American Journal of Clinical Nutrition最新文献

Background: Childhood represents a critical period of nutritional risk in the programming of later chronic disease. Few longitudinal studies have explored repeated measures of nutrition throughout the first decade of life in relation to preteen cardiometabolic outcomes.

Objectives: This research aimed to explore associations of early feeding practices (human milk exposure and duration and timing of introduction to solids) and childhood dietary quality and inflammatory scores (at 5 and 9-11 y and change during childhood) on preteen cardiometabolic outcomes.

Methods: This is an analysis of children from the ROLO longitudinal birth cohort study (n = 399). Information on early feeding practices were obtained at postnatal study visits. Food frequency questionnaires collected maternal-reported dietary intakes for each child at 5 and 9-11 y of age. Healthy Eating Index (HEI)-2015 and the Children's Dietary Inflammatory Index (C-DII) scores were calculated. Anthropometry, body composition, blood pressure, heart rate, cardiorespiratory endurance, and blood biomarkers were obtained at 9-11 y. Crude and adjusted linear regression models examined nutritional exposure associations with preteen cardiometabolic outcomes.

Results: In the adjusted model, any human milk exposure was associated with lower body fat (%) at 9-11 y (β: -2.86; 95% confidence interval [CI]: -5.46, -0.27; P = 0.03), than never receiving human milk. At 5 y, diet scores were favorably associated with lean mass at 9-11 y (P < 0.05 for both). Higher preteen HEI-2015 scores were associated with lower preteen leptin levels (tertile 3 compared with tertile 1-β: -2.92; 95% CI: -5.64, -0.21; P = 0.03). Diet quality significantly deteriorated (HEI-2015 score decreased) and became more proinflammatory (C-DII score increased) from 5 to 9-11 y of age. Diet quality/inflammation deterioration (compared with improvement) or overall change in dietary scores were not related to preteen cardiometabolic outcomes.

Conclusions: Exposure to human milk in early life was associated with lower preteen adiposity, irrespective of duration. Diet quality/inflammatory potential deteriorated between early childhood and the preteen years, highlighting a potential period for intervention.

Background: Limited studies explored the association between consumption of ultraprocessed food (UPF) and rheumatoid arthritis (RA).

Objectives: This study aimed to examine the association between UPF consumption and RA risk and explore the potential mediating effects of RA-related biomarkers.

Methods: This retrospective cohort study included 207,012 participants without RA at recruitment and completed 24-h dietary recalls. UPF was defined based on the NOVA food classification system. Incident RA was ascertained using the International Classification of Diseases version 10. Cox regression models were used to examine the association between UPF consumption and the incidence of RA. Additionally, mediation analyses were conducted to evaluate the contribution of biomarkers related to the lipid profile, systemic inflammatory factors, serum liver enzymes, and glucose metabolism to the observed associations.

Results: The participants' mean (standard deviation [SD]) age at recruitment was 56.08 (7.95) y. During a median follow-up of 12.24 (interquartile range: 11.66-13.03) y, 1869 RA events were recorded. Compared with the lowest quintile of UPF consumption (weight percentage of the UPF), the adjusted hazard ratio (HR) of RA in the highest quintile was 1.17 (95% confidence interval (CI): 1.01, 1.36). There was a 6% elevated risk of RA incidence per SD increase in UPF intake (HR: 1.06; 95% CI: 1.01, 1.11). In the mediation analyses, the biomarkers explained 3.07%-14.80% of the association between UPF intake and RA.

Conclusions: Higher UPF consumption was associated with an increased risk of RA, which may be mediated by inflammation, lipids, and liver enzymes. Lower UPF consumption is recommended to reduce RA incidence.

Background: Persistent tinnitus is common, disabling, and difficult to treat. Diet has been implicated in tinnitus etiology, but studies are inconsistent and longitudinal data are scarce. Seafood intake is associated with lower risk of hearing loss, but the longitudinal association with tinnitus is unknown.

Objective: We examined the independent associations of seafood intake, fish oil supplement use, and risk of developing persistent tinnitus.

Methods: This prospective cohort study followed 73,482 females in the Nurses' Health Study II from 1991 to 2021. Diet was assessed using a validated food frequency questionnaire every 4 years. Multivariable-adjusted Cox proportional hazards regression was used to evaluate independent associations between total seafood intake, specific types of fish, shellfish, fish oil supplements, and risk of persistent tinnitus (defined as tinnitus experienced daily).

Results: After 1,998,421 person-years of follow-up, 9,362 cases of incident persistent tinnitus were reported. Seafood intake was independently associated with lower risk of developing persistent tinnitus. Compared with participants who never or rarely consumed seafood, the multivariable-adjusted hazard ratios (MVHR,95% CI) for tinnitus were 0.87 (0.78, 0.95) among participants who consumed 1 serving/week, 0.77 (0.68, 0.86) for 2-4 servings/week, and 0.79 (0.64, 0.96) for 5+/servings/week (p-trend<0.0001). Examined individually, higher intakes of tuna fish, light-meat fish and shellfish were associated with lower risk. Compared with participants who never or rarely consumed the specific type, the MVHRs for consumption of 1+ servings/week were 0.84 (0.78, 0.90)(p-trend <0.0001) for tuna fish, 0.91 (0.83, 0.99)(p-trend=0.04) for light-meat fish, and 0.82 (0.72, 0.93)(p-trend<0.0001) for shellfish. Higher risk for dark-meat fish intake was suggested (MVHR: 1.09 (0.99,1.21)(p-trend=0.04). Fish oil supplement use (yes/no) was associated with higher risk (MVHR: 1.12 (1.06,1.19)).

Conclusion: Regular consumption of tuna fish, light-meat fish or shellfish is associated with lower risk of developing persistent tinnitus in females. Fish oil supplement use is associated with higher risk.

Background: The prospective effect of healthy and planetary diets on cardiometabolic health at young ages remains unclear.

Objective: This study aims to investigate the prospective associations between adherence to the EAT-Lancet dietary recommendations at age 7 and the prevalence of obesity and Metabolic Syndrome (MetS) at 7, 10, and 13 years old (y).

Methods: Participants are children from the Generation XXI birth cohort, who completed 3-day food diaries at age 7, with complete data in variables of interest (n 3564). Adherence to the EAT-Lancet dietary recommendations was evaluated using the World Index for Sustainability and Health (WISH); a higher score indicating a healthier and environmentally sustainable diet. At 7, 10 and 13y, anthropometrics (weight, height and waist circumference-WC), blood pressure (BP) and serum-fasting triglycerides, HDL-cholesterol and glucose were measured. Obesity and MetS prevalence were determined by the World Health Organization and the International Diabetes Federation criteria, respectively. Adjusted custom binomial log-linear models were used to calculate prevalence ratios (PR) and the respective 95% confidence intervals (95%CI) (covariates: mother's age, education, pre-pregnancy BMI, gestational diabetes, child's sex, age, tanner stage, sports practice and total grams of the remaining food).

Results: From 7 to 13y, obesity decreased from 14.1% to 9.3% and MetS increased from 1.0% to 5.1%. Higher WISH scores at 7y were associated with a lower prevalence of obesity, measured by both BMI (≥97^th percentile: PR=0.912, 95%CI: 0.839,0.991; PR=0.882, 95%CI: 0.79,0.938, respectively at 10 and 13y) and WC (≥90^th percentile: PR=0.899, 95%CI: 0.830,0.974; PR=0.858, 95%CI:0.782,0.942, respectively at 10 and 13y). For each 10-point increase in the WISH, a reduction of 16% in MetS prevalence at 13y was observed (PR=0.837, 95%CI: 0.732,0.957). No significant effects were found at younger ages.

Conclusions: The adherence to the EAT-Lancet diet from an early age may help reduce cardiometabolic risk in early adolescence.

Background and aims: Mechanistic studies and short-term randomised trials suggest higher intakes of dietary flavonoids may protect against non-alcoholic fatty liver disease (NAFLD).

Objective: We aimed to perform the first population-based study with long-term follow-up on flavonoid consumption, incident NAFLD, and validated NAFLD biomarkers.

Methods: In a prospective study, we assessed the associations between flavonoid intake based on ≥2 24-hour dietary assessments and NAFLD risk among 121,064 adults aged 40 to 69 years by multivariable Cox regression analyses. We further assessed the associations between flavonoid intake and MRI-derived liver fat (subset of n = 11,435) and liver-corrected T1 values (cT1, subset of n = 9,570), a marker of steatosis, more sensitive to inflammatory pathology.

Results: Over 10 years of follow-up, 1081 cases of NAFLD were identified. Participants in the highest quartile (Q4) of the Flavodiet Score (FDS) reflecting the consumption of foods high in flavonoids, had a 19% lower risk of NAFLD compared to the lowest quartile (Q1) (HR (95%CI): 0.81 (0.67, 0.97), P trend = 0.02). Moreover, participants in the Q4 of the FDS had a lower liver fat and cT1 values, compared to those in Q1 (liver fat: relative difference Q1 vs Q4: -5.28%, P trend = <0.001; cT1: relative difference Q1 vs Q4: -1.73%, P trend = <0.001). When compared to low intakes, high intakes of apples and tea were associated with lower NAFLD risk (apples: HR (95%CI): 0.78 (0.67, 0.92), P trend = <0.01; tea: HR (95%CI): 0.86 (0.72, 1.02), P trend = 0.03). Additionally, when compared to low intakes, high apple, tea, and dark chocolate intakes were significantly associated with lower liver fat values, while high tea and red pepper intakes were significantly associated with lower cT1 values.

Conclusion: The consumption of flavonoid-rich foods was associated with a reduced risk of NAFLD among middle-aged adults.

Background: Folate and cobalamin status, although essential for pregnancy, are not routinely monitored in prenatal care.

Objective: To investigate folate and cobalamin status and determinants throughout pregnancy, in the absence of mandatory fortification with folic acid (FA).

Methods: In a cohort study of 831 women recruited at <12 gestational weeks (GW), plasma folate, total homocysteine (tHcy), cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), red blood cell folate (RBCF) concentrations and the combined cobalamin status indicator (cB12) were determined at ≤12, 15, 24-27, 34 GW, labor and in the cord. Single nucleotide polymorphisms affecting folate and cobalamin status were determined. FA, cobalamin, micronutrient supplement use and dietary folate and cobalamin intake (food frequency questionnaire) were recorded. Folate and cobalamin status predictors were assessed by multiple linear regression analysis.

Results: Only 36.1% of the participants took FA preconceptionally and 47.4% and 7.3% had suboptimal RBCF (<906 nmol/L) and plasma cobalamin status (≤221 pmol/L), respectively, at ≤12 GW. RBCF status was principally determined by planned pregnancy, FA supplementation, plasma cobalamin and methylenetetrahydrofolate (MTHFR) 677C>T genotype. Cobalamin supplement use was positively associated, while smoking and BMI were inversely associated with plasma cobalamin and holoTC. None of these were associated with plasma MMA. Only participants with the MTHFR 677TT genotype exceeding FA supplement recommendations improved their folate status (interaction term: B (95% CI):0.015 (0.01, 0.29), p: 0.032). Smoking was inversely associated with plasma cobalamin status in participants with the methionine synthase reductase (MTRR) 524CC genotype only(interaction term:0.07 (0.01, 0.04), p: 0.014). Mothers with low early pregnancy cobalamin status and also those with bigger newborns, had lower cobalamin status at labor.

Conclusions: Suboptimal early pregnancy folate or cobalamin status affected47.4% and 7.3% of the participants, respectively. The MTHFR 677TT genotype consistently predicted folate status throughout pregnancy. Smoking and BMI were negatively associated with cobalamin status throughout pregnancy.

Clinical trial registry number and website where it was obtained: NCT01778205. www.

Clinicaltrials: gov.

Background: Although water is essential for maintaining health and life, the association between water turnover as an indicator of daily water requirement and water deficit and mortality is unclear.

Objective: We aimed to investigate this association in Japanese adults.

Methods: A total of 63,488 (36,739 females and 26,749 males) Japanese aged 40-79 years in the Japan Collaborative Cohort Study in 1988-1990 were followed up their mortality through 2009. Water turnover was calculated considering lifestyle and environmental factors using an equation previously developed by the International Doubly Labeled Water Database Group. Participants were classified into sex-specific quintiles based on their water turnover. Water deficit levels were calculated from water turnover and dietary water consumption, which were estimated using a validated questionnaire.

Results: The average daily water turnovers were 2,950 mL and 3,466 mL in females and males, respectively. During 19.4 years of median follow-up (1,039,914 person-years), 12,551 deaths were recorded. After adjusting for lifestyle and medical history, the bottom quintile was associated with higher hazard ratios (HRs) of mortality from all causes (females: HR, 1.26; 95% confidence interval, 1.12, 1.41; males: HR, 1.18; 95% CI, 1.07, 1.29) and cardiovascular disease (CVD). In spline analyses, the water turnover range with the lowest HR for all-cause mortality was 3,000-3,300 mL/day in females and the water turnover at which the HR for all-cause mortality plateaued was approximately 3,500-3,700 mL/day in males. Water deficiency levels were associated with all-cause and CVD mortality in both sexes.

Conclusion: This study showed an L-shaped association between water turnover and deficit and all-cause and CVD mortalities (especially coronary heart disease and ischemic stroke) in adults. These findings may be useful for setting the target values of water requirement, and differences between dietary requirements and actual intake may bridge the knowledge gap in water-mortality associations.

Background: Excess body weight and adiposity can adversely affect metabolic health. Prebiotics such as inulin-type fructans (ITF) from chicory root are known to modulate gut microbiota and may improve body weight regulation.

Objective: This study aimed to assess evidence for chicory ITF supplementation to support weight management.

Methods: Eligible articles (initial search to 2021, updated to February 2023) were searched from EMBASE, MEDLINE (PubMed), and Cochrane Library. Data on primary (body weight) and secondary outcomes [body mass index (BMI), total fat mass, body fat percentage and waist circumference] were extracted by two reviewers independently. Random-effects model using inverse variance method was utilized. Subgroup analysis (health status, ITF-type) and meta-regression (dose and duration) were evaluated.

Results: A total of 32 eligible studies were included. Chicory ITF significantly reduced body weight [mean difference (MD) -0.97 kg, 95% confidence interval (95% CI: -1.34, -0.59); n = 1184] compared with placebo. ITF favored overall effects reduction in BMI (MD: -0.39 kg/m²; 95% CI: -0.57 to -0.20; n = 985), fat mass (MD: -0.37 kg; 95% CI: -0.61 to -0.13; n = 397), waist circumference (MD: -1.03 cm; 95% CI: -1.69 to -0.37; n = 604), and for intervention duration >8 wk, body fat percentage (MD: -0.78%; 95% CI: -1.17 to -0.39; n = 488). Except for considerable heterogeneity in body weight (I² = 73%) and body fat percentage (I² = 75%), all other outcomes had negligible to moderate heterogeneity. Significant reduction in body weight, BMI and waist circumference was evident irrespective of participants' health status. There was minimal evidence that dose, duration, or type of ITF influenced the magnitude of reductions in outcomes.

Conclusions: Chicory ITF supplementation may benefit weight management by reducing body weight, BMI, fat mass, waist circumference, and to a certain extent body fat percentage.

Prospero registration number: CRD42020184908.

Background: Diet and lifestyle factors have been linked to developing diverticulitis. However, it remains largely unknown whether the associations are mediated by metabolic disturbance, such as hyperinsulinemia and corresponding metabolomic perturbations.

Objective: We investigated associations of the insulinemic potential of diet, lifestyle (diet, physical activity, body weight), and metabolomic patterns with the risk of incident diverticulitis.

Design: We conducted a prospective cohort study including participants in three nationwide cohorts of US health professionals. The risk of incident diverticulitis was estimated according to quintiles of the empirical dietary index for hyperinsulinemia (EDIH) and empirical lifestyle index for hyperinsulinemia (ELIH). In a subset of participants with metabolomic measurements, we developed metabolomic dietary index for hyperinsulinemia (MDIH) and metabolomic lifestyle index for hyperinsulinemia (MLIH), metabolite profile scores correlating with EDIH and ELIH, respectively, and tested their associations with subsequent risk of diverticulitis. We also examined whether the associations of EDIH and ELIH with diverticulitis were mediated by the metabolite profile scores.

Results: Among 184,508 participants (median age, 51 [IQR, 46-56] years), we documented 9,123 incident diverticulitis cases over 3,419,945 person-years. Compared with those in the lowest quintile, participants with the most hyperinsulinemic diets and lifestyles (highest quintiles of EDIH and ELIH) had a hazard ratio for the risk of diverticulitis of 1.22 (95% CI, 1.13-1.31) and 1.69 (95% CI, 1.57-1.81), respectively. Similarly, the metabolite profile scores were significantly associated with the diverticulitis risk with odds ratio of 1.96 for MDIH (95% CI, 1.47-2.60) and 1.93 for MLIH (95% CI, 1.48-2.51) when comparing extreme quintiles. The explainable proportions of EDIH- and ELIH-related diverticulitis risk by MDIH and MLIH were 70% (95% CI, 6%-99%) and 57% (95% CI, 23%-86%), respectively (P <.0001 for both).

Conclusions: Participants with dietary and lifestyle patterns corresponding to higher insulinemic potential had an increased risk of diverticulitis, which might be mediated by metabolomic profiles.

Background: Although diet quality during pregnancy and postpartum is important for multiple parent and child outcomes, within-person changes in diet quality throughout these periods have not been extensively examined.

Objective: This study investigated diet quality from early pregnancy through 12 months postpartum and examined differences by sociodemographic characteristics in participants receiving obstetric care in Chapel Hill, North Carolina, United States.

Methods: Participants completed 24-hour dietary recalls at six study visits (each pregnancy trimester and 6 weeks, 6 months, and 12 months postpartum) (n=383). Between-visit mean HEI scores (Healthy Eating Index-2015; min=0, max=100) were compared using the population ratio method (PR). The NCI usual intakes method estimated the distribution of HEI scores in pregnancy and postpartum; unpaired t-tests compared usual mean HEI scores by covariates; paired t-tests compared differences between mean pregnancy and postpartum.

Results: The total HEI mean ± SE scores (NCI method) were 61.4 ± 0.8 in pregnancy and 61.7 ± 0.9 in postpartum. Mean HEI scores differed by sociodemographic characteristics, particularly education, marital status, and federal assistance participation. The highest scores were observed in participants with at least a bachelor's degree (64.1 ± 0.9 in pregnancy, 64.5 ± 1.0 in postpartum, n = 257) and those with other non-Hispanic white race/ethnicity (64.7±1.8 in pregnancy, 66.4±2.2 in postpartum). There were no between-visit differences in mean total HEI scores (PR). While differences were observed in some mean HEI component scores between pregnancy and postpartum visits, they were small (mostly < 1 point) in magnitude and in inconsistent directions.

Conclusions: Stable total HEI mean scores suggest adherence to dietary guidelines was consistent throughout pregnancy and postpartum in this sample. While some sociodemographic characteristics may identify individuals at greater risk of diet-related pregnancy complications, low diet quality was pervasive throughout all subgroups and reflect an urgent need for widespread improvement.