Current Developments in Nutrition

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.

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.

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.

This study examines the trends in health and dietary disparities by economic status among elderly individuals in Japan from 2004 to 2014 with subjective measures. The study design utilized a repeated cross-sectional approach, using data from the Survey of Attitudes among the Elderly toward Daily Life in 2004 and 2014. Logistic regression analysis was performed with subjective economic status, survey year, and their interactions as independent variables, and self-rated health, dietary satisfaction, and intake of balanced meals as dependent variables. The results revealed that disparities in self-rated health, dietary satisfaction, and intake of a balanced meal were present due to economic status. Furthermore, the disparities in self-rated health, dietary satisfaction, and balanced meal intake by economic status remained unchanged from 2004 to 2014 (p for interaction [&ge;] 0.05). The findings were consistent in sensitivity analyses conducted on those aged 75 and older, as well as on long-term care insurance recipients.

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[&ge;]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[&ge;]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.

BackgroundVegetarianism is widely recognized for its health and environmental benefits. However, its broader impacts on physical, mental, and social well-being remain underexplored. This study investigates the health and behavioral outcomes associated with vegetarianism across diverse populations. MethodsWe analysed polygenic scores for vegetarianism (VegPGS) in 495,971 UK Biobank (UKB) participants and performed phenome-wide association studies (PheWAS) on 443 health and behavioral traits. Cross-validation analyses were conducted using data from 9,009 vegetarians and 486,962 non-vegetarians. One- and two-sample Mendelian randomization (MR) analyses explored causal relationships. Findings were further validated in 11,642 participants from the China Health and Nutrition Survey (CHNS). Additionally, machine-learning classification models were developed to predict vegetarian status using behavioral, physiological, and genetic factors. FindingsPheWAS identified 57 health-related and 1 behavior-related factor significantly associated with VegPGS, with cross-validation confirming these links. MR analyses supported causal effects of vegetarianism on lower basal metabolic rate, reduced body mass index (BMI), decreased fat mass, and lower risk of type 2 diabetes. CHNS data confirmed associations with lower BMI and diabetes risk in East Asian populations. Machine-learning models achieved high accuracy in predicting vegetarian status (AUC 0.913C{+/-}C0.018). InterpretationThis study provides robust evidence supporting the metabolic health benefits of vegetarianism. The integration of multimodal genetic, behavioral, and physiological data enhances understanding and prediction of dietary choices, offering valuable insights for policymakers and individuals considering a transition to plant-based diets to achieve sustainability. FundingNational Natural Science Foundation of China (Nos. 72103187 and 72061147002) and the 2115 Talent Development Program at China Agricultural University.

Circulating metabolites may reflect biological homeostasis and have been linked to dietary intakes and human health, and may hold the promises to facilitate objective assessments of intakes and metabolic response to diets. Here, we integrated metabolomic, genetic, and metagenomic data from five longitudinal cohorts comprising 21,474 participants of diverse ethnic backgrounds, to develop metabolomic signatures for popular dietary patterns (i.e., three guideline-based diets, three plant-based diets, and two mechanism-based diets) and systematically investigated their clinical relevance. Applying machine-learning models in two deeply-phenotyped lifestyle validation studies, we identified eight metabolomic signatures (each included 37 to 66 metabolites) significantly correlated with their respective dietary pattern indices, consistently across multiple independent validation cohorts (r = 0.11-0.38; P < 8.06x10-). These signatures included shared metabolites between diets (e.g., up to 67% among guideline-based diets, including hippuric and 3-indolepropionic acid), and metabolites unique to specific diets (e.g., N6,N6,N6-trimethyllysine to proinflammatory diet). In multivariable-adjusted analyses of 5 prospective cohorts (1,832 incident cases during up to 27 years of follow-up), the metabolomic signatures of healthful diets (i.e., Mediterranean and healthful plant-based diets) were associated with lower T2D risk (HR: 0.82-0.90; P < 3x10-), while signatures for unhealthy diets (e.g., proinflammatory and hyperinsulinemia diets) were associated with higher T2D risk (HR: 1.23-1.26; P < 2x10-{superscript 1}); these associations were further supported by Mendelian randomization analysis incorporating genetic data. Finally, through genome-wide and taxa-wide associating analyses, we identified 15 genetic loci - including those involved in fatty acid and energy metabolism (e.g., FADS1/2 and CERS4; P < 5x10-8), and 39 gut microbial species - including those relevant to butyric acid metabolism (e.g., E. eligens and F. pranusnitzii; FDR < 0.05), significantly associated with the metabolomic signatures of diets. Genetic variants and gut microbial diversity explained up to 19.1% and 10.6% of the variation in these signatures, respectively, underscoring a potential role of host genetics and gut microbiota in dietary metabolism. In conclusion, our study identified metabolomic signatures reflecting both intakes and individual metabolic response to various diets and are associated with future T2D risk. These signatures may facilitate individualized dietary assessments and risk stratification in future nutritional research.

BACKGROUNDCarbohydrates as starch are a staple part of the Mediterranean diet. Starch is digested in the small intestine and the resulting glucose is absorbed into the blood, eliciting an insulin response. The digestion and absorption kinetics (rapid or slow) depends on starch structure. OBJECTIVETo study the relationship between the in vivo glycemic and insulinemic index and the in vitro digestibility characteristics of six bakery products, made from non-conventional wholemeal/wholegrain flours. METHODSWe analyzed in vitro the rapidly- and slowly- available glucose (RAG and SAG), the rapidly- and slowly- digestible starch (RDS and SDS), and the resistant starch (RS) fraction of the six wholemeal/wholegrain products and one white type of bread. The glycemic and the insulinemic index (GI and II respectively) were estimated by in vivo testing in a group of eleven healthy individuals. RESULTSThe GI of the wholemeal/wholegrain flour biscuits and breads were low, (range 28{+/-}3.2 to 41{+/-}3.9, Mean{+/-}SEM) correlating with the II. RAG positively correlated with both GI and II, with fiber having a marginal correlation. CONCLUSIONSOur findings indicate that both conventional and non-conventional wholemeal/wholegrain bakery products have low GI and moderate II, correlating to in vitro starch digestibility and the type of processing.

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.

ScopeAntioxidants, including vitamin E (VE) and grape seed extract, as anti-aging supplementation have been widely used to improve human health. However, the role of gut microbiota in dietary antioxidant supplementation is debatable. This study aimed to assess the longitudinal impact of dietary supplementation with antioxidant compounds on body health and the gut microbiota. Methods and resultsOne hundred and twenty healthy individuals were randomly divided into a placebo group (amylodextrin) and three experimental groups ingesting different supplement (VE, grape seed extract, or mixed berry juice). Blood and fecal samples were collected during three intervention phases. We found that VE and mixed berry juice ameliorated blood cholesterol levels by reducing the levels of low-density lipoprotein cholesterol (LDL-C) in healthy volunteers. After the intervention, there was an increase in the relative abundance of short-chain fatty acid (SCFA)-producing bacteria and bile acid metabolizers. Specifically, the abundances of Lachnospira sp. and Faecalibacterium spp. increased in the VE and berry juice groups. Interestingly, the gut microbiota of poor responders harbored a greater proportion of disease-associated bacterial species. ConclusionJuice and VE could promote health by lowering LDL-C, partly and indirectly by affecting gut bacteria with the ability to produce SCFAs or metabolize bile acids.

Ultra-processed foods (UPFs) intake may increase cardiovascular disease (CVD) risk, but the mechanisms remain unclear and evidence on UPF biomarkers is limited. Leveraging untargeted blood metabolomics in three prospective cohorts, we identified and validated circulating metabolites associated with UPF intake and CVD risk and mortality. Discovery was conducted in the Southern Community Cohort Study (N=1,688), with validation in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N=2,315) and the Atherosclerosis Risk in Communities Study (N=3,682). We identified (n=142) and validated (n=43) metabolites associated with UPF intake, with several of these metabolites further linked to incident coronary heart disease (n=5), CVD mortality (n=2), and total mortality (n=20). Importantly, we developed a metabolite signature for UPF intake, which demonstrated strong associations with outcomes (OR/HR=1.25-1.46 per 1-SD increase) and explained 59-77% of the UPF-disease associations. These findings may enhance the assessment and mechanistic understanding of how UPFs impact human health.

The I-STARCH (Indian Study to Assess Real-World CarboHydrate Consumption) investigation quantified decadal changes in macronutrient intake and carbohydrate quality among Indian adults by benchmarking a 2025 multicentric cross-sectional survey against STARCH 2014. A total of 1,104 adults were enrolled from twenty-nine healthcare centres across fourteen Indian states. Each participant completed three non-consecutive 24 h dietary recalls, harmonised using the ICMR-NIN Food Composition Tables. Temporal contrasts treated 2014 cohort means as fixed benchmarks. In 2025, carbohydrates contributed 62.1% of total energy (2014: 65.8%), fat 25.1% (2014: 21.4%), and protein 12.8% (2014: 12.8%). Carbohydrate quality declined, with simple sugars comprising 20.3% of total carbohydrate (2014: 10.5%) and fibre providing only 1.8% of energy. Across all geographic zones including north, south, east, and west, macronutrient patterns remained suboptimal, indicating persistent dietary imbalance regardless of regional cereal dominance. Adults with type 2 diabetes reported lower carbohydrate intake (61.0%E) than those without diabetes (64.1%E), although both exceeded the recommended 50-55%E range. The composite Diet-Quality Index (protein%E + fibre%E - simple carbohydrate%E; higher = better) was lower in 2025, reflecting refined carbohydrate substitution without improvements in fibre or protein density. A secondary Protein-Fat Quality Index (PFQI = Protein % E / Fat % E) was also computed to assess balance between protein and fat energy. These findings indicate a continuing nutrition transition in India, characterised by persistent carbohydrate predominance, higher dietary fat, and declining carbohydrate quality. Region-specific dietary policies and clinical practices that promote fibre and protein-rich foods, complex carbohydrate sources, and balanced macronutrient quality are needed to support better metabolic health in India.

IntroductionThe dietary habits of the population are undergone dramatic changes in recent years, with an increasing proportion of people adopting different variants of plant-based diets, limiting their consumption of food of animal origin. Moreover, the shift toward a plant-based diet is supported by scientific reports promoting them as a more sustainable dietary option, which is necessary to adopt on a global scale to mitigate the human influence on climate change. However, despite their growing popularity, many questions regarding their safety and long-term health effects remain unanswered. One of the biggest concerns is the health impact during childhood and adolescence, due to the higher risk of development of severe nutritional deficiencies accompanied by the lack of good quality evidence to guide clinical recommendations and management in those groups. To close the knowledge gap, we decided to establish a family cohort study with increased representation of vegetarian and vegan families with the aim to describe not only adult and child-specific outcomes associated with plant-based diet, but also shared family risks. The aim of the presented manuscript is to introduce the background of the establishment of the family cohort study and provide a description of its protocol. MethodsTo investigate the long-term effect of these newly emerging dietary habits, a cohort of families with at least one child under 7 years of age and with the same diet followed by all members was established. The goal for the first year of the study was to recruit at least 40 vegetarian, 40 vegan, and 60-80 omnivore families. At the time of enrollment, biological samples, as well as medical history, together with 3 day dietary records, were taken. The initial active follow-up is planned for at least 5 years. Ethics and disseminationThe study was approved by the Institutional Review Board no. EK-VP/391012. The results of the study will serve as a basis for future research, as well as clinical guidelines and dietary recommendations in Czechia and neighboring regions.

ObjectiveTraditional pairwise meta-analyses indicated that nuts consumption can improve blood pressure. We iamed to determine the dose-dependent effect of nuts on systolic (SBP) and diastolic blood pressure (DBP) in adults. MethodsA systematic search was undertaken in PubMed, Scopus, and ISI Web of Science till March 2021. Randomized controlled trials (RCT) evaluating the effects of nuts on SBP and DBP in adults were included. We estimated change in blood pressure for each 20 g/d increment in nut consumption in each trial and then, calculated mean difference (MD) and 95%CI using a random-effects model. We estimated dose-dependent effect using a dose-response meta-analysis of differences in means. The certainty of evidence was rated using the GRADE instrument, with the minimal clinically important difference being considered 2 mmHg. ResultsA total of 31 RCTs with 2784 participants were included. Each 20 g/d increase in nut consumption reduced SBP (MD: -0.50 mmHg, 95%CI: -0.79, -0.21; I2 = 12%, n = 31; GRADE = moderate certainty) and DBP (MD: -0.23 mmHg, 95%CI: -0.38, -0.08; I2 = 0%, n = 31; GRADE = moderate certainty). The effect of nuts on SBP was more evident in patients with type 2 diabetes (MD: -1.31, 95%CI: -2.55, -0.05; I2 = 31%, n = 6). The results were robust in the subgroup of trials with low risk of bias. Levels of SBP decreased proportionally with the increase in nuts consumption up to 40 g/d (MD40g/d: -1.60, 95%CI: -2.63, -0.58), and then appeared to plateau with a slight upward curve. A linear dose-dependent reduction was seen for DBP, with the greatest reduction at 80 g/d (MD80g/d: -0.80, 95%CI: -1.55, -0.04). ConclusionsThe available evidence provides a good indication that nut consumption can result in a small improvement in blood pressure in adults. Well-designed trials are needed to confirm the findings in long term follow-up.

BackgroundRising rates of diet-related chronic diseases and disparities in disease prevalence by sociodemographic factors highlight the need to improve the diet quality of Americans. Understanding how the Healthy Eating Index-2020 (HEI-2020) can be used as a measure of diet quality to create benchmarks for national nutrition monitoring can assist in surveillance and improve the design of nutrition programs and policies. ObjectiveTo examine the utility of the HEI-2020 to create benchmarks for national diet quality monitoring. MethodsThis serial cross-sectional study used data from the 2009-2018 National Health and Nutrition Examination Surveys (NHANES). Nationally representative data for 22,168 US adults ([&ge;]20 years) who completed two 24-hour recalls were analyzed. We derived HEI-2020 scores (0-100) from participants two 24-hour dietary recalls. Diet quality categories were established: high diet quality (>70-100), marginal (>60-70), low (>50-60), and very low (0-50). ResultsOnly 13% of US adults had high diet quality while nearly two-thirds had low or very low diet quality. Diet quality was higher for older adults, female, "Other" race or ethnicity, born outside of the US, have higher education attainment, higher income, and food security. Compared to adults with high diet quality, adults with very low diet quality had lower intakes of unprocessed or minimally processed foods, fruits, vegetables, whole grains, and seafood and the highest intakes of ultra-processed foods, refined grains, and red and processed meats (all P-trends <0.01). Adults with very low diet quality were more likely to have elevated adiposity, lower HDL cholesterol, and higher triglycerides, fasting glucose, and hemoglobin A1c (all P-trends [&le;]0.01). ConclusionsThe HEI-2020 is a robust measure of diet quality that can be directly linked to biological measures associated with chronic disease risk. Using evidence-based HEI categories could allow policymakers, public health practitioners, and nutrition professionals to set benchmarks and nationwide targets for achieving improved 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.

Plant-based foods are complex systems, where a multitude of bioactive molecules, such as (poly)phenols and carotenoids are the outcome of endless interactions defining food chemical composition. Significant progress has been made to develop reliable food composition databases that can be used to assess the intake of dietary plant bioactives. However, many lesser-known phytochemicals, like glucosinolates and monoterpenoids are often excluded, also due to the fragmented information available in the literature. Therefore, we present PhytoFooD, a comprehensive phytochemical food database that collects qualitative and quantitative information on 1,067 bioactive compounds in 1,410 plant-based foods. We evaluated the intake of main plant bioactives in European diets and demonstrated the role of concentration variability within foods in intake assessments. This database represents a promising tool for dietary intake assessors and researchers in nutrition, paving the way for a comprehensive and accurate knowledge of our diet and the interconnected health effects of plant bioactives.

BackgroundBeneficial effects of diets with predominance of plant-based foods as fruits, vegetables, whole grain and plant-protein and less animal-based foods, or so-called "plant-based" diets, on cardiometabolic risk have been reported. We aimed to examine the effects of two distinct plant-based diets on intermediate cardiometabolic risk factors, particularly lipid metabolism, while also considering the impact of the gut microbiome, genetic predisposition, and immune status on the metabolic response to a dietary change. MethodsIn this randomized, controlled dietary intervention trial, 120 obese adults (59 {+/-} 1 years, 70 females) consumed an isoenergetic Nordic (ND) or a lacto-ovo vegetarian diet (VD) or maintained their habitual diet (control group) for six weeks. At baseline and after the end of the trial, in-depth metabolic characterization was conducted, including measurement of incretins such as glucagon-like peptide 1 (GLP-1), postprandial lipids with lipidomic profiling, and microbiome analysis. Genetic makeup and peripheral immune system composition were characterized at baseline. ResultsND intervention beneficially altered lipid metabolism up to 15%. The largest changes were observed in participants with high genetic predisposition for hyperlipidemia, while lipid metabolism remained stable upon VD. The changes observed were associated with specific microbial signatures and pathways. GLP-1 levels remained stable during the study period. ConclusionThe metabolic response to a dietary change in obese adults is linked to the individual genetic risk, baseline microbiome composition, and immune phenotype, pointing towards a personalized nutritional approach in preventing cardiometabolic diseases.

ObjectivePlant protein is gaining interest for dietary phosphorus management in CKD due to its potential benefits, including possible lower phosphorus bioaccessibility. However, data on phosphorus remain limited, particularly for processed plant protein products. This pilot study aimed to compare phosphorus bioaccessibility of processed plant protein products with their animal protein counterparts, using in vitro simulation of adult human digestion. MethodsSoy protein (n=16), pulse protein (n=17), and animal protein (n=13) products representing food categories of beef, dairy, sausage/bacon, chicken/turkey were evaluated for phosphorus bioaccessibility using in vitro digestion based the INFOGEST protocol, followed by dialysis of the final digesta. Pre-digestion samples, final digesta, and final dialysate were analyzed for phosphorus content to calculate total and bioaccessible phosphorus and percent phosphorus bioaccessibility. ResultsAverage percent phosphorus bioaccessibility of all processed soy and pulse products studied ranged from 32-100%, while animal products ranged from 81-100%. Average bioaccessible phosphorus and bioaccessible phosphorus-to-protein ratio were lower for many soy and pulse protein beef and chicken/turkey alternatives, soy protein milk alternatives, and pulse protein sausage alternatives than their animal protein counter products. ConclusionSome soy and pulse protein products offered lower bioaccessible phosphorus per 100g serving and per gram of protein than their animal protein counterparts. Thus, this pilot study suggests that certain processed plant protein products may be acceptable to include in a diet for phosphorus management in CKD. However, more data on phosphorus bioaccessibility in a larger number and variety of processed plant-based protein products is needed to better inform individualized guidance.