (FFQ) at age 7 years. Academic performance was assessed using the Wechsler Individual Achievement Test-III (WIAT-III) at age 9 years (n=288) and the Primary School Leaving Examination (PSLE) at age 12 years (n=408). The relationships of LC-PUFAs to academic performance scores were examined using multivariable linear regression models.

Results: Percent DHA at age 8 years was associated with higher reading fluency (β (95% CI) =3.54 (0.52, 6.56), p=0.022) and spelling scores (4.49 (0.02, 8.95), p=0.021) at age 9 years, and lower PSLE scores (β (95% CI) =-1.43 (-2.68, -0.618), p=0.025) (indicating better performance) at age 12 years. However, these associations were attenuated after adjusting for unhealthy dietary pattern. Total n-3 LC-PUFA at age 8 years was associated with higher reading fluency (β (95% CI) =1.55 (0.03, 3.07), p=0.046) scores at age 9 years, and lower PSLE scores (β (95% CI) =-0.83 (-1.42, -0.24), p=0.006) at age 12 years. The association with PSLE scores remained significant even after adjusting for healthy or unhealthy dietary patterns (β (95% CI) =-0.68 (-1.29, -0.08), p=0.028).

Conclusions: Higher plasma total n-3 LC-PUFA and DHA were prospectively associated with better academic performance in primary school children, but the relationship with DHA was modulated by an unhealthy dietary pattern. The results suggest that beyond DHA, total n-3 LC-PUFA status plays a significant role in the cognitive development of children.

Background: The ingestion of protein-rich whole-foods may stimulate (post-exercise) whole-body and myofibrillar protein synthesis (MyoPS) rates to a greater extent than more isolated protein sources.

Objective: We assessed whole-body protein turnover and MyoPS rates following a bout of resistance exercise and ingestion of a variety of protein-rich whole-foods (animal and non-animal) and egg whites (more isolated protein source) in resistance trained young adults.

Methods: In a randomized parallel group design, sixty-five healthy individuals received primed, continuous infusions of L-[ring-²H₅]phenylalanine and L-[3,3-²H₂]tyrosine and completed a bout of lower-body resistance exercise before ingesting 0.25 g protein per kg body mass [bm]from: egg whites (n=11), egg (n=11), salmon (n=10), pork (n=11) lentils (n=11) or mycoprotein (n=11). Blood and muscle samples were taken pre- and (120 and 300 min) post-exercise/food ingestion to determine whole-body (WB) phenylalanine kinetics and MyoPS rates. Calculated WB phenylalanine kinetics and FSRs were analyzed using two-way (group x time) ANOVAs.

Results: WB protein synthesis and breakdown rates increased and decreased, respectively, post-exercise/food ingestion in all groups; though a greater positive whole-body net protein balance was achieved (primarily via greater suppression of breakdown) following egg white ingestion, despite similar insulinemia across all groups (postprandial net balance [0-300 min]; egg whites, 256.6±15.4 vs; egg, 161.0±6.1; pork, 166.8±7.2; salmon, 195.4±7.1; lentils, 175.8±8.1; mycoprotein, 189.7±8.4 μmol⋅kg^-1⋅min^-1 [P<0.0001, all]). MyoPS rates increased following exercise/food ingestion with no (temporal) differences between groups despite divergent plasma amino acid responses (Δ change in FSRs [0-300 min]; egg whites, 0.050±0.013; egg, 0.051±0.009; pork, 0.008±0.008; salmon, 0.021±0.014; lentils, 0.029±0.012; mycoprotein, 0.041±0.012 %·h^-1 [P=0.077]).

Conclusion: The ingestion of a variety of protein-rich whole-foods or a more isolated protein source (egg whites) following lower body exercise results in comparable MyoPS rates, though a greater whole-body net protein anabolism was achieved with egg whites. This trial was registered at clinicaltrials.gov (NCT04794153). Date of Registration: 2021-03-04. https://clinicaltrials.gov/study/NCT04794153?term=NCT04794153&rank=1.

Background: Language models are a form of generative artificial intelligence that excel at natural language understanding and generation, with possible applications for providing evidence-based nutrition information in an interactive and personalized manner. However, they also pose risks to public health related to inaccuracy, bias, and data protection. It is unclear what quantity or type of research has been conducted on these models applied within nutrition and dietetics.

Objectives: To identify the ways in which language models are being applied to nutrition and dietetics and the associated opportunities and challenges.

Methods: The review was conducted in accordance with a predefined protocol and included original studies from peer-reviewed journals. The databases Medline, EMBASE, PsycINFO, CINAHL, PubMed, Global Health, Web of Science, Scopus, DBLP, and IEEE Xplore were searched, and forward and backward citation chasing was conducted for included articles.

Results: There were 2118 articles identified, and after screening 40 remained for data charting. All studies were published between 2022 and 2024. A total of 23 different language models were used with 9 studies creating domain-specific models using retrieval augmented generation or fine-tuning. A total of 17 nutrition-related diseases were considered. The tasks assigned to the language models included extraction or summarization of data from the scientific literature or electronic health records (n = 5), estimation of food composition (n = 9), creation of meal plans (n = 7), and provision of dietary advice (n = 21). Most studies (n = 38) focused on evaluating the models in hypothetical situations such as researcher-designed case studies or questions.

Conclusion: This is an emerging area with limited evidence for real-world implementations or domain-specific models in nutrition and dietetics. Future work is required in real-world settings to strengthen this evidence base and to broaden it to incorporate the views of nutritionists, dietitians, people with medical conditions, and the general public.

Background: Dietary assessment is essential for understanding associations between diet and health. The number of days of dietary data collection must account for high variation in daily intakes, while balancing accuracy with participant burden. Although several methods exist for determining the optimal amount, few have been applied to pregnancy.

Objectives: This study aimed to algorithmically determine the number of days needed to accurately estimate key dietary characteristics: energy, macronutrients, macronutrient density, diet quality, and intake timing during pregnancy.

Methods: We analyzed dietary data from 147 pregnant individuals in the Temporal Research in Eating, Nutrition, and Diet during Pregnancy study. Each participant provided ≤28 d of image-based dietary records to determine nutrients. Using mixed-effects models and assuming the only source of error is day-to-day variation in diet, we calculated the number of days required for the correlation between estimated and true intake to be ≥0.90 (N_R) and for estimated intake to be within 20% of true intake (N_C) for: energy, absolute macronutrients, macronutrient density, healthy eating index 2020 score (HEI 2020), and intake timing. Using bootstrapping, we extended N_C into a probabilistic framework linking methodological choices to practical consequences.

Results: Within-person coefficient of variation (CV_W) exceeded between-person coefficient of variation (CV_B) for all characteristics, with fat (g) having the largest difference (CV_W = 40.6; CV_B = 26.2). Macronutrients required the most days to estimate usual absolute intake (fat: 17 d), whereas macronutrient density (% calories from fat: 5 d), HEI 2020 (5 d), and intake timing (2-6 d) required fewer. Individual-level analysis showed that cohort-based estimates underestimated the number of days needed for accurate assessment, as only 56% of participants met the cohort-level requirement for HEI.

Conclusions: We provide a new approach to estimating required dietary days to inform future study design. Existing studies may be underpowered, and cohort estimates may overstate individual-level accuracy.

Background: Although numerous cross-sectional studies have examined the relationship between anemia and cognitive impairment or dementia in older adults, data from larger longitudinal studies, especially in generally healthy older adults, are limited.

Objectives: To investigate the associations between baseline hemoglobin levels, anemia, and mild cognitive impairment (MCI) over 3 y in generally healthy older adults.

Methods: This is an observational analysis of the 3-y DO-HEALTH trial, a double-blind, randomized controlled trial including 2157 European community-dwelling adults age 70+. Cognition was assessed at baseline, 12, 24, and 36 mo using the Montreal Cognitive Assessment (MoCA). MCI was defined as a MoCA score <26 at 2 consecutive time points. The exposures were the quintiles of hemoglobin levels and anemia at baseline. Logistic regression models based on generalized estimating equations controlled for age, sex, prior falls, study site, treatment allocation, body mass index, number of comorbidities, smoking status, use of iron supplements, alcohol consumption, renal function, and vitamin B12 levels.

Results: A total of 2150 participants were included in the analyses (mean age of 74.9 y; 61.7% females). Compared with the lowest quintile, participants in all higher quintiles had a significantly lower odds of MCI: 2nd = 34% lower odds of MCI [odds ratio (OR) = 0.66; 95% confidence interval (CI): 0.47, 0.93; P = 0.02], 3rd = 39% (OR = 0.61; 95% CI: 0.43, 0.86; P = 0.005), 4th = 44% (OR = 0.56; 95% CI: 0.39, 0.82; P = 0.003), and 5th = 36% (OR = 0.64; 95% CI: 0.43, 0.97; P = 0.03). For anemia, there was no association with the odds of MCI over time.

Conclusions: Baseline hemoglobin levels >130 g/L were associated with reduced odds of MCI over 3 y. Although this study does not establish causality, it suggests further investigations in monitoring and managing hemoglobin levels, even in generally healthy older adults. This trial was registered at clinicaltrials.gov as NCT01745263.

Background: In 2018, Scotland introduced a minimum unit pricing (MUP) policy to remove very-low-cost alcoholic drinks from the market in an effort to reduce the adverse impacts of excessive alcohol consumption. Any increased spending on alcohol may be associated with reduced food and lower diet quality.

Objectives: This study aimed to estimate the relationship between MUP and dietary energy, nutrients, and diet quality.

Methods: Difference-in-differences analyses were conducted on household-level purchase data, collected by Kantar Worldpanel (KWP) over 53 wk before and 54 wk after the implementation of MUP, from 1987 households in Scotland and 6064 households in the north of England. The Poisson pseudomaximum likelihood regression model with household fixed effects was used, with estimates adjusted for age of main shopper, household composition, duration of KWP participation, total spending on nonfood items, and month of the year. Primary outcomes were dietary energy, energy density, Diet Quality Index, and foods and nutrients relevant to the Scottish dietary goals after adjustment to per adult-equivalent values. Secondary outcomes explored the differential effects of MUP by area-level deprivation and levels of alcohol purchase.

Results: The introduction of MUP in Scotland was associated with a 1.6% [95% confidence interval (CI): 0.02%, 3.16%] reduction in the purchase of sugar from food and beverages or 8 g per adult equivalent per week. This reduction was partly a result of a 16.6% (95% CI: 7.15%, 25.96%) reduction in sugar from alcoholic drinks purchased. No other significant associations were found. Households from more deprived areas, and households with greater alcohol purchases, had greater levels of sugar reduction from alcohol.

Conclusions: MUP in Scotland is associated with small, but beneficial, statistically significant reductions in the purchase of sugar. There is no significant change in overall diet quality.