American Journal of Clinical Nutrition最新文献

Background: Only a few studies have investigated the role of diet on the risk of chronic kidney disease (CKD) in European populations and have mainly focused on the Mediterranean diet. This is the first study to evaluate the association between various diet quality indices and CKD incidence in British adults.

Objective: To study the relationship between a set of 6 different diet quality indices and CKD incidence among British adults.

Methods: A prospective cohort with 106,870 participants from the UK Biobank, followed from 2009 to 2012 through 2021. Food consumption was obtained from ≥2 24-h dietary assessments. Dietary patterns were assessed using previously established indices: Alternate Mediterranean Index (aMED), Alternative Healthy Eating Index 2010, dietary approaches to stop hypertension (DASH), healthful plant-based diet index (hPDI), unhealthful plant-based diet index (uPDI), and dietary inflammatory index (DII). Incident CKD was obtained from clinical records, death registries, and self-reports. Analyses were performed with Cox regression models and adjusted for the main confounders.

Results: After a median follow-up of 9.27 y, 2934 cases of CKD were ascertained. Hazard ratios (95% confidence interval) of CKD for the highest compared with lowest tertile of adherence to each diet score were 0.84 (0.76, 0.93) for aMED, 0.94 (0.85, 1.03) for alternative healthy eating index 2010, 0.77 (0.70, 0.85) for DASH, 0.79 (0.72, 0.87) for hPDI, 1.27 (1.16, 1.40) for uPDI, and 1.20 (1.18, 1.33) for DII. The results were robust in sensitivity analyses.

Conclusions: In British adults, higher adherence to the aMED, DASH, and hPDI patterns was associated with lower risk of CKD, whereas greater adherence to the uPDI and DII patterns was associated with greater risk.

Background: A comparison of commonly used diet quality indexes (DQIs) and their association with multiple indicators of sustainability has not been performed, which limits policy action.

Objectives: To evaluate the associations between 8 DQIs and 7 sustainability indicators in a nationally representative sample in the United States.

Methods: In this cross-sectional analysis, dietary data from the National Health and Nutrition Examination Survey (2011-2018, n = 18,522 ≥20 y) were merged with data on greenhouse gas emissions (GHGE), cumulative energy demand (CED), water scarcity footprint (WSF), land, fertilizer nutrients, pesticides, and food prices from multiple publicly available databases. Diet quality was measured using the Healthy Eating Index-2020 (HEI-2020), Alternate Healthy Eating Index-2010 (aHEI-2010), Mediterranean Diet Score (Med), Alternate Mediterranean Diet Score (aMed), Healthful Plant-Based Diet Index (hPDI), Planetary Health Diet Index (PHDI) for the United States, Dietary Approaches to Stop Hypertension Index (DASH), and Nutrient-Rich Foods Index 9.3 (NRF9.3). The relationship between each DQI and sustainability indicator was assessed using linear regression.

Results: Greater scores on most or all DQIs were associated with lower daily per capita GHGE (β = -0.908 to -0.250 carbon dioxide equivalents per 1 unit increment in diet quality z-score), CED (β = -2.699 to 0.202 MJ), land (β = -0.002 to <-0.001 ha), and fertilizer nutrients (β= -0.026 to 0.007 kg). By contrast, greater scores on most or all DQIs were associated with greater WSF (β = 343-649 L equivalents) and diet cost (β = 0.037-1.125 US$), and had mixed associations with pesticide use (β = -0.001 to <-0.001 kg). Greater scores on aHEI-2010 and hPDI were associated with the greatest ratio of favorable-to-unfavorable sustainability outcomes (5:2 each), followed by PHDI (4:1), Med and aMed (4:2 each), HEI-2020 and DASH (3:2 each), and NRF9.3 (3:4).

Conclusions: All DQIs had sustainability trade-offs, but those that emphasized plant-based foods, rather than nutrients or animal-based foods, were associated with more favorable sustainability outcomes.

Background: The transition toward sustainable dietary patterns, such as the planetary diet proposed by the EAT-Lancet Commission, is warranted to optimize health and achieve environmental sustainability.

Objectives: To examine the extent to which the evolution of dietary changes over an 8-y period in the French NutriNet-Santé cohort aligned with the EAT-Lancet diet.

Methods: A sample of 17,187 participants of the prospective NutriNet-Santé study was used. Dietary intakes were evaluated in 2014, 2018, and 2022 using a food frequency questionnaire. The alignment of dietary patterns with the EAT-Lancet diet was assessed using the EAT-Lancet dietary index (ELD-I). Changes over time in the ELD-I score and component sub-scores were evaluated using linear mixed regression models.

Results: The mean ELD-I score in 2014 (35.1 ± 0.4 points) increased by a mean of 5.5 points [95% confidence interval (CI): 5.0, 5.9] in 2018, with no further increase in 2022 (+4.2 points compared with 2014: 95% CI: 3.6, 4.9). The increase in the ELD-I observed in 2018 was mostly explained by increases in the sub-scores of these components: Beef, lamb, and pork (+3.4 points; 95% CI: 3.1, 3.6, i.e., lower consumption), Fruits (+1.6 points; 95% CI: 1.3, 1.9, i.e., greater consumption), and Nuts (+1.1 points; 95% CI: 1.0, 1.2, i.e., greater consumption). Changes of similar magnitudes were observed between 2014 and 2022, except for the Fruits component, which showed a decrease (-1.3 points; 95% CI: -1.7, -0.9). Greater changes in the ELD-I score over time were observed for females, younger adults, and adults with high education levels.

Conclusions: Results suggest that the slight shift toward more sustainable dietary patterns within the NutriNet-Santé cohort between 2014 and 2018 has stabilized in 2022. This suggests the need for strong efforts from various actors in the field of nutrition and public health that may facilitate the transition toward sustainable dietary patterns.

Background: Preeclampsia (PE) contributes to maternal and fetal mortality and morbidity. Supplementation with L-arginine, the precursor of nitric oxide, has not proven effective, possibly due to extensive arginine catabolism in the splanchnic bed. Citrulline is converted by the kidney to L-arginine. Citrulline, therefore, could be a more effective nitric oxide donor in the treatment of PE.

Objectives: The study aimed to determine whether oral L-citrulline supplementation would prolong the delay between diagnosis and delivery in preeclamptic females.

Methods: A total of 115 females with monofetal preeclamptic pregnancy were enrolled before 36 weeks of gestation in a multicenter randomized, double-blind trial: 58 received oral L-citrulline supplementation, and 57 received placebo. The duration of pregnancy, neonatal and maternal outcomes, and soluble fms-like tyrosine kinase 1/placental growth factor ratio, an index of placental dysfunction, were monitored.

Results: Gestational age at inclusion was similar in both groups. The duration of pregnancy between inclusion and delivery was unaltered (hazard ratio: 0.90; 95% confidence interval: 0.62, 1.31). Neither neonatal weight nor pregnancy outcome differed between groups. Liver enzymes were higher on the day of delivery in the treated, compared to the placebo group (65.1 compared with 33.2 UI and 70.4 compared with 33.7 UI for alanine aminotransferase and aspartate aminotransferase, respectively, (estimate: 5.92; 95% confidence interval: 1.09, 10.74). Systolic blood pressure (BP) was higher at delivery in the citrulline group compared with the control group (P = 0.015), whereas the diastolic BP showed no difference. We did not find any difference in neonatal outcomes nor soluble fms-like tyrosine kinase 1/placental growth factor ratio.

Conclusions: The current trial found no benefit of oral L-citrulline supplementation to females with PE regarding either the duration of pregnancy, fetal growth, or maternal and neonatal outcomes. Systolic BP and liver enzymes levels were found to increase at delivery in the treated group. L-citrulline oral supplementation does not seem to be a promising candidate as a therapeutic intervention in pregnancies with PE. This trial was registered at CITRUPE as NCT02801695.

Background: Plant-based meat alternatives (PBMAs) are emerging in global markets. However, the effects of substituting meat for PBMAs on cardiometabolic health are uncertain.

Objectives: This study aimed to determine the effects of replacing meat consumption by PBMAs on cardiometabolic parameters in adults.

Methods: Five databases were systematically explored from inception to July 2024, searching for RCTs assessing the effects of replacing meat consumption by PBMAs on cardiometabolic parameters in adults without cardiovascular diseases. Meta-analyses were conducted when ≥4 studies addressed the same outcome (i.e. blood lipids, blood pressure, fasting glucose, and body weight). Pooled raw mean differences (MDs) with their 95% CIs were estimated using a random-effects method. Sensitivity analyses were conducted to assess the robustness of our estimates.

Results: Eight publications from 7 RCTs comprising 369 adults (60% females; mean age range: 24-61 y) were included. The substitution of PBMAs for meat was associated with significant reductions in LDL-cholesterol: -0.25 mmol/L (95% CI: -0.42, -0.08 mmol/L; I² = 65.8%; n = 7), total cholesterol (TC): -0.29 mmol/L (95% CI: -0.52, -0.06 mmol/L; I² = 64.8.%; n = 6), and body weight: -0.72 kg (95% CI: -1.02, -0.42 kg; I² = 0%; n = 5). No significant changes were shown in HDL-cholesterol, triglycerides, blood pressure, or fasting glucose concentrations. Sensitivity analyses considering mycoprotein-based alternatives showed a significant reduction in LDL-cholesterol (MD: -0.37 mmol/L; 95% CI: -0.61, -0.13 mmol/L; I² = 52.5%; n = 4), and TC (MD: -0.39 mmol/L; 95% CI: -0.56, -0.21 mmol/L; I² = 0%; n = 4).

Conclusions: Our findings suggest substituting PBMAs for meat for ≤8 wk lowered TC (6%), LDL-cholesterol (12%), and body weight (1%) in adults without cardiovascular diseases. PBMAs may facilitate the transition to a plant-based diet, but long-term studies are needed to evaluate their cardiometabolic effects. This trial was registered at PROSPERO as CRD42024556191.

Background: Existing equations for prediction of basal energy expenditure (BEE) may not be accurate in children with overweight or obesity (OW/OB). We aimed to develop BEE prediction equations applicable to children and adolescents across a wide BMI spectrum using gold standard room calorimetry.

Methods: We measured weight, height, and waist and hip circumferences; body composition (dual-energy X-ray absorptiometry); and BEE (whole room calorimetry) in a cross-sectional cohort of 1155 healthy children, aged 5-19 y; 67% of the males and 51% of the females were classified as OW/OB. We applied multiple linear regression analyses to develop BEE prediction models for each sex. Using relevant predictors, we developed models with fat-free mass; waist and hip circumferences; weight and height only; and weight only. A representative sample of participants (83 males, 125 females) served as a validation data set to test model performance. The models' performance in predicting BEE was compared with existing models in the literature.

Results: Model fits (R²) for the new BEE prediction models were 0.84 (P < 0.0001). Our BEE prediction models performed equally in children with normal weight and OW/OB, with <1.5% difference between the measured and predicted BEE in the validation data set for both sexes. In Bland-Altman analysis, our BEE prediction models were superior to existing prediction models, especially for children with higher BEEs.

Conclusions: New BEE prediction models developed and tested in cohorts representative of children with normal weight and OW/OB has superior performance compared with existing models. The BEE prediction equations based on simple anthropometrics or body composition provided improved accuracy and precision for children with NW or OW/OB (ages 5-19 y). More accurate estimates of BEE should allow for better estimates of energy requirements of children.

Background: Establishing the effectiveness of high-protein supplementation in reducing cancer-related side effects is crucial.

Objective: The study aimed to assess the effectiveness and safety of high-protein supplementation on clinical outcomes of patients undergoing cancer therapy.

Methods: Systematic searches were conducted on Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane Central Register of Controlled Trials, and Scopus from inception until July 2023. Randomized controlled trials administering supplements with ≥10 g protein/serving, given to 20+ adult patients undergoing cancer therapy were included. Random-effects meta-analyses were used to estimate the effects of high-protein supplementation on the primary outcomes of body weight and health-related quality of life (HRQoL). We employed a vote-counting approach based on effect direction for secondary outcomes (that is, body composition, muscle function, hospitalization, response to cancer therapy/toxicity, survival, and systemic inflammation). Risk-of-bias (ROB) was assessed.

Results: Thirty-five studies involving 3701 patients with diverse cancer types were included. Patients who received high-protein supplementation lost less body weight than controls (mean difference = 1.45 kg; 95% CI: 0.42, 2.48 kg; P = 0.006; I² = 80%). No differences in HRQoL were observed; all studies assessing HRQoL were rated as high ROB. A beneficial effect on muscle mass was found in 11 of 13 studies, although most had a high ROB due to assessment techniques. When considering higher quality studies, evidence of a beneficial effect was found in 5 of 5 studies for muscle strength, and 3 of 4 for hospitalization rate. Effects on other secondary outcomes were inconsistent or limited. No serious adverse effects were reported.

Conclusions: High-protein supplementation mitigates weight loss, improves muscle strength, and lowers hospitalization rates in patients undergoing cancer therapy. These positive clinical outcomes, along with a favorable safety profile, suggest that high-protein supplementation may be a valuable addition to medical practice. However, given the need for more robust trials and the high ROB observed in the existing studies, these conclusions should be interpreted with caution. This review was prospectively registered with PROSPERO under the registration number CRD42021237372.

Food is Medicine (FIM) interventions reflect the critical links between food security, nutrition security, health, and health equity, integrated into health care delivery. They comprise programs that provide nutritionally tailored food, free of charge or at a discount, to support disease management, disease prevention, or optimal health, linked to the health care system as part of a patient's treatment plan. Such programs often prioritize health equity. On 26-27 April, 2023, Tufts University's Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and Food & Nutrition Innovation Institute held a 2-day National Food is Medicine Summit with leaders, practitioners, and individuals with diverse lived experiences in health care, research, government, advocacy, philanthropy, and the private sector to identify challenges and opportunities to sustainably incorporate FIM services into the health care system and at scale. This report of a meeting describes key themes of the Summit, based on presentations and discussions on momentum around FIM, incorporating FIM in health care, tradeoffs and unintended consequences of various FIM models, scaling of programs, financing and payment mechanisms, educating and engaging the health care workforce, and federal and state government actions and opportunities on FIM. Speakers highlighted examples of recent public and private sector actions on FIM and innovative cross-sector partnerships, including state Medicaid waivers, academic and philanthropic research initiatives, health care system screenings and interventions, and collaborations including community-based organizations and/or entities outside of the food and health care sectors. Challenges and opportunities to broader implementation and scaling of FIM programs identified include incorporating FIM into health care business models, educating the health care workforce, and sustainably scaling FIM programs while leveraging the local connections of community-based organizations. This meeting report highlights recent advances, best practices, challenges, and opportunities discussed at the National Summit to inform future actions on FIM.