Current Developments in Nutrition

BackgroundPopular dietary patterns for cardiovascular and cognitive health such as the Mediterranean and MIND diets emphasize plant-based foods while limiting red meat intake. However, most research combines processed and unprocessed forms, limiting conclusions about unprocessed red meat. ObjectiveTo evaluate the effects of incorporating minimally processed lean red meat into a nutrient-dense, plant-forward, healthy dietary pattern on markers of aging-associated health decline. MethodsThis 18-week all-food-provided randomized controlled crossover feeding PRODMED2 trial tested an omnivorous red meat diet with 162g/d minimally processed pork (MPP) against a macronutrient- and energy-matched no-meat control diet with minimally processed lentils (MPL). Serum biomarkers relevant to metabolic-related cognitive and physical health were explored in 36 adults aged [&ge;]65 years. Primary and secondary endpoints included five cardiovascular-related markers, 12 nutrition- and neurotransmitter-related measures, two metrics of body composition, and two muscular fitness outcomes. Data was analyzed using robust mixed effects models adjusted for covariates. ResultsIntervention diets were well tolerated, with high adherence. Improvements in cognitive related metabolic biomarkers were observed across both arms. Fasting insulin declined more after MPP (p < 0.001), with a corresponding increase in SPISE (p = 0.032), though between-group differences were not significant. HDL was higher post-MPP than post-MPL (p = 0.034). Body weight decreased in both arms (p < 0.05), with a smaller lean mass loss trend following MPP. Grip strength and chair-rise performance were maintained. Neuroactive metabolites and bioactive amino acid profiles shifted favorably in both arms. ConclusionThese findings challenge the perception that red meat is broadly unsuitable for older adults. Including familiar foods like red meat, particularly in minimally processed form and within a healthy overall dietary pattern, may provide age-associated health benefits and improve adherence to plant-forward diets. These results have important implications for healthspan of older U.S. populations where red meat remains popular. Clinical Trial RegistryRegistered at www.clinicaltrials.gov as NCT05581953 and NCT06261775.

We revealed critical vulnerabilities of nutrient content claims under FDA per serving size (serving), CAC per 100 g or mL, CAC per serving, and CAC per 100 kcal and developed the proposed method to remove all vulnerabilities. We calculated the nutrient content of foods based on nutrient content claims under the proposed method. Then, we determined nutrient content claims for foods and food groups, and specified similarities between nutrient content claims in food groups. Also, we ranked foods and food groups based on met claims of the nutrient content. Nutrient content claims based on the proposed method, including free, very low, low, source, and high claims were determined in 8596 food items, 29 nutrients, and 25 food groups of the USDA National Nutrient Database for Standard Reference, release 28. Source and high claims are used for positive nutrients (including vitamins, minerals except sodium, protein, and dietary fiber). The very low claim is used for sodium, and free and low claims are used for cholesterol, energy, saturated fat, sodium, and total fat (also known as negative nutrients). In general, critical vulnerabilities of nutrient content claims under FDA and CAC can cause: (1) excessive energy intake based on FDA and CAC per serving and CAC per 100 g or mL; (2) exceeding the DV (NRV) for low nutrients under FDA per serving and CAC per 100 g or mL by consuming small amounts of foods per day; (3) the presence of nutrient free, but not low nutrient, foods based on FDA per serving and CAC per 100 g or mL; (4) the calculation of nutrient content in inappropriate amounts of foods based on FDA per serving, CAC per 100 g or mL, CAC per 100 kcal, and CAC per serving; and (5) determination of energy from total fat and saturated fat for relevant claims in inappropriate portions based on FDA per serving and CAC per 100 g or mL. Breakfast cereals, baby foods, pork products, lamb, veal, and game products, poultry products, and beef products had the highest average of scores for source and high nutrients. Restaurant foods, fast foods, and sausages and luncheon meats had the lowest average of scores for free, very low, and low nutrients. Nutrient source or high nutrient foods for all 24 positive nutrients were found in seven food groups (American Indian/Alaska Native foods; baby foods; beverages; dairy and egg products; legumes and legume products; meals, entrees, and side dishes; vegetables and vegetable products). There were very few source and high foods for potassium and vitamin D. Also, there were very few energy free foods.

BackgroundUndernutrition among children under five remains a critical global health challenge, contributing to higher mortality. Traditional therapeutic foods often overlook the gut microbial derangements, critical for nutrient assimilation, growth, and long-term recovery. Finger millet, with its exceptional nutritional profile, stands as a sustainable alternative to cereal-based foods to address this nutritional gap while supporting gut-health and inflammation. ObjectivesThe aim of this study is to evaluate a Finger Millet-based Complementary Food (FMCF) as a nutrient-dense, safe, and acceptable intervention for moderately acute malnourished (MAM) children. MethodsFinger millet (GPU-28) was germinated, roasted, and gamma-irradiated to improve nutrient bioavailability, reduce antinutrients, and ensure microbial-safety. We enrolled 200 children (100 MAM, 100 Healthy controls) aged 18-59 months from Anganwadi Centres. Participants have been randomized to receive either FMCF or an equicaloric wheat-based control (Balamrutham+) for 8-weeks. Anthropometry, dietary intake, gut-microbiota composition, and inflammation marker estimation and correlation will be performed at different timepoints. ResultsProduct analysis revealed superior protein-energy ratio, fibre, calcium, and micronutrient content in FMCF compared to Balamrutham+. Microbiological and aflatoxin testing confirmed safety and shelf-life stability. Pilot feeding trial showed higher consumption (81-98%) and shorter eating times (53-71%, p<0.001). ConclusionFMCF is promising, cost-effective, and scalable intervention for nutritional-recovery in MAM, with potential to modulate the gut-microbiome and alleviate inflammation. The product aligns with SDG-2 (Zero Hunger) and SDG-3 (Good Health and Well-being), reinforcing its relevance as a public-health intervention. Approval and registrationInstitutional Ethics Committee (IEC)-CR/2/V/2023 and Clinical Trials Registry of India (CTRI)-CTRI/2023/06/053590.

Autophagy is a cellular mechanism that degrades damaged or unwanted material from cells and is particularly important during ageing. Autophagy has been widely studied in pre-clinical models and is known to respond to nutrient availability and in particular amino acids. However, clinical data are limited. This protocol paper describes a randomized cross-over clinical study investigating the effect of a four-week long reduction of dietary protein intake on autophagic flux (autophagic degradative activity) measured via a blood test in healthy adults. Sixty-one healthy participants will be recruited. Study participants will be randomly assigned to one of two diets for four weeks, then cross over to the other diet with a four-week washout period between diets. The diets will be: 1) Average Protein Diet: a control comparator diet with a macronutrient profile of 20% of energy from protein, 35% from fat (<10% saturated) and 45% from carbohydrate, with >30 g of fiber/day; 2) Reduced Protein Diet: 10% protein, 35% fat (<10% saturated), 55% carbohydrate, >30 g of fiber/day. This diet will provide 0.7 g of protein per kg of body weight (the recommended minimum daily protein intake). The primary outcome will be the change in autophagic flux between each diet. This study aims to determine whether reducing dietary protein intake in healthy adults can increase autophagy in humans. If positive, it creates the possibility that nutritional strategies could be used to prevent or delay autophagy- related diseases such as Alzheimer disease or atherosclerosis.

BackgroundHealthy diets during childhood and adolescence are paramount for growth, development, and long-term health. However, there is a lack of low-burden standardized metrics to assess and monitor healthy diets among children and adolescents aged 2-19 years of age on a global scale. ObjectiveThis critical review aimed to identify and evaluate existing metrics for assessing healthy diets in this age group and to determine their suitability for global monitoring based on feasibility and adaptability across different contexts. MethodsA systematic search was conducted across three global databases, encompassing both peer-reviewed and grey literature. ResultsA total of 127 distinct healthy diet metrics were identified many of which were developed or adapted based on national dietary guidelines across various geographical contexts. Only five were deemed suitable for global monitoring due to their feasibility and adaptability: the Individual Dietary Diversity Score, 7 food group Minimum Dietary Diversity, 10 food group Minimum Dietary Diversity, Healthy Plate Variety Score, and Adapted ultra-processed food (UPF) Nova Score. Among these metrics, diversity was the most commonly measured sub-construct of a healthy diet, while only the Adapted Nova Score aimed to capture moderation. These five metrics were further evaluated for construct validity, reliability, and cross-context equivalence, which revealed large evidence gaps, particularly regarding sensitivity to change and test-retest reliability. ConclusionsThese findings highlight the need for additional research to validate healthy diet metrics globally to ensure their accuracy, sensitivity, and reliability to differentiate populations and changes over time. Developing robust, low-burden metrics is essential for informing effective, timely nutrition policies and interventions aimed at improving the diets of children and adolescents worldwide. Statement of significanceThis review is the first to systematically evaluate the feasibility and adaptability of existing healthy diet metrics for global monitoring among children and adolescents, identifying key gaps in their validity and reliability, particularly regarding sensitivity to change and test-retest reliability.

Obesity and the increased postprandial glycaemic response (PPGR) are risk factors for type 2 diabetes. Few studies have explored the association of body weight with PPGRs. The study aimed to investigate the PPGR between healthy adults with normal weight and overweight/obesity to two commercially available breads (white and wholemeal) with different dietary fibre contents. In this acute randomised crossover trial, 20 healthy adults (10 normal weight, 10 overweight/obese) consumed two slices of white (100 g, fibre 3.6 g) or wholemeal bread (88 g, fibre 5.6 g) alongside 150 ml of orange juice and 10 g butter on separate visits in random order after fasting for 8-12 hours. The blood glucose concentration was measured fasted, 30 min, 60 min, 90 min and 120 min postprandially by finger pricks. Information on age, gender, ethnicity, body mass index (BMI), and body fat percentage were collected. Two-way repeated measures ANCOVA was used for controlling for age, gender, ethnicity and body fat percentage, and results showed no significant difference was observed in fasting blood glucose concentrations (F(1, 14)=2.968, P=0.107), incremental areas under the curve (iAUCs) (F (1, 14) = 0.702, P=0.416) and peak values (PVs) (F (1, 14) = 0.507, P=0.488) between participants with normal weight and overweight/obesity, or in fasting blood glucose concentrations (F(1, 14)=0.007, P=0.964), iAUCs (F (1, 14) = 0.008, P=0.929) and PVs (F (1, 14) = 0.036, P=0.851) between white and wholemeal bread consumption. The BMI or body fat percentage was not associated with iAUCs or PVs regardless of bread type adjusted by age, gender and ethnicity. Our results did not find that body weight is associated with PPGR in healthy adults, and the wholemeal bread used in the current study did not deliver the health benefit of attenuating PPGR compared with white bread consumption despite the higher dietary fibre content.

ImportanceMajor concerns regarding vegan dieters are whether they meet protein and essential amino acids (EAA) recommendations, and how reliant they are on ultra-processed foods (UPF). ObjectivesTo investigate whether vegan dieters meet protein and EAA recommendations. As secondary objectives, to determine UPF intake and potential predictors of inadequate protein intake in this population. DesignA survey conducted between September 2021 and January 2023. SettingBrazil. ParticipantsVegan dieters of both sexes, aged 18 years or older, following a vegan diet for at least 6 months. ExposureAdherence to a vegan diet, and unprocessed and minimally processed foods (UMPF) and UPF consumption. Main outcome measuresProtein and EAA intake, and food consumption according to processing level (Nova classification). ResultsOne thousand and fourteen participants completed the survey, and 774 confirmed vegan dieters with adequate food recalls were included in the analysis. Most participants (74%) met daily protein intake according to the Recommended Dietary Allowance (RDA) (median: 1.12 g{middle dot}kg-1{middle dot}day-1, 95%CI 1.05; 1.16). Median EAA intake was also above RDA (with 71-91% meeting recommendations). Median UMPF intake was 66.5% (95%CI 65.0; 67.9) of total energy intake (TEI), whereas UPF consumption was 13.2% TEI (95%CI 12.4; 14.4). Adjusted logistic regression models showed that consuming protein supplements or textured soy protein, higher caloric, and higher UPF intakes were associated with reduced odds of inadequate protein intake, and that higher UMPF intakes were associated with increased odds of inadequate protein intake. Conclusions and RelevanceThe majority of vegan dieters attained protein and EAA intake recommendations, largely based their diet on UMPF, and had a significantly lower proportion of UPF as compared to previous reports on vegans and overall Brazilian population. Importantly, participants consuming less UPF more likely exhibited inadequate protein intake, suggesting the importance of ultra-processed proteins for this population. Key pointsO_ST_ABSQuestionC_ST_ABSDo vegan dieters meet protein needs, and how reliant are they on ultra-processed foods (UPF)? FindingsIn this large survey including 774 vegan dieters, 74% had adequate daily protein intake. Unprocessed and minimally processed foods and UPF consumption accounted for 66.5% and 13.2% of total energy intake. Consuming protein supplements and textured soy protein, and higher caloric and UPF intakes were associated with reduced odds of inadequate protein intake, whereas higher UMPF intakes were associated with increased odds of inadequate protein intake. MeaningMost vegan dieters attain protein recommendations, while being less likely to do so when consuming less UPF.

Plant-based diets (PBD) have been found to be environmentally sustainable as well as beneficial for health. Observational research showed that higher plant-based diet quality improves well-being in adult women, however this is unclear for older adults. This association may be due to anti-inflammatory properties of PBD. Older adults, often suffering from chronic inflammation, may therefore profit from a more PBD. Therefore, we investigated the relation between PBD and well-being in older adults of both genders and tested whether the effects are influenced by circulating high-senstivity C-reactive protein (hsCRP) levels. We used the data of the population-based Lifelines Cohort Study (n=6,635, mean age=65.2 years) and a subsample in which hsCRP was measured (n=2,251, mean age=65.2 years). We applied a plant-based diet index measuring adherence to a healthful (hPDI) and an unhealthful (uPDI) plant-based diet based on food frequency questionnaires. The RAND-36 questionnaire was applied as measure of quality of life, from which we derived physical (PCS) and mental component scores (MCS). Older adults with the highest adherence to a healthful plant-based diet had respectively 14% and 12% greater odds for high physical well-being and mental well-being. Meanwhile, higher adherence to uPDI was associated with respectively 19% and 14% lower odds for high physical and mental well-being. We observed an additive but no mediating effect of hsCRP on the association between plant-based diets and well-being. We conclude that in older men and women, adherence to a healthful plant-based diet and circulating levels of inflammation are independently associated with physical and mental well-being.

BackgroundUltra-processed food (UPF) accounts for a majority of calories consumed in the United States, but the impact on human health remains unclear. ObjectiveTo identify poly-metabolite scores in blood and urine that are predictive of UPF intake. MethodsIDATA participants (n=718) with serially collected blood and urine and up to 6 24-hour dietary recalls (ASA-24s), collected over 12-months, were selected for metabolomics analysis using ultra-high performance liquid chromatography with tandem mass spectrometry. Average daily UPF intake was estimated as percentage energy according to the Nova system. Partial Spearman correlations and Least Absolute Shrinkage and Selection Operator (LASSO) regression were used to estimate UPF-metabolite correlations and build poly-metabolite scores of UPF intake, respectively. Scores were tested post hoc in a previously conducted randomized, controlled, crossover-feeding trial of 20 domiciled participants who consumed ad libitum diets that were 80% and 0% energy from UPF for 2 weeks each. ResultsIDATA participants were 51% female, and 97% completed [&ge;]4 ASA-24s. Mean intake was 50% energy from UPF. UPF intake was correlated with 187 (of 952) serum and 284 (of 1111) 24-hour urine metabolites (p.FDR [&le;] 0.01), including lipid (n=53 serum, n=21 24-hour urine), amino acid (n=33, 59), carbohydrate (n=3, 8), xenobiotic (n=33, 69), cofactor and vitamin (n= 9, 11), peptide (n=7, 6), and nucleotide (n=6, 8) metabolites. Using LASSO regression, 28 serum and 33 24-hour urine metabolites were selected as predictors of UPF intake; biospecimen-specific scores were calculated as a linear combination of selected metabolites. Overlapping metabolites included (S)C(S)S-S-methyl cysteine sulfoxide (rs= -0.19, -0.23), N2-N5-diacetylornithine (rs= - 0.26, -0.27), pentoic acid (rs= -0.28, -0.31), and N6-carboxymethylysine (rs=0.15, 0.21). Within the cross-over feeding trial, the poly-metabolite scores discriminated, within individual, between UPF diet phases (P paired t-test<1x10-5). ConclusionsPoly-metabolite scores, developed in IDATA participants with varying diets, are predictive of UPF intake and could advance epidemiological research on UPF and health.

Wildmeat is crucial for the food security of Indigenous Peoples and Local Communities, yet information about its nutritional profile remains scarce. This study systematically reviewed the impact of anatomical part and taxonomic class (mammals, birds, reptiles) on the nutritional composition of wildmeat. Using the PRISMA protocol, we selected articles from Web of Science, Scopus, and Medline/PubMed databases, with criteria including original articles on wild animal meat composition consumed by humans, excluding studies presenting secondary data or lacking detailed methodologies. We employed a quality questionnaire and concordance analysis (Fleiss Kappa = 1.00) for robustness. Artificial intelligence techniques (eg., K-Nearest Neighbors) estimated missing nutritional values in all 21 articles included in our study, covering 26 species and 10 nutrients. Results show statistically significant nutritional variations between anatomical parts and animal classes. Reptile viscera have over twice the fat content and triple the iron compared to muscles. Mammal viscera contain five times more omega-6 and selenium, four times more iron and manganese, and almost double the zinc compared to muscles. Among classes, bird muscles have over 90% higher fat content than mammal muscles and 20% higher than reptile muscles. Mammals have over 100% higher zinc levels than birds, and reptiles have over 400% more selenium than birds. No significant difference in iron content between mammals and birds was noted, likely due to bird slaughter methods. This study highlights the importance of wildmeat for food security. Importantly, we demonstrate an enormous variation in nutritional composition, underscoring how different anatomical parts and taxonomic classes can contribute to tackling different nutritional deficiencies. Additionally, it introduces a novel methodology for handling missing nutritional composition data, providing a comprehensive approach to understanding the nutritional value of wildmeat. Our findings can inform food security policies and wildlife management, balancing conservation and subsistence.

IntroductionFiber intake is the most common nutritional inadequacy in the Western diet, with most adults consuming less than half of the recommended intake with only 5% of adults meeting the RDI. A novel, short-chain beta-glucan derived from oats (scOat Fiber), with improved solubility, low viscosity and enhanced palatability, compared to conventional oat fibers, was investigated for its benefits as a source of fiber supplementation. MethodsA 14-day pilot study evaluated the gastrointestinal tolerance and functional benefits of scOat Fiber in 63 healthy adults randomized to receive 5, 10 or 20 g daily doses. The primary outcome, gastrointestinal tolerability, was assessed using the Gastrointestinal Symptom Rating Scale (GSRS). Secondary outcome included glycemic response during rice challenges, measured via continuous glucose monitoring (CGM). CGM was also used to explore overall glucose dynamics. Additional exploratory outcomes (mood, energy, appetite and sleep) were assessed via validated questionnaires. ResultsscOat Fiber was exceptionally well tolerated across all doses, with no increase in GSRS scores, which remained in the low to mild range. Significant reductions in total GSRS scores were observed, with benefits evident after just one week at 5 g/day and maintained over time at both 5 and 10 g/day groups. Evaluation of GSRS sub-categories revealed that the 5 g/day and 10 g/day dose groups experienced significant reductions in abdominal pain symptoms. Both dose groups also demonstrated a significant decrease in constipation at the end of the study. Postprandial glucose responses were attenuated following product use, with a significant reduction in peak glucose during rice challenges after 2 weeks in the 20 g/day group. Both 10 and 20 g/day doses were associated with significant improvement in glycemic metrics during the study, including reductions in glucose mean, all glycemic excursions, and an increase in time-in-range. Exploratory analysis suggested that scOat Fiber may improve mental health and concentration in participants with elevated baseline symptoms. ConclusionsDespite the lack of a placebo control and short duration, the dose-dependent nature of the results supports the potential of scOat Fiber as a well-tolerated and functional source of fiber with benefits including glycemic control, digestive health and mental health (NCT06739941)

AimThe dietary pattern in the downstream Yangtze River region of Eastern China has garnered widespread attention for its potential health benefits but lacks empirical evidence. This study aimed to identify and characterize this dietary pattern, develop a dietary pattern index, and evaluate its associations with adiposity, cardiometabolic diseases (CMDs), mortality, and gut microbiota. MethodsThis study used data from 8665 participants aged 18-80 years in the WELL-China cohort (2016-2019, Hangzhou, Eastern China) as the discovery cohort. K-means clustering identified an "Eastern Diet" (EastDiet) pattern and an adherence index based on the 12 food groups and flavor preferences were developed. Adiposity was measured using dual-energy X-ray absorptiometry. Incident CMDs and mortality were tracked through June 2024. Validation involved two external cohorts. ResultsThe EastDiet pattern was identified characterizing by high plant-based and aquatic food consumption, low refined grains and red meat intake, and a high preference for light-flavored. EastDiet index was favorably associated with lower adiposity. Comparing the highest to the lowest adherence tertiles, hazard ratios (HRs) for CMDs, type 2 diabetes, and cardiovascular diseases were 0.75 (95% CI: 0.62-0.90), 0.76 (0.60-0.96), and 0.71 (0.53-0.94), respectively. All-cause mortality was similarly reduced. Gut microbiota profiles associated with higher EastDiet adherence were linked to improved adiposity and reduced CMDs risk. Validation cohorts replicated these findings. ConclusionThis study identified and characterized the EastDiet pattern from Eastern China and determined its health benefits. Our findings highlighted the potential of the EastDiet as a healthful dietary pattern for Chinese population.

Ready-to-use therapeutic and supplementary foods (RUTF/RUSF) are a primary treatment for childhood malnutrition, but measuring intervention compliance is labor intensive. We applied FoodSeq, a fecal genomic dietary assessment biomarker, in malnourished infants (3-15 months) from Matiari, Pakistan. FoodSeq identified a significant spike in chickpea, a primary RUSF ingredient, during RUSF administration, highlighting the potential of genomics as an empirical tool for compliance monitoring and dietary analysis in community-based malnutrition programs.

BackgroundAnimal and plant protein sources have contrasting relationships with nutrient adequacy and long-term health, and their adequate ratio is highly debated. ObjectiveWe aimed to explore how the percentage of plant protein in the diet (%PP) relates to nutrient adequacy and long-term health but also to environmental pressures, to determine the adequate and potentially optimal %PP values. MethodsObserved diets were extracted from the dietary intakes of French adults (INCA3, n=1 125). Using reference values for nutrients and disease burden risks for foods, we modeled diets with graded %PP values that simultaneously ensure nutrient adequacy, minimize long-term health risks and preserve at best dietary habits. This multi-criteria diet optimization was conducted in a hierarchical manner, giving priority to long-term health over diet proximity, under the constraints of ensuring nutrient adequacy and food cultural acceptability. We explored the tensions between objectives and identified the most critical nutrients and influential constraints by sensitivity analysis. Finally, environmental pressures related to the modeled diets were estimated using the AGRIBALYSE database. ResultsWe find that nutrient-adequate diets must fall within the [~]15%-80% %PP range, a slightly wider range being nevertheless identifiable by waiving the food acceptability constraints. Fully healthy diets, also achieving the minimum-risk exposure levels for both unhealthy and healthy foods, must fall within the 25%-70% %PP range. All of these healthy diets were very distant from current typical diet. Those with higher %PP had lower environmental impacts, notably on climate change and land use, while being as far from current diet. ConclusionsThere is no single optimal %PP value when considering only nutrition and health, but high %PP diets are more sustainable. For %PP>80%, nutrient fortification/supplementation and/or new foods are required.

Increasing physical activity and drinking green tea are alternate non-surgical or pharmaceutical complementary treatments that many individuals opt to employ to manage overweight/obesity, and a number of recent clinical randomized controlled studies (RCTs) have shown interest in combining the two. The effectiveness of these three therapies in treating overweight/obesity has not been summarized, compared, or interpreted. A reticulated meta-analysis is superior than a meta-analysis for comparing and rating the effectiveness of different therapies for a particular condition. Through a reticulated meta-analysis, we wanted to examine the efficacy of three alternative supplementary treatments for overweight/obesity, namely green tea, physical activity, and green tea coupled with physical activity, and to provide recommendations. A total of 44 RCTs assessing the effects of nine alternative supplementary treatments on body weight, BMI, body fat percentage, waist circumference, total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein were included. Green tea combined with aerobic exercise may be optimal for reducing body weight, BMI, TC, and LDL; green tea combined with resistance training may be optimal for reducing body fat percentage and waist circumference; aerobic exercise may be optimal for reducing TG; and resistance combined with aerobic exercise may be optimal for increasing HDL. Nevertheless, based on the NMA results for the aforementioned eight indicators, we believe that the combination of green tea and increased physical activity is preferable to green tea or increased physical activity alone for non-elderly adult populations seeking non-surgical or pharmacological treatment or management of overweight/obesity.

AimsTo explore the associations between breakfast energy intake and quality and time trajectories of cardiometabolic traits in high cardiovascular risk. Methods383 participants aged 55-75 from the PREDIMED-Plus cohort were included. Longitudinal averages of breakfast energy intake and quality were calculated. Three categories were defined for energy intake: 20-30% (reference), <20% (low), and >30% (high). Quality was estimated using the Meal Balance Index; categories were above (reference) or below the median score (low). Smoothed cubic spline mixed effects regressions described trajectories of cardiometabolic indicators (anthropometry, blood pressure, lipids, glucose, glycated hemoglobin, and estimated glomerular filtration rate) at breakfast groups. Inter-group differences in predicted values were estimated by linear regressions. ResultsAt 36 months, compared to the reference, low- or high-energy breakfasts were associated with differences in: body mass index (low: 0.62 kg/m2 [95% confidence interval: 0.28; 0.96]; high: 1.17 kg/m2 [0.79; 1.56]), waist circumference (low: 2.24 cm [1.16; 3.32]; high: 4.55 cm [3.32; 5.78]), triglycerides (low: 18.3 mg/dL [15.3; 21.4]; high: 34.5 cm [31.0; 38.1]), and HDL cholesterol (low: -2.13 mg/dL [-3.40; -0.86]; high: -4.56 mg/dL [-6.02; -3.10]). At 36 months, low-quality breakfast was associated with higher waist circumference (1.49 cm [0.67; 2.31]), and triglycerides (3.46 mg/dL [1.13; 5.80]) and less HDL cholesterol (-1.65 mg/dL [-2.61; -0.69]) and glomerular filtration rate (-1.21 mL/min/1.73m2 [-2.01; -0.41]). ConclusionsLow- or high-energy and low-quality breakfasts were associated with higher adiposity and circulating triglycerides, and lower HDL cholesterol in high-risk older adults. Low-quality breakfasts were also linked to poorer kidney function. LAY SUMMARYOur work studied the relationship of the amount of energy consumed at breakfast or the dietary quality of breakfast with the evolution over time of 10 cardiometabolic traits (body mass index, waist circumference, triglycerides, HDL cholesterol, LDL cholesterol, systolic blood pressure, diastolic blood pressure, fasting plasma glucose, glycated hemoglobin, and estimated glomerular filtration rate) in older adults with excess weight and metabolic syndrome. Key findingsO_LICompared to a breakfast with an adequate energy intake (containing 20-30% of daily energy), participants consuming either an insufficient or excessive energy in breakfast had higher values of body mass index, waist circumference, and triglycerides, and lower levels of HDL cholesterol. C_LIO_LIParticipants with poor breakfast quality, compared to those following a breakfast of higher quality, had higher waist circumference and triglycerides, and lower HDL cholesterol levels and estimated glomerular filtration rate. C_LI Graphical abstractBMI: body mass index; DBP: diastolic blood pressure; eGFR: estimated glomerular filtration rate; Hb1Ac: glycated hemoglobin; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; SBP: systolic blood pressure; WC: waist circumference.

Inadequate dietary fiber intake and excess added sugar intake are dietary factors attributed to the rise in obesity, type 2 diabetes, and associated cardiometabolic diseases. Until recently, consumers had limited options for finding similar tasting, yet highly approachable, solutions to meet intake recommendations for added sugars and dietary fiber. Modern sodas with lower sugar and supplemented with prebiotic fiber may serve as functionally beneficial alternatives to traditional sugar-sweetened beverages. The primary objective was to compare the acute effects of a prebiotic soda, (PREB: 3g sugar, 6g dietary fiber) versus traditional soda (SODA: 39g sugar, no dietary fiber), with or without a meal, on postprandial glucose in generally healthy adults. Thirty middle- aged men and women [19 F, 11 M; (mean {+/-} standard deviation) 46.5 {+/-} 10.4 y; 29.5 {+/-} 2.6 kg/m2] consumed their assigned study product during the traditional lunch time in a free-living setting on 4-consecutive test days in a crossover design, counterbalanced by test sequence. Continuous glucose monitoring for blood glucose dynamics, visual analog scales for perceived hunger and alertness, and dietary logs for second meal behavior were all measured throughout the intervention. Glucose incremental area under the curve (iAUC) [mean difference (95% confidence interval); - 837 mg/min/dL (-1250, 188), p=0.032; -1690 mg/min/dL (-2790, -909), p<0.001; with and without meal, respectively] and maximum glucose concentration (Cmax) [-9 mg/dL (-27, 0), p=0.018; -36 mg/dL (-50, -22), p<0.001; with and without meal, respectively] were lower with PREB compared to SODA. PREB did not affect second meal timing nor energy intake compared to SODA. Perceived hunger or alertness were not altered by beverage type. In conclusion, a prebiotic soda is a favorable alternative to traditional soda formulations for managing postprandial blood glucose levels and maximal glucose excursion in generally healthy adults with overweight or obesity.

BackgroundWhile dietary guidelines recommend limiting foods high in added sugars, saturated fat, refined grains, and sodium, there is no criteria for identifying foods high in these components. ObjectiveTo evaluate a novel nutrient-based method to classify moderation foods and compare with two alternative methods. DesignFace validity was assessed by examining the proportion of recommended and non-recommended foods classified as moderation using the 2017-2018 Food and Nutrient Database for Dietary Studies (FNDDS, n=6909). Convergent validity was evaluated by comparing nutrient density in moderation vs. non-moderation foods in FNDDS, and investigating correlations of moderation food intake with diet quality from 2-day dietary recalls. Results were compared with the hyperpalatable food and NOVA ultra-processed food classifications. ParticipantsNational Health and Nutrition Examination Survey (2017-2018) non-pregnant participants aged 2+ years (n=6136) were included. Main outcome measuresThe Nutrient Rich Foods 9.3 index (NRF) measured nutrient density; Healthy Eating Index-2020 scores (HEI-2020) measured diet quality. Statistical AnalysesT-tests and ANOVA evaluated differences in NRF by moderation, hyperpalatable, and ultra-processed classifications. Fishers z-transformation compared associations of HEI-2020 with intake (%kcal) from moderation, hyperpalatable, and ultra-processed foods. ResultsMore non-recommended (e.g., 97% of snacks) than recommended (e.g., 18% of vegetables) food groups were classified as moderation. NRF was significantly lower in moderation foods than non-moderation foods (mean diff: -74.8, 95%CI:-70.6 --78.9). The difference in NRF between moderation vs. non-moderation foods was larger than that between ultra-processed vs. non-ultra-processed (mean diff=-29.7, 95%CI:-25.1--34.2) and hyperpalatable vs. non-hyperpalatable foods (mean diff=-53.2, 95%CI:-49.3--57.1)(p-diff<0.001). Moderation food intake (% kcal) was correlated with HEI-2020 (r=-0.72), and associations were stronger than those with hyperpalatable (r=-0.40) or ultra-processed food intake (r=-0.49). ConclusionsThe moderation food classification method demonstrated strong face and convergent validity, and may improve diet quality assessment and public health interventions.

BackgroundWhile there are numerous dietary quality indices for individuals, a lon-gitudinal population-level index is missing from the literature. This article presents a novel population-level dietary index, the Population Eating Quality Index (PEQI) that measures a countrys annual dietary quality. MethodsUsing data from the Food and Agriculture Organization and the Global Dietary Database, PEQI comprises of ten waste-adjusted food items for which weighted scores are assigned according to their effect on human health. Associations between the PEQI and health outcomes for a panel of developed countries were studied to further validate the instrument. ResultsThe index shows good predictive ability regarding life expectancy at birth and premature mortality for an average developed country. ConclusionsPEQI has multiple potential applications in the ecological study of health and nutrition as an exposure or even as an outcome.

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