BMJ Nutrition, Prevention & Health

PurposeAdequate hydration is vital for health, yet many people do not meet fluid recommendations. This study aimed to characterise the role of water and sugar-sweetened beverages in hydration across different levels of socioeconomic status (SES) in the UK. MethodsIn a pre-registered cross-sectional study, participants (N = 1,112) recalled beverages consumed on the previous day and reported urine colour as an indicator of their hydration status. We analysed water intake (H1), sugar-sweetened beverage (SSB) intake (H2), and SES (education; H3) as predictors of hydration status using stepwise binomial logistic regression adjusted for health, demographic, and lifestyle covariates. ResultsForty percent of participants were classified as underhydrated. Higher water intake was associated with a greater likelihood of adequate hydration: Drinking one extra glass of water per day (250 ml) increased the odds of being adequately hydrated by about 16%. However, SSB intake was not associated with hydration unless intake from other drink sources was held constant. Having a higher versus lower level of education was not significantly associated with hydration status, although finer-grained and income-based analyses suggested modest socioeconomic differences. ConclusionWater intake--rather than SSB intake--is the primary correlate of adequate hydration in this UK sample. Public health initiatives should emphasise the importance of water for hydration, invest in ways to make water more appealing, and promote the use of urine colour as a marker of hydration status.

BackgroundOverweight and obesity are causing growing public health, economic and clinical burden, particularly within under-resourced communities. There is an urgent need to develop an in-depth understanding of experiences of weight management, and preferences for support within under-resourced communities, with a view to developing more effective weight management interventions. MethodsFocus groups were run in under-resourced communities using storyboarding; a method to facilitate inclusive communication (n=37). Thematic analysis was applied to textual and visual data, and a realist lens applied to provide in-depth insight into weight management experiences and needs. We believe this is the first study to use this combined methodology to explore weight management experiences and needs. ResultsCombining storyboarding with a realist lens, generated four themes. Living circumstances indicated that mental health, individual needs, and cost of weight management services were key contextual factors. Mechanisms of weight management identified emotional eating and portion control to be central to individual weight management. Yo-yo dieting centred on participants experiences of weight regain after attempting weight loss. Weight management intervention needs indicated psychological support was perceived as severely lacking, and the only route to attain sustained weight management. Offering both in-person and online support for weight management was considered important to reach more people. ConclusionMoving weight management support from short- to long-term and incorporating more robust psychological support would better serve the needs of people living in under-resourced communities who are overweight or obese. Ideally interventions should be multicomponent and tailored to individual needs and circumstances.

Poor sleep is linked to consumption of sugary foods/beverages and high neural responsivity to palatable food cues. Yet, whether hedonic liking for sweet taste explains these associations remains unclear. We examined cross-sectional associations of five sleep traits (chronotype, sleep duration, insomnia frequency, snoring, daytime dozing) and a composite sleep score with sweet food liking, and total and free sugar intake in 76,734 UK Biobank participants (39-72 years, 56.3% female). Models adjusted for age, sex, ethnicity, socioeconomic deprivation, and body mass index (Bonferroni-corrected =0.0025). Evening chronotype, more frequent insomnia and daytime dozing, and lower composite sleep score were associated with higher sweet food liking. Associations with intake were stronger for free than total sugar. Evening chronotype was associated with higher free sugar intake (g/day: {beta}=1.523, 1.309-1.737; g/1000 kcal: {beta}=0.450, 0.361-0.538), and daytime dozing showed a dose-response (dozing often vs never/rarely: g/day {beta}=6.307, 4.631-7.983). Snoring was associated with higher absolute (but not energy-adjusted) free sugar intake. A healthier sleep score was associated with lower free sugar intake (g/day {beta}=-2.193 [-2.464 to -1.922]; g/1000 kcal {beta}=-0.691 [-0.804 to -0.579]) but higher energy-adjusted total sugar intake ({beta}=0.633 [0.485-0.781]). Mediation analyses indicated sweet liking accounted for 15%-91% of several sleep trait and free sugar intake associations (indirect effects p<0.001). Poorer sleep health, particularly evening chronotype and daytime sleepiness, was associated with greater sweet liking and higher free sugar intake, with sweet liking partially mediating associations between sleep traits and sugar consumption. Sweet-taste liking may represent an underexamined pathway linking sleep/circadian disruption to free sugar intake.

BackgroundThe surgical stress response is a predictable, physician-managed metabolic state triggered by anesthesia and tissue injury, marked by insulin resistance and hypercatabolism that create unique nutritional needs unmet by standard, pre-surgical fasting diets. We developed a multi-nutrient medical food to support perioperative metabolic homeostasis and piloted its safety/tolerability and exploratory outcomes. MethodsIn a single-center pilot trial (n=67) of adults undergoing elective abdominal, cardiac/thoracic, gynecological, or orthopedic surgery, participants were allocated to medical food or no-treatment control. The product was taken twice preoperatively (evening before and 4 h pre-op) with standard care. Primary safety outcomes were adverse events, postoperative nausea/vomiting (PONV), 30-day readmission, and infections. Exploratory outcomes were fasting glucose, HbA1c, electrolytes, cortisol, pre-operative emotional state, and post-operative pain. ResultsAll participants completed the intervention. No product-attributed adverse events occurred. Gastric clearance was achieved within 2 h in all, and there were no 30-day readmissions or infections. PONV occurred in 30.3% vs 35.3% (risk ratio 0.86, 95% CI 0.43-1.71, p=0.796). Post-operative glycemia favored the intervention; at 48 hr the intervention group showed lower glucose (HL -9 mg/dL, g=0.35, p=0.030), while earlier timepoints were nonsignificant. Post-operative magnesium was numerically lower with intervention (4.76 vs 5.10) without statistical significance; other electrolytes and cortisol showed minimal differences. Post-operative pain was 5.33 vs 5.62 (g=0.19, p=0.43). Positive pre-operative emotion was more frequent with intervention (17/33 vs 9/34; risk ratio 1.95, p=0.046). ConclusionThe medical food was safe and well tolerated without increased PONV or readmissions. Preliminary metabolic and emotional signals justify a larger, adequately powered efficacy trial. Clinical Relevancy StatementThis pilot trial demonstrates that a preoperative multi-nutrient medical food was well tolerated and feasible to administer in a routine clinical setting: all participants achieved gastric clearance within 2 hours of the pre-operative dose, with no increase in PONV and no readmissions. Exploratory findings indicate potential benefits that could nutritionally support recovery if confirmed. These results support the feasibility of administering a targeted nutrition intervention shortly before surgery and justify evaluation in a larger efficacy trial. Clinical Trial RegistrationNCT07359222

BackgroundCentral obesity is a critical public health issue linked to non- communicable diseases and long-term maternal health risks. Women beyond the postpartum period often face barriers to weight management, yet limited evidence exists on their specific challenges and the role of healthcare systems in addressing them. This study aimed to assess central obesity among women beyond postpartum period, focusing on the associated challenges and available health support systems. MethodologyA cross-sectional design was employed whereby 120 women (1 to 5 years postpartum), aged 18 - 49 years, attending selected one private and two government health facilities in Morogoro Urban District participated. Face-to-face interviews using semi-structured questionnaires and anthropometric measurements of waist and hip circumference were conducted. Data were recorded using Kobo digital Toolbox. Key findingsHigh prevalence of central obesity, with 68.3% of participants having a waist circumference above normal ([&ge;]80 cm) was observed. Although no socio-demographic factor assessed showed a statistically significant association with central obesity, trends indicated higher odds among older (OR=1.544; 95% CI, 0.084-28.557), married (OR= 1.730; 95% CI, 0.612-4.892) and higher income women (OR= 4.878; 95% CI, 0.367-64.818). Lifestyle behaviors such as low physical activity, poor dietary habits and lack of portion control were prevalent. 57.5% reported lacking information on weight and waist management. Despite attending health care facilities, 94.2% of the women had never received guidance from health providers regarding weight or central obesity management and 95% reported not receiving any form of support such as nutrition counseling or exercise recommendations. ConclusionThe study concludes that central obesity is highly prevalent among women beyond postpartum period and is influenced by poor lifestyle behaviors and inadequate healthcare system support. It recommends integrating weight management strategies into routine postpartum care and strengthening healthcare systems to offer tailored guidance and support to women after childbirth.

BackgroundThe introduction of mandatory calorie labelling among large food businesses (chains) in England in 2022 has been found to have little impact on consumer behaviour, but overall calories on restaurant menus have decreased slightly. This study examined menu changes post policy implementation, and the population groups likely to have been affected most. MethodsMenu data from 169 chains in Great Britain were extracted from two online food delivery platforms in June 2022 and June 2023. We selected 10 categories (specific foods or chains) jointly with public and policy advisors. Menu changes over time were assessed with multilevel models accounting for whether an item was continuously on the menu and for the type of chain. Where changes were found, we assessed differences in purchasing frequency by consumer characteristics using 2022 OOH purchase data (Worldpanel by Numerator, GB OOH Panel). ResultsChanges were observed in two (out of 10) categories examined and were driven by changing items on the menu rather than reformulating continuous dishes. Chains that used a healthy tag on the delivery website increased the share of mains under 600 kcal by 3.7 percentage points (95% CI 0.2 to 7.2), while average calories did not change (-17.6 kcal/item, 95% CI -38.7 to 3.4). Men, people aged 35-44 years and with high SES were found to purchase more frequently from these chains. Across all chains, the share of lower-calorie coffees decreased by 10 pp (95% CI -18.0 to - 0.02), with purchasing more frequent among men and increasing with age. ConclusionsAlthough data were available for one year only post-policy implementation, menu changes among the investigated foods and chains were limited. While menu change may equitably improve population dietary health, dietary inequalities may exacerbate if only healthy chains already offering lower-calorie food change their menus.

BackgroundTime-restricted eating (TRE) has gained popularity for weight loss and metabolic health. While some evidence suggests greater benefits when TRE aligns with circadian rhythms--characterized by early daytime eating and avoidance of nighttime intake, often referred to as early TRE (eTRE), other studies report no meaningful differences between eTRE, other TRE approaches with or without exercise, or calorie restriction (CR), and robust comparative evidence remains limited. AimTherefore, the aim of this network meta-analysis (NMA) is to evaluate the physiological effects of eTRE, midday time-restricted eating (mTRE), late time-restricted eating (lTRE), with and without exercise, CR, and control (without prescribed energy or fasting windows) on anthropometric measures and cardiometabolic markers in adults with cardiometabolic risk factors. MethodsA comprehensive literature search was conducted in four major databases (PubMed, Web of Science, Scopus, and Embase) up to April 24, 2025. A Bayesian NMA was performed, using a control group as the reference comparator across interventions. Treatment effects were expressed as mean differences with 95% confidence intervals. The relative ranking of the included arms on the outcomes was assessed using surface under the cumulative ranking curve, values derived from the NMA, where higher values reflect a higher probability of superior effectiveness. Resultsa total of 40 trials comprising 3259 subjects were included in the analysis. There were significant reductions in most anthropometric measures in all intervention groups compared to control group. Whereas eTRE and eTRE + exercise (EX) significantly improved glucoregulatory outcomes compared to control, eTRE + EX showed superior results over other interventions. ConclusionWhile our results did not detect statistically significant differences between TRE patterns and CR, the consistent SUCRA rankings in favor of eTRE (particularly with exercise) suggest that meal timing may play an important role in metabolic regulation.

Opioid use disorder (OUD) has been linked to cardiometabolic diseases in adults through reductions in adiponectin--an adipocytokine with insulin-sensitizing effects. Opioid use during pregnancy dysregulates neonatal growth and may predispose to adult-onset diseases, but the impact of maternal OUD on neonatal adiponectin has not been studied. We hypothesize that maternal OUD also reduces adiponectin level in offspring (primary outcome) and alters growth (secondary outcome). To test our hypothesis, we conducted a prospective, observational pilot study and compared the expression of salivary adiponectin receptor 1/ADIPOR1 and anthropometric and body composition (fat and fat-free mass) measurements between opioid-exposed and age-matched non-exposed neonates born at [&ge;]34 weeks gestation. Data were stratified by exposure and sex using a Students t-test. Significance was set at p<0.05. A total of 67 neonates (35 opioid-exposed, 32 non-exposed neonates) were enrolled. Compared to healthy, non-exposed neonates, the expression of ADIPOR1 was reduced in opioid-exposed neonates (0.27-fold, p<0.01), with the lowest expression in those requiring pharmacotherapy (0.048-fold, p<0.001). Despite the smaller anthropometric measurements in the exposed than non-exposed neonates (2915{+/-}625 grams vs. 3209{+/-}345 grams, p=0.02), opioid-exposed neonates had comparable adiposity to non-exposed neonates (8.60{+/-}4.52% vs. 8.53{+/-}4.00%, p=0.95). Less breast milk was used in the exposed than non-exposed group (25.7% vs. 71.9%, p<0.01). Maternal OUD may be associated with aberrant growth and excess adiposity in offspring through its effect on adiponectin signaling, predisposing these neonates to cardiometabolic risks.

BackgroundPacked lunches are a common feature of early childhood food provision, yet evidence describing their nutritional composition in early years settings remains limited. Understanding the foods provided during this developmental period is important, given the potential influence of early dietary exposures on later health. AimTo characterise the composition, nutritional quality, cost, and dietary patterns of packed lunches brought from home in Early Childhood Education and Care settings, and to examine variation by child age and area-level deprivation. MethodsA cross-sectional analysis was conducted using a remote food photography method to assess packed lunches provided for children aged 1-4 years attending early years settings across Essex, UK. Food items were categorised into predefined groups, and nutrient composition was estimated. Area-level deprivation was determined using the English Index of Multiple Deprivation (2019). Non-parametric tests assessed between-group differences. Principal components analysis (PCA) was used to identify patterns of co-occurring foods. ResultsA total of 389 packed lunches were analysed. Starchy foods (82%), fruit (81%), dairy or alternatives (72%), and savoury snacks (74%) were commonly provided, while vegetables were less frequent and fish was rarely observed (1.5%). Overall, 97.7% of lunches contained at least one ultra-processed food (UPF), with a median of three UPF items per lunch and 74% of total energy derived from UPFs. Median energy provision was 400 kcal (IQR 309-518). Nutrient composition was broadly similar across deprivation groups, although cake and biscuit counts and UPF item counts were modestly higher in more deprived areas. The median estimated lunch cost was {pound}1.79 and did not differ by deprivation. ConclusionsPacked lunches in early years settings frequently contained ultra-processed foods and showed considerable variability in nutritional quality. Socioeconomic differences were limited, suggesting that contemporary packed lunch practices may reflect influences operating across population groups. Further research across diverse regions is warranted to better understand the provision of packed lunches and their implications for early dietary exposure.

Front-of-pack nutrition labels (FOPLs) have been adopted as a key government strategy to address the significant burden of diet-related noncommunicable diseases. However, research on public knowledge and perceptions of FOPLs and their relationships with sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption remains limited. A cross-sectional study with 2870 individuals was conducted to explore their knowledge and perceptions of Nutri-Grade, a national front-of-pack nutrition labeling scheme introduced in Singapore in 2022. Knowledge was not significantly associated with SSB consumption; however, individuals who perceived these labels more positively were significantly less likely to consume SSBs daily (AOR=0.72, p<0.001) and consumed fewer types of SSBs weekly (IRR=0.91, p<0.001). Moderation analyses indicated that greater knowledge of Nutri-Grade FOPLs was associated with a higher likelihood of SSB consumption among younger individuals and those residing in areas with higher house prices. Additionally, individuals with positive perceptions were more likely to consume SSBs daily when living in areas with food court density exceeding 2.99 per km{superscript 2} (AOR = 1.12, p = 0.004). Individuals with positive perceptions of Nutri-Grade FOPL were also less likely to consume ASBs (AOR=0.69, p<0.001), whereas, in contrast to SSBs, greater knowledge of Nutri-Grade FOPLs was associated with increased ASB consumption (AOR=1.42, p<0.001). These findings indicate that informational labeling itself is insufficient to change consumption behavior. Although positive perceptions of Nutri-Grade FOPLs provide a protective effect, this effect diminishes when the food environment is taken into account.

IntroductionDepression is highly prevalent among young adults worldwide. While research links health behaviours, such as dietary intake, to depression, few studies have examined these associations among young adults in low- and middle-income countries, including South Africa. This study investigated whether dietary intake was associated with an increased risk of depression in a cohort of young South African adults, aged 20-30 years, as part of the Global burden of disease Lifestyle And mental Disorder (GLAD) project. MethodsThis five-year prospective cohort study was conducted in the North West Province of South Africa in accordance with the GLAD project protocol (DERR1-10.2196/65576). Dietary exposures were evaluated using three non-consecutive 24-hour dietary recalls, measuring daily intake of various food groups and nutrients as defined by the Global Burden of Disease study. Depression outcomes were assessed at baseline (N=1039) and follow-up (N=551) using the Patient Health Questionnaire (PHQ-9, cut-off [&ge;]10). Logistic and Poisson regression analyses were performed, with results presented as odds ratios (OR) and relative risk ratios (RR), respectively. Four models were run: unadjusted, sociodemographic-adjusted, total energy (TE) intake-adjusted and fully adjusted (including sociodemographic information and TE intake). For longitudinal analyses of incident depression, baseline depression cases were additionally excluded (n=403). ResultsParticipants (average age 24.55 years) had a balanced distribution of sex (51.4% female) and race (48.6% Black), and a 29.45% baseline prevalence of depression. Higher milk intake was associated with a lower risk of incident depression (RR=0.94, 95% CI 0.91-0.98) in the TE-adjusted longitudinal model. Cross-sectionally, higher sugar-sweetened beverage consumption associated with higher odds of depression, while higher calcium intake (OR=0.48, 95% CI 0.31; 0.76) and vegetable consumption (OR=0.74, 95% CI 0.61, 0.91) were associated with lower odds of depression after TE intake adjustment. Higher fibre intake was associated with lower odds of depression in the unadjusted model. ConclusionHigher daily milk intake was associated with a lower risk of depression, while higher calcium, vegetable, and fibre intake were associated with a lower prevalence of depression in young adults. These findings suggest that prevention strategies for common mental disorders could include dietary approaches within mental health care.

As plant-based (PB) diets become more common among UK children, understanding their nutritional adequacy and environmental impact is vital. This study assessed nutrient intake and dietary greenhouse gas emissions among children following omnivorous, vegetarian, and vegan diets. A cross-sectional analysis was conducted using three-day weighed food diaries from 39 UK children aged 2-12 years (omnivore n=15; and PB: vegetarian n=11; vegan n=13). Nutrients were analysed with and without supplementation using Nutritics software. GHGEs were calculated at the ingredient level (kgCO2e/day) and grouped by Eatwell Guide food categories. No dietary group met all nutrient reference values. Omnivores exceeded recommended intakes for saturated fat and free sugars while failing to meet the recommended intake for fibre, whereas PB children had intakes of these nutrients in the healthy range. PB diets were adequate in protein and vitamin B12 even in the absence of supplementation. Vegan children also met iron requirements from diet alone, whereas omnivore and vegetarian children did not meet iron targets without supplementation. Vitamin D intake was insufficient across all groups when supplements were excluded, with only vegan children achieving recommended levels through supplementation. Zinc requirements were met only by vegetarian children with the aid of supplements and were not met by vegan or omnivore children with or without supplementation. Iodine intake remained inadequate in vegan children even with supplementation. Mean daily GHGEs differed significantly between diet groups (p < 0.001): omnivores having the highest emissions, while vegans had the lowest emissions: 46% lower than omnivores, and 20% lower than vegetarians. Well-planned PB diets can meet most nutrient needs in UK children when supported by fortified foods and supplements, while substantially reducing dietary GHGEs compared with omnivorous diets. Shifting away from animal protein and dairy provides the greatest opportunity for improving both nutritional quality and environmental sustainability.

BackgroundAnorexia nervosa (AN) remains difficult to treat, partly due to co-occurring mental health challenges and gastrointestinal symptoms. Emerging research suggests that individuals with AN exhibit gut microbiota dysbiosis and dysregulation in the gut-brain axis (GBA). However, research examining the role of gut microbiota as a potential driver of AN-related pathologies remains limited. The Norwegian Microbiota Study in Anorexia Nervosa (NORMA) will therefore investigate gut microbiota and its interaction with the GBA in AN. MethodsNORMA is a collaboration between the Norwegian University of Life Sciences and seven Norwegian specialized eating disorder inpatient treatment units, consisting of three work packages (WP): a clinical observational trial (WP1), in vitro fermentation experiments (WP2), and animal experiments (WP3). In WP1, 90 patients with AN (age 16-50, BMI<18.5) admitted for treatment and 90 healthy controls (HCs, age 16-50, BMI 18.5-27) will be recruited. Data on mental and physical health, dietary intake, and blood and fecal samples for biomarker and microbiota analyses will be collected at baseline, 6 and 12 weeks after start of treatment for AN patients and once for HCs. Outcomes will be compared between groups, and longitudinal effects of standard treatment examined within the AN group. In WP2, fecal microorganisms from patients and HCs will be grown in vitro to assess influence of prebiotics. In WP3, mice will receive fecal microbiota from AN and HC donors to determine if and how AN-related microbiota affects AN-relevant phenotypes. ConclusionNORMA is pioneering in its integration of clinical, in vitro, and animal studies, providing the most comprehensive gut microbiota study of AN so far. By investigating the role of gut microbiota in AN and effects of standardized treatment on gut microbiota composition, this study aims to inform the development of innovative therapeutic strategies and ultimately improve treatment outcomes and life quality for individuals with AN. Trial registrationNORMA is a registered clinical trial: clinicaltrials.gov as NCT06144905.

IntroductionMechanistic research has shown that prior obesity induces durable transcriptomic and epigenetic reprogramming in adipose tissue that persists after weight loss and predisposes individuals to weight regain. This phenomenon, termed obesogenic memory (OM), is currently conceptualized primarily as a molecular process. We propose extending OM beyond adipose tissue biology to include interacting biological and sociocultural processes through which past exposures shape present physiological regulation and health-related behavior. MethodsIn-depth qualitative interviews were conducted with individuals living with obesity (n=31) and with healthcare professionals (n=18). The data were analyzed abductively to examine participants lived experiences of obesogenesis. ResultsWe developed a three-phase model of OM comprising memorizing, remembering, and rescribing. The memorizing phase describes the initial acquisition and encoding of biological and sociocultural obesogenic influences. The remembering phase captures the persistence of these influences, contributing to long-term obesity maintenance. The rescribing phase refers to processes through which obesogenic influences may be attenuated or reversed, creating conditions for sustainable health behavior change. ConclusionExtending OM to include sociocultural dimensions provides a more comprehensive understanding of obesity persistence. This integrative framework identifies multilevel targets for obesity prevention and treatment that acknowledge past exposures while supporting resilience and long-term weight management.

Iron deficiency (ID) is the most common nutritional deficiency worldwide, often caused by insufficient dietary intakes. Oral supplementation is one of the means to improve iron status. This study evaluated the efficacy and safety of two low-dose iron supplements - >Your< Iron Forte Capsules (YIFC) and Ferrous Sulfate Capsules (FSC) - in individuals with dietary ID. One hundred and one participants (mean age 30.6 years; 98% women) with low iron stores (mean serum ferritin 16.1 {micro}g/L) were randomized to receive either YIFC or FSC once daily for 12 weeks. Changes in blood indices and iron-related parameters were assessed at four and 12 weeks of intervention relative to baseline. The primary outcome was the change in hemoglobin (Hb) after 12 weeks. Eighty-seven participants completed the study. Both supplements significantly increased Hb at 12 weeks (YIFC: mean 6.52 g/L, p<0.001; FSC: mean 5.71 g/L, p<0.001). Product-related adverse events (AEs) were few (17% of all AEs) and of mild to moderate intensity only. One participant receiving FSC withdrew due to a probable product-related AE. The frequencies of product-related AEs were similar between study arms, however, statistically significantly more AEs judged to be definitely related to the product occurred in in the FSC arm. While product-related AEs were confined to the gastrointestinal tract in the YIFC arm, they affected multiple organ systems in the FSC arm. Supplementation with either YIFC or FSC proved as an effective, well-tolerated, and safe strategy for improving iron status in non-anemic dietary iron deficiency. In terms of the AE profile, supplementation with YIFC may offer advantages over supplementation with FSC.

Outcomes from the COSMOS trial have reinforced the notion of flavanols as important plant-derived bioactives contributing to cardiovascular health. As discussions continue on whether specific dietary reference values for flavanols are warranted, it is possible that existing dietary guidelines emphasizing fruits and vegetables already yield sufficient flavanol intake levels. If this were the case, developing flavanol specific dietary reference values might be unnecessary. This study therefore aimed at assessing whether adherence to dietary recommendations for fruit and vegetable intake and overall diet quality achieves flavanol intake levels of 500 mg/day, the amount proven to mediate cardiovascular benefits in the COSMOS trial. Flavanol intake was objectively evaluated using two validated and complementary biomarkers, 5-(3{square},4{square}-dihydroxyphenyl)-{gamma}-valerolactone metabolites (gVLMB) and structurally related (-)-epicatechin metabolites (SREMB), in two geographically distinct studies: COSMOS (US; n=6,509) and EPIC-Norfolk (UK; n=24,154). The results showed that higher fruit and vegetable intakes and diet quality (assessed via the alternative healthy eating index-aHEI) were associated with increased flavanol intake in COSMOS. Nevertheless, fewer than 25% of participants meeting dietary guidelines achieved an estimated flavanol intake of [&ge;]500 mg/day. Similar findings were observed in EPIC-Norfolk as well as through flavanol intake simulations considering fruits and vegetables commonly consumed in the US diet. In conclusion, adherence to existing dietary guidelines does not yield flavanol intake levels comparable to those shown to provide cardiovascular benefits in COSMOS. Thus, specific dietary reference values for flavanols may still be necessary if aiming to increase the intake of these dietary compounds. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=101 SRC="FIGDIR/small/26346949v1_ufig1.gif" ALT="Figure 1"> View larger version (39K): org.highwire.dtl.DTLVardef@24faeaorg.highwire.dtl.DTLVardef@1d52a29org.highwire.dtl.DTLVardef@1c2ff33org.highwire.dtl.DTLVardef@100a384_HPS_FORMAT_FIGEXP M_FIG C_FIG

BackgroundPrediabetes is associated with an increased risk of progression to type 2 diabetes. While dietary interventions in prediabetes traditionally primary focus on energy and macronutrient intake, the role of eating timing has recently been highlighted. This study aimed to examine the relationships between components of eating timing patterns and glycaemic parameters in prediabetes. MethodsIn 297 individuals with prediabetes, i.e. impaired fasting glucose or impaired glucose tolerance (age 59.4 {+/-} 9.0 y, BMI 31.3 {+/-} 6.2 kg/m2), glycaemic traits were assessed using the oral glucose tolerance test (OGTT). Parameters of eating timing pattern (eating timing itself, daily calorie distribution, and meal number) were extracted from four-day food records. Eating start (ES) was defined as the start of the first caloric event of the day. ResultsAmong eating timing components, the most associations with glycaemic parameters were observed for ES. Individuals with late ES showed higher fasting insulin (p = 0.006), AUC insulin (p = 0.020), insulinogenic index (p = 0.049), HOMA-IR (p = 0.004), and lower Matsuda insulin sensitivity index (p = 0.004) compared to those with early ES, even after adjustment for age, sex, daily energy intake, and body fat. Participants with late ES had decreased insulin clearance (p<0.001) upon comparable glucose and C-peptide levels. ConclusionLate ES is associated with estimates of lower insulin sensitivity and hyperinsulinemia in prediabetes, independent of energy intake and body fat. Our findings suggest that an earlier ES is related to improved glucose metabolism which might lower the risk of progression to diabetes.

BackgroundThe sodium-restricted rice diet (RD) was once the only effective treatment for malignant hypertension (MH); however, a modern, comprehensive data analysis is lacking. We determined patient survival and ocular improvements in 544 MH patients treated between 1942-1982. MethodsAt entry, systolic blood pressure (SBP) was [&ge;]170 mmHg and retinal hemorrhage (n = 312), hemorrhage with papilledema (n= 211) or papilledema alone (n = 21) were present. Dates of death were available for 454 patients; ocular data (at baseline and again before day 365) for 342 patients with hemorrhage and 143 with papilledema. We used actuarial analysis to determine survival and resolution of ocular findings. We used Cox proportional hazards to calculate mortality hazard ratio (HR), and period life tables to estimate loss of longevity. ResultsMedian initial SBP of 213.3 mmHg fell to 178.4 during year 1, and to [~]143 after 9 years. RD patients survived longer than untreated patients: 1890 vs 540 days for patients with hemorrhage alone; 510 vs 180 days with both hemorrhage and papilledema. Few patients reached their expected longevity; median loss of potential life was 15.4 years. Compared to patients whose SBP fell <15 mmHg by 4 weeks, those with a fall [&ge;] 37 mmHg had HR for mortality of 0.32. Retinal hemorrhages cleared in 260/342 patients; papilledema, in 133/143. ConclusionWith RD treatment blood pressure decreased, and ocular abnormalities largely resolved. Survival improved, but predicted longevity was not achieved. The RD helped MH and could still provide a useful adjunct to pharmacologic therapy.

IntroductionThere is no comparison of iron phenotypes and menses, pregnancies, and live births reports of women with HFE-related hemochromatosis (HFE p.C282Y (rs1800562) homozygosity) and HFE wt/wt (absence of p.C282Y and HFE p.H63D (rs1799945)). Subjects and MethodsWe compared phenotypes and reports of non-Hispanic white women women aged [&ge;]25 y in post-population screening evaluations using univariable methods. ResultsThere were 153 p.C282Y/p.C282Y and 273 wt/wt. Median ages were 50 y (25, 86) and 55 y (25, 92), respectively (p=0.0019). Median transferrin saturation (TS), median serum ferritin (SF), and provisional iron overload prevalence were higher in p.C282Y/p.C282Y (p [&le;]0.0001, each comparison). Prevalences of documented iron overload (3.3% p.C282Y/p.C282Y vs. 0.7% wt/wt), iron overload-related disease (2.0% vs. 0.4%, respectively), and iron deficiency (3.9% vs. 2.6%, respectively) were not significantly different. Median ages at menarche (13 y p.C282Y/p.C282Y vs. 13 y wt/wt) and menopause (50 y vs. 49 y, respectively) were not significantly different. Reports of "in-between bleeding?" (24.2% p.C282Y/p.C282Y vs. 25.2% wt/wt, respectively), "early stopping of periods?" (11.8% vs. 13.9%, respectively), and "had a hysterectomy?" (30.1% vs. 35.9%, respectively) were not significantly different. Respective percentage pairs of women with p.C282Y/p.C282Y and wt/wt who reported 0, 1, 2, 3, or [&ge;]4 pregnancies (or live births) did not differ significantly. Live births/pregnancies were 287/363 (79.1%, p.C282Y/p.C282Y) and 534/673 (79.3%, wt/wt) (p=0.7549). ConclusionsMedian TS, median SF, and provisional iron overload prevalence are greater in women with HFE p.C282Y/p.C282Y than those with wt/wt, although reports of menses, pregnancies, and live births are similar.

Background/ObjectivesNutrient interactions in multi-ingredient supplements may influence absorption and bioavailability, yet pharmacokinetic data in this context remains limited. This clinical trial assessed the post-prandial absorption kinetics of key micronutrients in AG1, a comprehensive supplement containing vitamins, minerals, probiotics, and phytonutrients. MethodsIn a randomized, double-blind, placebo-controlled crossover trial 16 healthy adults (8 males and 8 females) consumed a single serving (13g) of AG1 or a taste- and appearance-matched placebo mixed in water, following a 10-hour overnight fast. Each condition was separated by a 1-week washout. Blood samples were collected pre-consumption and at 30, 60, 90, 120, 180, 240, 360, and 480 minutes post-ingestion. Plasma concentrations of folate, calcium, zinc, vitamin C, biotin, nicotinamide, pyridoxine, riboflavin, thiamin, and hesperidin were measured. Area under the curve (AUC0-480 min) was used to assess nutrient absorption. Safety and tolerability were assessed throughout the study. Statistical analysis included repeated measures ANOVA and paired t-tests. ResultsAG1 significantly increased AUC0-480 min values (p<0.05) for all measured nutrients except pyridoxine which revealed a strong trend (p = 0.075) and hesperidin (p = 0.224). Both AG1 and placebo were well tolerated, with no serious adverse events reported. ConclusionsAcute consumption of AG1 resulted in measurable increases in circulating levels of most of the tested micronutrients, indicating effective absorption and bioavailability. These findings support the potential of AG1 to contribute meaningfully to nutritional status and overall health.