Current Developments in Nutrition

BackgroundUltra-processed food (UPF) intake has been associated with multiple negative health outcomes. Research investigating UPF intake and cognitive health outcomes has begun. The aim of this review is to summarise the existing evidence of associations between exposure to UPFs, as defined by the NOVA food classification system, and cognitive health outcomes. MethodsWe conducted a systematic search across MEDLINE, PsycINFO, Embase, and APA Psych Articles through OVID, and PubMed for relevant studies up-until October 2024. The Newcastle-Ottawa Scale was used to assess the quality of included studies. A narrative approach was used to summarise and integrate results across studies. ResultsThree hundred and eighty-three articles were screened and five met the inclusion criteria. All studies were published between 2022 and 2024. The association between UPF intake and four different cognitive outcomes (dementia risk, cognitive impairment risk, cognitive performance and cognitive change trajectories) were explored across the studies. Three out of the five included studies found a significant negative main effect of consuming UPF on the cognitive outcome of interest. All studies identified adverse consequences of consumption in either a sub-group of the population or a sub-group of UPF type. ConclusionsDeleterious effects of UPF consumption on multiple cognitive health outcomes were identified across all studies. However, the results suggest the relationship may be specific to sub-groups of the population or sub-groups of UPF type. Conclusions should be drawn with caution due to the limited number of studies available examining UPF intake according to NOVA and its association with cognitive outcomes, as well as the variability in cognitive measures assessed and other methodological differences across studies.

BackgroundBased on systematic literature reviews, the Institute of Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) landmark risk factor paper attributes about 8 million noncommunicable diseases deaths/year to a composite of 15 dietary risk factors. Another 27 million noncommunicable deaths out of 56.5 million total deaths worldwide are attributed to high levels of metabolic risk factors. MethodsWe format and population weight IHME GBD worldwide data resulting in7886 rows of data from cohorts of about 1 million people each representing about 7.8 billion people in 2020. Noncommunicable disease deaths/100k/year (NCD) are correlated with the four metabolic risk factors, 15 dietary risk factors, six dietary covariates, and the composite "dietary risks" variable. We compare NCD groups of cohorts (about 1000 cohorts, representing about 1 billion people) with the lowest and highest NCD and the same for body mass index (BMI). We compare literature reviews attributions of NCD causation with findings from the GBD data in assessing the impact of dietary and metabolic risk factors on NCD. FindingsLiterature review derived dietary risks composite risk factor correlated with NCD account for 1.9% of worldwide NCD. Using GBD data to compare groups with the lowest versus the highest rates of NCD: the lowest NCD 990 cohorts average 923.8 NCD and consume 320.4 kcal/day from six animal foods. The highest NCD 1054 cohorts average 2064 NCD and on average and consume 117.2 kcal/day of six animal foods. Vitamin A deficiency in children is 75% higher in children in the high NCD cohorts. Evaluating high BMI cohorts, 973 cohorts with BMI[≥]25 account for 10.5% of the worldwide NCD. These high BMI cohorts also have higher than average fasting plasma glucose (FPG: FPG mean=4.71 versus FPG mean=4.25) and low density lipoprotein cholesterol (LDLC: LDLC mean=2.79 versus LDLC mean=2.30). InterpretationThe evidence basis of the dietary risks composite risk factor, accounting for only 1.9% of NCD worldwide should be questioned. Systematic literature reviews based versus GBD data based estimates of metabolic and dietary risk factor impacts on NCD vary markedly. Systematic literature reviews of studies involving individual subjects are better at ascertaining the impact on NCD of obesity, hyperglycemia, high LDLC, and hypertension. High levels of metabolic risk factors cannot be analysed with GBD data giving only the mean values for NCD and risk factors. Since high mean BMI cohorts (mean BMI[≥]25) account for only 10.5% of worldwide NCD, literature reviews appear to overestimate the worldwide impacts of high metabolic risk factors on NCD (i.e., accounting for nearly 50% of worldwide deaths: 27 million/56.5 million worldwide deaths). High NCD, including cardiovascular disease deaths, associated with low animal food intake suggests that fat soluble vitamin deficiencies (vitamins A, D, E and K2, all largely from animal foods that also supply fatty acids for gut absorption) may partly account for high rates of NCD worldwide, especially in developing countries. Literature review based and GBD raw data based approaches should be complementary in assessing dietary and other attributable risks for NCD and other individual health outcomes. FundingNone Research in contextO_ST_ABSEvidence before this studyC_ST_ABSThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD 2019) provides the most recent assessment of deaths, attributable to metabolic, environmental and occupational, and behavioural risk factors. Controversies abound in the field of nutritional epidemiology. The lipid hypothesis that dietary saturated fat and cholesterol promote cardiovascular diseases has been disputed with no scientific consensus on the outcome. Added value of this studyThis study assesses the evidence basis of deaths attributed to dietary risks and metabolic risk factors derived from systematic reviews of the medical literature in GBD 2019. This study uses GBD raw data formatted and population weighted to assess the worldwide deaths from noncommunicable diseases attributable to dietary and metabolic risk factors. With this GBD data analysis methodology, the levels of 20 dietary risk factors are assessed in cohorts with the highest and lowest rates of noncommunicable disease deaths. Worldwide GBD data show that many deaths are associated with low levels of animal foods and saturated fatty acids (kcal/day percapita) and associated with low levels of metabolic risk factors. These findings are at variance with the lipid hypothesis operating uniformly worldwide. In the UK, USA, Mexico, and Japan, with subnational GBD data, many deaths are attributable to high levels of animal foods, saturated fatty acids, and metabolic risk factors, supporting the lipid hypothesis. Implications of all the available evidenceThe findings of systematic literature reviews in assessing the health impacts of high metabolic risk factors are superior than using GBD data analysis because GBD data only assess mean cohort levels of metabolic risk factors. However, GBD data can show effects of dietary risk factors acting directly and mediating metabolic risks leading to noncommunicable disease deaths. This GBD data based methodology can enhance understanding of the complex interrelationships of diet, metabolic risk factors and noncommunicable disease deaths. The findings are consistent with a "fat soluble vitamin hypothesis" that deficiencies of vitamins A, D, E, and K2 and fatty acids from inadequate animal food consumption lead to increased cardiovascular disease and noncommunicable disease deaths.

BackgroundUltra-processed foods (UPFs) are becoming dominant in the global food and supply. Prospective cohort studies have found an association between UPF dietary pattern and increased risk of several non-communicable diseases and all-cause mortality. In this study, we (1) estimated the risk of all-cause mortality associated for each 10% increase in the share of UPF consumption in the total energy intake; (2) estimated the population attributable fractions (PAF) and the total number of premature deaths attributable to the consumption of UPF in adults (30-69 years) from 8 selected countries. MethodsFirst, we performed a dose-response meta-analysis of observational cohort studies assessing the association between UPFs dietary pattern and all-cause mortality. As we found evidence of linearity, we estimated the pooled RR (and its 95% CI) for all-cause mortality per each 10% increment in the % UPF. Then, we estimated the population attributable fraction (PAF) of premature all-cause mortality attributable to UPF in 8 selected countries with relatively low (Colombia and Brazil), intermediate (Chile and Mexico), and high (Australia, Canada, UK, and US) UPF consumption. ResultsWe found a linear dose-response association between UPF intake and all-cause mortality, with a 2.7% increased risk of all-cause mortality per 10% increase in the % UPF. Considering the magnitude of the association between UPFs intake and all-cause mortality, and the dietary share of UPF in each of the 8 selected countries, we estimated that 4% (Colombia) to 14% (United Kingdom and United States) of premature deaths were attributable to UPF intake. ConclusionsOur findings support that UPF intake contributes significantly to the overall burden of disease in many countries and its reduction should be included in national dietary guideline recommendations and addressed in public policies.

BackgroundThis research evaluates the association between increased animal product consumption and population-level dementia incidence. Design/methodology/approachPublicly available data from 54 countries across a 10-year span was used to conduct a multivariate panel data regression to determine significant relationships between dietary changes and rates of dementia. Fixed effects analysis controls for the effect of omitted time-invariant differences between countries. FindingsExcess calorie consumption is associated with a significant increase in dementia whereas fish consumption appears protective. On a population-level basis, increases in milk and egg consumption were associated with an increase in dementia rates. Meat, as a broadly defined category, was found to have no significant effect. Practical ImplicationsThis study supports the well-documented benefits of calorie control and fish consumption to protect against dementia, but indicates that egg and milk consumption is associated with increased population-level dementia incidence. Originality/valueThis research expands current literature by using an updated data set, evaluating considerably more countries, and utilizing a regression model that controls for the effects of time-invariant sources of heterogeneity in the data.

BackgroundEvidence suggests that adherence to the Mediterranean diet (MedDiet) affects human metabolism and may contribute to better cognitive performance. However, the underlying mechanisms are not clear. ObjectiveWe generated a metabolite profile for adherence to MedDiet and evaluated its cross-sectional association with aspects of cognitive performance. MethodsA total of 1,250 healthy Greek middle-aged adults from the Epirus Health Study cohort were included in the analysis. Adherence to the MedDiet was assessed using the 14-point Mediterranean Diet Adherence Screener (MEDAS); cognition was measured using the Trail Making Test, the Verbal Fluency test and the Logical Memory test. A targeted metabolite profiling (n = 250 metabolites) approach was applied, using a high-throughput nuclear magnetic resonance platform. We used elastic net regularized regressions, with a 10-fold cross-validation procedure, to identify a metabolite profile for MEDAS. We evaluated the associations of the identified metabolite profile and MEDAS with cognitive tests, using multivariable linear regression models. ResultsWe identified a metabolite profile composed of 42 metabolites, mainly lipoprotein subclasses and fatty acids, significantly correlated with MedDiet adherence (Pearson r = 0.35, P-value = 5.5 x 10-37). After adjusting for known risk factors and accounting for multiple testing, the metabolite profile and MEDAS were not associated with the cognitive tests. ConclusionsA plasma metabolite profile related to better adherence to the MedDiet was not associated with the tested aspects of cognitive performance, in a middle-aged Mediterranean population.

Background & aims Food- and nutrient-based inflammatory scores may capture different dietary features. We compared the Food Inflammation Score for Individuals (FISI) and Dietary Inflammatory Index (DII) in relation to cognitive performance and incremental discrimination. Methods This cross-sectional analysis included 2,455 adults aged [&ge;]60 years in NHANES 2011-2014 with four cognitive tests and two reliable 24-h recalls. Daily FISI summed [(food FII per 100 g) x grams/100] across foods; two days were averaged. DII used 33 parameters averaged across the same days. Survey-weighted linear and logistic models incorporated strata, primary sampling units, and WTDR2D/2. Discrimination used survey-weighted AUROCs and 500 stratified primary-sampling-unit bootstrap replicates. Results After full adjustment, a 1-SD higher DII was associated with a 0.091 lower global cognitive Z-score ({beta} = -0.091; 95% CI, -0.143 to -0.040; P = 0.005), whereas FISI was not ({beta} = -0.019; 95% CI, -0.064 to 0.026; P = 0.341). The DII quartile trend was significant (P = 0.007), but nominal domain associations did not survive false-discovery-rate correction. Neither score was associated with low cognitive performance. The base AUROC was 0.8242; adding FISI changed it by <0.0001 (95% bootstrap CI, -0.0002 to 0.0007), and adding DII changed it by 0.0005 (-0.0003 to 0.0021). Conclusions Higher DII, but not FISI, was associated with lower global cognitive performance. Neither score materially improved discrimination for low cognitive performance. The two scores should not be assumed equivalent or interchangeable.

Background and objectivesThe consumption of unprocessed or minimally processed whole plant foods and of ultra-processed foods, as defined by the Nova food classification system, are associated in opposite ways with diet quality and risk of diseases. However, it can be difficult to evaluate and monitor the consumption of these foods in some contexts due to lack of resources and time constraints for data collection. This study aimed to describe two simple and easily derived diet quality scores and evaluate their performance in reflecting the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods. MethodsA total of 812 adults (18 years old or older) answered the Nova24h screener, a 2-minute self-administered questionnaire that measures the consumption of a set of foods on the day before the interview. Food items included in this tool belong to two main groups of Nova classification: unprocessed or minimally processed whole plant foods (WPF, 33 food items) and ultra-processed foods (UPF, 23 food items). Two scores are obtained from this tool by summing the number of items checked - the Nova-WPF and the Nova-UPF. We compared the Nova-WPF and the Nova-UPF scores with the dietary intake (% of total energy) of all unprocessed or minimally processed whole plant foods and all ultra-processed foods, respectively, obtained through a full self-administered web-based 24-hour recall, applied on the same day. We evaluated the relationship between the approximate quintiles or intervals of each score and the corresponding % of energy intake by linear regression, and the agreement between the intervals of each score with the intervals of the corresponding % of energy intake, using the Prevalence-Adjusted and Bias-Adjusted Kappa (PABAK). ResultsApproximate quintiles of each score presented a direct and linear relationship with the corresponding % of energy intake (p-value for linear trend <0.001). We found a substantial agreement between the intervals of each score and of the corresponding % of energy intake (PABAK 0.72, 95% CI 0.64-0.81 for the Nova-WPF score and PABAK 0.79, 95% CI 0.69-0.88, for the Nova-UPF score). ConclusionsThese two scores performed well against the dietary share of unprocessed or minimally processed whole plant foods and ultra-processed foods in Brazil and can thus be used to evaluate and monitor diet quality.

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.

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.

Frailty is an age-related syndrome characterized by biological dysfunction and reduced physiological reserve in response to stressors. Its prevalence is increasing with population aging, resulting in a substantial health burden due to adverse outcomes on health, such as cardiovascular disease and mortality. Ultra-processed foods (UPFs), defined as industrial formulations made primarily from processed ingredients, have received increasing attention due to their potential role in the development and progression of frailty. This systematic review and meta-analysis examined the association between ultra-processed food intake and the risk of frailty in older adults. This study systematically searched for all relevant studies published up to January 2026. Ten observational studies involving 105327 participants, comprising 6 prospective and 4 cross-sectional studies, were included in the systematic review, of which 6 were eligible for meta-analysis. Random-effects models were employed to estimate pooled effect sizes and 95% confidence intervals (95% CIs). Meta-analysis showed that higher consumption of UPFs was significantly associated with an increased risk of frailty (pooled OR = 1.43, 95% CI = [1.02-2.005], p = 0.041). Narrative synthesis further supported a positive association between UPF intake and frailty or related outcomes. Our findings suggest that a higher consumption of ultra-processed foods may contribute to frailty risk, potentially through inflammatory pathways. However, given the high heterogeneity, results should be interpreted with caution. Overall, our findings suggest that reducing UPF consumption may be a promising target for public health strategies to prevent frailty in ageing populations.

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@2966f5org.highwire.dtl.DTLVardef@269232org.highwire.dtl.DTLVardef@483edborg.highwire.dtl.DTLVardef@116a957_HPS_FORMAT_FIGEXP M_FIG C_FIG

BackgroundUnhealthy diets are a major public health concern. However, a lack of available and up-to-date quantitative dietary intake data, accurate low-burden data collection methods, and valid and interpretable metrics across contexts has hindered frequent monitoring of diets globally. MethodsIn this multi-country validation study, we compared the relationships between low-burden metrics of a healthy diet, identified by the FAO, UNICEF, and WHO Healthy Diets Monitoring Initiative, and a suite of reference metrics of dietary intake. To this end, we used harmonized open access quantitative 24-hour recall and food record data collected from 77,118 adolescent and adult females across 27 countries. FindingsOn any given day, non-consumption of sweet foods or sweet beverages was associated with greater population-level adherence to <10% energy from free sugars in available upper-middle income countries [odds ratio (95% CI): 5.35 (5.05, 5.66)]. Food group diversity score (FGDS) was positively associated with mean adequacy ratio of micronutrients [{beta} of 1-SD change (95% CI): [~]11 percentage points (9, 12)], while NCD-Protect score best predicted consumption of [&ge;]400 g/day of fruits and vegetables [range odds ratio of 1-SD changes (95% CI): 2.56 to 3.01 (2.40 to 3.13) in lower-middle and high income countries, respectively]. FGDS and Global Diet Quality Score Positive were associated with achieving [&ge;]25 g/day of fibre and [&ge;]3,510 mg/day of potassium across contexts. No indicator accurately predicted adherence to WHO guidelines for sodium intake or energy intake ranges for carbohydrates, lipids, and proteins. InterpretationAccurate low-burden dietary assessment methods can provide valid metrics that enable timely monitoring of key characteristics of healthy diets globally. Specifically, avoiding sweet foods or sweet beverages serves as an indicator for population-level adherence to the WHO guideline for free sugar intake, while metrics reflecting nutritious food group diversity are strongly predictive of better micronutrient adequacy and adherence to WHO guidelines for fruits and vegetables, fibre, and potassium intakes across settings. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSUnhealthy diets are a common cause of all forms of malnutrition and are the major risk factor for non-communicable diseases. However, a lack of up-to-date nationally representative quantitative dietary intake data, and a lack of consensus on fit-for-purpose lower-burden data collection methods and metrics, based on comparative epidemiological evidence, has hindered monitoring of healthy diets globally. Added value of this studyUsing open access quantitative 24-hour recall and food record data collected in 27 countries, our validation analyses compared the relationships between measures of a healthy diet, deemed most promising for global surveillance by the FAO, UNICEF, and WHO Healthy Diets Monitoring Initiative, and a suite of reference metrics of dietary intake, both within and across countries. Implications of all the available evidenceNationally representative quantitative dietary intake assessments remain the reference for nutrition. Nevertheless, complementary low-burden methods can yield metrics that are suitable for high-frequency monitoring of healthy diets. Specifically, on any given day, avoiding sweet foods or sweet beverages is an accurate population-level indicator for achieving the WHO guideline of <10% kcal/day from free sugars, while metrics capturing nutritious food group diversity are associated with better micronutrient adequacy, as well as, higher probabilities of reaching WHO guidelines of [&ge;]400 and [&ge;]25 g/day for fruits and vegetables and fibre, respectively, and [&ge;]3,510 mg/day of potassium across contexts.

There are scarce resources available for analyzing 24-hour dietary records. Here we introduce DietR, a set of functions written in R for the analysis of 24-hour dietary recall or records data, collected with either the Automated Self-Administered 24-hour (ASA24) dietary assessment tool or two-day data from the National Health and Nutrition Examination Survey (NHANES). The R functions are intended for food and nutrition researchers who are not computational experts. DietR provides users with functions to (1) clean dietary data; (2) analyze 24-hour dietary intakes in relation to other study-specific metadata variables; (3) visualize percentages of calorie intake from macronutrients; (4) perform principal component analysis (PCA) or k-means to group participants by similar dietary patterns; (5) generate foodtrees based on the hierarchical information of food items consumed; (6) perform principal coordinate analysis (PCoA) taking food classification information into account; (7) and calculate diversity metrics for overall diet and specific food groups. DietR includes a set of tutorials available on a website (https://computational-nutrition-lab.github.io/DietR/), which are designed to be self-paced study materials. DietR enables users to visualize dietary data and conduct data-driven dietary pattern analyses using R to answer research questions regarding diet. As a demonstration of DietR, we applied DietR to a set of created 24-hour dietary records data to demonstrate the basic functions of the package. We also applied DietR to a subset of 24-hour recall data from NHANES to demonstrate analyses using dietary diversity metrics. We present the results of this example NHANES analysis comparing legume diversity with waist circumference.

BackgroundDebate about whether high intake of dietary saturated fatty acids (SFA) causes coronary heart disease (the lipid hypothesis) is ongoing. MethodsUsing worldwide Global Burden of Disease (GBD) data on cardiovascular disease deaths/100k/year, ages 15-69 years old in male and female cohorts (CVD) and dietary and other CVD risk factors, we formatted and population weighted data from 195 countries. The formatted rows of data (n=7846 cohorts) each represented about 1 million people, totaling about 7.8 billion people in 2020. We correlated CVD with dietary and other risk factors worldwide and in appropriate subsets. Outcome measures included CVD versus dietary and other risk factor correlations worldwide and in subsets. FindingsAfter empirical data exploration, we defined a "fat-soluble vitamin variable" Kcal/day (FSVV) as, "FSVV=processed meat + red meat + fish + milk + poultry + eggs + (SFA + polyunsaturated fatty acids (PUFA) + trans fatty acids (TFA)) * 0.46 (all in Kcal/day)." Low density lipoprotein cholesterol mmol/L correlated strongly positively with FSVV worldwide (r=0.780, 95% CI 0.771 to 0.788, p<0001, n=7846 cohorts), so we considered FSVV our marker variable to test both the lipid hypothesis and our fat-soluble vitamin hypothesis. LDL-C correlated negatively with CVD worldwide (r= -0.279, 95% CI -0.299 to -0.258, p<0.0001 as did FSVV versus CVD (r= -0.329, 95% CI -0.349 to -0.309, p<0.0001). However, FSVV correlated positively with CVD in the highest FSVV cohorts (mean male/female FSVV [&ge;]567.27 Kcal/day: r=0.523, 95% CI 0.476 to 0.567, p<0001, n=974 cohorts). InterpretationSince FSVV correlated positively with CVD only in high FSVV cohorts, the data supported the lipid hypothesis only in GBD cohorts with high FSVV intake. Since both FSVV and LDL-C correlated negatively with CVD worldwide, only the fat-soluble vitamin hypothesis was supported worldwide. This GBD cohort data analysis methodology could be used to help develop food policy and education strategies for improving public health. Fundingnone Research in contextO_ST_ABSEvidence before this studyC_ST_ABSRelating to dietary and other risk factors for early death from cardiovascular diseases worldwide, the EAT-Lancet Commission proposed the "Planetary Health Diet" to reduce non-communicable diseases and mitigate climate change. The Planetary Health Diet has been controversial and did not achieve the goal of leading a worldwide "Great Food Transformation" towards a more plant-based diet. The comparative risk assessment (CRA) systematic literature review-based methodology used in drafting the Planetary Health Diet has no significant competitors as published methodologies used to parse health effects of worldwide dietary and other risk factors. No consensus exists about an optimal range of diets for optimum human health, including cardiovascular disease prevention/treatment. Added value of this study{square}Cardiovascular disease deaths/100k/year in 15-69-year-old males and females (CVD) worldwide correlated with dietary risk factors had two patterns based on the amounts of kilocalories/day (Kcal/day) of animal foods and added fats. We differentiated the two patterns by defining a "fat-soluble vitamin variable" Kcal/day (FSVV=processed meat + red meat + fish + milk + poultry + eggs + (added saturated fatty acids (SFA)+polyunsaturated fatty acids (PUFA)+trans fatty acids (TFA)) * 0.46 (all in Kcal/day). Worldwide, all nine risk factors comprising FSVV correlated negatively with CVD, but in high FSVV cohorts (FSVV[&ge;]567.27 Kcal/day), all nine risk factors in the FSVV correlated positively with CVD. Implications of all the available evidenceAnimal foods and added fats afforded significant protection from CVD worldwide. The data suggested that the fat-soluble vitamins in animal foods and added fat facilitating gut absorption may have been partially or entirely responsible for the worldwide protection from CVD. However, in high FSVV intake cohorts, SFA in food and in extracted added fats facilitating atherosclerosis may have partially or entirely accounted for the positive correlation of FSVV and CVD. The findings suggest that a yet not precisely defined moderate amount of animal food and added fat intake contributed to lower cardiovascular risk relative to very high or very low intakes.

IntroductionTo date, most food-based nutrition interventions have not considered food production practices, particularly the use of synthetic chemicals. This study aimed to evaluate the impact of a multi-component food-based nutrition intervention involving homestead food production, nutrition counselling, cooking demonstrations, and crop planning exercises, and employing agroecological production practices (herein nutrition-sensitive agroecology program), on dietary diversity, nutritional status, and child development in Andhra Pradesh, India. MethodsA cross-sectional assessment was conducted in 2021-2022 of 50 intervention villages where the nutrition-sensitive agroecology program had been implemented since 2018 and 79 control villages where only the agroecology program had been implemented. Data on self-reported dietary intake, caregiver-reported early child development, anthropometric measurements, and hemoglobin concentrations were collected using standardized procedures by trained Nutrition Farming Fellows, who were also responsible for implementing the program. ResultsA sample of 3,511 households (1,121 intervention and 2,390 control) participated in the survey. Dietary diversity scores (DDS) among women and men were mean (SD) 6.53 ({+/-}1.62) and 6.16 ({+/-}1.65), respectively, in intervention villages and 5.81 ({+/-}1.58) and 5.39 ({+/-}1.61), respectively, in control villages (p<0.01). DDS among children 6-24 months of age in intervention and control villages was 2.99 ({+/-}1.52) and 2.73 ({+/-}1.62), respectively (p<0.01). Children <2 years of age were less likely to be anemic in intervention versus control villages (59% versus 69%, p<0.01). Children 18-35 months age in intervention villages had higher child development scores than children in control villages (all p<0.05). ConclusionNutrition-sensitive agroecological programs may be effective in improving diets, nutrition, and child development in rural India.

Objective: Observational studies have provided evidence for positive associations between inflammatory dietary patterns (IDP) and mental health, which might be mediated by immune activation. However, a causal relationship has not yet been established. Here we aim to investigate the causal nature of associations between IDP and mental health traits (depressed affect, mood swings, neuroticism, feed-up feelings, worry, irritability) using Mendelian Randomization (MR) analyses. Method: In the UK Biobank dataset, IDP was identified by conducting a partial least squares regression (PLSR) on the items of the food frequency questionnaire along with three inflammatory biomarkers as response variables: C-reactive protein, platelets, and white blood cell (WBC) counts. An individual-level genome-wide association study (GWAS) of IDP was performed within an unrelated European subsample from the UK Biobank (n=320,137) and summary-level GWAS data for mental health traits were utilized for bi-directional two-step MR to test the association between genetically predicted IDP and mental health traits. Result: The first PLSR component was retained for subsequent analysis, with a higher IDP score indicating a more frequent consumption of processed meat, beef, pork, lamb/mutton, and poultry. Genome-wide association analysis identified 101 independent genomic loci. MR analyses indicated a uni-directional positive relationship from IDP to neuroticism and a positive bi-directional relationships between IDP and depressed affect, mood swings, fed-up feelings, and irritability. The mediation effect of total white blood cell count on neuroticism score was also significant (adjusted P<0.05). Conclusion: Our findings identified genetic loci and functional properties of IDP and provided evidence for causal pathways with depressed affect, mood swings, irritability, and fed-up feelings. Implementing dietary advice and interventions should become part of a public mental health approach. Keywords: Inflammatory dietary pattern; Partial least squares regression; Genome-wide association study; Mendelian Randomization; Mental health.

Background: Recent food-based recommendations for flavan-3-ols highlight a growing need to understand the breadth of our dietary polyphenol exposure. However, estimation of dietary polyphenol intake remains challenging, requiring custom computational tools that are often difficult to implement or not fully reproducible. Objective: We aimed to an automated, user-friendly tool to estimate polyphenol intake from diet recalls and records. Methods: We developed Polyphenol Estimator, a tool that processes dietary data from the Automated Self-Administered 24-Hour (ASA24) Dietary Assessment Tool or the Automated Multiple-Pass Method from the National Health and Examination Survey (NHANES). Polyphenol Estimator disaggregates foods using the FDA Food Disaggregation Database into ingredients, matches these ingredients to FooDB, and estimates polyphenol intake at the total, class, and compound level. Optionally, these polyphenol estimates can be used to calculate the Dietary Inflammatory Index (DII). Polyphenol Estimator is freely available online (https://swi1.github.io/polyphenol_estimator) with a tutorial for users with limited programming experience. Results: To illustrate Polyphenol Estimator, we applied it to two days of diet recalls from adults ([&ge;] 20 years) in NHANES 2021-2023 (n = 2778). For 97.7% of participants, less than 2.5% of reported foods went unmapped, with 75.7% of participants having complete mappings. Total polyphenol intake was 517 +/- 439 (mean +/- SD) mg/1000 kcal, largely from green tea, coffee, black tea, apples, wine, oranges, and blueberries. At the class level, polyphenols classified as organooxygen compounds, flavonoids, and cinnamic acids and derivatives were top intake contributors. At the compound level, cyptochlorogenic acid, neocholorogenic acid, and caffeic acid were top contributors. Lastly, the DII was 1.4 +/- 1.9, indicating the average diet had proinflammatory potential. Conclusions: Polyphenol Estimator offers an automated method to obtain total, class, and compound-level polyphenol estimates from dietary data to aid future efforts to understand polyphenol intake exposures and their biological impact on health.

India faces an escalating burden of non-communicable diseases (NCDs) concur-rent with rapid expansion of the ultra-processed food (UPF) market. This study provides comprehensive analysis of UPF market dynamics and associated health risks in India using multi-source secondary data. We analyzed market data from Euromonitor International (2011-2021), consumption patterns from National Fam-ily Health Survey-5 (NFHS-5), dietary data from ICMR-INDIAB study, and health burden statistics from Global Burden of Disease (GBD) 2021. Mathematical mod-eling examined relationships between UPF consumption and NCD prevalence using regression analysis, compound annual growth rate (CAGR) calculations, and popu-lation attributable fraction (PAF) estimations. Indias UPF sector grew at 13.37% CAGR from 2011-2021, with market value increasing from USD 0.9 billion (2006) to USD 38 billion (2019). Per capita processed food sales doubled from USD 31.3 (2012) to USD 57.7 (2018). Urban households increased UPF purchases from 6.0 kg to 6.4 kg per person annually (2013-2016), representing 6% growth. Sweet bis-cuits dominated market share (43% in 2021). NCD mortality rose from 37.9% (1990) to 61.8% (2016). Diabetes prevalence reached 11.4% (101 million cases), with prediabetes at 15.3% (136 million). Obesity affected 28.6% (generalized) and 39.5% (abdominal). Regression models demonstrated significant positive associa-tions between UPF consumption share and diabetes risk ({beta} = 0.28, p < 0.001), hypertension ({beta} = 0.24, p < 0.001), and obesity ({beta} = 0.31, p < 0.001). Each 10% increase in UPF dietary share correlated with 14-30% higher cardiometabolic risk. Economic burden projects to USD 4.58 trillion by 2030. Indias UPF market ex-pansion parallels rising NCD burden, with quantifiable dose-response relationships. Comprehensive policy interventions including taxation, front-of-package labeling, marketing restrictions, and public health campaigns are urgently needed to miti-gate health and economic impacts.

Ready-to-eat, shelf-stable tortillas contain several phosphorus- and aluminum-containing additives that may increase the risk of adverse events in patients with chronic kidney disease (CKD). The present study analyzes and compares the elemental content of wheat flour and corn tortillas with special reference to dietary aluminum and phosphorus burden. Twenty-one elements were quantified by ICP-MS and ICP-OES in 14 corn and 13 wheat flour tortilla brands purchased from local supermarkets in Southern California. The aluminum and phosphorus concentrations of many ready-to-eat tortilla brands can present a daily dietary load of up to approximately 100 mg aluminum and 700 mg phosphorus based on an average daily tortilla intake of 330 grams. Ready-to-eat wheat flour tortillas generally had more phosphorus than corn tortillas. Tortillas with aluminum listed as a food additive contained a higher aluminum content than those without such listing, exceeding the tolerable weekly intake. Despite conventional wisdom that CKD patients should avoid phosphorus-rich corn tortillas, ready-to-eat wheat flour tortillas consistently had a higher aluminum and phosphorus content due to additives. CKD patients and healthcare providers should pay attention to food labels, and regulatory authorities should monitor the use of approved food additives and mandate food label warnings for patients at risk.

AimsThis study aimed to explore the relationship between gut microbiota composition, obesity, and the effects of a dietary intervention in 50 participants with obesity diagnosis from Antioquia, Colombia. MethodsA single-blind intervention study was conducted, with 25 participants assigned to a control group (CG) and 25 to an intervention group (IG), these last followed a microbiota-enhancing dietary plan for 90 consecutive days. Gut microbiota changes were assessed by sequencing region V3-V4 of 16S rRNA gene and applying the analytical methodology of Biomatest(R) gut health index. Blood biomarkers, including HbA1C, cholesterol, HDL, LDL, triglycerides, and glucose, were measured at baseline and post-intervention. ResultsPrevotella and Succinivibrio were prevalent in the study population. The IG showed significant increases in gut microbial diversity (Shannon index) from baseline to post-intervention. Both groups exhibited significant changes in the Biomatest gut health index, with significant improvements in the IG. Significant correlations were found between dietary intake, blood biomarkers, and microbial abundances, such as the direct association between serum glucose and ultra-processed food intake and between total cholesterol and Dialister. Fish and seafood consumption correlated positively with Akkermansia, while egg intake was associated with higher levels of Desulfovibrio, and Lactobacillus with decreased glycated hemoglobin. The IG experienced a significant rise in Roseburia, a gut health biomarker, while the CG showed higher levels in inflammatory groups like Fusobacteriota. ConclusionsDietary intake significantly influences gut microbiota composition and blood biomarkers. Nutritional programs that improve gut microbiota, as demonstrated by the IG, positively impact gut health in people with obesity diagnosis and may influence healthier dietary choices. These findings support integrating microbiota diagnostics into personalized nutrition strategies, contributing valuable data on Latin American populations. O_FIG O_LINKSMALLFIG WIDTH=195 HEIGHT=200 SRC="FIGDIR/small/25331845v1_ufig1.gif" ALT="Figure 1"> View larger version (48K): org.highwire.dtl.DTLVardef@1652035org.highwire.dtl.DTLVardef@25a04borg.highwire.dtl.DTLVardef@3ed98corg.highwire.dtl.DTLVardef@3caedf_HPS_FORMAT_FIGEXP M_FIG C_FIG